Effect of nursing on postoperative respiratory function and mental health of lung cancer patients

BACKGROUND Both pulmonary rehabilitation training and psychological care have been shown to have a positive effect on the postoperative recovery of patients with lung cancer.However,few studies have combined the two to explore their combined effect.Therefore,this study aimed to investigate the effects of pulmonary rehabil-itation training combined with psychological care on postoperative respiratory function and mental health in lung cancer patients.AIM To investigate effect of nursing on postoperative respiratory function and mental health of lung cancer patients.METHODS 122 cases of lung cancer patients who underwent surgical treatment in our hospital and were treated in our department from January 2022 to April 2023 were selected and randomly divided into the control group and observation group.The control group performed the routine care intervention.The obser-vation group was given pulmonary rehabilitation training and psychological care based on conventional nursing interventions.Forced expiratory volume,forced vital capacity.Maximum ventilatory volume(MVV)in one second was measured,and the patient's 6-min walking distance and dyspnoea index scale were used to assess the patient's respiratory condition.The Connor-Davidson resilience scale(CD-RISC),self-rating anxiety scale(SAS),and self-rating depression scale(SDS)were used to evaluate the mental health of the patients.RESULTS There was no difference between the two groups regarding age,gender,education level,surgical procedure,type of pathology,and treatment(P>0.05).After treatment,MVV,6-min walking distance,toughness,strength,optimism,and total CD-RISC scores were significantly higher in the observation group(P<0.05),dyspnoea scores,SAS,and SDS scores were substantially lower in the control group compared to the observation group(P<0.05).CONCLUSION Pulmonary rehabilitation training combined with psychological care for patients after lung cancer resection could improve lung function,enhance daily activities,effectively relieve negative emotions such as anxiety and depression,and reduce complications.

Physiologic postoperative presepsin kinetics following primary cementless total hip arthroplasty:A prospective observational study

BACKGROUND Presepsin is an emerging biomarker in the diagnosis of sepsis.In the field of orthopaedics,it could be useful in diagnosing and managing periprosthetic joint infections.AIM To define the normal postoperative presepsin plasmatic curve,in patients undergoing primary cementless total hip arthroplasty(THA).METHODS Patients undergoing primary cementless THA at our Institute were recruited.Inclusion criteria were:Primary osteoarthritis of the hip;urinary catheter time of permanence<24 h;peripheral venous cannulation time of permanence<24 h;no postoperative homologous blood transfusion administration and hospital stay≤8 d.Exclusion criteria were:The presence of other articular prosthetic replacement or bone fixation devices;chronic inflammatory diseases;chronic kidney diseases;history of recurrent infections or malignant neoplasms;previous surgery in the preceding 12 mo;diabetes mellitus;immunosuppressive drug or corticosteroid assumption.All the patients received the same antibiotic prophylaxis.All the THA were performed by the same surgical and anaesthesia team;total operative time was defined as the time taken from skin incision to completion of skin closure.At enrollment,anthropometric data,smocking status,osteoarthritis stage according to Kellgren and Lawrence,Harris Hip Score,drugs assumption and comorbidities were recorded.All the patients underwent serial blood tests,including complete blood count,presepsin(PS)and C-reactive protein 24 h before arthroplasty and at 24,48,72 and 96 h postoperatively and at 3,6 and 12-mo follow-up.RESULTS A total of 96 patients(51 female;45 male;mean age=65.74±5.58)were recruited.The mean PS values were:137.54 pg/mL at baseline,192.08 pg/mL at 24 h post-op;254.85 pg/mL at 48 h post-op;259 pg/mL at 72 h post-op;248.6 pg/mL at 96-h post-op;140.52 pg/mL at 3-mo follow-up;135.55 pg/mL at 6-mo follow-up and 130.11 pg/mL at 12-mo follow-up.In two patients(2.08%)a soft-tissue infection was observed;in these patients,higher levels(>350 pg/mL)were recorded at 3-mo follow-up.CONCLUSION The dosage of plasmatic PS concentration is highly recommended in patients undergoing THA before surgery to exclude the presence of an unknown infection.The PS plasmatic concentration should be also assessed at 72 h postoperatively,evaluate the maximum postoperative PS value,and at 96 h post-operatively when a decrease of presepsin should be found.The lack of a presepsin decrease at 96 h post-operatively could be a predictive factor of infection.

