|(image) (image)||Related Articles|
Can quality of recovery be enhanced by premedication with midazolam?: A prospective, randomized, double-blind study in females undergoing breast surgery.
Medicine (Baltimore). 2017 Feb;96(7):e6107
Authors: Kim MH, Kim MS, Lee JH, Seo JH, Lee JR
BACKGROUND: Preoperative anxiety is known to be related with the postoperative outcomes, although it remains unclear whether pharmacologic anxiolysis preoperatively leads to better postanesthesia recovery. Hence, the purpose of this study was to assess whether midazolam premedication would result in improved Quality of Recovery-40 survey scores, as a postoperative recovery parameter, in female patients undergoing mastectomy.
METHODS: This randomized double-blind study was performed at Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea. Eighty-two females undergoing breast cancer surgery with propofol-remifentanil anesthesia were enrolled and randomized to receive midazolam 0.02 mg kg (group M) or saline (group C). Anesthesia was conducted with total intravenous anesthesia using propofol and remifentanil. On postoperative day 1, the Quality of Recovery-40 survey scores were surveyed.
RESULTS: The global Quality of Recovery-40 survey scores on postoperative day 1 did not significantly differ between groups M and C (183 vs 181, P = 0.568). However, the induction time was significantly shorter in group M (3.2 vs 4.5 min, P < 0.001), as was the total intraoperative propofol consumption (705 vs 1004 mg; P = 0.022).
CONCLUSION: Midazolam premedication does not seem to improve the postoperative quality of recovery, though group M showed faster induction and less propofol consumption.
PMID: 28207530 [PubMed - indexed for MEDLINE]
Clinical auditing as an instrument for quality improvement in breast cancer care in the Netherlands: The national NABON Breast Cancer Audit.
J Surg Oncol. 2017 Mar;115(3):243-249
Authors: van Bommel AC, Spronk PE, Vrancken Peeters MT, Jager A, Lobbes M, Maduro JH, Mureau MA, Schreuder K, Smorenburg CH, Verloop J, Westenend PJ, Wouters MW, Siesling S, Tjan-Heijnen VC, van Dalen T, NABON Breast Cancer Audit
BACKGROUND: In 2011, the NABON Breast Cancer Audit (NBCA) was instituted as a nation-wide audit to address quality of breast cancer care and guideline adherence in the Netherlands. The development of the NBCA and the results of 4 years of auditing are described.
METHODS: Clinical and pathological characteristics of patients diagnosed with invasive breast cancer or in situ carcinoma (DCIS) and information regarding diagnosis and treatment are collected in all hospitals (n = 92) in the Netherlands. Thirty-two quality indicators measuring care structure, processes and outcomes were evaluated over time and compared between hospitals.
RESULTS: The NBCA contains data of 56,927 patients (7,649 DCIS and 49,073 invasive cancers). Patients being discussed in pre- and post-operative multidisciplinary team meetings improved (2011: 83% and 91%; 2014: 98% and 99%, respectively) over the years. Tumour margin positivity rates after breast-conserving surgery for invasive cancer requiring re-operation were consistently low (∼5%). Other indicators, for example, the use of an MRI-scan prior to surgery or immediate breast reconstruction following mastectomy showed considerable hospital variation.
CONCLUSIONS: Results shown an overall high quality of breast cancer care in all hospitals in the Netherlands. For most quality indicators improvement was seen over time, while some indicators showed yet unexplained variation. J. Surg. Oncol. 2017;115:243-249. © 2016 Wiley Periodicals, Inc.
PMID: 27885679 [PubMed - indexed for MEDLINE]
Hospital variation in outcomes following appendectomy in a regional quality improvement program.
Am J Surg. 2016 Nov;212(5):857-862
Authors: Jenkins PC, Oerline MK, Mullard AJ, Englesbe MJ, Campbell DA, Hemmila MR
BACKGROUND: The aim of this study was to determine hospital variation in clinical outcomes after appendectomy for acute appendicitis.
METHODS: Using data from the Michigan Surgical Quality Collaborative, we selected patients with procedure codes for open or laparoscopic appendectomy with a diagnosis of acute appendicitis (2006 to 2011). We used multivariate regression models for risk adjustment of patient-level factors and reliability adjustment for sample size differences between hospitals. Adjusted rates of outcomes for each hospital were generated by multiplying ratios of observed to expected events by overall mean event rates.
