Science.gov

Sample records for preoperational alara review

  1. ALARA Review for the 221-U Characterization

    SciTech Connect

    T. A. Edwards

    1998-11-10

    The following ALARA review provides a description of the engineeringand administrative controls used to manage personnel exposure; controlcontamination levels, and control airborne radioactivity concentrationswhile conducting surveillance and maintenance and Canyon DispositionInitiative effort activities at the U Plant 221-U Building locatedin the 200 West Area of the Hanford Site.

  2. Five-year ALARA review of dosimetry results :

    SciTech Connect

    Paulus, Luke R.

    2013-08-01

    A review of personnel dosimetry (external and internal) and environmental monitoring results from 1 January 2008 through 31 December 2012 performed at Sandia National Laboratories, New Mexico was conducted to demonstrate that radiation protection methods used are compliant with regulatory limits and conform with the ALARA philosophy. ALARA is the philosophical approach to radiation protection by managing and controlling radiation exposures (individual and collective) to the work force and to the general public to levels that are As Low As is Reasonably Achievable taking social, technical, economic, practical, and public policy considerations into account. ALARA is not a dose limit but a process which has the objective of attaining doses as far below applicable dose limits As Low As is Reasonably Achievable.

  3. ALARA Review of 233-S Process Hood D D and Related Activities

    SciTech Connect

    S. D. Landsman.

    1999-03-18

    This document is an as low as reasonably achievable (ALARA) review of design packages for planned work at the 233-S Facility. The ALARA review was initiated in accordance with the Bechtel Hanford, Inc. (BHI) Integrated Environmental, Safety, and Health Management System (ISMS) workflow process.

  4. ALARA Review for the Sediment Relocation and Removal from the 105-N Fuel Storage Basin

    SciTech Connect

    Demers, J.W.

    1998-03-01

    This as low as reasonable achievable (ALARA) review revision provides a description of the engineering and administrative controls used to manage personnel exposure, control contamination levels, and airborne radioactivity concentrations during sediment relocation and removal in the 105-N Fuel Storage Basin. This document updates and supercedes the ALARA review of the sediment-related activities contained in 100-N Basin Stabilization Project As Low As Reasonably Achievable Plan (BHI 1995).

  5. Fuel transfer system ALARA design review - Project A.15

    SciTech Connect

    KUEBERTH, L.R.

    2001-11-12

    One mission of the Spent Nuclear Fuel (SNF) Project is to move the SNF from the K Basins in the Hanford 100K Area to an interim dry storage at the Canister Storage Building (CSB) in the Hanford 200 East Area. The Fuel Transfer System (FTS) is a subproject that will move the SNF from the 105K East (KE) Facility to the 105K West (KW) Facility. The SNF will be treated for shipment to the Cold Vacuum Drying (CVD) facility at the KW Basin. The SNF canisters will be loaded underwater into a Shielded Transfer Cask (STC) in the KE Basin. The fully loaded STC will be brought out of the water and placed into a Cask Transfer Overpack (CTO) by the STC Straddle Carrier. As the STC is removed from the water, it will be washed down with demineralized water by an manual rinse system. The CTO with the STC inside will be placed on a transport trailer and transferred to the KW Basin as an intra-facility transfer. The CTO will be unloaded from the shipping trailer at the KW Basin and the STC will be removed from the CTO. The STC will then be lowered into the KW Basin water and the fuel will be removed. The SNF will then be processed for shipment to the CVD. As soon as all of the fuel has been removed from the STC, the cask will be removed from the KW Basin water and placed into the CTO. The CTO will again be placed on the trailer for transport back to the KE Basin where the entire cycle will be repeated approximately 400 times. This document records the As Low As Reasonably Achievable (ALARA) findings and design recommendations/requirements by the SNF Project noted during the Final Design Review of the STC, CTO, STC Transfer System, Annexes and Roadways for support of FTS. This document is structured so that all statements that include the word ''shall'' represent design features that have been or will be implemented within the project scope. Statements that include the words ''should'' or ''recommend'' represent ALARA design features to be evaluated for future implementation.

  6. ALARA Review for Concrete Sampling and Robot Deployment at221-U

    SciTech Connect

    T. A. Edwards.

    1999-05-28

    This document is an as low as reasonably achievable (ALARA) review for performing characterization activities at 221-U Plant (U-Plant) in support of the Canyon Disposition Initiative. The scope of work includes sampling concrete and deployment of the robot into the ventilation tunnel to support characterization activities. While performing a radiological review of the work scope, it was determined that contamination levels in the work area may exceed the Level 2 ALARA review trigger levels specified in BHI-SH-02, Volume 1, Safety and Health Procedures, Procedure 1.22, Planning Radiological Work. This ALARA review provides a description of the engineering and administrative controls used to manage personnel exposure, control contamination levels, and control airborne radioactivity concentrations while conducting characterization and sampling activities at the 221-U Plant (U-Plant).

  7. ALARA development in Mexico

    SciTech Connect

    Lopez, M.A.M.

    1995-03-01

    Even though the ALARA philosophy was formally implemented in the early 1980`s, to some extent, ALARA considerations already had been incorporated into the design of most commercial equipment and facilities based on experience and engineering development. In Mexico, the design of medical and industrial facilities were based on international recommendations containing those considerations. With the construction of Laguna Verde Nuclear Power Station, formal ALARA groups were created to review some parts of its design, and to prepare the ALARA Program and related procedures necessary for its commercial operation. This paper begins with a brief historical description of ALARA development in Mexico, and then goes on to discuss our regulatory frame in Radiation Protection, some aspects of the ALARA Program, efforts in controlling and reducing of sources of radiation, and finally, future perspectives in the ALARA field.

  8. Five-Year ALARA Review of Dosimetry Results 1 January 2009 through 31 December 2013.

    SciTech Connect

    Paulus, Luke R

    2014-08-01

    A review of dosimetry results from 1 January 2009 through 31 December 2013 was conducted to demonstrate that radiation protection methods used are compliant with regulatory limits and conform to the ALARA philosophy. This included a review and evaluation of personnel dosimetry (external and internal) results at Sandia National Laboratories, New Mexico as well as at Sandia National Laboratories, California. Additionally, results of environmental monitoring efforts at Sandia National Laboratories, New Mexico were reviewed. ALARA is a philosophical approach to radiation protection by managing and controlling radiation exposures (individual and collective) to the work force and to the general public to levels that are As Low As is Reasonably Achievable taking social, technical, economic, practical, and public policy considerations into account. ALARA is not a dose limit but a process which has the objective of attaining doses as far below applicable dose limits As Low As is Reasonably Achievable.

  9. Five-Year ALARA Review of Dosimetry Results 1 January 2010 through 31 December 2014.

    SciTech Connect

    Paulus, Luke R.

    2015-06-01

    A review of dosimetry results from 1 January 2010 through 31 December 2014 was conducted to demonstrate that radiation protection methods used are compliant with regulatory limits and conform to the philosophy to keep exposures to radiation As Low As is Reasonably Achievable (ALARA). This included a review and evaluation of personnel dosimetry (external and internal) results at Sandia National Laboratories, New Mexico as well as at Sandia National Laboratories, California. Additionally, results of environmental monitoring efforts at Sandia National Laboratories, New Mexico were reviewed. ALARA is a philosophical approach to radiation protection by managing and controlling radiation exposures (individual and collective) to the work force and to the general public to levels that are As Low As is Reasonably Achievable taking social, technical, economic, practical, and public policy considerations into account. ALARA is not a dose limit but a process which has the objective of attaining doses as far below applicable dose limits As Low As is Reasonably Achievable.

  10. ALARA Design Review for the Resumption of the Plutonium Finishing Plant (PFP) Cementation Process Project Activities

    SciTech Connect

    DAYLEY, L.

    2000-06-14

    The requirements for the performance of radiological design reviews are codified in 10CFR835, Occupational Radiation Protection. The basic requirements for the performance of ALARA design reviews are presented in the Hanford Site Radiological Control Manual (HSRCM). The HSRCM has established trigger levels requiring radiological reviews of non-routine or complex work activities. These requirements are implemented in site procedures HNF-PRO-1622 and 1623. HNF-PRO-1622 Radiological Design Review Process requires that ''radiological design reviews [be performed] of new facilities and equipment and modifications of existing facilities and equipment''. In addition, HNF-PRO-1623 Radiological Work Planning Process requires a formal ALARA Review for planned activities that are estimated to exceed 1 person-rem total Dose Equivalent (DE). The purpose of this review is to validate that the original design for the PFP Cementation Process ensures that the principles of ALARA (As Low As Reasonably Achievable) were included in the original project design. That is, that the design and operation of existing Cementation Process equipment and processes allows for the minimization of personnel exposure in its operation, maintenance and decommissioning and that the generation of radioactive waste is kept to a minimum.

  11. ALARA Review of the Spallation Neutron Source Accumulator Ring and Transfer Lines

    SciTech Connect

    Haire, M.J.

    2003-06-30

    The Spallation Neutron Source (SNS) is designed to meet the growing need for new tools that will deepen our understanding in materials science, life science, chemistry, fundamental and nuclear physics, earth and environmental sciences, and engineering sciences. The SNS is an accelerator-based neutron-scattering facility that when operational will produce an average beam power of 2 MW at a repetition rate of 60 Hz. The accelerator complex consists of the front-end systems, which will include an ion source; a 1-GeV full-energy linear accelerator; a single accumulator ring and its transfer lines; and a liquid mercury target. This report documents an as-low-as-reasonably-achievable (ALARA) review of the accumulator ring and transfer lines at their early design stage. An ALARA working group was formed and conducted a review of the SNS ring and transfer lines at the {approx}25% complete design stage to help ensure that ALARA principles are being incorporated into the design. The radiological aspects of the SNS design criteria were reviewed against regulatory requirements and ALARA principles. Proposed features and measures were then reviewed against the SNS design criteria. As part of the overall review, the working group reviewed the design manual; design drawings and process and instrumentation diagrams; the environment, safety, and health manual; and other related reports and literature. The group also talked with SNS design engineers to obtain explanations of pertinent subject matter. The ALARA group found that ALARA principles are indeed being incorporated into the early design stage. Radiation fields have been characterized, and shielding calculations have been performed. Radiological issues are being adequately addressed with regard to equipment selection, access control, confinement structure and ventilation, and contamination control. Radiation monitoring instrumentation for worker and environment protection are also being considered--a good practice at this

  12. What is ALARA

    SciTech Connect

    Auxier, J.A.; Dickson, H.W.

    1981-01-01

    The as-low-as-reasonably-achievable (ALARA) philosophy as it applies to personnel radiation exposure has been with us for a long time. The essential tenets of this philosophy surfaced quite early in the history of the Manhattan Project. Although the terminology has suffered through various translations and the application has seen many organizations and agencies come and go, the principles remain as valid today as ever. It is regretable that some regulatory agencies claim ALARA as their newfound miracle drug and that application according to their prescriptions will result in endless rounds of cyclical improvement in radiation protection practices. Others have taken advantage of the popularity of ALARA and have bastardized the philosophy to mean whatever is expedient for their purposes. In this paper, we review briefly the history of ALARA and what it seemingly means to different interest groups and offer a balanced viewpoint that health physicists should adopt.

  13. Review of ALARA plan for activities at the 105 K-East fuel storage basin

    SciTech Connect

    Vargo, G.J.; Durham, J.S.; Hickey, E.E.; Stansbury, P.S.; Cicotte, G.R.

    1994-09-01

    As part of its ongoing efforts to reduce doses to workers to levels as low as reasonably achievable (ALARA), Westinghouse Hanford Company (WHC) tasked the Health Protection Department of the Pacific Northwest Laboratory (PNL) to review operations at the 105 K-East Fuel Storage Basin (105 K-East). This review included both routine operations and a proposed campaign to encapsulate N-Reactor fuel stored there. This report summarizes the results of PNL`s reviews of policy, procedures, and practices for operations at 105 K-East as well as an evaluation of the major sources of occupational radiation exposures. Where possible, data previously collected by WHC and its predecessors were used. In addition, PNL staff developed a three-dimensional model of the radiological environment within 105 K-East to assess the relative contributions of different radiation sources to worker dose and to provide a decision tool for use in evaluating alternative methods of dose rate reduction. The model developed by PNL indicates that for most areas in the basin the primary source of occupational radiation exposure is the contaminated concrete surfaces of the basin near the waterline. Basin cooling water piping represents a significant source in a number of areas, particularly the Technical Viewing Pit. This report contains specific recommendations to reduce the impact of these sources of occupational radiation exposure in 105 K-East. Other recommendations to reduce doses to workers during activities such as filter changes and filter sampling are also included.

  14. ALARA in European nuclear installations

    SciTech Connect

    Lefaure, C.; Croft, J.; Pfeffer, W.; Zeevaert, T.

    1995-03-01

    For over a decade the Commission of the European Community has sponsored research projects on the development and practical implementation of the Optimization principle, or as it is often referred to, ALARA. These projects have given rise to a series of successful international Optimization training courses and have provided a significant input to the periodic European Seminars on Optimization, the last one of which took place in April 1993. This paper reviews the approaches to Optimization that have development within Europe and describes the areas of work in the current project. The on-going CEC research project addresses the problem of ALARA and internal exposures, and tries to define procedures for ALARA implementation, taking account of the perception of the hazard as well as the levels of probability of exposure. The relationships between ALARA and work management, and ALARA and decommissioning of installations appear to be other fruitful research areas. Finally, this paper introduces some software for using ALARA decision aiding techniques and databases containing feed back experience developed in Europe.

  15. Savannah River Site ALARA Program appraisals

    SciTech Connect

    Johnson, J.R.

    1992-06-01

    ALARA Program audits are recommended in PNL-6566, ``Health Physics Manual of Good Practices for Reducing Radiation Exposure to Levels that are As Low As Reasonably Achievable (ALARA).`` The Department of Energy (DOE) Order 5480.11, ``Radiation Protection For Occupational Workers,`` requires contractors to conduct internal audits of all functional elements of the radiological protection program, which includes the ALARA program, as often as necessary, but at a minimum every three years. At the Savannah River Site (SRS), these required audits are performed as part of the Health Protection Internal Appraisal Program. This program was established to review the Site radiological protection program, which includes the ALARA program, on an ongoing basis and to provide recommendations for improvement directly to senior Health Protection management. This paper provides an overview of the SRS Health Protection Internal Appraisal program. In addition, examples of specific performance criteria and detailed appraisal guidelines used ALARA appraisals are provided.

  16. Savannah River Site ALARA Program appraisals

    SciTech Connect

    Johnson, J.R.

