Impact of centralization of pancreaticoduodenectomy coupled with fast track recovery protocol:a comparative study from India

BACKGROUND: Fast track strategy in the management of patients undergoing intra-abdominal surgery of various types has emerged as a landmark approach to reduce surgical stress and accelerate recovery. This study was to evaluate the effect of fast track strategy on patients subjected to pancreaticoduo-denectomy (PD) from an individual unit during transit from low to a high volume center. METHODS: A total of 142 PD patients who had been subjected to fast track strategy between June 2008 and September 2012 were compared with 46 patients who had received convention-al surgery between January 2006 and May 2008. Comparative analysis was made of postoperative complications, postopera-tive recovery, length of hospital stay and patient readmission requirement. RESULTS: The patients subjected to fast track strategy had a faster recovery and a shorter hospital stay than those who were treated conventionally (7.8 vs 12.1 days). The intraoperative events like operative blood loss (417.9±83.8 vs 997.4 ±151.8 mL, P<0.001), blood transfused (a median of 0 vs 1 unit,P<0.001) and operative time taken (125 vs 245 minutes,P<0.001) were signiifcantly lower in the fast track group. The frequency of pancreatic ifstula (4.9% vs 13.0%) and delayed gastric empty-ing (7.0% vs 17.4%) was also signiifcantly reduced with fast track treatment. Nevertheless, the readmission rate (11.3% vs 6.5%) was found relatively higher within the fast track group. However, increased readmission rates in this study seem to be independent of fast track protocol. CONCLUSIONS: This preliminary analysis suggests that the fast track approach might be beneifcial to the well-being of the patients after PD, for it accelerates the immediate clinical recovery of patients and signiifcantly shortens their length of hospital stay.

APEC ON FAST TRACK

The 1993 Seattle First Informal Leaders Meeting elevated it from a ministerialmeeting to a cooperative mechanism at the summit level.The 1994 Bogor Dec-laration then ushered it into a de facto regular mechanism.The 1995 Osaka ActionPlan went a step further to initiate the transition of its function from working outprograms of intent into their enforcement.The forthcoming 1996 Subic Bay Meet-ing will eventually launch it out on fast track.

Fast Track Surgery and Its Outcome in Colorectal Surgery in a Tertiary Care Hospital

Background: Fast track surgery is an evidence-based multidisciplinary approach. The underlying principle is to enable patients to recover from surgery and leave the hospital sooner by minimizing the stress responses on the body during surgery. Our aim was to compare the outcome of fast-track protocol and conventional methods in colorectal surgery. Method: It was an observational cross-sectional study carried out at the Department of Surgery in different tertiary level hospitals, Dhaka Bangladesh during the period January 2014 to December 2017. Among this population, 50 patients were placed in the fast-track program (Group A) from January 2014 to December 2015 and 50 patients were in the conventional method (Group B), from January 2016 to December 2017. The fast-track patients were selected after receiving ethical approval from the Bangladesh College of Physician & Surgeons. Data analysis was done using the statistical package for social science (SPSS) for windows version 20. Results: The average age of the patients was 45.24 ± 16.65 years (range: 11 - 70 years) in the fast track group (Group A) and 43.24 ± 17.76 years in the conventional method (Group B). The majority were female between two groups, with 56% in group A and 52% in group B. General and surgical complications occurred in 9 (18%) patients and 11 (22%) patients respectively in group A. On the other hand in group B general and surgical complications occurred in 10 (20%) patients and 13 (26%) patients respectively. The average hospital stay was 9.24 ± 5.99 days in group A and the average hospital stay was 10.10 ± 6.04 days in group B. Conclusion: Making the decision to adopt fast-track surgery will challenge current traditional practice for all members of the multidisciplinary team across the whole local health community.

Nanjing on the Fast Track

Boasting top-notch infrastructure and dynamic economic growth,Nanjing is pushing towards an exhibition limelight in the Yangtze River Delta.