Comparison of Surgical Techniques Used in Treating Acromioclavicular Dislocation in Patients Participating in Sports: A Systematic Review

Introduction: The acromioclavicular joint is a superficial diarthrodial joint that surrounds the medial articular facet of the acromion and the distal portion of the clavicle. Due to its anatomy and biomechanics, it is highly susceptible to trauma and in young men who play contact sports, acromioclavicular dislocation is common. This article aimed to systematically review the literature and compare the surgical techniques used in the treatment of acromioclavicular dislocation in patients who practice sports. Methods: This systematic review was conducted according to the International Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Eligible studies for this systematic review included articles in English or Spanish published between 2013 and 2023, which mention the occurrence of acromioclavicular dislocation during sports practices. Additionally, only studies that addressed the surgical treatment of acromion-clavicular dislocation and contained original data on the topic were included. Results: We found 144 eligible studies after searching the LILACS and PubMed databases. Based on the inclusion and exclusion criteria and the reviewers’ consensus, we selected four studies for the systematic review. 133 patients with AC joint displacement were evaluated. Mean Age: approximately 31.90 years. 81.92 of these injuries occurred during sports practice. Surgical Procedures Used: titanium plates fixation (49 patients), arthroscopy (24), single tunnel technique (30) and coracoid sling technique (30). The results of the visual analog scale and Constant-Murley scores varied between the techniques used. Twenty-two complications after surgical treatment were identified. Conclusion: A significant variability of operative techniques can be used in the surgical approach of acromioclavicular dislocation, such as arthroscopy, single tunnel, coracoid sling and titanium plates. Although it presented excellent functional results compared to the other three techniques evaluated by this review, using titanium plates is not the gold standard since other techniques not assessed by this work may be more effective.

Risk factors and prognosis of critically ill cancer patients with postoperative acute respiratory insufficiency

BACKGROUND:This study aimed to investigate the risk factors and outcome of critically ill cancer patients with postoperative acute respiratory insufficiency.METHODS:The data of 190 critically ill cancer patients with postoperative acute respiratory insufficiency were retrospectively reviewed.The data of 321 patients with no acute respiratory insufficiency as controls were also collected.Clinical variables of the first 24 hours after admission to intensive care unit were collected,including age,sex,comorbid disease,type of surgery,admission type,presence of shock,presence of acute kidney injury,presence of acute lung injury/acute respiratory distress syndrome,acute physiologic and chronic health evaluation(APACHE Ⅱ) score,sepsis-related organ failure assessment(SOFA),and PaO_2/FiO_2 ratio.Duration of mechanical ventilation,length of intensive care unit stay,intensive care unit death,length of hospitalization,hospital death and one-year survival were calculated.RESULTS:The incidence of acute respiratory insufficiency was 37.2%(190/321).Multivariate logistic analysis showed a history of chronic obstructive pulmonary diseases(P=0.001),surgeryrelated infection(P=0.004),hypo-volemic shock(P<0.001),and emergency surgery(P=0.018),were independent risk factors of postoperative acute respiratory insufficiency.Compared with the patients without acute respiratory insufficiency,the patients with acute respiratory insufficiency had a prolonged length of intensive care unit stay(P<0.001),a prolonged length of hospitalization(P=0.006),increased intensive care unit mortality(P=0.001),and hospital mortality(P<0.001).Septic shock was shown to be the only independent prognostic factor of intensive care unit death for the patients with acute respiratory insufficiency(P=0.029,RR:8.522,95%CI:1.243-58.437,B=2.143,SE=0.982,Wald=4.758).Compared with the patients without acute respiratory insufficiency,those with acute respiratory insufficiency had a shortened one-year survival rate(78.7%vs.97.1%,P<0.001).CONCLUSION:A history of chronic obstructive pulmonary diseases,surgery-related infection,hypovolemic shock and emergency surgery were risk factors of critically ill cancer patients with postoperative acute respiratory insufficiency.Septic shock was the only independent prognostic factor of intensive care unit death in patients with acute respiratory insufficiency.Compared with patients without acute respiratory insufficiency,those with acute respiratory insufficiency had adverse shortterm outcome and a decreased one-year survival rate.