    1992-01-01

    ALARA Program audits are recommended in PNL-6566, Health Physics Manual of Good Practices for Reducing Radiation Exposure to Levels that are As Low As Reasonably Achievable (ALARA).'' The Department of Energy (DOE) Order 5480.11, Radiation Protection For Occupational Workers,'' requires contractors to conduct internal audits of all functional elements of the radiological protection program, which includes the ALARA program, as often as necessary, but at a minimum every three years. At the Savannah River Site (SRS), these required audits are performed as part of the Health Protection Internal Appraisal Program. This program was established to review the Site radiological protection program, which includes the ALARA program, on an ongoing basis and to provide recommendations for improvement directly to senior Health Protection management. This paper provides an overview of the SRS Health Protection Internal Appraisal program. In addition, examples of specific performance criteria and detailed appraisal guidelines used ALARA appraisals are provided.

  17. Practical and effective ALARA.

    PubMed

    Bevelacqua, Joseph John

    2010-05-01

    The ALARA Principle ensures that the total effective dose equivalent is minimized subject to economic and social factors. Effective ALARA programs must include the participation of all facility workgroups, management support, teamwork, and strong leadership. The development and sustainability of effective ALARA programs require the establishment and monitoring of goals, rewarding the successful achievement of those goals, and incorporating lessons learned from tasks that fail to meet their goals.

  18. Proceedings of the Department of Energy ALARA Workshop

    SciTech Connect

    Dionne, B.J.; Baum, J.W.

    1992-12-31

    The report contains summaries of papers, discussions, and operational exercises presented at the first Department of Energy ALARA Workshop held at Brookhaven National Laboratory, Upton, New York on April 21--22, 1992. The purpose of this workshop was to provide a forum for, and enhance communication among, ALARA personnel, as well as to inform DOE`s field office and contractor personnel about the Office of Health`s programs and expectations from the entire DOE complex efforts in the ALARA area.The two-day workshop consisted of one day dedicated to presentations on implementing various elements of a formal ALARA program at the DOE contractors` facilities, regulatory aspects of ALARA programs, and DOE Headquarters` ALARA expectations/initiatives. The second day was devoted to detailed discussions on ALARA improvements and problems, and operational exercises on cost-benefit analyses and on ALARA job/experiment reviews. At this workshop, 70 health physicists and radiation safety engineers from 5 DOE Headquarter Offices, 7 DOE operations/area offices, and 27 contractor facilities exchanged information, which is expected to stimulate further improvement in the DOE contractors` ALARA programs. Individual papers are indexed separately.

  19. Proceedings of the Department of Energy ALARA Workshop

    SciTech Connect

    Dionne, B.J.; Baum, J.W.

    1992-01-01

    The report contains summaries of papers, discussions, and operational exercises presented at the first Department of Energy ALARA Workshop held at Brookhaven National Laboratory, Upton, New York on April 21--22, 1992. The purpose of this workshop was to provide a forum for, and enhance communication among, ALARA personnel, as well as to inform DOE's field office and contractor personnel about the Office of Health's programs and expectations from the entire DOE complex efforts in the ALARA area.The two-day workshop consisted of one day dedicated to presentations on implementing various elements of a formal ALARA program at the DOE contractors' facilities, regulatory aspects of ALARA programs, and DOE Headquarters' ALARA expectations/initiatives. The second day was devoted to detailed discussions on ALARA improvements and problems, and operational exercises on cost-benefit analyses and on ALARA job/experiment reviews. At this workshop, 70 health physicists and radiation safety engineers from 5 DOE Headquarter Offices, 7 DOE operations/area offices, and 27 contractor facilities exchanged information, which is expected to stimulate further improvement in the DOE contractors' ALARA programs. Individual papers are indexed separately.

  20. Intraoperative radiation safety in orthopaedics: a review of the ALARA (As low as reasonably achievable) principle.

    PubMed

    Kaplan, Daniel J; Patel, Jay N; Liporace, Frank A; Yoon, Richard S

    2016-01-01

    The use of fluoroscopy has become commonplace in many orthopaedic surgery procedures. The benefits of fluoroscopy are not without risk of radiation to patient, surgeon, and operating room staff. There is a paucity of knowledge by the average orthopaedic resident in terms proper usage and safety. Personal protective equipment, proper positioning, effective communication with the radiology technician are just of few of the ways outlined in this article to decrease the amount of radiation exposure in the operating room. This knowledge ensures that the amount of radiation exposure is as low as reasonably achievable. Currently, in the United States, guidelines for teaching radiation safety in orthopaedic surgery residency training is non-existent. In Europe, studies have also exhibited a lack of standardized teaching on the basics of radiation safety in the operating room. This review article will outline the basics of fluoroscopy and educate the reader on how to safe fluoroscopic image utilization.

  1. BNL ALARA Center: ALARA Notes, No. 9

    SciTech Connect

    Khan, T.A.; Xie, J.W.; Beckman, M.C.

    1994-02-01

    This issue of the Brookhaven National Laboratory`s Alara Notes includes the agenda for the Third International Workshop on ALARA and specific instructions on the use of the on-line fax-on-demand service provided by BNL. Other topics included in this issue are: (1) A discussion of low-level discharges from Canadian nuclear plants, (2) Safety issues at French nuclear plants, (3) Acoustic emission as a means of leak detection, (4) Replacement of steam generators at Doel-3, Beaznau, and North Anna-1, (5) Remote handling equipment at Bruce, (6) EPRI`s low level waste program, (7) Radiation protection during concrete repairs at Savannah River, (8) Reactor vessel stud removal/repair at Comanche Peak-1, (9) Rework of reactor coolant pump motors, (10) Restoration of service water at North Anna-1 and -2, (11) Steam generator tubing problems at Mihama-1, (12) Full system decontamination at Indian Point-2, (13) Chemical decontamination at Browns Ferry-2, and (14) Inspection methodolody in France and Japan.

  2. Exposure reduction through faster speed film-screen systems and a review of A.L.A.R.A. (as low as reasonably achievable).

    PubMed

    Nickoli, P C

    1993-08-01

    One of the most talked about and recognized practices for dose reduction is the "as low as reasonably achievable" (A.L.A.R.A.) concept initiated by the International Commission on Radiological Protection. Many new technologists, however, are neither familiar with the concept nor recognize how important their part is in its implementation. In addition, some experienced technologists may need to refresh their knowledge of certain practices and how they relate to the A.L.A.R.A. concept. This article reviews the literature and presents new data on exposure technique reduction through film-screen speed combinations. The latest 250- and 600-speed film-screen combinations were obtained from leading manufacturers and tested to determine what new techniques would provide adequate radiographs using lower exposures. Comparisons were made between the 100- and 250-speed systems and the 400- and 600-speed systems. These comparisons were objectively based on aluminum stepwedge exposures measured by densitometry and subjectively based on exposure of 3M phantoms utilizing the newly established techniques with the higher speed film-screen system compared to the original techniques using the lower speed film-screen system. It was found that using a 250-speed system instead of a 100-speed system will reduce exposure dose by 36 to 60 per cent; using a 600-speed system in place of a 400-speed system exposure dose is reduced by 31 to 63 per cent. There is no apparent loss of resolution for either film-screen combination.

  3. Applied ALARA techniques

    SciTech Connect

    Waggoner, L.O.

    1998-02-05

    The presentation focuses on some of the time-proven and new technologies being used to accomplish radiological work. These techniques can be applied at nuclear facilities to reduce radiation doses and protect the environment. The last reactor plants and processing facilities were shutdown and Hanford was given a new mission to put the facilities in a safe condition, decontaminate, and prepare them for decommissioning. The skills that were necessary to operate these facilities were different than the skills needed today to clean up Hanford. Workers were not familiar with many of the tools, equipment, and materials needed to accomplish:the new mission, which includes clean up of contaminated areas in and around all the facilities, recovery of reactor fuel from spent fuel pools, and the removal of millions of gallons of highly radioactive waste from 177 underground tanks. In addition, this work has to be done with a reduced number of workers and a smaller budget. At Hanford, facilities contain a myriad of radioactive isotopes that are 2048 located inside plant systems, underground tanks, and the soil. As cleanup work at Hanford began, it became obvious early that in order to get workers to apply ALARA and use hew tools and equipment to accomplish the radiological work it was necessary to plan the work in advance and get radiological control and/or ALARA committee personnel involved early in the planning process. Emphasis was placed on applying,ALARA techniques to reduce dose, limit contamination spread and minimize the amount of radioactive waste generated. Progress on the cleanup has,b6en steady and Hanford workers have learned to use different types of engineered controls and ALARA techniques to perform radiological work. The purpose of this presentation is to share the lessons learned on how Hanford is accomplishing radiological work.

  4. ALARA: Progress and prospects

    SciTech Connect

    Khan, T.A.; Baum, J.W.

    1988-01-01

    This paper has two main topics. The first part describes the establishment and work of the ALARA Center; the second part presents some results of studies at the Center with international data on doses at PWR plants. This data then is used to reach a preliminary understanding of some of the factors that are causing high doses at PWRs. This approach should help in reducing occupational exposures in a more effective manner.

  5. ALARA training at DOE contractor facilities

    SciTech Connect

    Neeser, J.L.

    1992-05-22

    ALARA training is an important element of a sound ALARA program. ALARA training at a nuclear facility needs to be conducted for all occupational workers, for radiation workers, for radiation protection technicians, and for all other employees who have ALARA responsibilities. Each of these groups needs to receive ALARA training specific to their responsibilities. This report describes how to develop this training. It also outlines what should be included in an acceptable ALARA training program.

  6. Preoperative patient assessment: a review of the literature and recommendations.

    PubMed Central

    Barnard, N. A.; Williams, R. W.; Spencer, E. M.

    1994-01-01

    The aims of preoperative assessment of patients are outlined, and the role of clinical and laboratory testing is defined. Following a review of the literature, guidelines for requesting such investigations are suggested. PMID:7979066

  7. An integrative review of a preoperative nursing care structure.

    PubMed

    Turunen, Elina; Miettinen, Merja; Setälä, Leena; Vehviläinen-Julkunen, Katri

    2017-04-01

    The aims of this integrative literature review are to define the role of a preoperative nurse and to describe the main components and hypothetical outcomes of a preoperative nursing care structure before a surgical patient arrives to an elective procedure. The development of medical care has impacted surgical processes, and patients are now spending less time in hospital settings. Patients often enter the hospital on the day of a procedure and are discharged as soon as it is medically safe, creating challenges for nursing care. Preoperative clinics have been opened, and the importance of preoperative nursing care has been widely understood. Previous literature has provided descriptions about the roles, tasks and outcomes of preoperative nurses; however, the terminology is heterogeneous, and the optimal model remains unknown. A systematic procedure for searching, selecting, and evaluating the literature was followed. The data were collected from PubMed and CINAHL between 1 January 2004 and 20 September 2014. In total, 41 articles were included in the study and were analysed by qualitative inductive content analysis. The data provided seven main tasks of a preoperative nurse, tools to support preoperative nursing and outcomes of structured preoperative nursing care. A preoperative nurse is a specialised coordinator of patient care, and the main purposes of this role are to meet the patient's and the family's needs individually and to prepare them for the scheduled procedure and postoperative recovery. By following the structure of the seven main tasks and using different supportive tools, preoperative nursing can positively impact patient and provider satisfaction, patient safety, quality of care and cost savings. A preoperative nursing care structure should be implemented in clinical practice and then evaluated to measure whether the hypothetical outcomes reported in this literature review can be achieved. © 2016 John Wiley & Sons Ltd.

  8. Chernobyl Deconstruction ALARA Analysis

    SciTech Connect

    Shipler, Dillard B.; Batiy, Valeriy; Povlovsky, Leonid; Schmidt, John P.; Schmieman, Eric A.

    2004-03-24

    The Bechtel/EDF/Battelle Consortium has recently completed the conceptual design for the Chernobyl New Safe Confinement (NSC). Battelle has the scope of work related to environment and safety of the design. As part of the safety analysis, an ALARA analysis was performed for deconstruction of the major, unstable elements of the Shelter Object over the destroyed Unit 4 of the reactor complex. The major elements addressed in the analysis included the current roof sections and the major beams supporting the roof sections. The analysis was based on the existing configuration of the Shelter Object, the developing conceptual design of the NSC arch structure, the developing conceptual design of the facilities within and associated with the NSC (including handling and processing of deconstructed elements, and waste management), and existing Ukranian regulations and working processes and procedures. KSK (a Ukranian Consortium) is a subcontractor to the Bechtel/EDF/Battelle Consortium and performed much of the dose analysis. The analysis concluded that ALARA could be achieved with appropriate implementation of existing Ukrainian regulations and procedures, and developing conceptual design criteria and features.

  9. Project W-320 ALARA Plan

    SciTech Connect

    Harty, W.M.

    1995-06-06

    This supporting document establishes the As Low As Reasonable Achievable (ALARA) Plan to be followed during Sluicing Project W-320 design and construction activities to minimize personnel exposure to radiation and hazardous materials.

  10. Preoperative predictors of weight loss following bariatric surgery: systematic review.

    PubMed

    Livhits, Masha; Mercado, Cheryl; Yermilov, Irina; Parikh, Janak A; Dutson, Erik; Mehran, Amir; Ko, Clifford Y; Gibbons, Melinda Maggard

    2012-01-01

    Obesity affects 32% of adults in the USA. Surgery generates substantial weight loss, but 20-30% fails to achieve successful weight loss. Our objective was to identify preoperative psychosocial factors associated with weight loss following bariatric surgery. We performed a literature search of PubMed® and the Cochrane Database of Reviews of Effectiveness between 1988 and April 2010. Articles were screened for bariatric surgery and weight loss if they included a preoperative predictor of weight loss: body mass index (BMI), preoperative weight loss, eating disorders, or psychiatric disorder/substance abuse. One thousand seven titles were reviewed, 534 articles screened, and 115 included in the review. Factors that may be positively associated with weight loss after surgery include mandatory preoperative weight loss (7 of 14 studies with positive association). Factors that may be negatively associated with weight loss include preoperative BMI (37 out of 62 studies with negative association), super-obesity (24 out of 33 studies), and personality disorders (7 out of 14 studies). Meta-analysis revealed a decrease of 10.1% excess weight loss (EWL) for super-obese patients (95% confidence interval (CI) [3.7-16.5%]), though there was significant heterogeneity in the meta-analysis, and an increase of 5.9% EWL for patients with binge eating at 12 months after surgery (95% CI [1.9-9.8%]). Further studies are necessary to investigate whether preoperative factors can predict a clinically meaningful difference in weight loss after bariatric surgery. The identification of predictive factors may improve patient selection and help develop interventions targeting specific needs of patients.

  11. The effect of preoperative smoking cessation or preoperative pulmonary rehabilitation on outcomes after lung cancer surgery: a systematic review.