Fast track clinical pathway implications in esophagogastrectomy

AIM:To investigate the feasibility of fast track clinical pathway for esophageal tumor resections. METHODS:One hundred and fourteen patients with esophageal carcinoma who underwent esophagogastrectomy from January 2006 to October 2007 in our department were studied.Fast track clinical pathway included analgesia control,fluid infusion volume control,early ambulation and enteral nutrition. Nasogastric tube was removed 3 d after operation and chest tube was removed 4 d after operation as a routine,and full liquid diet 5 d after operation. RESULTS:Among 114 patients(84 men and 30 women),26 patients underwent fast track surgery,including 17 patients over 65 years old and 9 under 65(P=0.014);18 patients who had preoperative complications could not bear fast track surgery(P< 0.001).No significant differences in tolerance of fast track surgery were attributed to differences in gender,differentiated degree or stage of tumor,pathological type of tumor,or operative incision.The median length of hospital stay was 7 d(5-28 d),4%patients were readmitted to hospital within 30 d of discharge.Three patients died and postoperative mortality was 2.6%. All 3 patients had no determinacy to fast track surgery approach.CONCLUSION:The majority of patients with esophageal carcinoma can tolerate fast track surgery. Patients younger than 65 or who have no preoperative diseases have the best results.Median length of hospital stay has been reduced to 7 d.

Fast track anesthesia for liver transplantation: Review of the current practice

Historically,patients undergoing liver transplantation were left intubated and extubated in the intensive care unit(ICU)after a period of recovery.Proponents of this practice argued that these patients were critically ill andneed time to be properly optimized from a physiological and pain standpoint prior to extubation.Recently,there has been a growing movement toward early extubation in transplant centers worldwide.Initially fueled by research into early extubation following cardiac surgery,extubation in the operating room or soon after arrival to the ICU,has been shown to be safe with proper patient selection.Additionally,as experience at determining appropriate candidates has improved,some institutions have developed systems to allow select patients to bypass the ICU entirely and be admitted to the surgical ward after transplant.We discuss the history of early extubation and the arguments in favor and against fast track anesthesia.We also described our practice of fast track anesthesia at Mayo Clinic Florida,in which,we extubate approximately 60%of our patients in the operating room and send them to the surgical ward after a period of time in the post anesthesia recovery unit.

Study of the retina algorithm on FPGA for fast tracking

Real-time track reconstruction in high-energy physics experiments at colliders running at high luminosity is very challenging for trigger systems. To perform pattern recognition and track fitting, artificial retina or Hough transformation algorithms have been introduced to the field typically implemented on state-of-the-art field programmable gate array(FPGA) devices. In this paper, we report on two FPGA implementations of the retina algorithm: one using a mixed Floating-Point core and the other using Fixed-Point and Look-Up Table, and detailed measurements of the retina performance are investigated and compared. So far, the retina has mainly been used in a detector configuration comprising parallel planes, and the goal of our work is to study the hardware implementation of the retina algorithm and estimate the possibility of using such a method in a real experiment.

Early discharge after major gynaecological surgery: advantages of fast track surgery

Introduction: Fast Track Surgery (FTS) programs have been adopted by many specialties with documented improved patient outcomes and reduced length of stay (LOS). Methods: We initiated a FTS program in January 2008 and present our experience up to and including November 2010 on patients whose LOS was 2 days. Results: During the study period 242 patients had a laparotomy performed. Overall 54(22.3%) patients were discharged on day 2. In the first year of initiating our FTS program 10% were discharged on day 2, 25% in year 2 and 31% in year 3. Twenty-two patients (41%) had malignant pathology and of these, 16 (73%) had local or regional spread and 6 (27%) had distant spread. Forty patients (74%) had vertical midline incisions (VMI) performed. Surgery was classified as complex in 40 cases (74%) and 6 (11%) patients underwent staging lymph node dissection. Average patient BMI was 26.1 with 44% of patients considered overweight or obese. There were no intraoperative complications recorded. When compared to 188 patients whose LOS was greater than 2 days, the early discharge cohort were more likely to have benign pathology, more likely to be younger, to have a transverse incision, to have received COX II inhibitors, to have a lower net haemoglobin (Hb) change and to tolerate early oral feeding. Conclusions: Increased clinical experience with FTS enables over 31% patients undergoing laparotomy to be safely discharged on day 2 without an increase in the read-mission rate or morbidity.