Major liver resections,perioperative issues and posthepatectomy liver failure:A comprehensive update for the anesthesiologist

Significant advances in surgical techniques and relevant medium-and long-term outcomes over the past two decades have led to a substantial expansion in the indications for major liver resections.To support these outstanding results and to reduce perioperative complications,anesthesiologists must address and master key perioperative issues(preoperative assessment,proactive intraoperative anesthesia strategies,and implementation of the Enhanced Recovery After Surgery approach).Intensive care unit monitoring immediately following liver surgery remains a subject of active and often unresolved debate.Among postoperative complications,posthepatectomy liver failure(PHLF)occurs in different grades of severity(A-C)and frequency(9%-30%),and it is the main cause of 90-d postoperative mortality.PHLF,recently redefined with pragmatic clinical criteria and perioperative scores,can be predicted,prevented,or anticipated.This review highlights:(1)The systemic consequences of surgical manipulations anesthesiologistsmust respond to or prevent,to positively impact PHLF(a proactive approach);and(2)the maximal intensivetreatment of PHLF,including artificial options,mainly based,so far,on Acute Liver Failure treatment(s),to buytime waiting for the recovery of the native liver or,when appropriate and in very selected cases,toward livertransplant.Such a clinical context requires a strong commitment to surgeons,anesthesiologists,and intensivists towork together,for a fruitful collaboration in a mandatory clinical continuum.

Hypotension after intensive care unit drop-off in adult cardiac surgery patients

BACKGROUND Hypotension is a frequent complication in the intensive care unit(ICU)after adult cardiac surgery.AIM To describe frequency of hypotension in the ICU following adult cardiac surgery and its relation to the hospital outcomes.METHODS A retrospective study of post-cardiac adult surgical patients at a tertiary academic medical center in a two-year period.We abstracted baseline demographics,comorbidities,and all pertinent clinical variables.The primary predictor variable was the development of hypotension within the first 30 min upon arrival to the ICU from the operating room(OR).The primary outcome was hospital mortality,and other outcomes included duration of mechanical ventilation(MV)in hours,and ICU and hospital length of stay in days.RESULTS Of 417 patients,more than half(54%)experienced hypotension within 30 min upon arrival to the ICU.Presence of OR hypotension immediately prior to ICU transfer was significantly associated with ICU hypotension(odds ratio=1.9;95%confidence interval:1.21-2.98;P<0.006).ICU hypotensive patients had longer MV,5(interquartile ranges 3,15)vs 4 h(interquartile ranges 3,6),P=0.012.The patients who received vasopressor boluses(n=212)were more likely to experience ICU drop-off hypotension(odds ratio=1.45,95%confidence interval:0.98-2.13;P=0.062),and they experienced longer MV,ICU and hospital length of stay(P<0.001,for all).CONCLUSION Hypotension upon anesthesia-to-ICU drop-off is more frequent than previously reported and may be associated with adverse clinical outcomes.

