Introduction: Intraoperative care includes a unique knowledge of how to perform a safe and effective surgery procedure. Surgery performed under regional or local anaesthesia allows the patient to remain conscious duri...Introduction: Intraoperative care includes a unique knowledge of how to perform a safe and effective surgery procedure. Surgery performed under regional or local anaesthesia allows the patient to remain conscious during the procedure and is rather common in Swedish healthcare today. Aim: The aim was to obtain a deeper understanding of the main concerns of operating theatre nurses (OTN) when caring for conscious patients during the intraoperative phase. Methods: Interviews were conducted with 23 OTNs from five different hospitals in Sweden and analysed according to grounded theory. Findings: The main concern among the OTNs was to take the patient in consideration. The core category “achieve and maintain ethical treatment of patients” in the operating theatre (OT) was a strategy used throughout the intraoperative process. Ethical treatment was described as moral behaviour at different levels and included the team’s behaviour, respectful and individualised patientcare, and the working-morale of the professionals. Being vigilant and being flexible were the categories related to the core category. The OTNs constantly assessed where to pay most attention as they balanced between the needs of the patient, the team, and the surgery procedure. Conclusion: It is important that every patient is taken into consideration and that ethical principles are held to the highest standards in the OT. A familiar team can facilitate that. The complex skills that operating theatre nurses develop can be added to explain important competencies within the profession.展开更多
BACKGROUND Routine outpatient endoscopy is performed across a variety of outpatient settings.A known risk of performing endoscopy under moderate sedation is the potential for over-sedation,requiring the use of reversa...BACKGROUND Routine outpatient endoscopy is performed across a variety of outpatient settings.A known risk of performing endoscopy under moderate sedation is the potential for over-sedation,requiring the use of reversal agents.More needs to be reported on rates of reversal across different outpatient settings.Our academic tertiary care center utilizes a triage tool that directs higher-risk patients to the in-hospital ambulatory procedure center(APC)for their procedure.Here,we report data on outpatient sedation reversal rates for endoscopy performed at an inhospital APC vs at a free-standing ambulatory endoscopy digestive health center(AEC-DHC)following risk stratification with a triage tool.AIM To observe the effect of risk stratification using a triage tool on patient outcomes,primarily sedation reversal events.METHODS We observed all outpatient endoscopy procedures performed at AEC-DHC and APC from April 2013 to September 2019.Procedures were stratified to their respective sites using a triage tool.We evaluated each procedure for which sedation reversal with flumazenil and naloxone was recorded.Demographics and characteristics recorded include patient age,gender,body mass index(BMI),American Society of Anesthesiologists(ASA)classification,procedure type,and reason for sedation reversal.RESULTS There were 97366 endoscopic procedures performed at AEC-DHC and 22494 at the APC during the study period.Of these,17 patients at AEC-DHC and 9 at the APC underwent sedation reversals(0.017%vs 0.04%;P=0.06).Demographics recorded for those requiring reversal at AEC-DHC vs APC included mean age(53.5±21 vs 60.4±17.42 years;P=0.23),ASA class(1.66±0.48 vs 2.22±0.83;P=0.20),BMI(27.7±6.7 kg/m^(2) vs 23.7±4.03 kg/m^(2);P=0.06),and female gender(64.7%vs 22%;P=0.04).The mean doses of sedative