A 5-Year Review of Gynaecological Oncology Patients Managed by a Fast Track Surgery Program

Introduction: The aim of this study is to provide a comprehensive 5-year audit of patients undergoing laparotomy for suspected or confirmed gynaecological malignancy to document the frequency and incidence of adverse events and to investigate factors associated with shorter length of stay and readmission to hospital. Methods: A 5-year surgical audit of the period commencing 2008 and concluding 2012. All patients undergoing laparotomy were included in the audit without exclusions. Approval was granted by the local Ethics Review Committee. Results: Four hundred and twenty-seven patients underwent laparotomy for suspected or confirmed gynaecological malignancy and were managed by Fast Track Surgery (FTS) principles. Average age was 54.8 years and average weight and BMI were 73.4 kg and 28.1 respectively. Ultimately 254 (59%) patients had confirmed malignancy. Average surgery duration was 2.36 hours and average estimated blood loss (EBL) at surgery was 262 mL. Median and mean LOS was 3.0 and 3.5 days respectively with 125 (29%) patients discharged on day 2. Overall transfusion rate was 5%. Other adverse events in decreasing frequency were hospital readmission (3.7%), significant wound infection (3%) and unplanned High Dependency Unit (HDU) admission (1.4%). All other adverse events were uncommon with rates <0.5%. Factors associated with a short LOS included year of surgery, age, performance status, malignant vs benign pathology, the use of COX-2 inhibitors, operation time, incision type, transfusion, and radical hysterectomy, at least 1 complication, if patients tolerated early oral feeding (EOF). In multivariable analysis, year, age, performance status, the use of COX-2 inhibitors, operation time and incision type were significant. Factors associated with readmission included the use of COX-2 inhibitors, operation time, performance of a lymph node dissection, return to operating theatre, operation category at least 1 complication, and in multivariable analysis lymph node dissection and the occurrence of at least 1 complication were significant. Conclusions: This 5-year audit is important in establishing a contemporary incidence and the prevalence rate of serious adverse events for patients with suspected or confirmed gynaecological cancer undergoing laparotomy and managed by FTS principles. The community can be reassured that the incidence of serious adverse events is low when managed by FTS principles.

Effect of fast track surgery care on knee joint function in patients with knee joint replacement surgery: A systematic review

目的:系统评价加速康复外科护理对膝关节置换术患者膝关节功能的影响。方法:计算机检索电子数据库TheCochraneLibrary、PubMed、EBSCO、CINAHL、知网、万方、维普及中国生物医学数据库,获取国内外关于加速康复外科护理在膝关节置换术中应用的随机对照试验,由2人根据纳入排除标准独立筛选文献并提取数据,采用RevMan5.3对纳入研究进行Meta分析。结果:共纳入8篇RCT文献,共计患者635例。Meta分析结果显示:(1)与常规护理相比,加速康复外科护理能提高膝关节置换患者特种外科医院膝关节评分,根据资料收集时间的不同,对膝关节特殊手术医院评分进行亚组分析,结果显示:加速康复外科护理提高膝关节置换患者术后2个月、3个月、6个月、1年的膝关节特殊手术医院评分[2个月:加权均数差(WMD)=15.20,95%CI:13.58-16.82,P<0.01;3个月:WMD=9.42,95%CI:7.80-11.04,P<0.01;6个月:WMD=11.01,95%CI:9.73-12.28,P<0.01;1年:WMD=10.78,95%CI:9.33-12.24,P<0.01];(2)与常规护理相比,加速康复外科护理能提高膝关节置换患者美国膝关节学会评分中膝评分(WMD=9.23,95%CI:0.86-17.6,P<0.05)。(3)与常规护理相比,加速康复外科护理降低术后深静脉血栓、便秘、肺部感染、泌尿系感染等并发症的发生。结论:与常规护理相比,加速康复外科护理能促进患者膝关节功能恢复、降低术后深静脉血栓、便秘、肺部感染、泌尿系感染的发生。但尚需进一步开展严谨的大样本、多中心的随机对照试验加以验证。