RESULTS: During the study period, 12,410 patients underwent appendectomies in 49 participating Michigan Surgical Quality Collaborative hospitals. Neither the mortality rate nor the rate of superficial or deep surgical site infection demonstrated significant variation. However, significant variation was observed for all other clinical outcomes, including a 14-fold difference of the rate of postoperative sepsis and septic shock.
CONCLUSIONS: We found significant hospital variation in outcomes after appendectomy and identified missing variables that could help to explain the observed variation. These findings have been used to enhance ongoing quality improvement efforts across the state of Michigan.
PMID: 27324383 [PubMed - indexed for MEDLINE]
Hand-assisted laparoscopic vs open colectomy: an assessment from the American College of Surgeons National Surgical Quality Improvement Program procedure-targeted cohort.
Am J Surg. 2016 Nov;212(5):808-813
Authors: Benlice C, Costedio M, Stocchi L, Abbas MA, Gorgun E
BACKGROUND: Perioperative outcomes of patients who underwent hand-assisted colorectal laparoscopic (HALS) vs open colectomy were compared using recently released procedure-targeted database.
METHODS: Review was conducted using the 2012 colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database. Patients were classified into 2 groups according to final surgical approach: HALS vs open (planned). Groups were matched (1:1) based on age, gender, body mass index, surgical procedure, diagnosis, American Society of Anesthesiologists score, and wound classification. Multivariate logistic regression analysis was conducted for group comparison.
RESULTS: Of 7,303 patients, 1,740 patients were matched in each group. Open group had higher proportion of patients with preoperative dyspnea (P = .01), ascites (P = .01), weight loss (P < .001), smoking history (P = .04), and increased work relative value units (P < .001). After adjusting for difference in baseline comorbidities, overall morbidity, superficial, deep, and organ-space surgical site infection, urinary tract infection, ileus, reoperation, readmission, and hospital stay were significantly higher in open group (P < .05).
CONCLUSIONS: National Surgical Quality Improvement Program targeted-data demonstrated several advantages of HALS compared with open colonic resection including shorter hospital stay and lower complication rate. Further adoption of HALS technique as a bridge to straight laparoscopy or tool in difficult cases can positively impact the short-term outcomes after colectomy when compared with open technique.
PMID: 27324382 [PubMed - indexed for MEDLINE]
|(image) (image)||Related Articles|
Tobacco smoking is associated with decreased semen quality.
Reprod Health. 2016 Aug 05;13(1):90
Authors: Asare-Anane H, Bannison SB, Ofori EK, Ateko RO, Bawah AT, Amanquah SD, Oppong SY, Gandau BB, Ziem JB
BACKGROUND: Tobacco smoking is a public health issue and has been implicated in adverse reproductive outcomes including semen quality. Available data however provides conflicting findings. The objective of this study was to evaluate the effect of tobacco smoking on semen quality among men in Ghana.
METHODS: In this study, a total of 140 subjects were recruited, comprising 95 smokers and 45 non-smokers. Smokers were further categorized into mild, moderate and heavy smokers. Semen parameters such as sperm concentration, motility, viability and normal morphology were measured according to the World Health Organisation criteria.
RESULTS: The study showed that smokers had significantly lower semen volume, sperm concentration, sperm motility, total sperm count, sperm morphology, free testosterone and follicle stimulating hormone (p <0.05 respectively), compared with non-smokers. Smokers were at a higher risk of developing oligospermia, asthenozoospermia and teratozoospermia (OR = 3.1, 4.2 and, 4.7; p <0.05) than non-smokers.
CONCLUSION: Results demonstrated a decline in semen quality in a dose dependent tobacco smoking manner.
PMID: 27496053 [PubMed - indexed for MEDLINE]
Factors influencing the perceived quality of clinical supervision of occupational therapists in a large Australian state.
Aust Occup Ther J. 2016 Oct;63(5):338-346
Authors: Martin P, Kumar S, Lizarondo L, Tyack Z
BACKGROUND/AIM: Clinical supervision is important for effective health service delivery, professional development and practice. Despite its importance there is a lack of evidence regarding the factors that improve its quality. This study aimed to investigate the factors that influence the quality of clinical supervision of occupational therapists employed in a large public sector health service covering mental health, paediatrics, adult physical and other practice areas.