    PubMed

    Schmidt-Hansen, Mia; Page, Richard; Hasler, Elise

    2013-03-01

    The preferred treatment for lung cancer is surgery if the disease is considered resectable and the patient is considered surgically fit. Preoperative smoking cessation and/or preoperative pulmonary rehabilitation might improve postoperative outcomes after lung cancer surgery. The objectives of this systematic review were to determine the effectiveness of (1) preoperative smoking cessation and (2) preoperative pulmonary rehabilitation on peri- and postoperative outcomes in patients who undergo resection for lung cancer. We searched MEDLINE, PreMedline, Embase, Cochrane Library, Cinahl, BNI, Psychinfo, Amed, Web of Science (SCI and SSCI), and Biomed Central. Original studies published in English investigating the effect of preoperative smoking cessation or preoperative pulmonary rehabilitation on operative and longer-term outcomes in ≥ 50 patients who received surgery with curative intent for lung cancer were included. Of the 7 included studies that examined the effect of preoperative smoking cessation (n = 6) and preoperative pulmonary rehabilitation (n = 1) on outcomes after lung cancer surgery, none were randomized controlled trials and only 1 was prospective. The studies used different smoking classifications, the baseline characteristics differed between the study groups in some of the studies, and most had small sample sizes. No formal data synthesis was therefore possible. The included studies were marked by methodological limitations. On the basis of the reported bodies of evidence, it is not possible to make any firm conclusions about the effect of preoperative smoking cessation or of preoperative pulmonary rehabilitation on operative outcomes in patients undergoing surgery for lung cancer.

  12. Music intervention and preoperative anxiety: an integrative review.

    PubMed

    Pittman, S; Kridli, S

    2011-06-01

    Hospitalized patients and patients scheduled to undergo surgery or invasive medical procedures experience high levels of anxiety. Recently, music intervention has been evaluated for its anxiolytic effects in preoperative patients. The aim of this integrative review was to illustrate the varying methodological approaches utilized to assess the efficacy of a music intervention in reducing preoperative anxiety in adults. A total of 11 articles, meeting the inclusion criteria, were evaluated and included. Three of the eight (38%) studies, investigating the effect of listening to music on blood pressure, concluded that listening to music lowered blood pressure. Three of seven (43%) studies, investigating the relationship between listening to music and heart rate, illustrated patterns of decreased heart rates. Finally, two of four (50%) studies, investigating relaxing effects of listening to music on breathing, provided evidence of a decreased respiratory rate. There was inconsistent evidence regarding music's effectiveness in lowering blood pressure, heart rate and respirations in anxious patients. However, music intervention can still be used by nurses to create a calm, relaxing atmosphere geared towards reducing anxiety in preoperative patients. © 2011 The Authors. International Nursing Review © 2011 International Council of Nurses.

  13. ALARA and planning of interventions

    SciTech Connect

    Rocaboy, A.

    1995-03-01

    The implementation of ALARA programs implies integration of radiation protection criterion at all stages of outage management. Within the framework of its ALARA policy, Electricide de France (EDF) has given an incentive to all of its nuclear power plants to develop {open_quotes}good practices{close_quotes} in this domain, and to exchange their experience by the way of a national feed back file. Among the developments in the field of outage organization, some plants have focused on the planning stage of activities because of its influence on the radiological conditions of interventions and on the good succession of tasks within the radiological controlled areas. This paper presents the experience of Chinon nuclear power plant. At Chinon, we are pursuing this goal through careful outage planning. We want the ALARA program during outages to be part of the overall maintenance task planning. This planning includes the provision of the availability of every safety-related component, and of the variations of water levels in hthereactor and steam generators to take advantage of the shield created by the water. We have developed a computerized data base with the exact position of all the components in the reactor building in order to avoid unnecessary interactions between different tasks performed in the same room. A common language between Operation and Maintenance had been established over the past years, using {open_quotes}Milestones and Corridors{close_quotes}. A real time dose rate counting system enables the Radiation Protection (RP) Department to do an accurate and efficient follow up during the outage for all the {open_quotes}ALARA{close_quotes} maintenance tasks.

  14. ALARA Center of Technology -- resource guide

    SciTech Connect

    Waggoner, L.O.

    1998-02-05

    The purpose is to provide a source of information that can be used to assist personnel in the planning, training, and execution of radiological work using the principles of ALARA. This document is not intended to replace HNF or WHC Control Manual requirements. The ALARA Tools-List provides detailed information on the use and procurement of engineered controls, mockup training guidelines, and good radiological work practices that have been proven to be ALARA.

  15. Pheochromocytoma: a review on preoperative treatment with phenoxybenzamine or doxazosin.

    PubMed

    van der Zee, P A; de Boer, A

    2014-05-01

    During surgical treatment of pheochromocytoma,`haemodynamic instability may occur. To prevent this, patients receive preoperative treatment with an alpha-blocker. Nowadays, some centres use phenoxybenzamine, while others use doxazosin. The purpose of this review is to analyse the current evidence of the benefits and risks of phenoxybenzamine and doxazosin in the preoperative treatment of pheochromocytoma. The literature was reviewed by searching PubMed using the following search terms: pheochromocytoma, phenoxybenzamine, doxazosin and alpha-blockade. The filter was set on English language. No randomised controlled trials were found. Five follow-up studies comparing phenoxybenzamine and doxazosin in the treatment of pheochromocytoma were retrieved and analysed. There was a trend that systolic arterial pressure is slightly better controlled by phenoxybenzamine. However, this resulted in more pronounced postoperative hypotension as well. The use of an alpha-blocker was often accompanied by other vasoactive agents. phenoxybenzamine was often accompanied by a beta-blocker to control reflex tachycardia, while patients on doxazosin received significantly more additional antihypertensive medicines. Most of the studies showed that the use of vasoactive drugs and fluid infusion does not differ significantly between the two drugs. Phenoxybenzamine caused significantly more orthostatic hypotension, oedema and complaints of a stuffy nose. On the basis of the current evidence, there is no evidently superior alpha-blocker for the pretreatment of patients with pheochromocytoma. Perioperative haemodynamics seem to be slightly better controlled with phenoxybenzamine, at the cost of more pronounced postoperative hypotension. Side effects occurred less often in the doxazosin group.

  16. ALARA input into the design of modifications at Philadelphia Electric Company

    SciTech Connect

    Robb, J.T.; Mallon, J.

    1988-01-01

    The engineering and research department of Philadelphia Electric Company (PECo) has recently instituted changes in the design process for major plant modifications at the company's nuclear units. These changes support the design engineer and allow for greater input of as-low-as-reasonably-achievable (ALARA) considerations in the design of modifications. At PECo the input of ALARA considerations in the design of modifications has always been a part of design practices as provided in engineering procedures. The need to establish a more formal framework for the input of ALARA criteria into the design of modifications was identified by the Institute of Nuclear Power Operations (INPO). In order to address the INPO concerns and in keeping with PECo's strong commitment to maintaining ALARA plant personnel radiation exposures, the engineering and research department has formalized a procedure to allow for an ALARA review of major plant modifications. A formal framework for the input of ALARA criteria aids the design engineer by clearly identifying systems or areas that generally represent the greatest ALARA concern.

  17. Pancreatic cystic neoplasms: a review of preoperative diagnosis and management*

    PubMed Central

    Bai, Xue-li; Zhang, Qi; Masood, Noman; Masood, Waqas; Zhang, Yun; Liang, Ting-bo

    2013-01-01

    Pancreatic cystic neoplasms (PCNs) are a diverse group of neoplasms in the pancreas, and are more increasingly encountered with widespread abdominal screening and improved imaging techniques. The most common types of PCNs are serous cystic neoplasms (SCNs), mucinous cystic neoplasms (MCNs), and intraductal papillary mucinous neoplasms (IPMNs). Clinicians frequently feel bewildered in the differential diagnosis and subsequent management among the various types of lesions in the pancreas, which may lead to overtreatment or delayed treatment. The current review provides recent developments in the understanding of the three most common types of PCNs, the latest modalities used in preoperative diagnosis and differential diagnosis, as well as the most up to date management. Suggestions for diagnosis and differential diagnosis of SCNs, MCNs, and IPMNs are also provided for young surgeons. Better understanding of these neoplasms is essential for clinicians to make accurate diagnosis and to provide the best management for patients. PMID:23463761

  18. ALARA at nuclear power plants

    SciTech Connect

    Baum, J.W.

    1990-01-01

    Implementation of the As Low As Reasonably Achievable (ALARA) principle at nuclear power plants presents a continuing challenge for health physicists at utility corporate and plant levels, for plant designers, and for regulatory agencies. The relatively large collective doses at some plants are being addressed though a variety of dose reduction techniques. It is planned that this report will include material on historical aspects, management, valuation of dose reduction, quantitative and qualitative aspects of optimization, design, operational considerations, and training. The status of this work is summarized in this report. 30 refs., 1 fig., 6 tabs.

  19. ALARA and work management

    SciTech Connect

    Schieber, C.; Perin, M.; Saumon, P.

    1995-03-01

    At the request of Electricite de France (EDF) and Framatome, the Nuclear Protection Evaluation Centre (CEPN) developed a three-year research project, between 1991 and 1993, to evaluate the impact of various work management factors that can influence occupational exposures in nuclear power plants (NPPs) and to assess the effectiveness of protective actions implemented to reduce them. Three different categories of factors have been delineated: those linked to working conditions (such as ergonomic of work areas and protective suits), those characterizing the operators (qualification, experience level, motivation, etc.). In order to quantify the impact of these factors, a detailed survey was carried out in five French NPPs, focusing on three types of operations: primary valves maintenance, decontamination of reactor cavity, and specialized maintenance operations on the steam generator. This survey was augmented by a literature review on the influence of {open_quotes}hostile{close_quotes} environment on working conditions. Finally, a specific study was performed in order to quantify the impact of various types of protective suits used in French nuclear installations according to the type of work to be done. All of these factors have been included in a model aiming at quantifying the effectiveness of protection actions, both from dosimetric and economic point of views.

  20. Practice of ALARA in the pediatric interventional suite.

    PubMed

    Connolly, Bairbre; Racadio, John; Towbin, Richard

    2006-09-01

    As interventional procedures have become progressively more sophisticated and lengthy, the potential for high patient radiation dose has increased. Staff exposure arises from patient scatter, so steps to minimize patient dose will in turn reduce operator and staff dose. The practice of ALARA in an interventional radiology (IR) suite, therefore, requires careful attention to technical detail in order to reduce patient dose. The choice of imaging modality should minimize radiation when and where possible. In this paper practical steps are outlined to reduce patient dose. Further details are included that specifically reduce operator exposure. Challenges unique to pediatric intervention are reviewed. Reference is made to experience from modern pediatric interventional suites. Given the potential for high exposures, the practice of ALARA is a team responsibility. Various measures are outlined for consideration when implementing a quality assurance (QA) program for an IR service.

  1. Innovative ALARA Techniques Used at Hanford

    SciTech Connect

    WAGGONER, L.O.

    2002-02-08

    An ALARA Center of Technology was established at Hanford to show workers the latest tools, equipment, and work practices used in the industry in an effort to improve how radiological work gets accomplished using better engineered controls.

  2. Effective use of metrics in an ALARA program

    SciTech Connect

    Bates, B.B. Jr.

    1996-07-01

    ALARA radiological protection programs require metrics to meet their objectives. Sources of metrics include; external dosimetry; internal dosimetry; radiological occurrences from the occurrence reporting and processing system (ORPS); and radiological incident reports (RIR). The sources themselves contain an abundance of specific ``indicators``. To choose the site-specific indicators that will be tracked and trended requires careful review. This required the end users to expend valuable time and effort to locate the data they needed. To address this problem, a central metrics database has been developed so that customers can have all their questions addressed quickly and correctly. The database was developed in the beginning to answer some of the customer`s most frequently asked questions. It is now also a tool to communicate the status of the radiation protection program to facility managers. Finally it also addresses requirements contained in the Rad Con manual and the 10CFR835 implementation guides. The database uses currently available, ``user friendly``, software and contains information from RIR`s, ORPS, and external dosimetry records specific to ALARA performance indicators. The database is expandable to allow new metrics input. Specific reports have been developed to assist customers in their tracking and trending of ALARA metrics.

  3. ALARA: Analytic and Laplacian adaptive radioactivity analysis

    NASA Astrophysics Data System (ADS)

    Wilson, Paul Philip Hood

    While many codes have been written to compute the induced activation and changes in composition caused by neutron irradiation, most of those which are still being updated are only slowly adding functionality and not improving the accuracy, speed and usability of their existing methods. ALARA moves forward in all four of these areas, with primary importance being placed on the accuracy and speed of solution. By carefully analyzing the various ways to model the physical system, the methods to solve the mathematical problem and the interaction between these two issues, ALARA chooses an optimum combination to achieve high accuracy, fast computation, and enhanced versatility and ease of use. In addition to a set of base features, standard to any activation code, ALARA offers a number of extensions, including arbitrary hierarchical irradiation schedules and a form of reverse problem for calculating the detailed activation of specific isotopes. The physical system is modeled using advanced linear chains, which include the contributions from straightened loops in the reaction scheme, while the truncation philosophy minimizes the discrepancies between the model and the real problem. The mathematical method is then adaptively chosen based on the characteristics of each linear chain to use analytically exact methods when possible and an accurate expansion technique otherwise. ALARA has been successfully validated against established fusion activation codes using a standard activation benchmark problem. In addition to demonstrating ALARA 's accuracy, this validation excerise has demonstrated its speed. Furthermore, by extending the benchmark problem to validate its advanced features, ALARA 's flexibility has been proven. With its modern computational techniques and continuing development, it is hoped that ALARA will become a widely used code for the activation analysis of nuclear systems.

  4. Pacific Northwest Laboratory ALARA report for CY 1990

    SciTech Connect

    Ceffalo, G.M.; Oxley, C.L.; Wright, P.A.

    1992-05-01

    This report provides summary results of the CY 1990 ALARA Program at the Pacific Northwest Laboratory. Information has been included regarding whole-body exposures to radiation, skin contaminations, and the nonradiological ALARA program.

  5. The organization of ALARA program at a DOE facility

    SciTech Connect

    Setaro, J.A.

    1992-01-01

    The organization of an ALARA Program at a DOE Facility (Oak Ridge National Laboratory), it's relationship with laboratory management, facility operators, and the radiation protection program is described. The use of chartered ALARA committees at two distinct levels is discussed.

  6. ALARA implementation throughout project life cycle

    SciTech Connect

    Haynes, M.J.

    1995-03-01

    A strength of radiation protection programs generally has been endorsement and application of the ALARA principle. In Ontario Hydro, which currently operates 20 commercial size nuclear units, great strides have been made in the last three decades in reducing occupational radiation exposure per unit of electricity generated. This paper will discuss specific applications of elements of the overall ALARA program which have most contributed to dose reduction as the nuclear program has expanded. This includes such things as management commitment, ALARA application in the design phase and major rehabilitation work, the benefits of the self protection concept, a specific example of elimination (or reduction) of the source term and the importance of dose targets. Finally, it is concluded that the major opportunities for further improvements may lie in the area of information management.