agents and reversal drugs used at AEC-DHC vs APC were midazolam(5.9±1.7 mg vs 8.9±3.5 mg;P=0.01),fentanyl(147.1±49.9μg vs 188.9±74.1μg;P=0.10),flumazenil(0.3±0.18μg vs 0.17±0.17μg;P=0.13)and naloxone(0.32±0.10 mg vs 0.28±0.12 mg;P=0.35).Procedures at AEC-DHC requiring sedation reversal included colonoscopies(n=6),esophagogastroduodenoscopy(EGD)(n=9)and EGD/colonoscopies(n=2),whereas APC procedures included EGDs(n=2),EGD with gastrostomy tube placement(n=1),endoscopic retrograde cholangiopancreatography(n=2)and endoscopic ultrasound's(n=4).The indications for sedation reversal at AEC-DHC included hypoxia(n=13;76%),excessive somnolence(n=3;18%),and hypotension(n=1;6%),whereas,at APC,these included hypoxia(n=7;78%)and hypotension(n=2;22%).No sedation-related deaths or long-term post-sedation reversal adverse outcomes occurred at either site.CONCLUSION Our study highlights the effectiveness of a triage tool used at our tertiary care hospital for risk stratification in minimizing sedation reversal events during outpatient endoscopy procedures.Using a triage tool for risk stratification,low rates of sedation reversal can be achieved in the ambulatory settings for EGD and colonoscopy.展开更多
目的分析某三甲医院重症监护病房(intensive care uni,ICU)患者发生败血症的危险因素。方法回顾性选取2021年1月—2023年12月在广西壮族自治区南溪山医院ICU住院的186例患者的临床资料,收集并比较败血症和非败血症患者的一般资料,并使...目的分析某三甲医院重症监护病房(intensive care uni,ICU)患者发生败血症的危险因素。方法回顾性选取2021年1月—2023年12月在广西壮族自治区南溪山医院ICU住院的186例患者的临床资料,收集并比较败血症和非败血症患者的一般资料,并使用多因素二元Logistic回归分析ICU患者发生败血症的危险因素。结果186例ICU住院患者中有22例患者感染败血症,164例患者未感染败血症,败血症发生率为11.83%(22/186)。败血症患者和非败血症患者的年龄、糖尿病、慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)、侵入性操作、预防性应用抗生素、意识障碍、中心静脉导管相关性血流感染、急性生理学与慢性健康状况评分系统Ⅱ(Acute Physiology and Chronic Health Evalution Scoring System,APACHEⅡ)和血白蛋白浓度情况比较,差异有统计学意义(P均<0.05)。多因素二元Logistic回归分析结果显示,存在糖尿病(OR=2.045,95%CI:1.067~4.226)、存在COPD(OR=1.034,95%CI:1.005~1.132)、有侵入性操作(OR=3.657,95%CI:2.344~6.827)、有预防性应用抗生素(OR=4.882,95%CI:3.274~7.954)、存在意识障碍(OR=2.167,95%CI:1.602~3.167)、存在中心静脉导管相关性血流感染(OR=1.065,95%CI:1.003~2.147)、APACHEⅡ评分(OR=3.471,95%CI:2.141~7.443)和血白蛋白浓度(OR=1.473,95%CI:1.117~1.826)是ICU患者发生败血症的独立危险因素(P均<0.05)。结论影响ICU患者发生败血症的主要因素有存在糖尿病、存在COPD、有侵入性操作、有预防性应用抗生素、存在意识障碍、中心静脉导管相关性血流感染、高APACHEⅡ评分和低血白蛋白浓度,针对以上因素给予患者的针对性预防,可降低败血症的发生率。展开更多
文摘Introduction: Intraoperative care includes a unique knowledge of how to perform a safe and effective surgery procedure. Surgery performed under regional or local anaesthesia allows the patient to remain conscious during the procedure and is rather common in Swedish healthcare today. Aim: The aim was to obtain a deeper understanding of the main concerns of operating theatre nurses (OTN) when caring for conscious patients during the intraoperative phase. Methods: Interviews were conducted with 23 OTNs from five different hospitals in Sweden and analysed according to grounded theory. Findings: The main concern among the OTNs was to take the patient in consideration. The core category “achieve and maintain ethical treatment of patients” in the operating theatre (OT) was a strategy used throughout the intraoperative process. Ethical treatment was described as moral behaviour at different levels and included the team’s behaviour, respectful and individualised patientcare, and the working-morale of the professionals. Being vigilant and being flexible were the categories related to the core category. The OTNs constantly assessed where to pay most attention as they balanced between the needs of the patient, the team, and the surgery procedure. Conclusion: It is important that every patient is taken into consideration and that ethical principles are held to the highest standards in the OT. A familiar team can facilitate that. The complex skills that operating theatre nurses develop can be added to explain important competencies within the profession.