METHODS: A mixed method, sequential explanatory study design was used consisting of two phases. This article reports the quantitative phase (Phase One) which involved administration of the Manchester Clinical Supervision Scale (MCSS-26) to 207 occupational therapists.
RESULTS: Frequency of supervision sessions, choice of supervisor and the type of supervision were found to be the predictor variables with a positive and significant influence on the quality of clinical supervision. Factors such as age, length of supervision and the area of practice were found to be the predictor variables with a negative and significant influence on the quality of clinical supervision.
CONCLUSION: Factors that influence the perceived quality of clinical supervision among occupational therapists have been identified. High quality clinical supervision is an important component of clinical governance and has been shown to be beneficial to practitioners, patients and the organisation. Information on factors that make clinical supervision effective identified in this study can be added to existing supervision training and practices to improve the quality of clinical supervision.
PMID: 27488592 [PubMed - indexed for MEDLINE]
|(image) (image)||Related Articles|
Biobanking of Fresh-Frozen Human Adenocarcinomatous and Normal Colon Tissues: Which Parameters Influence RNA Quality?
PLoS One. 2016;11(4):e0154326
Authors: Galissier T, Schneider C, Nasri S, Kanagaratnam L, Fichel C, Coquelet C, Diebold MD, Kianmanesh R, Bellon G, Dedieu S, Marchal Bressenot A, Boulagnon-Rombi C
Medical research projects become increasingly dependent on biobanked tissue of high quality because the reliability of gene expression is affected by the quality of extracted RNA. Hence, the present study aimed to determine if clinical, surgical, histological, and molecular parameters influence RNA quality of normal and tumoral frozen colonic tissues. RNA Quality Index (RQI) was evaluated on 241 adenocarcinomas and 115 matched normal frozen colon tissues collected between October 2006 and December 2012. RQI results were compared to patients' age and sex, tumor site, kind of surgery, anastomosis failure, adenocarcinoma type and grade, tumor cell percentage, necrosis extent, HIF-1α and cleaved caspase-3 immunohistochemistry, and BRAF, KRAS and microsatellites status. The RQI was significantly higher in colon cancer tissue than in matched normal tissue. RQI from left-sided colonic cancers was significantly higher than RQI from right-sided cancers. The RNA quality was not affected by ischemia and storage duration. According to histological control, 7.9% of the samples were unsatisfactory because of inadequate sampling. Biobanked tumoral tissues with RQI ≥5 had lower malignant cells to stromal cells ratio than samples with RQI <5 (p <0.05). Cellularity, necrosis extent and mucinous component did not influence RQI results. Cleaved caspase-3 and HIF-1α immunolabelling were not correlated to RQI. BRAF, KRAS and microsatellites molecular status did not influence RNA quality. Multivariate analysis revealed that the tumor location, the surgical approach (laparoscopy versus open colectomy) and the occurrence of anastomotic leakage were the only parameters influencing significantly RQI results of tumor samples. We failed to identify parameter influencing RQI of normal colon samples. These data suggest that RNA quality of colonic adenocarcinoma biospecimens is determined by clinical and surgical parameters. More attention should be paid during the biobanking procedure of right-sided colon cancer or laparoscopic colectomy specimen. Histological quality control remains essential to control sampling accuracy.
PMID: 27124490 [PubMed - indexed for MEDLINE]
Indices of dietary fat quality during midpregnancy is associated with gestational diabetes.
Nutrition. 2016 Jun;32(6):656-61
Authors: Barbieiri P, Nunes JC, Torres AG, Nishimura RY, Zuccolotto DC, Crivellenti LC, Franco LJ, Sartorelli DS
OBJECTIVE: To investigate the relationship between gestational diabetes mellitus (GDM) and the usual intake of fatty acids and indices of dietary fat quality [the atherogenicity (AI) and thrombogenicity indices (TI), and the ratios of hypo-and hypercholesterolemic (hH), ∑n-3/∑n-6, and polyunsaturated/saturated fatty acids (P:S)], during mid-pregnancy.
METHODS: 799 adult pregnant women living in Ribeirão Preto, SP, Brazil were screened and accepted for this cross-sectional GDM study. The Multiple Source Method was used to estimate participants' usual diet, using two 24-hour dietary recalls during mid-pregnancy. Diagnosis of GDM was defined by the American Diabetes Association criteria of 2015. Logistic regression analysis were used to assess the association between GDM and dietary fat, adjusted for age, education, parity, gestational age at the time of the interview, pre-pregnancy and current BMI, prior GDM, family history of diabetes, smoking, physical activity, energy, fiber, and fatty acids.