Preoperative and Postoperative Spirometry in Patients Undergoing Lobectomy for Sequelae of Pulmonary Tuberculosis

Objective: To assess preoperative and postoperative spirometry values in patients undergoing lobectomy for sequelae of pulmonary tuberculosis. Method: A total of 20 patients (10 males) with history of treatment for tuberculosis and presenting with symptomatic sequelae (repeat infection or hemoptysis) who sought assistance at the chest surgery outpatient clinic between 11.09.07 and 04.02.10, were selected for the study. Only patients that met theeligibility criteria (symptomatic, submitted to tuberculosis treatment) were included in the study. The age of patients ranged from 15 to 56 years (mean: 35.75 years). The average treatment time for tuberculosis was 6 months and onset of symptoms occurred between 01 and 32 years after treatment. To assess the impact of surgery on the variables VC, FVC, FEV1, FEV1/FVC, FEF and PEF preoperative values were compared with postoperative values at 1st, 3rd, 6th and 12th month using the paired t test. The level of significance (α) applied for all tests was 5% where a value of p 0.05 was considered significant. Results: 11 patients were treated because of recurrent infections and 9 because of haemoptysis. The most common lobectomy was right upper lobectomy (7 patients), followed by left upper lobectomy (6 patients), left lower lobectomy (6 patients), and right middle lobectomy (1 patient). There were no postoperative complications. There was no postoperative mortality. Conclusion: Based on the results of the present study, it can be concluded that, at the 12th postoperative month, spirometric parameters of patients with tuberculosis sequelae submitted to lobectomy had returned to preoperative levels.

Amiodarone for Postoperative Atrial Fibrillation in Lung Cancer Patients: A 6-Year Follow-Up Study

Background: The preventive effect of prophylactic amiodarone on postoperative atrial fibrillation (POAF) in patients undergoing thoracic surgery has previously been demonstrated. Meanwhile, the long-term effect remains unknown. We investigated the long-term effect of prophylactic amiodarone, in patients undergoing surgery for lung cancer, along with the long-term prognosis of patients with POAF within 6 years of follow-up. Methods: Using data from national databases, we retrospectively analysed 250 patients included and randomized, in the randomized control trial, PASCART, in which patients were allocated to receive either amiodarone or placebo as prophylaxis for POAF. Prophylactic groups, and subgroups, were compared on a number of outcomes. Long-term overall survival was evaluated using Kaplan-Meier survival curves, and Cox proportional hazards models were used for multivariable analysis. Competing risk analysis was used to evaluate time-to-event data in presence of competing risk. Results: When comparing the prophylactic groups, prophylaxis with amiodarone was not convincingly related to a higher frequency of long-term side effects. Patients who developed POAF, were more likely to develop late atrial fibrillation (AF) and POAF was associated with an increased risk of late AF in both the competing risk analysis hazard rate (HR) 4.80 [95% 1.75;13.18] and multivariable analysis of the Cox regression, HR 5.03 [95% 1.80;14.10]. When comparing the Kaplan Meier survival curves between groups, we found no statistically significant difference in the long-term overall survival. Conclusions: Intravenous prophylactic amiodarone is safe in patients undergoing lung cancer surgery. POAF is associated with an increased risk of late AF.

Liver transplantation in China: problems and their solutions

BACKGROUND: The past decade has witnessed the rapid development of liver transplantation in China. The 1-year survival of liver transplant patients comes to 80% in many leading medical centers and the number of liver transplanta- tion is increasing. However, liver transplantation in China is facing several challenges including recipient with hepato- cellular carcinoma (HCC), recurrence of HCC and hepati- tis B, long-term postoperative care, the bridge to liver transplantation, and shortage of liver donor. This review was to understand the status of and problems in liver trans- plantation in China. DATA RESOURCES: An English-language literature search using MEDLINE (1990-2003) on liver transplantation and other related reports and review articles in Chinese from major transplant centers in China. RESULTS: HCC is one of the main indications for liver transplantation in China but different centers adopted dif- ferent criteria for selection of patients. Hepatitis B virus re- infection is a vital problem after liver transplantation in HBV-related patients. More and more attention was fo- cused on long-term postoperative care and donor shortage. Artificial liver support system has been applied in patients waiting for a graft in many centers. CONCLUSIONS: HCC remains to be one of the main indi- cations for liver transplantation in China; combined hepati- tis B immune globulin and lamivudine is considered effec- tive to prevent hepatitis B virus reinfection. Apart from long-term postoperative care for the improvement of the survival rate, early steroid withdrawal is feasible in liver transplantation. Living donor liver transplantation, split liv- er transplantation, and marginal donor transplantation can deal with donor shortage to some extent. Artificial liver as- sist system serves as a bridge to liver transplantation.