Assessing outcomes after fast track surgical management of corpus cancer

Objective: The aim of the study was to audit the outcomes of patients with corpus cancer managed with a fast track surgery (FTS) program. Design: Clinical audit of outcomes after laparotomy for corpus cancer and managed by FTS principles. Setting: Tertiary hospital, University based subspecialty gynaecological oncology practice. Population or Sample: Consecutive patients with uterine corpus cancer. There were no exclusions. Methods: Three year audit of FTS Database. Main Outcome Measures: Ability to tolerate early oral feeding (EOF), length of stay (LOS), perioperative complication rate and readmission rate. Results: Sixty six patients were operated upon whose median age was 59.5 years. Forty six (70%) had stage I disease, 7 (11%) stage II, 9 (14%) stage III and 4 (6%) had stage IV disease. Twenty seven (41%) had lymph node sampling performed. Median operating time was 2.5 hours. Mean BMI was 30 kg/m2 (Range: 18 - 47). Fifty patients (76%) were classified as over-weight or obese. Twenty four patients (36%) had a “non-zero” performance status. Mean intraoperative EBL was 227 ml. Median LOS was 3.0 days. There were 3 (5%) intraoperative complications. There were no intraoperative ureteric, bowel or vascular injuries. Postoperatively, 13 (20%) patients experienced a total of 24 adverse events. Only 2 (3%) patients experienced complications greater than grade 2. Conclusion: This audit shows that in an unselected group of patients undergoing laparotomy as management for their uterine malignancy and managed by a FTS protocol, overall excellent results can be achieved.

Fast Track Gynaecologic Surgery in the Overweight and Obese Patient

Introduction: To review the outcomes of overweight and obese patients undergoing laparotomy and managed with a Fast Track Surgical (FTS) protocol. Methods: Between January 2008 and May 2010 patients having a laparotomy and managed on a FTS protocol were identified. They were compared to patients with a normal body mass index (BMI). Data was collected in a real time fashion and analysis undertaken in a retrospective fashion. Results: 194 patients were identified, 94 (48.4%) classified as normal BMI, 51 (26.3%) as overweight and 49 (25.3%) as obese. A vertical midline incision was performed in 170 (88%) patients. When comparing the group of overweight/obese patients (n = 100) to those with a normal BMI (n = 94) there was no significant difference in the number of benign or malignant pathologies, FIGO stage, age, insurance status, complexity of surgery, operation duration, blood loss, haemoglobin change, or need for transfusion. The proportion of patients successfully fast tracked and able to tolerate early oral feeding was similar. Patients classified as overweight or obese were significantly more likely to have a poorer performance status, have un?dergone vertical midline incision and to have had COX II inhibitors withheld. The median length of stay (LOS) was 3 days for the patients with a normal BMI and also 3 days for those overweight or obese. Conclusions: Overweight and obese patients undergoing a fast track surgical protocol after laparotomy for gynaecological surgery have similar out comes when compared to patients of normal body mass index.