文摘BACKGROUND Routine outpatient endoscopy is performed across a variety of outpatient settings.A known risk of performing endoscopy under moderate sedation is the potential for over-sedation,requiring the use of reversal agents.More needs to be reported on rates of reversal across different outpatient settings.Our academic tertiary care center utilizes a triage tool that directs higher-risk patients to the in-hospital ambulatory procedure center(APC)for their procedure.Here,we report data on outpatient sedation reversal rates for endoscopy performed at an inhospital APC vs at a free-standing ambulatory endoscopy digestive health center(AEC-DHC)following risk stratification with a triage tool.AIM To observe the effect of risk stratification using a triage tool on patient outcomes,primarily sedation reversal events.METHODS We observed all outpatient endoscopy procedures performed at AEC-DHC and APC from April 2013 to September 2019.Procedures were stratified to their respective sites using a triage tool.We evaluated each procedure for which sedation reversal with flumazenil and naloxone was recorded.Demographics and characteristics recorded include patient age,gender,body mass index(BMI),American Society of Anesthesiologists(ASA)classification,procedure type,and reason for sedation reversal.RESULTS There were 97366 endoscopic procedures performed at AEC-DHC and 22494 at the APC during the study period.Of these,17 patients at AEC-DHC and 9 at the APC underwent sedation reversals(0.017%vs 0.04%;P=0.06).Demographics recorded for those requiring reversal at AEC-DHC vs APC included mean age(53.5±21 vs 60.4±17.42 years;P=0.23),ASA class(1.66±0.48 vs 2.22±0.83;P=0.20),BMI(27.7±6.7 kg/m^(2) vs 23.7±4.03 kg/m^(2);P=0.06),and female gender(64.7%vs 22%;P=0.04).The mean doses of sedative agents and reversal drugs used at AEC-DHC vs APC were midazolam(5.9±1.7 mg vs 8.9±3.5 mg;P=0.01),fentanyl(147.1±49.9μg vs 188.9±74.1μg;P=0.10),flumazenil(0.3±0.18μg vs 0.17±0.17μg;P=0.13)and naloxone(0.32±0.10 mg vs 0.28±0.12 mg;P=0.35).Procedures at AEC-DHC requiring sedation reversal included colonoscopies(n=6),esophagogastroduodenoscopy(EGD)(n=9)and EGD/colonoscopies(n=2),whereas APC procedures included EGDs(n=2),EGD with gastrostomy tube placement(n=1),endoscopic retrograde cholangiopancreatography(n=2)and endoscopic ultrasound's(n=4).The indications for sedation reversal at AEC-DHC included hypoxia(n=13;76%),excessive somnolence(n=3;18%),and hypotension(n=1;6%),whereas,at APC,these included hypoxia(n=7;78%)and hypotension(n=2;22%).No sedation-related deaths or long-term post-sedation reversal adverse outcomes occurred at either site.CONCLUSION Our study highlights the effectiveness of a triage tool used at our tertiary care hospital for risk stratification in minimizing sedation reversal events during outpatient endoscopy procedures.Using a triage tool for risk stratification,low rates of sedation reversal can be achieved in the ambulatory settings for EGD and colonoscopy.
文摘目的分析某三甲医院重症监护病房(intensive care uni,ICU)患者发生败血症的危险因素。方法回顾性选取2021年1月—2023年12月在广西壮族自治区南溪山医院ICU住院的186例患者的临床资料,收集并比较败血症和非败血症患者的一般资料,并使用多因素二元Logistic回归分析ICU患者发生败血症的危险因素。结果186例ICU住院患者中有22例患者感染败血症,164例患者未感染败血症,败血症发生率为11.83%(22/186)。败血症患者和非败血症患者的年龄、糖尿病、慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)、侵入性操作、预防性应用抗生素、意识障碍、中心静脉导管相关性血流感染、急性生理学与慢性健康状况评分系统Ⅱ(Acute Physiology and Chronic Health Evalution Scoring System,APACHEⅡ)和血白蛋白浓度情况比较,差异有统计学意义(P均<0.05)。多因素二元Logistic回归分析结果显示,存在糖尿病(OR=2.045,95%CI:1.067~4.226)、存在COPD(OR=1.034,95%CI:1.005~1.132)、有侵入性操作(OR=3.657,95%CI:2.344~6.827)、有预防性应用抗生素(OR=4.882,95%CI:3.274~7.954)、存在意识障碍(OR=2.167,95%CI:1.602~3.167)、存在中心静脉导管相关性血流感染(OR=1.065,95%CI:1.003~2.147)、APACHEⅡ评分(OR=3.471,95%CI:2.141~7.443)和血白蛋白浓度(OR=1.473,95%CI:1.117~1.826)是ICU患者发生败血症的独立危险因素(P均<0.05)。结论影响ICU患者发生败血症的主要因素有存在糖尿病、存在COPD、有侵入性操作、有预防性应用抗生素、存在意识障碍、中心静脉导管相关性血流感染、高APACHEⅡ评分和低血白蛋白浓度,针对以上因素给予患者的针对性预防,可降低败血症的发生率。