  7. ALARA efforts in nordic BWRs

    SciTech Connect

    Ingemansson, T.; Lundgren, K.; Elkert, J.

    1995-03-01

    Some ALARA-related ABB Atom projects are currently under investigation. One of the projects has been ordered by the Swedish Radiation Protection Institute, and two others by the Nordic BWR utilities. The ultimate objective of the projects is to identify and develop methods to significantly decrease the future exposure levels in the Nordic BWRS. As 85% to 90% of the gamma radiation field in the Nordic BWRs originates from Co-60, the only way to significantly decrease the radiation doses is to effect Co and Co-60. The strategy to do this is to map the Co sources and estimate the source strength of Co from these sources, and to study the possibility to affect the release of Co-60 from the core surfaces and the uptake on system surfaces. Preliminary results indicate that corrosion/erosion of a relatively small number of Stellite-coated valves and/or dust from grinding of Stellite valves may significantly contribute to the Co input to the reactors. This can be seen from a high measured Co/Ni ratio in the feedwater and in the reactor water. If stainless steel is the only source of Co, the Co/Ni ratio would be less than 0.02 as the Co content in the steel is less than 0.2%. The Co/Ni ratio in the reactor water, however, is higher than 0.1, indicating that the major fraction of the Co originates from Stellite-coated valves. There are also other possible explanations for an increase of the radiation fields. The Co-60 inventory on the core surfaces increases approximately as the square of the burn-up level. If the burn-up is increased from 35 to 5 MWd/kgU, the Co-60 inventory on the core surfaces will be doubled. Also the effect on the behavior of Co-60 of different water chemistry and materials conditions is being investigated. Examples of areas studied are Fe and Zn injection, pH-control, and different forms of surface pre-treatments.

  8. ALARA radiation considerations for the AP600 reactor

    SciTech Connect

    Lau, F.L.

    1995-03-01

    The radiation design of the AP600 reactor plant is based on an average annual occupational radiation exposure (ORE) of 100 man-rem. As a design goal we have established a lower value of 70 man-rem per year. And, with our current design process, we expect to achieve annual exposures which are well below this goal. To accomplish our goal we have established a process that provides criteria, guidelines and customer involvement to achieve the desired result. The criteria and guidelines provide the shield designer, as well as the systems and plant layout designers with information that will lead to an integrated plant design that minimizes personnel exposure and yet is not burdened with complicated shielding or unnecessary component access limitations. Customer involvement is provided in the form of utility input, design reviews and information exchange. Cooperative programs with utilities in the development of specific systems or processes also provides for an ALARA design. The results are features which include ALARA radiation considerations as an integral part of the plant design and a lower plant ORE. It is anticipated that a further reduction in plant personnel exposures will result through good radiological practices by the plant operators. The information in place to support and direct the plant designers includes the Utility Requirements Document (URD), Federal Regulations, ALARA guidelines, radiation design information and radiation and shielding design criteria. This information, along with the utility input, design reviews and information feedback, will contribute to the reduction of plant radiation exposure levels such that they will be less than the stated goals.

  9. Shippingport station decommissioning project ALARA Program

    SciTech Connect

    Crimi, F.P.

    1995-03-01

    Properly planned and implemented ALARA programs help to maintain nuclear worker radiation exposures {open_quotes}As Low As Reasonably Achievable.{close_quotes}. This paper describes the ALARA program developed and implemented for the decontamination and decommissioning (D&D) of the Shippingport Atomic Power Station. The elements required for a successful ALARA program are discussed along with examples of good ALARA practices. The Shippingport Atomic Power Station (SAPS) was the first commercial nuclear power plant to be built in the United States. It was located 35 miles northwest of Pittsburgh, PA on the south bank of the Ohio river. The reactor plant achieved initial criticality in December 1959. During its 25-year life, it produced 7.5 billion kilowatts of electricity. The SAPS was shut down in October 1982 and was the first large-scale U.S. nuclear power plant to be totally decommissioned and the site released for unrestricted use. The Decommission Project was estimated to take 1,007 man-rem of radiation exposure and $.98.3 million to complete. Physical decommissioning commenced in September 1985 and was completed in September 1989. The actual man-rem of exposure was 155. The project was completed 6 months ahead of schedule at a cost of $91.3 million.

  10. Prevention and intervention strategies to alleviate preoperative anxiety in children: a critical review.

    PubMed

    Wright, Kristi D; Stewart, Sherry H; Finley, G Allen; Buffett-Jerrott, Susan E

    2007-01-01

    Preoperative anxiety (anxiety regarding impending surgical experience) in children is a common phenomenon that has been associated with a number of negative behaviors during the surgery experience (e.g., agitation, crying, spontaneous urination, and the need for physical restraint during anesthetic induction). Preoperative anxiety has also been associated with the display of a number of maladaptive behaviors postsurgery, including postoperative pain, sleeping disturbances, parent-child conflict, and separation anxiety. For these reasons, researchers have sought out interventions to treat or prevent childhood preoperative anxiety and possibly decrease the development of negative behaviors postsurgery. Such interventions include sedative premedication, parental presence during anesthetic induction, behavioral preparation programs, music therapy, and acupuncture. The present article reviews the existing research on the various modes of intervention for preoperative anxiety in children. Clinical implications and future directions are discussed.

  11. Effectiveness of non-cardiac preoperative testing in non-cardiac elective surgery: a systematic review.

    PubMed

    Johansson, T; Fritsch, G; Flamm, M; Hansbauer, B; Bachofner, N; Mann, E; Bock, M; Sönnichsen, A C

    2013-06-01

    Elective surgery is usually preceded by preoperative diagnostics to minimize risk. The results are assumed to elicit preventive measures or even cancellation of surgery. Moreover, physicians perform preoperative tests as a baseline to detect subsequent changes. This systematic review aims to explore whether preoperative testing leads to changes in management or reduces perioperative mortality or morbidity in unselected patients undergoing elective, non-cardiac surgery. We systematically searched all relevant databases from January 2001 to February 2011 for studies investigating the relationship between preoperative diagnostics and perioperative outcome. Our methodology was based on the manual of the Ludwig Boltzmann Institute for Health Technology Assessment, the Scottish Intercollegiate Guidelines Network (SIGN) handbook, and the PRISMA statement for reporting systematic reviews. One hundred and one of the 25 281 publications retrieved met our inclusion criteria. Three test grid studies used a randomized controlled design and 98 studies used an observational design. The test grid studies show that in cataract surgery and ambulatory surgery, there are no significant differences between patients with indicated preoperative testing and no testing regarding perioperative outcome. The observational studies do not provide valid evidence that preoperative testing is beneficial in healthy adults undergoing non-cardiac surgery. There is no evidence derived from high-quality studies that supports routine preoperative testing in healthy adults undergoing non-cardiac surgery. Testing according to pathological findings in a patient's medical history or physical examination seems justified, although the evidence is scarce. High-quality studies, especially large randomized controlled trials, are needed to explore the effectiveness of indicated preoperative testing.

  12. TRADE ALARA for design and operations engineers

    SciTech Connect

    Not Available

    1993-04-01

    This product has been developed by the Training Resources and Data Exchange (TRADE) network for use at Department of Energy (DOE) and DOE contractor facilities. The TRADE network encourages and facilitates the exchange of ideas, techniques, and resources for improving training and development and serves as a forum for the discussion of issues of interest to the DOE community. This TRADE product has been developed for DOE contractor employees who are asked to deliver training to Design and Operations Engineers on the concept of As Low As Reasonably Achievable (ALARA). The ALARA concept is an approach to radiation protection to control or manage exposures as low as social, technical, economic, practical, public policy, and other considerations permit. Worldwide panels of radiation experts have concluded that it is conservative to assume that a proportional relationship exists between radiation dose (exposure) and the biological effects resulting from it. This assumption implies that every dose received, no matter how small, carries some risk: the higher the dose, the higher the risk. The federal government, including agencies such as DOE, subscribes to the concept of ALARA and requires its facilities to subscribe to it as well. This course was developed to introduce engineers to the fundamentals of radiation and contamination reduction that they will use when designing or modifying plant facilities. The course was developed by the ALARA Program group and the Radiation Protection Monitoring/Training Group of Martin Marietta Energy Systems, Inc. at Oak Ridge National Laboratory. We wish to express our appreciation to Emily Copenhaver, Scott Taylor, and Janet Westbrook at Oak Ridge National Laboratory for their willingness to share their labors with the rest of the DOE community and for technical support during the development of the TRADE ALARA for Design and Operations Engineers Course Manual.

  13. Iron therapy for the treatment of preoperative anaemia in patients with colorectal carcinoma: a systematic review.

    PubMed

    Borstlap, W A A; Stellingwerf, M E; Moolla, Z; Musters, G D; Buskens, C J; Tanis, P J; Bemelman, W A

    2015-12-01

    Preoperative anaemia is associated with increased morbidity and mortality. The aim of this systematic review is to evaluate the efficacy of preoperative iron supplementation in the treatment of anaemia, and its effect on the postoperative recovery of patients undergoing surgery for colorectal carcinoma. This systematic review was performed using MEDLINE, EMBASE and the Cochrane library to assess current evidence on the role of iron supplementation in the treatment of preoperative anaemia. Our main outcomes were absolute increase in haemoglobin, blood transfusion rate and postoperative morbidity. Main inclusion criteria were: preoperative iron supplementation, presence of colorectal carcinoma and elective surgery. The Downs-Black questionnaire was used for quality assessment of the included studies. Of the 605 studies analysed, seven, three randomized controlled trials and four cohort studies, were included. Despite iron supplementation, the three randomized controlled trials showed a decrease in haemoglobin level. This was contrary to the four cohort studies which all showed a significant increase. All studies showed a decreased blood transfusion rate following iron supplementation. None of the included studies assessed postoperative morbidity. Due to heterogeneity in study design, duration of treatment, dosages and variation in iron substrates, we were unable to perform a meta-analysis. In anaemic patients who require surgery for colorectal carcinoma, current evidence is of inadequate quality to draw a definitive conclusion on the efficacy of the various measures to treat preoperative anaemia. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

  14. ALARA pre-job studies using the VISIPLAN 3D ALARA planning tool.

    PubMed

    Vermeersch, Fernand

    2005-01-01

    The optimisation of the radiation protection for the workers in nuclear industry is an important part of the safety culture. The application of the ALARA concept (to keep exposures as low as reasonably achievable) is not always straightforward as it is influenced by the site geometry, source distribution and work organisation. A good ALARA pre-job study must therefore be performed and should contain predicted doses for the different suggested work scenarios and provide a quantitative basis to select between various alternative work scenarios for a specific operation. In order to handle this information, SCK-CEN developed the VISIPLAN 3D ALARA planning tool. The tool makes it possible to evaluate the dose due to external gamma exposure based on the simulation of work scenarios taking into account worker positions and subsequent geometry and source distribution changes in a three-dimensional environment.

  15. The alara center and its information service--ACE

    SciTech Connect

    Khan, T.A.; Baum, J.W.

    1991-08-01

    In compliance with its congressional mandate to oversee the radiation safety of workers at nuclear power plants, the NRC asked Brookhaven National Laboratory (BNL) to create a center to help monitor efforts that were likely to reduce occupational radiation exposure. The NRC project required the ALARA Center to evaluate dose-reduction research and the ALARA-related programs, and to note any areas where additional effort may be fruitful. The Center also was directed to inform the NRC on promising research and developments related to ALARA that were being carried out abroad, and to examine areas where international collaboration may be valuable. This document discusses the objectives of the ALARA Center.

  16. The role of preoperative CT scan in patients with tracheoesophageal fistula: a review.

    PubMed

    Garge, Saurabh; Rao, K L N; Bawa, Monika

    2013-09-01

    The morbidity and mortality associated with esophageal atresia with or without a fistula make it a challenging congenital abnormality for the pediatric surgeon. Anatomic factors like inter-pouch gap and origin of fistula are not taken into consideration in various prognostic classifications. The preoperative evaluation of these cases with computerized tomography (CT) has been used by various investigators to delineate these factors. We reviewed these studies to evaluate the usefulness of this investigation in the intra operative and post operative period. A literature search was done on all peer-reviewed articles published on preoperative computed tomography (CT) in cases of tracheoesophageal fistula using the PUBMED and MEDLINE search engines. Key words included tracheoesophageal fistula, computerized tomography, virtual bronchoscopy, and 3D computerized tomography reconstruction. Further, additional articles were selected from the list of references obtained from the retrieved publications. A total of 8 articles were selected for analysis. In most of the studies, comprising 96 patients, observations noted in preoperative CT were confirmed during surgery. In a study by Mahalik et al [Mahalik SK, Sodhi KS, Narasimhan KL, Rao KL. Role of preoperative 3D CT reconstruction for evaluation of patients with esophageal atresia and tracheoesophageal fistula. Pediatr Surg Int. 2012 Jun 22. [Epub ahead of print

  17. Preoperative muscle weakness as defined by handgrip strength and postoperative outcomes: a systematic review

    PubMed Central

    2012-01-01

    Background Reduced muscle strength- commonly characterized by decreased handgrip strength compared to population norms- is associated with numerous untoward outcomes. Preoperative handgrip strength is a potentially attractive real-time, non-invasive, cheap and easy-to-perform "bedside" assessment tool. Using systematic review procedure, we investigated whether preoperative handgrip strength was associated with postoperative outcomes in adults undergoing surgery. Methods PRISMA and MOOSE consensus guidelines for reporting systematic reviews were followed. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Clinical Trials (1980-2010) were systematically searched by two independent reviewers. The selection criteria were limited to include studies of preoperative handgrip strength in human adults undergoing non-emergency, cardiac and non-cardiac surgery. Study procedural quality was analysed using the Newcastle-Ottawa Quality Assessment score. The outcomes assessed were postoperative morbidity, mortality and hospital stay. Results Nineteen clinical studies (17 prospective; 4 in urgent surgery) comprising 2194 patients were identified between1980-2010. Impaired handgrip strength and postoperative morbidity were defined inconsistently between studies. Only 2 studies explicitly ensured investigators collecting postoperative outcomes data were blinded to preoperative handgrip strength test results. The heterogeneity of study design used and the diversity of surgical procedures precluded formal meta-analysis. Despite the moderate quality of these observational studies, lower handgrip strength was associated with increased morbidity (n = 10 studies), mortality (n = 2/5 studies) and length of hospital stay (n = 3/7 studies). Conclusions Impaired preoperative handgrip strength may be associated with poorer postoperative outcomes, but further work exploring its predictive power is warranted using prospectively acquired, objectively defined measures of

  18. Focused microwave thermotherapy for preoperative treatment of invasive breast cancer: a review of clinical studies.

    PubMed

    Dooley, William C; Vargas, Hernan I; Fenn, Alan J; Tomaselli, Mary Beth; Harness, Jay K

    2010-04-01

    Preoperative focused microwave thermotherapy (FMT) is a promising method for targeted treatment of breast cancer cells. Results of four multi-institutional clinical studies of preoperative FMT for treating invasive carcinomas in the intact breast are reviewed. Externally applied wide-field adaptive phased-array FMT has been investigated both as a preoperative heat-alone ablation treatment and as a combination treatment with preoperative anthracycline-based chemotherapy for breast tumors ranging in ultrasound-measured size from 0.8 to 7.8 cm. In phase I, eight of ten (80%) patients receiving a single low dose of FMT prior to receiving mastectomy had a partial tumor response quantified by either ultrasound measurements of tumor volume reduction or by pathologic cell kill. In phase II, the FMT thermal dose was increased to establish a threshold dose to induce 100% pathologic tumor cell kill for invasive carcinomas prior to breast-conserving surgery (BCS). In a randomized study for patients with early-stage invasive breast cancer, of those patients receiving preoperative FMT at ablative temperatures, 0 of 34 (0%) patients had positive tumor margins, whereas positive margins occurred in 4 of 41 (9.8%) of patients receiving BCS alone (P = 0.13). In a randomized study for patients with large tumors, based on ultrasound measurements the median tumor volume reduction was 88.4% (n = 14) for patients receiving FMT and neoadjuvant chemotherapy, compared with 58.8% (n = 10) reduction in the neoadjuvant chemotherapy-alone arm (P = 0.048). Wide-field adaptive phased-array FMT can be safely administered in a preoperative setting, and data from randomized studies suggest both a reduction in positive tumor margins as a heat-alone treatment for early-stage breast cancer and a reduction in tumor volume when used in combination with anthracycline-based chemotherapy for patients with large breast cancer tumors. Larger randomized studies are required to verify these conclusions.