Effect of intradermal needle therapy at combined acupoints on patients’ gastrointestinal function following surgery for gastrointestinal tumors

BACKGROUND Postoperative gastrointestinal function recovery is critical for rapid rehabilitation of patients with gastrointestinal tumors.Traditional Chinese medicine offers considerable advantages for gastrointestinal disease treatment.However,no study has reported the clinical efficacy of intradermal needle therapy(INT)at the Yuan-source,Luo-connecting,and He-sea points of the corresponding meridian for gastrointestinal function in patients following surgery for gastrointestinal tumors.AIM To investigate the effect of INT at combined acupoints on patients’gastrointestinal function following surgery for gastrointestinal tumors.METHODS This randomized controlled trial was conducted at the Second Affiliated Hospital of Xi’an Jiaotong University on patients with diagnosed gastrointestinal cancer,no distant metastases or organ failure,and hospitalized for elective radical tumor resection,who did not receive preoperative radiotherapy or chemotherapy.Participants were randomly allocated to either the intervention(n=32)or the control(n=32)group.Participants in the control group received enhanced recovery care,while those in the intervention group received enhanced recovery care combined with INT at the Yuan-source,Luo-connecting,and He-sea points.After surgery,INT was performed immediately upon the patient's return to the ward,and continued for seven consecutive days.The independent samples t-test,chi-square test,and generalized estimating equations were used for data analysis.RESULTS The participants’ages ranged from 40 to 80 years(average 63±10.1 years).Most participants underwent surgery for either gastric(43.8%)or colon cancer(39.1%)and had adenocarcinoma(87.5%).Significant differences were noted in time to first postoperative flatus passage(66±27 h vs 103±41 h,P<0.001),time to first defecation(106±44 h vs 153±50 h,P<0.001),and time to first oral feeding(73±30 h vs 115±38 h,P<0.001)between the intervention and control groups.Gastrointestinal symptoms,including abdominal distension,nausea,and fatigue 48 h and 72 h after surgery,were significantly alleviated in the intervention group compared with that observed in the control group(P<0.05).CONCLUSION INT at the Yuan-source,Luo-connecting,and He-sea points can promote recovery of gastrointestinal function and ease gastrointestinal symptoms in patients following surgical resection of gastrointestinal tumors.

Intraoperative patient information handover between anesthesia providers

Currently,no reported studies have evaluated intraoperative handover among anesthesia providers.Studies on anesthetic handover in the US recovery room setting observed that handover processes are insufficient and,in many instances,significant intraoperative events are disregarded.An online survey tool was sent to anesthesia providers at US anesthesia residency programs nationwide（120 out of the 132 US programs encompassing around 4500 residents and their academic MDAs） and a smaller survey selection of CRNAs（10 institutions about 300 CRNAs in the metropolitan area of Detroit,MI,USA） to collect information on handover practices.The response rate to this survey（n=216） was comprised of approximately 5%（n = 71） of the resident population in US anesthesia programs,5%（n=87） of MDAs,and 20%（n=58） of the CRNAs.Out of all respondents（n=212）,49.1%had no hand-over protocol at their institution and 88%of respondents who did have institutional handover protocols believed them insufficient for effective patient handover.In addiiton,84.8%of all responders reported situations where there was insufficient information received during a patient handover.Only 7%of the respondents reported never experiencing complications or mismanagement due to poor or incomplete hand-overs.In contrast,60%reported rarely having complications,31%reported sometimes having complications,and 3%reported frequent complications.In conclusion,handover transition of patient care is a vulnerable and potentially life-threatening event in the operating room.Our preliminary study suggests that current intraoperatvive handover practices among anesthesia providers are suboptimal and that national patient handover guidelines are required to improve patient safety.