Fast Track Extubation Post Coronary Artery Bypass Graft: A Retrospective Review of Predictors of Clinical Outcomes

Introduction: Fast track (FT) cardiac surgery and early extubation (EE) are aimed at safe and effective rapid post-operative progression to discharge, and have been practiced for more than two decades. Their goal is to optimize patient care perioperatively in order to decrease costs without negatively affecting morbidity and mortality. However, the factors that predict successful EE are poorly understood, and patients with significant co-morbidities are frequently excluded from protocols. We hypothesize that independent of disease severity, early extubation leads to shorter hospital stays and can be performed safely without negatively affecting outcomes. Materials and Methods: We performed a retrospective review of 919 patients who underwent coronary artery bypass grafting (CABG) at the Southern Arizona Veteran’s Affairs Health Care System medical center over 7 years. We collected pre-operative data regarding patients’ NYHA classification, presence and severity of cerebral vascular disease, peripheral vascular disease, pulmonary disease, diabetes and hypertension. Intra-operative variables were also recorded including ASA scores, ischemic times, and time to extubation. Finally, post-operative variables such as rates of reintubation and tracheotomy, and both length of ICU and total hospital stay were also compared. Results: Prolonged periods of ischemia were found to predict a delayed extubation (HR = 0.992;CI = 0.988 - 0.997, p = 0.0015) while small body surface area (HR = 1.57;CI = 1.13, 2.17, p = 0.007) and higher pre-operative functional status of the patient, such as independent versus dependent status (HR =1.68;CI = 1.30 - 2.16, p = 1.33;CI = 1.03 - 1.70, p = 0.03) were found to be associated with earlier extubation. The early extubation (EE) group (those extubated in less than the median 7.3 hours) had an average hospital stay of 5.1 ± 4.0 days, versus 7.8 ± 8.1 days in the delayed group (>4 hours), p Conclusions: In our study population, pre-operative functional class and total body surface area predicted those patients able to tolerate early extubation after cardiac surgery. Prolonged ischemia resulted in delayed extubation. Patients that were extubated in less than 4 hours had shorter ICU and hospitalization stays, while there was no significant difference between the two groups in rate of reintubation or tracheotomy.

基于Kano-FAST-E的鞋面压合机优化设计

目的降低鞋面压合机设备作业过程中的失误率、优化人机交互体验。方法基于Kano模型调研分析作业人员与企业经理对当前设备的使用感受及需求;利用FAST理论重新定义设备的功能区域并指导设计展开;基于人机工程学理论(E),对设计方案的功能布局和结构尺寸进行优化,提升人机操作效率;利用眼动试验对改进前后的功能布局进行对比分析验证,并借助李克特量表对设计方案进行用户满意度评价。结果完成鞋面压合机的优化设计实践,提升了设备的人机性能和用户满意度,有效提高了作业人员认读效率、减少视觉疲劳和错误操作。结论改进后的鞋面压合机赋予了工人更加安全、高效且人性化的操作模式,验证了Kano-FAST-E的设计策略对该设备的人机优化设计具有指导意义,也为同类设备的开发实践提供参考。

Probabilistic Global Maximum Power Point Tracking Algorithm for Continuously Varying Partial Shading Conditions on Autonomous PV Systems

A photovoltaic (PV) string with multiple modules with bypass diodes frequently deployed on a variety of autonomous PV systems may present multiple power peaks under uneven shading. For optimal solar harvesting, there is a need for a control schema to force the PV string to operate at global maximum power point (GMPP). While a lot of tracking methods have been proposed in the literature, they are usually complex and do not fully take advantage of the available characteristics of the PV array. This work highlights how the voltage at operating point and the forward voltage of the bypass diode are considered to design a global maximum power point tracking (GMPPT) algorithm with a very limited global search phase called Fast GMPPT. This algorithm successfully tracks GMPP between 94% and 98% of the time under a theoretical evaluation. It is then compared against Perturb and Observe, Deterministic Particle Swarm Optimization, and Grey Wolf Optimization under a sequence of irradiance steps as well as a power-over-voltage characteristics profile that mimics the electrical characteristics of a PV string under varying partial shading conditions. Overall, the simulation with the sequence of irradiance steps shows that while Fast GMPPT does not have the best convergence time, it has an excellent convergence rate as well as causes the least amount of power loss during the global search phase. Experimental test under varying partial shading conditions shows that while the GMPPT proposal is simple and lightweight, it is very performant under a wide range of dynamically varying partial shading conditions and boasts the best energy efficiency (94.74%) out of the 4 tested algorithms.