  19. ALARA engineering at Department of Energy facilities: Bibliography of selected readings in radiation protection and ALARA

    SciTech Connect

    Dionne, B.J.; Khan, T.A.; Lane, S.G.; Baum, J.W.

    1991-03-01

    This report is the second in the series of bibliographies supporting the efforts at the Brookhaven National Laboratory ALARA Center on dose reduction at US Department of Energy (DOE) facilities. The BNL ALARA Center was originally established in 1983 under the sponsorship of the US Nuclear Regulatory Commission to monitor dose-reduction research and ALARA activities at nuclear power plants. This effort was expanded in 1988 by the DOE's Office of Environment, Safety and Health to include DOE nuclear facilities. Abstracts for this bibliography were selected from proceedings of technical meetings, journals, research reports, searches of the DOE Energy Data Base, and reprints of published articles provided by the authors. Information that the reader feels should be included in the next volume of this bibliography may be submitted to the BNL ALARA Center. These abstracts, which have a bearing on dose reduction, consolidates information from publications pertinent to Radiological Engineers and Operational Health Physicists. Volume 2 contains 127 abstracts numbered from 69 through 195 as well as author and subject indices. The subject index contains the abstract numbers from both the previous volume and the current volume, the latter being indicated in boldface.

  20. ALARA engineering at Department of Energy facilities: Bibliography of selected readings in radiation protection and ALARA

    SciTech Connect

    Dionne, B.J.; Khan, T.A.; Lane, S.G.; Baum, J.W.

    1991-05-01

    Promoting the exchange of information related to implementation of the As Low As Reasonably Achievable (ALARA) philosophy is a continuing objective for the Department of Energy (DOE). This report, prepared by the Brookhaven National Laboratory (BNL) ALARA Center for the DOE Office of Health, is the second in a series of bibliographies on dose reduction at DOE facilities. This bibliography contains abstracts relating to various aspects of ALARA program implementation and dose reduction activities, with a specific focus towards DOE facilities. Facility types and activities covered in the scope of this report include: radioactive waste; uranium enrichment; fuel fabrication, storage, and reprocessing; facility decommissioning; hot laboratories; tritium production; research, test and production reactors; weapons fabrication and testing; and accelerators. Material on improved shielding design, decontamination, containments, robotics, job planning, improved operational techniques, and other topics has also been included. This volume (Volume 2 of the series) contains 127 abstracts numbered from 69 through 195, as well as author and subject indices. The subject index contains the abstract numbers from both the previous volume and the current volume, the latter being indicated in boldface. Information that the reader feels should be included in the next volume of this bibliography should be submitted to the BNL ALARA Center.

  1. Pacific Northwest Laboratory ALARA report for CY 1992

    SciTech Connect

    Ceffalo, G.M.

    1993-09-01

    This report provides summary results of the CY 1992 As Low As Reasonably Achievable (ALARA) Program at the Pacific Northwest Laboratory (PNL).(a) This report includes information regarding whole-body exposures to radiation, skin contaminations, and the nonradiological ALARA program.

  2. Pacific Northwest Laboratory ALARA report for CY 1991

    SciTech Connect

    Ceffalo, G.M.

    1992-09-01

    This report provides summary results of the CY 1991 As Low As Reasonably Achievable (ALARA) Program at the Pacific Northwest Laboratory (PNL).(a) This report includes information regarding whole-body exposures to radiation, skin contaminations, and the nonradiological ALARA program.

  3. The organization of ALARA program at a DOE facility

    SciTech Connect

    Setaro, J.A.

    1992-05-01

    The organization of an ALARA Program at a DOE Facility (Oak Ridge National Laboratory), it`s relationship with laboratory management, facility operators, and the radiation protection program is described. The use of chartered ALARA committees at two distinct levels is discussed.

  4. Does pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery? A systematic review.

    PubMed

    Ackerman, Ilana N; Bennell, Kim L

    2004-01-01

    A systematic review of randomised controlled trials was performed to evaluate the effectiveness of pre-operative physiotherapy programmes on outcome following lower limb joint replacement surgery. A search of relevant key terms was used to find suitable trials, with five papers meeting the inclusion criteria for the review. The methodological quality of the trials was rated using the PEDro scale. Estimates of the size of treatment effects were calculated for each outcome in each trial, with 95% confidence intervals calculated where sufficient data were provided. Of the three trials pertaining to total knee replacement, only very small mean differences were found between control and intervention groups for all of the outcome measures. Where confidence intervals could be calculated, these showed no clinically important differences between the groups. Two papers (one study) pertaining to total hip replacements found significant improvements in WOMAC scores, hip strength and range of movement, walking distance, cadence, and gait velocity for the intervention group, compared to a control group. Estimates of treatment effect sizes for these outcomes were larger than for the total knee replacement studies, with confidence intervals showing potentially clinically important differences between group means. However, as the intervention group also received an additional intensive post-operative physiotherapy program, these results cannot be attributed solely to the pre-operative program. This systematic review shows that pre-operative physiotherapy programmes are not effective in improving outcome after total knee replacement but their effect on outcome from total hip replacement cannot be adequately determined.

  5. Systematic review of pre-operative exercise in colorectal cancer patients.

    PubMed

    Boereboom, C; Doleman, B; Lund, J N; Williams, J P

    2016-02-01

    The aim of this systematic review was to evaluate the evidence for exercise interventions prior to surgery for colorectal cancer resection. The evidence for use of exercise to improve physical fitness and surgical outcomes is as yet unknown. A systematic search was performed of MEDLINE, EMBASE, CINAHL, AMED and BNI databases for studies involving pre-operative exercise in colorectal cancer patients. Eight studies were included in the review. There is evidence that pre-operative exercise improves functional fitness, and to a lesser extent objectively measurable cardio-respiratory fitness prior to colorectal cancer resection. There is no clear evidence at present that this improvement in fitness translates into reduced peri-operative risk or improved post-operative outcomes. Current studies are limited by risk of bias. This review highlights the common difficulty in transferring promising results in a research setting, into significant improvements in the clinical arena. Future research should focus on which type of exercise is most likely to maximise patient adherence and improvements in cardio-respiratory fitness. Ultimately, adequately powered, randomised controlled trials are needed to investigate whether pre-operative exercise improves post-operative morbidity and mortality.

  6. ALARA and an integrated approach to radiation protection.

    PubMed

    Hendee, W R; Edwards, F M

    1986-04-01

    Exposures of individuals to ionizing radiation have been restricted for many years by a number of guidelines and rules developed by various advisory and regulatory groups. Accompanying these restrictions has been an evolving principle that exposures to individuals and groups should be kept "as low as reasonably achievable" (ALARA), consistent with provision of the benefits of radiation use to society. Although the ALARA concept is a laudable goal in principle, its implementation in a clinical facility has not been a straightforward process. Problems of implementing ALARA have been confounded further by the efforts of regulatory agencies to incorporate the ALARA concept into regulations governing radiation exposures. To facilitate the implementation of ALARA as a workable construct in a clinical facility, guidelines are needed for its application to both individual and collective exposures to radiation. The provision of such guidelines, including action and inaction levels for both individual and collective exposures, are presented here.

  7. Systematic Review: Audiovisual Interventions for Reducing Preoperative Anxiety in Children Undergoing Elective Surgery.

    PubMed

    Chow, Cheryl H T; Van Lieshout, Ryan J; Schmidt, Louis A; Dobson, Kathleen G; Buckley, Norman

    2016-03-01

    To examine the effectiveness of Audiovisual (AV) interventions at reducing preoperative anxiety and its associated outcomes in children undergoing elective surgery. A systematic review of randomized controlled trials (RCTs) and nonrandomized studies where the primary outcome was children's preoperative anxiety was conducted. Secondary outcomes included postoperative pain, behavioral changes, recovery, induction compliance, satisfaction, and cost-effectiveness. The risk of bias of each study was assessed. In all, 18 studies were identified. A meta-analytic approach and narrative synthesis of findings were used to summarize the results of the studies. This systematic review suggests that AV interventions can be effective in reducing children's preoperative anxiety. Videos, multi-faceted programs, and interactive games appear to be most effective, whereas music therapy and Internet programs are less effective. While AV interventions appear potentially useful, adequately powered RCTs are required to conclusively pinpoint the components and mechanisms of the most effective AV interventions and guide practice. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Systematic Review: Audiovisual Interventions for Reducing Preoperative Anxiety in Children Undergoing Elective Surgery

    PubMed Central

    Van Lieshout, Ryan J.; Schmidt, Louis A.; Dobson, Kathleen G.; Buckley, Norman

    2016-01-01

    Objective To examine the effectiveness of Audiovisual (AV) interventions at reducing preoperative anxiety and its associated outcomes in children undergoing elective surgery. Methods A systematic review of randomized controlled trials (RCTs) and nonrandomized studies where the primary outcome was children’s preoperative anxiety was conducted. Secondary outcomes included postoperative pain, behavioral changes, recovery, induction compliance, satisfaction, and cost-effectiveness. The risk of bias of each study was assessed. Results In all, 18 studies were identified. A meta-analytic approach and narrative synthesis of findings were used to summarize the results of the studies. Conclusions This systematic review suggests that AV interventions can be effective in reducing children’s preoperative anxiety. Videos, multi-faceted programs, and interactive games appear to be most effective, whereas music therapy and Internet programs are less effective. While AV interventions appear potentially useful, adequately powered RCTs are required to conclusively pinpoint the components and mechanisms of the most effective AV interventions and guide practice. PMID:26476281

  9. Preoperative Testosterone Therapy Prior to Surgical Correction of Hypospadias: A Review of the Literature

    PubMed Central

    Chagani, Sean; Rohl, Austin J

    2016-01-01

    Hypospadias is a congenital anomaly of the male urethra that causes significant morbidity in the pediatric male population. The mainstay of treatment is hypospadias repair surgery. However, given the common co-occurrence of microphallus in these patients, surgery remains difficult without adequate tissue for proper reconstruction of the urethra. The use of preoperative testosterone therapy, parenterally or topically, has been a topic of study for several years in urologic literature. This literature review aims to summarize the different studies that have been conducted to address whether preoperative testosterone therapy is beneficial, inconsequential, or detrimental to the surgical and cosmetic outcomes of hypospadias repair as well as to address the differences in routes of administration. PMID:27551655

  10. Westinghouse Hanford Company ALARA year-end report, Calendar Year 1994: Revision 3, Radiological engineering and ALARA

    SciTech Connect

    Berglund, O.D.

    1995-04-01

    It has long been DOE`s Policy that radiation exposures should be maintained as far below the dose limits as is reasonably achievable. This policy, known as the ALARA Principle of radiation protection, maintains that radiation exposures should be maintained as low as reasonably achievable, taking into account social, technical, economic, practical, and public policy considerations. The ALARA Principle is based on the hypothesis that even very low radiation doses carry some risk. As a result, it is not enough to maintain doses at/or slightly below limits; the lower the doses, the lower the risks. Because it is not possible to reduce all doses at DOE facilities to zero, economic and social factors must be considered to determine the optimal level of radiation doses. According to the ALARA principle, if doses are too high, resources should be well spent to reduce them. At some point, the resources being spent to maintain low doses are exactly balanced by the risks avoided. Reducing doses below this point results in a misallocation of resources; the resources could be spent elsewhere and have a greater impact on health and safety. The WHC ALARA sitewide goals were developed by the WHC ALARA Council and the ALARA/CCIP Program Office, while the facility/organizational level ALARA goals were developed by the facility/organizational ALARA committees. Goal statuses have been approved by facility management or their representative and transmitted verbatim in this report. These goals reflect a commitment by management to ensure a quality ALARA program driven by an emphasis on safety, the health of workers, and the protection of the environment. The final status, performance, and lessons learned of ALARA goals developed for Calendar Year (CY) 1994, are provided in this report.

  11. Safety of preoperative erythropoietin in surgical calvarial remodeling: an 8-year retrospective review and analysis.

    PubMed

    Naran, Sanjay; Cladis, Franklyn; Fearon, Jeffrey; Bradley, James; Michelotti, Brett; Cooper, Gregory; Cray, James; Katchikian, Hurig; Grunwaldt, Lorelei; Pollack, Ian F; Losee, Joseph

    2012-08-01

    Calvarial remodeling is typically associated with significant blood loss. Although preoperative erythropoiesis-stimulating agents have proven to significantly decrease the need for blood transfusions, recent data in adults have raised concerns that elevating hemoglobin levels greater than 12.5 g/dl may increase the risk of thrombotic events. This study was designed to assess the risks of erythropoietin in the pediatric population. Records were retrospectively reviewed from 2000 to 2008 at three major metropolitan children's hospitals of all children undergoing calvarial remodeling after receiving preoperative erythropoietin. Demographic and perioperative outcome data were reviewed, including transfusion reactions, pressure ulcer secondary to prolonged positioning, pneumonia, infection, deep vein thrombosis, cerebrovascular accident, pulmonary embolism, sagittal sinus thrombosis, pure red cell aplasia, and myocardial infarction. A total of 369 patients met the inclusion criteria (mean age, 0.86±1.1 years). On average, three preoperative doses of erythropoietin were administered (600 U/kg). Iron was also supplemented. No complications associated with dosing were noted, there were no thrombotic events identified, and no other major complications were seen (i.e., death or blindness). Thirty-one patients (8.40 percent) experienced one or more postoperative complications. There was no significant correlation between hemoglobin levels greater than 12.5 g/dl and the occurrence of any noted complication. With zero thrombotic postoperative complications, the authors estimate the risk of a thrombotic event in the pediatric population to be less than 0.81 percent (95 percent confidence). These data suggest that preoperative administration of erythropoietin in children undergoing calvarial remodeling does not appear to increase the incidence of thrombotic events or other significant complications. Therapeutic, IV.