Typhoid intestinal perforation in developing countries: Still unavoidable deaths?

Typhoid fever is a public health challenge mostly concentrated in impoverished, overcrowded areas of the developing world, with lack of safe drinking and sanitation. The most serious complication is typhoid intestinal perforation(TIP), observed in 0.8% to 39%, with a striking rate difference between high-income and low-middle-income countries. Although the mortality rate consequent to TIP in resource-poor countries is improved in the last decades, it is still fluctuating from 5% to 80%, due to surgical-and not surgical-related constraints. Huge economic costs and long timelines are required to provide a short-to middle-term solution to the lack of safe water and sanitation. Inherent limitations of the currently available diagnostic tools may lead to under-evaluation as well as over-evaluation of the disease, with consequent delayed treatment or inappropriate, excessive antibiotic use, hence increasing the likelihood of bacterial resistance. There is a need for immunization programs in populations at greatest risk, especially in sub-Saharan Africa. Uniform surgical strategies and guidelines, on the basis of sound or prospective surgical studies and adapted to the local realities, are still lacking. Major drawbacks of the surgical treatment are the frequent delays to surgery, either for late diagnosis or for difficult transports, and the unavailable appropriate intensive care units in most peripheral facilities. As a consequence, poor patient's conditions at presentation, severe peritoneal contamination and unsuitable postoperative care are the foremost determinant of surgical morbidity and mortality.

Nursing Practice in Recovery Room: A Case of Kibuye Hope Hospital and Mutoyi Hospital

Background: Nursing care in the recovery room is oriented to take into account the patient’s condition after surgery intervention with its main purpose of providing direct and continuous patient observation in emergence from general or regional anesthesia. In the absence of professional assistance, patients can develop complications that can lead them into shock or death. This study aims to understand the place of nurses in guiding nursing care in recovery room in two hospitals of Gitega Province by assessing the nurse’s knowledge and attitudes for the promotion of quality nursing care for post-operative patients. Methods: A cross sectional study design was used to assess the practice of nurses in managing nursing care in the recovery room in these two hospitals. A purposive sampling method was used to select the 82 nurses working in the recovery room for these two hospitals and Alain Bouchard’s formula was used to calculate the sample size. Data were collected using a self-report method involving questionnaire completion with five components addressing participants identifications, factors related to the work organization, factors related to the work environment, factors related to healthcare system, and nursing interventions in recovery room. Results: Findings revealed a significant lack of knowledge among the participants and their attitudes were slightly poor as for most of the variables of factors related to healthcare system as their score was less than 50% and their knowledge for nursing interventions was also poor as most of variable scores were less than 25%. Conclusions: The study findings were slightly poor as their scores were less than 50% in most of the variables;therefore, it was recommended that in-service training and workshops should be organized by these healthcare facilities for the purpose of empowering the nurse’s knowledge and practice. Moreover, these institutions should provide and encourage nurses to use nursing guidelines and protocols.

Factors Inducing Drainage Tube Complications After Hepatobiliary Surgery

Objective:To explore the main factors of drainage tube complications after hepatobiliary surgery.Methods:From November 2019 to October 2021,103 patients with drainage tube complications after hepatobiliary surgery in Changshu No.2 People’s Hospital were selected as subjects for this study;the factors of postoperative drainage tube complications were analyzed by retrospective analysis.Results:The complications of drainage tubes include cavity organ damage,sliding of drainage tube into the abdominal cavity,broken drainage tube,blocked drainage tube,bleeding in drainage tube,bleeding from the mouth of drainage tube,abdominal cavity infection caused by drainage tube,and intestinal obstruction caused by drainage tube compression;the number of cases were 9,8,12,21,18,17,8,and 10,accounting for 8.74%,7.77%,11.65%,20.39%,17.48%,16.50%,7.77%,and 9.70%,respectively;the causes of these complications include early and late removal of drainage tube,improper positioning,color of drainage fluid,drainage tube falling out or self-removal,and so on.Conclusion:After hepatobiliary surgery,although the complications caused by drainage tubes have certain relationship with the indwelling time and surgery,the most critical is related to postoperative nursing care;therefore,it is necessary to observe the condition of the drainage tube and draining fluid after surgery,including the color of the fluid,its flow rate,and whether the drainage tube leaks or falls out;after surgery,patients should be encouraged to cooperate with the medical staffs,and family members should be reminded to pay attention to the observation of patients and informed about matters needing attention,so as to reduce the incidence of drainage tube complications after hepatobiliary surgery.