RESULTS: The mean (standard deviation) age of the women was 28 (5) years, and 19% had GDM. After multiple adjustments, inverse associations between the highest tertile of ∑n-3 fatty acids intake [0.21 (0.08-0.56)], α-linolenic intake [0.15 (0.05-0.42)], and GDM were found. A positive association between GDM and the highest tertile of TI [2.66 (1.34-5.29)], and a negative association with the highest tertile of hH ratio [0.41 (0.22-0.77)], were observed. No association between GDM and other indices of dietary fat quality were found.
CONCLUSION: The quality of dietary fat during pregnancy is strongly associated with GDM. Randomized clinical trial are needed to confirm these findings.
PMID: 26876000 [PubMed - indexed for MEDLINE]
Audit system on Quality of breast cancer diagnosis and Treatment (QT): results of quality indicators on screen-detected lesions in Italy, 2011-2012.
Epidemiol Prev. 2015 May-Jun;39(3 Suppl 1):40-7
Authors: Ponti A, Mano MP, Tomatis M, Baiocchi D, Barca A, Berti R, Casella D, D'Ambrosio E, Delos E, Donati G, Falcini F, Frammartino B, Frigerio A, Giudici F, Mantellini P, Naldoni C, Olla Atzeni C, Orzalesi L, Pagano G, Pietribiasi F, Pitarella S, Ravaioli A, Silvestri A, Taffurelli M, Tidone E, Zanconati F, Segnan N
This annual survey, conducted by the Italian group for mammography screening (GISMa), collects individual data on diagnosis and treatment of about 50% of screen-detected, operated lesions in Italy. The 2011-2012 results show good overall quality and an improving trend over time. A number of critical issues have been identified, including waiting times (which have had a worsening trend over the years) and compliance with the recommendation of not performing frozen section examination on small lesions. Pre-operative diagnosis improved constantly over time, but there is still a large variation between Regions and programmes. For almost 90% of screen-detected invasive cancers a sentinel lymph node (SLN) biopsy was performed on the axilla, avoiding a large number of potentially harmful dissections. On the other hand, potential overuse of SLN dissection for ductal carcinoma in situ, although apparently starting to decline, deserves further investigation. The detailed results have been distributed, among other ways by means of a web-based data-warehouse, to regional and local screening programmes, in order to allow multidisciplinary discussion and identification of the appropriate solutions to any issues documented by the data. The problem of waiting times should be assigned priority. Specialist Breast Units with adequate case volume and enough resources would provide the best setting for making monitoring effective in producing quality improvements with shorter waiting times.
PMID: 26405775 [PubMed - indexed for MEDLINE]
Sleep quality, but not quantity, is associated with self-perceived minor error rates among emergency department nurses.
Int Emerg Nurs. 2016 Mar;25:48-52
Authors: Weaver AL, Stutzman SE, Supnet C, Olson DM
INTRODUCTION: The emergency department (ED) is demanding and high risk. The impact of sleep quantity has been hypothesized to impact patient care. This study investigated the hypothesis that fatigue and impaired mentation, due to sleep disturbance and shortened overall sleeping hours, would lead to increased nursing errors.
METHODS: This is a prospective observational study of 30 ED nurses using self-administered survey and sleep architecture measured by wrist actigraphy as predictors of self-reported error rates. An actigraphy device was worn prior to working a 12-hour shift and nurses completed the Pittsburgh Sleep Quality Index (PSQI). Error rates were reported on a visual analog scale at the end of a 12-hour shift.
RESULTS: The PSQI responses indicated that 73.3% of subjects had poor sleep quality. Lower sleep quality measured by actigraphy (hours asleep/hours in bed) was associated with higher self-perceived minor errors. Sleep quantity (total hours slept) was not associated with minor, moderate, nor severe errors.
DISCUSSION: Our study found that ED nurses' sleep quality, immediately prior to a working 12-hour shift, is more predictive of error than sleep quantity. These results present evidence that a "good night's sleep" prior to working a nursing shift in the ED is beneficial for reducing minor errors.
PMID: 26360412 [PubMed - indexed for MEDLINE]