  12. Preoperative physical examination and imaging of femoroacetabular impingement prior to hip arthroscopy—a systematic review

    PubMed Central

    Haldane, Chloe E.; Ekhtiari, Seper; de SA, Darren; Simunovic, Nicole

    2017-01-01

    Abstract The purpose of this systematic review is to report current preoperative assessment for femoroacetabular impingement (FAI) including physical examination and imaging modalities prior to hip arthroscopy, and report current imaging measures used in the diagnosis of FAI. The electronic databases MEDLINE, EMBASE and PubMed were searched and screened in duplicate for relevant studies. Data regarding patient demographics, non-operative treatment, preoperative assessment including physical examination and imaging prior to hip arthroscopy were abstracted. Study quality was assessed in duplicate using the Methodological Index for Non-Randomized Studies criteria. Sixty-eight studies of fair quality evidence that involved a total of 5125 patients (5400 hips) were included. In total, 56% of all patients were male and mean age was 36 years (SD ± 10.0). Within physical examination, FADIR impingement testing was reported in 57% of patients. All included studies reported plain radiographic imaging as a component of preoperative assessment with anterior–posterior pelvis view being the most commonly reported view, followed by the cross-table lateral and Dunn views. Magnetic resonance imaging was obtained for 52% of included patients and computed tomography for 26% of patients. The most commonly reported measure within imaging for the diagnosis of cam type impingement was alpha angle (66%), whereas for pincer type impingement, the cross-over sign (48%) was most reported. Preoperative assessment is underreported in the FAI literature. Improved reporting is warranted to develop a more consistent and validated diagnostic algorithm for FAI to enhance patient selection. Level of evidence: Level IV, Systematic Review of Level I–IV Studies. PMID:28948032

  13. Preoperative education interventions to reduce anxiety and improve recovery among cardiac surgery patients: a review of randomised controlled trials.

    PubMed

    Guo, Ping

    2015-01-01

    To update evidence of the effectiveness of preoperative education among cardiac surgery patients. Patients awaiting cardiac surgery may experience high levels of anxiety and depression, which can adversely affect their existing disease and surgery and result in prolonged recovery. There is evidence that preoperative education interventions can lead to improved patient experiences and positive postoperative outcomes among a mix of general surgical patients. However, a previous review suggested limited evidence to support the positive impact of preoperative education on patients' recovery from cardiac surgery. Comprehensive review of the literature. The Cochrane Central Register of Controlled Trials from the Cochrane Library, MEDLINE, CINAHL, PsycINFO, EMBASE and Web of Science were searched for English-language articles published between 2000-2011. Original articles were included reporting randomised controlled trials of cardiac preoperative education interventions. Six trials were identified and have produced conflicting findings. Some trials have demonstrated the effects of preoperative education on improving physical and psychosocial recovery of cardiac patients, while others found no evidence that patients' anxiety is reduced or of any effect on pain or hospital stay. Evidence of the effectiveness of preoperative education interventions among cardiac surgery patients remains inconclusive. Further research is needed to evaluate cardiac preoperative education interventions for sustained effect and in non-Western countries. A nurse-coordinated multidisciplinary preoperative education approach may offer a way forward to provide a more effective and efficient service. Staff training in developing and delivering such interventions is a priority. © 2014 John Wiley & Sons Ltd.

  14. Preoperative measurement of serum thyroglobulin to predict malignancy in thyroid nodules: a systematic review.

    PubMed

    Trimboli, P; Treglia, G; Giovanella, L

    2015-04-01

    Several articles have assessed the role of preoperative serum thyroglobulin (Tg) as predictor of malignancy of thyroid nodules, with particular focus on nodules with indeterminate cytology. However, the role of serum Tg as diagnostic marker remains unclear. The aim of the study was to perform a systematic review to add more evidence-based data on this topic. A comprehensive literature search was conducted to find relevant published articles on this topic. MeSH terms were: "thyroglobulin" and "predict*". In order to include only recent serum Tg assay methods, we analyzed the timeframe between 2001 and July 31(st), 2014. To expand our search, references of the retrieved articles were also screened. Thirteen studies, including 3,580 patients, were analyzed. Nine out of these studies reported data on thyroid nodules with prior indeterminate cytology. Preoperative serum Tg levels demonstrated suboptimal accuracy in discriminating malignant from benign nodules due to a significant overlap of values between these groups. However, most articles demonstrated a statistically significant difference in mean or median serum Tg between patients with cancer and benign lesions correlated to final histology. Furthermore, most studies reported Tg as independent predictor of malignancy. According to the most recent literature, the preoperative measurement of Tg alone fails to discriminate thyroid cancers from benign lesions. However, our data show that Tg is an independent predictor of malignancy; as a consequence, the presurgical determination of Tg should be considered in patients with thyroid nodules, especially when cytology is indeterminate.

  15. Applying ALARA to cleanup criteria for a mixed waste site

    SciTech Connect

    MacDonell, M.; Peterson, J.; Haroun, L.; Blunt, D.; Dunning, D.; Green, S.

    1993-11-01

    The process of reducing exposures to levels as low as reasonably achievable (ALARA) is applied by the US Department of Energy (DOE) to the management of radioactive materials. A site-specific application of the ALARA process was incorporated into the development of cleanup criteria for both surface water and soil at a DOE environmental restoration site. Factoring ALARA considerations into the development of cleanup criteria demonstrated DOE`s commitment to maintaining both protectiveness and reason, and it also provided a working range for verifying residual levels after the cleanup actions have been completed.

  16. Effect of the preoperative use of dopamine agonists in the postoperative course of prolactinomas: a systematic review.

    PubMed

    Carija, Robert; Tudor, Mario; Vucina, Diana

    2014-01-01

    Since the 1980s, it has been discussed whether the preoperative treatment of prolactinomas with dopamine agonists (DAs) is beneficial or detrimental regarding postoperative residue or recurrence. Many neurosurgeons have emphasized the difficulties caused by fibrosis during the ablation of such prolactinomas. From February to December 2012, the authors searched electronic databases and book chapters published from 1991 to 2012; a total of 3,771 articles and 37 book chapters were searched. Ten articles that explicitly addressed this issue were identified. Five articles reported that preoperative treatment did not affect postoperative status. One article described a positive influence of preoperative treatment with DAs (P < .01), and 3 articles found a negative influence (P = .040, P = .02, no significance value reported). One article described histopathological evidence of tumor fibrosis that was found intraoperatively after preoperative DA treatment. This systematic review did not identify any strong evidence that preoperative treatment of prolactinomas with DAs is harmful or beneficial. Therefore, further studies are needed.

  17. Electricite de France`s ALARA policy

    SciTech Connect

    Stricker, L.; Rollin, P.

    1995-03-01

    In 1992, Electricite de France - EDF decided to improve the degree to which radiological protection is incorporated in overall management of the utility and set itself the objective of ensuring the same level of protection for workers from contractors as for those from EDF. This decision was taken in a context marked by a deterioration in exposure figures for French plants and by the new recommendations issued by the ICRP. This document describes the policy adopted by EDF at both corporate and plant level to meet these objectives, by: (1) setting up management systems which were responsive but not cumbersome; (2) a broad policy of motivation; (3) the development and use of suitable tools. The document then describes some quite positive results of EDF`s ALARA policy, giving concrete examples and analyzing the changes in global indicators.

  18. A review of anti-septic agents for pre-operative skin preparation.

    PubMed

    Digison, Mary Beth

    2007-01-01

    Pre-operative skin preparation of the surgical site using appropriate anti-septic product is recognized by the Centers for Disease Control and Prevention Guideline for Prevention of Surgical Site Infection, 1999, as a strongly recommended intervention to prevent surgical site infection. This article reviews anti-septic surgical skin preparation products according to the Food and Drug Administration classifications, efficacy, and safety. It also examines pertinent research regarding anti-septic products. This information provides the peri-operative registered nurse with information to make appropriate decisions when choosing anti-septic skin preparation products for surgical patients.

  19. A retrospective review of cases preoperatively diagnosed by radiologic imaging as cavernous venous malformations.

    PubMed

    Jayaram, Anupam; Cohen, Liza M; Lissner, Gary S; Karagianis, Achilles G

    2017-04-03

    The purpose of this study is to examine orbital lesions identified on preoperative radiologic imaging as cavernous venous malformations (CVMs), identify their imaging characteristics, and determine if these may help differentiate CVMs from other intraorbital masses. An IRB-approved retrospective chart review over 30 years was undertaken identifying lesions "consistent with cavernous hemangioma" on radiologic studies, which were subsequently surgically resected with a tissue diagnosis. All radiologic images (CT and MRI) obtained preoperatively were re-reviewed by a single masked neuroradiologist. The pattern of contrast enhancement on sequential MRI views was used to determine whether the enhancing characteristics helped identify CVMs compared to other intraorbital masses. Fifty-seven orbital lesions consistent with a CVM were identified on imaging. Fourteen (25%) of them were resected, of which nine (64%) were found to be CVMs on pathologic examination. Five (36%) were found to be a different lesion, most commonly schwannoma (21%). On imaging, CVMs tended to display heterogeneous progressive enhancement, whereas other tumors, in particular schwannomas, enhanced at their maximum level immediately. Based on these characteristics, on re-review, the masked neuroradiologist was able to differentiate a CVM versus other tumors for all 14 imaging cases. This study suggests that examining the pattern of contrast enhancement may help to correctly differentiate a CVM from other isolated, encapsulated orbital lesions on CT/MR imaging.

  20. Epidermoid Cyst in an Intrapancreatic Accessory Spleen: Case Report and Literature Review of the Preoperative Imaging Findings

    PubMed Central

    Kato, Shin; Mori, Hideki; Zakimi, Moriya; Yamada, Koki; Chinen, Kenji; Arashiro, Masayuki; Shinoura, Susumu; Kikuchi, Kaoru; Murakami, Takahiro; Kunishima, Fumihito

    2016-01-01

    An epidermoid cyst arising within an intrapancreatic accessory spleen (ECIAS) is rare, and also difficult to correctly diagnose before surgery. It is mostly misdiagnosed as a cystic tumor, such as a mucinous cystic neoplasm or as a solid tumor with cystic degeneration, such as a neuro endocrine tumor. We herein report a case of ECIAS and also perform a literature review of 35 reports of ECIAS. Although the preoperative diagnosis of ECIAS using conventional imaging is relatively difficult to make, careful preoperative examinations of the features on computed tomography and magnetic resonance imaging could lead to a correct preoperative diagnosis of ECIAS which might thereby reduce the number of unnecessary resections. PMID:27904107

  1. Environmental ALARA Program at the Savannah River Site

    SciTech Connect

    Jannik, G.T.

    1993-08-01

    The Savannah River Site (SRS) follows the ALARA (As Low As Reasonably Achievable) philosophy of keeping radiation doses to the general public as low as practical by minimizing radioactive releases to the environment. SRS accomplishes this goal by establishing challenging sitewide and area-specific Environmental ALARA Release Guides and trending radioactive releases against these guides on a monthly basis. The SRS Environmental ALARA Program, mandated by DOE Order 5400.5, is a dose-based program that has gone through many changes and improvements in recent years. A description of the SRS Environmental ALARA Program and its performance is presented in this paper. Recent SRS studies of the ``Zero Release`` option also are described.

  2. [The ALARA-principle. Backgrounds and enforcement in dental practices].

    PubMed

    Berkhout, W E R

    2015-05-01

    Optimization of radiation protection began soon after the discovery of X-rays. The optimization-concept has been refined more and more as a result of increa-sing knowledge of radiation and its effect on people. Since 1973 the acronym ALARA (As Low As Reasonably Achievable) has been used to designate the optimization of X-ray doses. For the dentist the ALARA-principle entails the obligation to minimize the radiation dose to patient and surroundings to a level as low as reasonably achievable. Currently in radiology the acronym ALADA is also used: As Low As Diagnostically Acceptable. To establish ALARA goals Diagnostic Reference Levels are employed in medical radiology. These Diagnostic Reference Levels are also being introduced in dental radiology. Practical measures for ALARA/ALADA in dental practice comprise an awareness of the field of view (for all types of imaging, including cone beam computed tomography) exposure time, and relation to anatomy and diagnostic justification, and shielding.

  3. Systematic Review and Meta-Analysis of Preoperative Antisepsis with Combination Chlorhexidine and Povidone-Iodine

    PubMed Central

    Davies, Benjamin M.; Patel, Hiren C.

    2016-01-01

    Importance  Effective preoperative antisepsis is recognized to prevent surgical site infection (SSI), although the definitive method is unclear. Many have compared chlorhexidine (CHG) with povidone-iodine (PVI), but there is emerging evidence for combination usage. Objective  To conduct a systematic review and meta-analysis to evaluate if combination skin preparation (1) reduces colonization at the operative site and (2) prevents SSI compared with single-agent use. Data Sources  A literature search of MEDLINE, Embase, and Cochrane Database of Clinical Trials was performed. Study Selection  Comparative, human trials considering the combination use of CHG and PVI, as preoperative antisepsis, to single-agent CHG or PVI use were included. Studies were excluded from meta-analysis if the use or absence of alcohol was inconsistent between study arms. Data Extraction and Synthesis  The study was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Main Outcomes and Measures  The primary outcome for meta-analysis was surgical site infection. The secondary outcome was colonization at the operative site. Results  Eighteen publications with a combination of CHG and PVI use were identified. Of these, 12/14 inferred promise for combination usage, including four trials eligible for meta-analysis. Only one trial reported SSI as its outcome. The remaining three considered bacterial colonization. Combination preparation had a pooled odds ratio for complete decolonization of 5.62 (95% confidence interval 3.2 to 9.7, p  < 0.00001). There was no evidence of heterogeneity (Cochran's Q 2.1, 2 df , p  = 0.35). Conclusions and Relevance  There is emerging, albeit low-quality, evidence in favor of combination CHG and PVI preoperative antisepsis. Further rigorous investigation is indicated. PMID:28824994

  4. Fluor Hanford ALARA Center is a D and D Resource

    SciTech Connect

    Waggoner, L.O.