Clinical Effect of an Improved Post-Operative Feeding Protocol“in Transition”Infants of Congenital Heart Disease with Pulmonary Hypertension

Background:To achieve successful management of infants with congenital heart disease(CHD)together with pulmonary hypertension(PH),postoperative care,especially feeding care is vital in addition to surgery.Postoperative feeding is comprised of three stages:feeding in the intensive care unit,feeding in the general ward and family feeding,in which the general ward is considered as the“transitional stage”.At present,there is little research on the optimal mode of feeding care for the transitional stage,and there is no universally recognized and accepted protocol.Methods:We retrospectively analyzed 114 CHD infants with PH who underwent family-centered(FC)feeding care from July 2017 to December 2018,and prospectively studied 122 CHD infants with the same baseline level who adopted the improved mode,nurse-parent-driven(NPD)feeding mode from January 2019 to June 2020.The feasibility and efficacy of NPD as a“transitional”feeding nursing mode in CHD infants with PH were compared with the FC cohort by observing and analyzing the stress of family caregivers,feedingrelated complications,the proportion of breastfeeding,improvement of nutritional status,acquisition of knowledge and skills of feeding care,inpatient’s satisfaction rating and prognosis.Results:When compared with the FC feeding care,the NPD mode significantly reduced the burden of family caregivers,improved the rate of feeding care knowledge and skills and inpatient’s satisfaction rating,reduced the incidence of improper feeding-related complications,and enhanced the proportion of breastfeeding and nutritional status of infants at the“transitional stage”(all P<0.05).The self-assessment score of care ability of family caregivers and weight gain of children in the NPD group were significantly higher than those in the FC group(all P<0.05)during the follow-up.Conclusions:As a transitional mode of feeding in CHD infants with PH,NPD feeding care is superior to the conventional FC mode,which therefore can be adopted as a standard protocol in clinical practice.

Self-management of cataract extraction among diabetes patients

Background:Diabetes-related cataract extraction is a minor surgery required to regain full vision.One of the recognized factors that can delay or prevent full-vision recovery is poor management,and most of this management is being carried out by patients themselves.Objective:This study aimed to assess the knowledge of diabetes patients on self-management after cataract extraction in two tertiary hospitals in Osun State.Methods:A cross-sectional descriptive design was conducted among 97 diabetes patients who underwent cataract extraction and were attending clinics and follow-up visits in Osun State.A self-structured questionnaire was used for data collection.Results:Moderate knowledge was found among the participants on an appropriate diet(56.7%),prevention of injury risk(57.5%),prevention of infection risk(50.9%),and low knowledge on the technique of administration of eye drop(60.8%)after cataract extraction,whereas 74.7%of the total respondents were knowledgeable on the indication for follow-up visit after cataract extraction,these results were found to be below the expected knowledge level.Conclusion:An intensive and comprehensive educational initiative by nurses should be tailored to meet the specific needs of diabetes patients with cataract surgery.Nurses also need to implement the use of checklist which will enhance learning and improve patient understanding of self-management after cataract extraction.