Fast track surgery accelerates the recovery of postoperative insulin sensitivity

Background Few clinical studies or randomized clinical trial results have reported the impact of fast track surgery on postoperative insulin sensitivity. This study aimed to investigate the effects of fast track surgery on postoperative insulin sensitivity in patients undergoing elective open colorectal resection. Methods Controlled, randomized clinical trial was conducted from November 2008 to January 2009 with one-month post-discharge follow-up. Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups： a fast track group （35 cases） and a conventional care group （35 cases）. All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia. Clinical parameters （complication rates, return of gastrointestinal function and postoperative length of stay）, stress index and insulin sensitivity were evaluated in both groups perioperatively. Results Sixty-two patients finally completed the study, 32 cases in the fast-track group and 30 cases in the conventional care group. Our findings revealed a significantly faster recovery of postoperative insulin sensitivity on postoperative day 7 in the fast-track group than that in the conventional care group. We also found a significantly shorter length of postoperative stay and a significantly faster return of gastrointestinal function in patients undergoing fast-track rehabilitation. Conclusion Fast track surgery accelerates the recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a shorter length of postoperative hospital stay.

“Fast Track”nasogastric decompression of rectal cancer surgery

This study evaluates the application of fast track(FT)nasogastric decompression in patients who underwent anterior resection of rectal cancer.A randomized control trial was performed comparing the group with the fast track treatment(n=57)and the group with traditional nasogastric decompression(n=84).Preoperative characteristics and postoperative recovery indices were recorded and analyzed.The results indicate no significant differences in gender(P=0.614),age(P=0.653),tumor location(P=0.113),and TNM stages(P=0.054)were observed between the 2 groups.The differences in the type of resection,anastomosis,and adoption of protective colostomy were all not significant between the FT and the traditional group.During the first 24 hours after surgery,the volume of nasogastric drainage averaged 197 ml in the FT group and 155 ml in the traditional group(P=0.197).The initiation of test-meal(P=0.000),semiliquid diet(P=0.002),and ordinary diet(P=0.008)were all significantly shorter in the FT group.Furthermore,compared with the other group,the patients in the FT group enjoyed earlier removal of the abdominal drainage,urinary catheter,and shorter hospital stays(P=0.000).Based on a correlation test,the duration of nasogastric decompression is related to the time of test-meal and semiliquid diet.The routine usage of nasogastric decompression in rectal surgery is unnecessary.The fast track procedure might help in facilitating postoperative functional and diet recovery,reducing the time of catheterization,and shortening hospital stay.

Fast track system optimization of emergency departments:Insights from a computer simulation study

Healthcare systems engineering in emergency departments(EDs)are developing rapidly in the world nowadays.Fast track(FT)as a rapid treatment system is considered to facilitate ED patient flow.To know how FT can improve the performance of ED,one should study the best configuration of resources for implementation of FT.This research presents a pattern for implementation of FT systems in hospital EDs using healthcare simulation paradigms.Simulation-based optimization model uses modeling and simulation capabilities to generate configurations of FT resources and its patient prioritization pattern with Arena r
simulation software.A decision making method is used to select the optimal configuration based on pre-specified performance indicators.The results imply that the proposed FT implementation pattern is efficient and capable of improving patient flow.

Fast Track to Study Abroad

Young Chinese students get ready for their overseas education at international high schools As the summer heat subsides,students are about to go back to school.Yang Guang,a tall and slender 16-yearold boy with a sunny smile,made an increasingly common decision. Rather than going to a first-rate public high school that prepares students for Chinese universities, Yang enrolled in a private international high school in Beijing,which is dedicated to preparing students to go to overseas universities.

Still on the Fast Track

North China’s Inner Mongolia Autonomous Region’s development is progressing comparatively fast,though there is still a long way to go until it catches up with advances being made in other parts of China, officials said.