    2008-01-15

    The mission at the Hanford Nuclear Reservation changed when the last reactor plant was shut down in 1989 and work was started to place all the facilities in a safe condition and begin decontamination, deactivation, decommissioning, and demolition (D and D). These facilities consisted of old shutdown reactor plants, spent fuel pools, processing facilities, and 177 underground tanks containing 53 million gallons of highly radioactive and toxic liquids and sludge. New skills were needed by the workforce to accomplish this mission. By 1995, workers were in the process of getting the facilities in a safe condition and it became obvious improvements were needed in their tools, equipment and work practices. The Hanford ALARA Program looked good on paper, but did little to help contractors that were working in the field. The Radiological Control Director decided that the ALARA program needed to be upgraded and a significant improvement could be made if workers had a place they could visit that had samples of the latest technology and could talk to experienced personnel who have had success doing D and D work. Two senior health physics personnel who had many years experience in doing radiological work were chosen to obtain tools and equipment from vendors and find a location centrally located on the Hanford site. Vendors were asked to loan their latest tools and equipment for display. Most vendors responded and the Hanford ALARA Center of Technology opened on October 1, 1996. Today, the ALARA Center includes a classroom for conducting training and a mockup area with gloveboxes. Two large rooms have a containment tent, several glove bags, samples of fixatives/expandable foam, coating displays, protective clothing, heat stress technology, cutting tools, HEPA filtered vacuums, ventilation units, pumps, hydraulic wrenches, communications equipment, shears, nibblers, shrouded tooling, and several examples of innovative tools developed by the Hanford facilities. See Figures I and

  5. ALARA plan for the Old Hydrofracture Facility tanks contents removal project at Oak Ridge National Laboratory, Oak Ridge, Tennessee

    SciTech Connect

    1998-04-01

    The purpose of the Old Hydrofracture Facility (OHF) Tanks Contents Removal Project is to remove the liquid low-level waste from the five underground storage tanks located at OHF and transfer the resulting slurry to the Melton Valley Storage Tanks facility for treatment and disposal. Among the technical objectives for the OHF Project, there is a specific provision to maintain personnel exposures as low as reasonably achievable (ALARA) during each activity of the project and to protect human health and the environment. The estimated doses and anticipated conditions for accomplishing this project are such that an ALARA Plan is necessary to facilitate formal radiological review of the campaign. This ALARA Plan describes the operational steps necessary for accomplishing the job together with the associated radiological impacts and planned controls. Individual and collective dose estimates are also provided for the various tasks. Any significant changes to this plan (i.e., planned exposures that are greater than 10% of original dose estimates) will require formal revision and concurrence from all parties listed on the approval page. Deviations from this plan (i.e., work outside the scope covered by this plan) also require the preparation of a task-specific ALARA Review that will be amended to this plan with concurrence from all parties listed on the approval page.

  6. Sentinel node biopsy: ALARA and other considerations.

    PubMed

    Strzelczyk, I; Finlayson, C

    2004-02-01

    For a majority of solid tumors, the most powerful and predictive prognostic factor is the status of the regional lymph nodes. Sentinel lymph node sampling continues to gain in popularity as patients and their physicians seek to avoid the potential morbidity associated with standard axillary node dissection. Lymphoscintigraphy, one of the recently explored techniques of lymphatic mapping, involves pre-operative intradermal or subcutaneous administration of a radiopharmaceutical. While this approach is gaining widely spread acceptance, there is still a lack of consensus on which radiopharmaceutical agent has the most ideal properties. By far, the most commonly used agents are 99mTc labeled colloids, but other agents are also used clinically and are under investigation or development worldwide. A number of other clinical, technical, dosimetric, and logistical considerations regarding this procedure remain. They include questions such as who should be performing the procedure, what precautions to take during surgery, how to better isolate "hot" nodes and thus improve the efficacy of determining metastases to the draining lymph node, what precautions to take when handling surgical specimens, etc. There is clearly a need to review as low as reasonably achievable considerations and other issues that arise as this technique evolves and finds its role in the evaluation of various types of cancers. This paper, based on our own experiences and those of others, fills this gap.

  7. Impact of Preoperative Computed Tomography Angiogram on Abdominal Flap Breast Reconstruction Outcomes: A Systematic Review.

    PubMed

    Mossa-Basha, Malik; Lee, Clara

    2017-02-24

    Introduction CT angiogram (CTA) is widely believed to improve operative time and flap outcomes for perforator flap breast reconstruction, but the quality of the evidence is not known. We conducted a systematic review of the efficacy of preoperative CTA for abdominal perforator flap breast reconstruction. Methods Inclusion criteria included published articles in English, CTA group, and control group, between 2000 and March 2013. Medline and PubMed were queried. Study quality criteria were developed based on standards of internal and external validity. One reviewer screened titles and abstracts. Two authors independently reviewed the full-text articles. Outcomes of interest were operative time and flap outcomes. Results Ten publications met inclusion criteria. Study designs included retrospective or mixed prospective-retrospective cohorts. In every study, the control group time period preceded the CTA group time period and no studies adjusted for improved surgical skill (i.e., learning curve effect). Sample sizes ranged from 41 to 357. Five studies did not perform or provide statistical analysis for the results presented. The mean quality rating was 2.8 (out of a maximum of 7). Seven of 10 studies found a shorter operative time with CTA. Two of nine studies found fewer partial flap failures with CTA. Conclusion CTA is associated with shorter operative time, but some of this may be due to a learning curve effect. The evidence does not show a difference in flap outcomes. The evidence in support of preoperative CTA is limited and subject to bias due to study design.

  8. ALARA ASSESSMENT OF SETTLER SLUDGE SAMPLING METHODS

    SciTech Connect

    NELSEN LA

    2009-01-30

    The purpose of this assessment is to compare underwater and above water settler sludge sampling methods to determine if the added cost for underwater sampling for the sole purpose of worker dose reductions is justified. Initial planning for sludge sampling included container, settler and knock-out-pot (KOP) sampling. Due to the significantly higher dose consequence of KOP sludge, a decision was made to sample KOP underwater to achieve worker dose reductions. Additionally, initial plans were to utilize the underwater sampling apparatus for settler sludge. Since there are no longer plans to sample KOP sludge, the decision for underwater sampling for settler sludge needs to be revisited. The present sampling plan calls for spending an estimated $2,500,000 to design and construct a new underwater sampling system (per A21 C-PL-001 RevOE). This evaluation will compare and contrast the present method of above water sampling to the underwater method that is planned by the Sludge Treatment Project (STP) and determine if settler samples can be taken using the existing sampling cart (with potentially minor modifications) while maintaining doses to workers As Low As Reasonably Achievable (ALARA) and eliminate the need for costly redesigns, testing and personnel retraining.

  9. Using Weibull Distribution Analysis to Evaluate ALARA Performance

    SciTech Connect

    E. L. Frome, J. P. Watkins, and D. A. Hagemeyer

    2009-10-01

    As Low as Reasonably Achievable (ALARA) is the underlying principle for protecting nuclear workers from potential health outcomes related to occupational radiation exposure. Radiation protection performance is currently evaluated by measures such as collective dose and average measurable dose, which do not indicate ALARA performance. The purpose of this work is to show how statistical modeling of individual doses using the Weibull distribution can provide objective supplemental performance indicators for comparing ALARA implementation among sites and for insights into ALARA practices within a site. Maximum likelihood methods were employed to estimate the Weibull shape and scale parameters used for performance indicators. The shape parameter reflects the effectiveness of maximizing the number of workers receiving lower doses and is represented as the slope of the fitted line on a Weibull probability plot. Additional performance indicators derived from the model parameters include the 99th percentile and the exceedance fraction. When grouping sites by collective total effective dose equivalent (TEDE) and ranking by 99th percentile with confidence intervals, differences in performance among sites can be readily identified. Applying this methodology will enable more efficient and complete evaluation of the effectiveness of ALARA implementation.

  10. Using Weibull Distribution Analysis to Evaluate ALARA Performance

    SciTech Connect

    E. L. Frome, J. P. Watkins, and D. A. Hagemeyer

    2009-10-01

    As Low as Reasonably Achievable (ALARA) is the underlying principle for protecting nuclear workers from potential health outcomes related to occupational radiation exposure. Radiation protection performance is currently evaluated by measures such as collective dose and average measurable dose, which do not indicate ALARA performance. The purpose of this work is to show how statistical modeling of individual doses using the Weibull distribution can provide objective supplemental performance indicators for comparing ALARA implementation among sites and for insights into ALARA practices within a site. Maximum likelihood methods were employed to estimate the Weibull shape and scale parameters used for performance indicators. The shape parameter reflects the effectiveness of maximizing the number of workers receiving lower doses and is represented as the slope of the fitted line on a Weibull probability plot. Additional performance indicators derived from the model parameters include the 99th percentile and the exceedance fraction. When grouping sites by collective total effective dose equivalent (TEDE) and ranking by 99th percentile with confidence intervals, differences in performance among sites can be readily identified. Applying this methodology will enable more efficient and complete evaluation of the effectiveness of ALARA implementation.

  11. An effective ALARA (As Low As Reasonably Achievable) Awareness Program

    SciTech Connect

    Aldridge, T.L.; Hammond, D.A.

    1990-10-01

    Following the January 1, 1989 issue of the US Department of Energy (DOE) revised Order 5480.1, Chapter XI (DOE 1985), the Westinghouse Hanford Company (Westinghouse Hanford) As Low As Reasonably Achievable (ALARA) Program Office (APO) began an aggressive ALARA Awareness Campaign. The revised DOE Order 5480.11 (DOE 1988) required the documentation and tracking of ALARA practices and principles. This major challenge for compliance to the new requirements necessitated an enhanced awareness of the goals and objectives of the APO. The Westinghouse Hanford APO began the expansion of the ALARA Program. The classic concept'' of radiological exposure minimization, which began in the early 1940's, increased in scope to include the new concept of exposure minimization for all hazardous materials and conditions commensurate with sound economics and operating practices. This expansion could only be implemented by bringing about a cultural change. Therefore, the attempt to introduce this change in thinking created a second major challenge for the Westinghouse Hanford APO. The direct result of the identification of these two major goals was the creation of an effective ALARA Awareness for Westinghouse Hanford. This paper describes this program. 3 refs.

  12. Westinghouse Hanford Company ALARA year-end report, Calendar Year 1994: Revision 3A, Radiological engineering and ALARA

    SciTech Connect

    Berglund, O.D.

    1995-06-01

    It has long been the US Department of Energy`s (DOE`s) Policy that radiation doses should be maintained as far below the dose limits as is reasonably achievable. This policy, known as the ``ALARA Principle of radiation protection,`` maintains that radiation exposures should be maintained as low as reasonably achievable, taking into account social, technical, economic, practical, and public policy considerations. The ALARA Principle is based on the hypothesis that even very low radiation doses carry some risk. As a result, it is not enough to maintain doses at/or slightly below limits; the lower the doses, the lower the risks. Because it is not possible to reduce all doses at DOE facilities to zero, economic and social factors must be considered to determine the optimal level of radiation doses. According to the ALARA Principle, if doses are too high, resources should be well spent to reduce them. At some point, the resources being spent to maintain low doses are exactly balanced by the risks avoided. Reducing doses below this point results in a misallocation of resources; the resources could be spent elsewhere and have a greater positive impact on health and safety. The objective of the Westinghouse Hanford Company (WHC) ALARA/Contamination Control Improvement Project (CCIP) Program is to manage and control exposures (both individual and collective) to the work force, the general public, and the environment to levels as low as is reasonable using the aforementioned ALARA Principle.

  13. ANI/MAELU engineering inspection criteria 8.3 ALARA

    SciTech Connect

    Schneider, L.

    1995-03-01

    The purpose of this criteria section is to provide guidelines for programs whose intent is to achieve occupational doses and doses to members of the public that are as low as is reasonably achievable (ALARA). The success that has been achieved by applying ALARA concepts at nuclear power plants is clearly illustrated by the major reductions in the annual cumulative dose to workers at many sites over the last few years. This success is the combined result of the general maturity of the nuclear industry, the intensive study of dose reduction practices by industry groups, and the successful sharing of experience and practices among plants. Source term reduction should be used as a primary ALARA mechanism. Methods which should be considered include: satellite and cobalt reduction, chemistry control, decontamination, submicron filters, zinc addition, hot spot reduction and permanent or temporary shielding.

  14. Report on the PWR-radiation protection/ALARA Committee

    SciTech Connect

    Malone, D.J.

    1995-03-01

    In 1992, representatives from several utilities with operational Pressurized Water Reactors (PWR) formed the PWR-Radiation Protection/ALARA Committee. The mission of the Committee is to facilitate open communications between member utilities relative to radiation protection and ALARA issues such that cost effective dose reduction and radiation protection measures may be instituted. While industry deregulation appears inevitable and inter-utility competition is on the rise, Committee members are fully committed to sharing both positive and negative experiences for the benefit of the health and safety of the radiation worker. Committee meetings provide current operational experiences through members providing Plant status reports, and information relative to programmatic improvements through member presentations and topic specific workshops. The most recent Committee workshop was facilitated to provide members with defined experiences that provide cost effective ALARA performance.

  15. Pacific Northwest Laboratory ALARA Report for Calendar Year 1993

    SciTech Connect

    Keller, S.L.

    1994-07-01

    This report provides summary results of the Calendar Year (CY) 1993 As Low As Reasonably Achievable (ALARA) Program at the Pacific Northwest Laboratory (PNL). This report includes information regarding whole-body exposures to radiation, and skin contaminations. The collective whole-body radiation dose to employees during 1993 was 0.58 person-sievert (58 person-rem). This dose was 11 percent lower than the projected dose of 0.65 person-sievert (65 person-rem). The Radiation Protection Section`s Field Dosimetry Services group projected that no PNL employee`s dose would exceed 0.02 sievert (2 rem) based on dosimeters processed during the year; no worker actually exceeded the limit by the end of CY 1993. There were 15 reported cases of skin contamination for PNL employees during 1993. This number of 60 percent of the projected total of 25 cases. There were an additional 21 cases of personal-effects contamination to PNL staff: Nine of these contamination events occurred at the 324 Building, nine occurred at the 325 Building, one occurred in the 327 Building, one occurred in the 3720 Building, and one occurred in the 326 Building. Line management set numerous challenging and production ALARA goals for their facilities. Appendix A describes the final status of the 1993 ALARA goals. Appendix B describes the radiological ALARA goals for 1994. The Radiation Protection Section of the Laboratory Safety Dept. routinely perform audits of radiological ALARA requirements for specific facilities with significant potential for exposure. These ALARA audits are part of a comprehensive safety audit of the facility, designed to evaluate and improve total safety performance.