Combined incisional ropivacaine infiltration and pulmonary recruitment manoeuvre for postoperative pain relief after diagnostic hysteroscopy and laparoscopy

Background Preoperative incisional local anaesthesia with ropivacaine is a common method of providing postlaparoscopy pain relief.The pulmonary recruitment manoeuvre also provides pain relief,but the combined effect of these two methods on pain following laparoscopic procedures has not been reported.We investigated the efficacy of combining local anaesthetic infiltration of ropivacaine with pulmonary recruitment manoeuvre on postoperative pain following diagnostic hysteroscopy and laparoscopy.Methods This prospective,randomized,controlled study involved 60 patients divided into two groups （n=30,each）.Group 1 received 20 ml of 0.5％ ropivacaine injected peri-incisionally preoperatively,with intra-abdominal carbon dioxide removed by passive deflation.Group 2 received 20 ml of 0.5％ ropivacaine injected peri-incisionally with five manual inflations of the lungs with a positive-pressure ventilation of 40 cmH2O at the end of surgery.The last inflation was held for 5 seconds.The intensity of postoperative incisional and shoulder pain was evaluated using a numerical rating scale at 0,2,4,8,12,24 and 48 hours postoperatively by an independent blinded anaesthesiologist.Tramadol was given postoperatively for analgesia.Results Compared with group 1,incisional ropivacaine infiltration combined with pulmonary recruitment manoeuvre significantly reduced dynamic pain at 0 hour,4 hours,and 24 hours postoperatively （4.1 ± 2.2 vs.2.1 ± 1.9,P=0.002;2.7 ± 2.7 vs.1.2 ± 1.3,P=0.035; and 3.5 ± 2.1 vs.2.1 ± 1.8,P=0.03,respectively）.Static incisional pain was significantly relieved at 0 hour,2 hours,and 24 hours postoperatively （3.1 ± 1.7 vs.1.6 ± 1.3,P=0.001; 1.4 ± 1.3 vs.0.5 ± 0.8,P=0.012;and 2.3 ± 1.9 vs.1.0 ± 1.5,P=0.038,respectively）.Group 2 had more patients without shoulder pain （P＜0.05） and fewer requiring tramadol （P＜0.05）.Conclusion Ropivacaine with pulmonary recruitment manoeuvre provided simple and effective pain relief after diagnostic hysteroscopy and laparoscopy.

Individualized red-cell transfusion strategy for non-cardiac surgery in adults:a randomized controlled trial

Background:Red-cell transfusion is critical for surgery during the peri-operative period;however,the transfusion threshold remains controversial mainly owing to the diversity among patients.The patient’s medical status should be evaluated before making a transfusion decision.Herein,we developed an individualized transfusion strategy using the West-China-Liu’s Score based on the physiology of oxygen delivery/consumption balance and designed an open-label,multicenter,randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively,providing valid evidence for peri-operative transfusion.Methods:Patients aged>14 years undergoing elective non-cardiac surgery with estimated blood loss>1000 mL or 20%blood volume and hemoglobin concentration<10 g/dL were randomly assigned to an individualized strategy,a restrictive strategy following China’s guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration<9.5 g/dL.We evaluated two primary outcomes:the proportion of patients who received red blood cells(superiority test)and a composite of in-hospital complications and all-cause mortality by day 30(non-inferiority test).Results:We enrolled 1182 patients:379,419,and 384 received individualized,restrictive,and liberal strategies,respectively.Approximately 30.6%(116/379)of patients in the individualized strategy received a red-cell transfusion,less than 62.5%(262/419)in the restrictive strategy(absolute risk difference,31.92%;97.5%confidence interval[CI]:24.42-39.42%;odds ratio,3.78%;97.5%CI:2.70-5.30%;P<0.001),and 89.8%(345/384)in the liberal strategy(absolute risk difference,59.24%;97.5%CI:52.91-65.57%;odds ratio,20.06;97.5%CI:12.74-31.57;P<0.001).No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies.Conclusion:The individualized red-cell transfusion strategy using the West-China-Liu’s Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries.Trial registration:ClinicalTrials.gov,NCT01597232.