  16. Integration of Formal Job Hazard Analysis & ALARA Work Practice

    SciTech Connect

    NELSEN, D.P.

    2002-09-01

    ALARA work practices have traditionally centered on reducing radiological exposure and controlling contamination. As such, ALARA policies and procedures are not well suited to a wide range of chemical and human health issues. Assessing relative risk, identifying appropriate engineering/administrative controls and selecting proper Personal Protective Equipment (PPE) for non nuclear work activities extends beyond the limitations of traditional ALARA programs. Forging a comprehensive safety management program in today's (2002) work environment requires a disciplined dialog between health and safety professionals (e.g. safety, engineering, environmental, quality assurance, industrial hygiene, ALARA, etc.) and personnel working in the field. Integrating organizational priorities, maintaining effective pre-planning of work and supporting a team-based approach to safety management represents today's hallmark of safety excellence. Relying on the mandates of any single safety program does not provide industrial hygiene with the tools necessary to implement an integrated safety program. The establishment of tools and processes capable of sustaining a comprehensive safety program represents a key responsibility of industrial hygiene. Fluor Hanford has built integrated safety management around three programmatic attributes: (1) Integration of radiological, chemical and ergonomic issues under a single program. (2) Continuous improvement in routine communications among work planning/scheduling, job execution and management. (3) Rapid response to changing work conditions, formalized work planning and integrated worker involvement.

  17. Preoperative embolization of a large vaginal leiomyoma: report of a case and review of the literature.

    PubMed

    Bapuraj, J R; Ojili, V; Singh, S K; Prasad, G R V; Khandelwal, N; Suri, S

    2006-04-01

    Leiomyoma of the vagina is a very rare tumour of the lower urogenital tract. These slow-growing masses may be asymptomatic or present with pain, dyspareunia or urinary symptoms. Rarely, these tumours may present with life-threatening haemorrhage. These hypervascular tumours are treated by surgical excision. Preoperative embolization therefore may aid in devascularization of these tumours before surgical excision. We present the MRI features of a case of vaginal leiomyoma, which was managed by preoperative embolization and was then excised in toto. To the best of our knowledge, this is the first report where preoperative embolization was performed before excision of a vaginal leiomyoma with minimal peroperative blood loss.

  18. ALARA and decommissioning: The Fort St. Vrain experience

    SciTech Connect

    Borst, T.; Niehoff, M.; Zachary, M.

    1995-03-01

    The Fort St. Vrain Nuclear Generating Station, the first and only commercial High Temperature Gas Cooled Reactor to operate in the United States, completed initial fuel loading in late 1973 and initial startup in early 1974. Due to a series of non-nuclear technical problems, Fort St. Vrain never operated consistently, attaining a lifetime capacity factor of slightly less than 15%. In August of 1989, the decision was made to permanently shut down the plant due to control rod drive and steam generator ring header failures. Public Service Company of Colorado elected to proceed with early dismantlement (DECON) as opposed to SAFSTOR on the bases of perceived societal benefits, rad waste, and exposure considerations, regulatory uncertainties associated with SAFSTOR, and cost. The decommissioning of Fort St. Vrain began in August of 1992, and is scheduled to be completed in early 1996. Decommissioning is being conducted by a team consisting of Westinghouse, MK-Ferguson, and Scientific Ecology Group. Public Service Company of Colorado as the licensee provides contract management and oversight of contractor functions. An aggressive program to maintain project radiation exposures As Low As Reasonably Achievable (ALARA) has been established, with the following program elements: temporary and permanent shielding contamination control; mockup training; engineering controls; worker awareness; integrated work package reviews communication; special instrumentation; video camera usage; robotics application; and project committees. To date, worker exposures have been less than project estimates. from the start of the project through Februrary of 1994, total exposure has been 98.666 person-rem, compared to the project estimate of 433 person-rem and goal of 347 person-rem. The presentation will discuss the site characterization efforts, the radiological performance indicator program, and the final site release survey plans.

  19. Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review.

    PubMed

    Moole, Harsha; Bechtold, Matthew; Puli, Srinivas R

    2016-07-11

    In patients requiring surgical resection for malignant biliary jaundice, it is unclear if preoperative biliary drainage (PBD) would improve mortality and morbidity by restoration of biliary flow prior to operation. This is a meta-analysis to pool the evidence and assess the utility of PBD in patients with malignant obstructive jaundice. The primary outcome is comparing mortality outcomes in patients with malignant obstructive jaundice undergoing direct surgery (DS) versus PBD. The secondary outcomes include major adverse events and length of hospital stay in both the groups. Studies using PBD in patients with malignant obstructive jaundice were included in this study. For the data collection and extraction, articles were searched in MEDLINE, PubMed, Embase, Cochrane Central Register of Controlled Trials & Database of Systematic Reviews, etc. Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian-Laird method (random effects model). Initial search identified 2230 reference articles, of which 204 were selected and reviewed. Twenty-six studies (N = 3532) for PBD in malignant obstructive jaundice which met the inclusion criteria were included in this analysis. The odds ratio for mortality in PBD group versus DS group was 0.96 (95 % CI = 0.71 to 1.29). Pooled number of major adverse effects was lower in the PBD group at 10.40 (95 % CI = 9.96 to 10.83) compared to 15.56 (95 % CI = 15.06 to 16.05) in the DS group. Subgroup analysis comparing internal PBD to DS group showed lower odds for major adverse events (odds ratio, 0.48 with 95 % CI = 0.32 to 0.74). In patients with malignant biliary jaundice requiring surgery, PBD group had significantly less major adverse effects than DS group. Length of hospital stay and mortality rate were comparable in both the groups.

  20. The Effects of Preoperative Embolization on Carotid Body Paraganglioma Surgery: A Systematic Review and Meta-analysis.

    PubMed

    Jackson, Ryan S; Myhill, Jeffrey A; Padhya, Tapan A; McCaffrey, Judith C; McCaffrey, Thomas V; Mhaskar, Rahul S

    2015-12-01

    There is no definitive consensus on the impact of preoperative embolization on carotid body paraganglioma management. The purpose of this study was to assess the effects of preoperative embolization on carotid body paraganglioma excision. A systematic search was conducted without limits, and it included studies published on or before July 2013 from PubMed, CINAHL, Web of Knowledge, and the Cochrane Library. Relevant synonyms for the search terms "paraganglioma,"carotid body tumor," and "embolization" were applied. Studies evaluating patients undergoing surgical intervention with embolization for carotid body tumors were included. Two reviewers independently assessed the titles and abstracts for inclusion and extracted the data. The guidelines set forth by the Cochrane Collaboration were followed in the process of data extraction. Data were pooled with a fixed effects model, and standardized mean difference (SMD) and 95% confidence intervals (95% CIs) are reported. A total of 22 studies (15 nonrandomized studies with a comparator, 7 single-arm studies) were included, enrolling 578 patients with 607 tumors. Patients undergoing preoperative embolization had significantly less estimated blood loss compared with those of surgical excision only (12 studies; 295 tumors; SMD: -0.52; 95% CI: -0.77, -0.28). Patients undergoing preoperative embolization had less operative time compared with that of surgical excision only (6 studies; 174 tumors; SMD: -0.46; 95% CI: -0.77, -0.14). Surgical excision with preoperative embolization appears to decrease estimated blood loss and operative time when compared with that without preoperative embolization for carotid body paragangliomas. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  1. ALARA: is there a cause for alarm? Reducing radiation risks from computed tomography scanning in children.

    PubMed

    Shah, Nikhil Bharat; Platt, Shari L

    2008-06-01

    Radiation exposure from computed tomography is associated with a small but significant increase in risk for fatal cancer over a child's lifetime. This review aims to heighten awareness and spearhead efforts to reduce unnecessary computed tomography scans in children. The use of pediatric computed tomography continues to grow despite evidence on known risks of computed tomography-related radiation and induction of fatal cancers in children. More than 60 million computed tomography scans are estimated to be performed annually in the USA, with 7 million in children. Pediatric radiologists apply the practice of ALARA ('as low as reasonably achievable') to reduce radiation exposure. Education and advocacy directed to the referring clinician reinforce these principles. Radiation exposure may be further reduced by developing clinical pathways limiting computed tomography scanning and encourage alternate, nonradiation imaging modalities, such as ultrasound and magnetic resonance imaging. Although individual risk estimates are small, widespread use of computed tomography in the population may implicate a future public health issue. Advocacy by pediatric healthcare providers to promote intelligent dose reduction based on the principles of ALARA and the judicious use of computed tomography scanning is essential to foster the safest possible care of children.

  2. Proceedings: Decommissioning, Decontamination, ALARA, and Worker Safety Workshop

    SciTech Connect

    2000-09-01

    This workshop on decontamination, ALARA, and worker safety was the sixth in a series initiated by EPRI to aid utility personnel in assessing the technologies for decommissioning nuclear power plants. The workshop focused on specific aspects of decommissioning related to the management of worker radiation exposure and safety. The information presented will help individual utilities assess benefits of programs in these areas for their projects, including their potential to reduce decommissioning costs.

  3. LANL Environmental ALARA Program Status Report for CY 2015

    SciTech Connect

    Whicker, Jeffrey Jay; Mcnaughton, Michael; Gillis, Jessica Mcdonnel; Ruedig, Elizabeth

    2016-03-29

    Los Alamos National Laboratory (LANL) ensures that radiation exposures to members of the public and the environment from LANL operations, past and present, are below regulatory thresholds and are as low as reasonably achievable (ALARA) through compliance with DOE Order 458.1 Radiation Protection for the Public and the Environment, and LANL Policy 412 Environmental Radiation Protection. In 2007, a finding (RL.2-F-1) and observation (RL.2-0-1) in the NNSA/ LASO report, September 2007, Release of Property (Land) Containing Residual Radioactive Material Self-Assessment Report, indicated that LANL had no policy or documented process in place for the release of property containing residual radioactive material. In response, LANL developed PD410, Los Alamos National Laboratory Environmental ALARA Program. The most recent version of this document became effective on September 28, 2011. The document provides program authorities, responsibilities, descriptions, processes, and thresholds for conducting qualitative and quantitative ALARA analyses for prospective and actual radiation exposures to the public and t o the environment resulting from DOE activities conducted on the LANL site.

  4. Preoperative psychosocial factors predicting patient's functional recovery after total knee or total hip arthroplasty: a systematic review.

    PubMed

    Bletterman, Anouck N; de Geest-Vrolijk, Marcella E; Vriezekolk, Johanna E; Nijhuis-van der Sanden, Maria W; van Meeteren, Nico Lu; Hoogeboom, Thomas J

    2017-09-01

    To evaluate the predictive value of preoperative psychosocial factors on the perceived and observed postoperative patient's functional recovery during the post-hospital phase and up to 12 months after hospital discharge of patients who underwent total knee or total hip arthroplasty. A systematic review was performed. MEDLINE, CINAHL, EMBASE and PsychINFO were systematically screened in order to find prospective longitudinal studies. Risk of bias was assessed using a modified version of a 27-item checklist for prognostic studies, as previously used by Veerbeek. A qualitative analysis was performed using the method of Zwikker. A total of 26 studies, with a total of 11,020 patients, were included. In total, 22 studies were judged as having a high risk of bias. Overall, no longitudinal association with perceived or observed functional recovery was found in all of the seven preoperative psychosocial categories: A: mental well-being, B: cognitions, C: beliefs, D: expectations, E: coping, F: social support or G: personality traits in total joint arthroplasty. Mental well-being seems to be the exception in one time period (>6 weeks through ≤3 months) and change score in observed functional recovery, but only in patients awaiting total knee arthroplasty (100% and 75% of the variables were significantly and consistently associated, respectively). Overall, the results of this systematic review suggest that there is no longitudinal association between preoperative psychosocial factors and perceived or observed patient's postoperative functional recovery after total joint arthroplasty. The psychological category mental well-being is related to observed postoperative recovery >6 weeks through ≤3 months and to change score after total knee arthroplasty.

  5. History and Culture of Alara--The Action Learning and Action Research Association

    ERIC Educational Resources Information Center

    Zuber-Skerritt, Ortrun; Passfield, Ron

    2016-01-01

    As co-founders of the Action Learning and Action Research Association (ALARA), we tell the story of this international network organisation through our personal experience. Our history traces the evolution of ALARA from origins at the first World Congress in 1990 in Brisbane, Australia, through development over two and a half decades, to its…

  6. History and Culture of Alara--The Action Learning and Action Research Association

    ERIC Educational Resources Information Center

    Zuber-Skerritt, Ortrun; Passfield, Ron

    2016-01-01

    As co-founders of the Action Learning and Action Research Association (ALARA), we tell the story of this international network organisation through our personal experience. Our history traces the evolution of ALARA from origins at the first World Congress in 1990 in Brisbane, Australia, through development over two and a half decades, to its…

  7. Functional and postoperative outcomes after preoperative exercise training in patients with lung cancer: a systematic review and meta-analysis.

    PubMed

    Sebio Garcia, Raquel; Yáñez Brage, Maria Isabel; Giménez Moolhuyzen, Esther; Granger, Catherine L; Denehy, Linda

    2016-09-01

    Lung cancer is the leading cause of cancer-related death worldwide. For early stages of the disease, lung resection surgery remains the best treatment with curative intent, but significant morbidity is associated, especially among patients with poor pulmonary function and cardiorespiratory fitness. In those cases, the implementation of a preoperative exercise-based intervention could optimize patient's functional status before surgery and improve postoperative outcomes and enhance recovery. The aim of this systematic review is to provide the current body of knowledge regarding the effectiveness of a preoperative exercise-based intervention on postoperative and functional outcomes in patients with lung cancer submitted to lung resection surgery. A systematic review of the literature using CINAHL, EMBASE, MEDLINE, Pubmed, PEDro and SCOPUS was undertaken in September 2015 yielding a total of 1656 references. Two independent reviewers performed the assessment of the potentially eligible records against the inclusion criteria and finally, 21 articles were included in the review. Articles were included if they examined the effects of an exercise-based intervention on at least one of the selected outcomes: pulmonary function, (functional) exercise capacity, health-related quality of life (HRQoL) and postoperative outcomes (length of stay and postoperative complications). Fourteen studies were further selected for a meta-analysis to quantify the mean effect of the intervention and generate 95% confidence intervals (CIs) using the Cochrane Review Manager 5.0.25. For two of the outcomes included (exercise capacity and HRQoL), studies showed large heterogeneity and thus, a meta-analysis was considered inappropriate. Pulmonary function (forced vital capacity and forced expiratory volume in 1 s) was significantly enhanced after the intervention [standardized mean difference (SMD) = 0.38; 95% CI 0.14, 0.63 and SMD = 0.27, 95% CI 0.11, 0.42, respectively]. In comparison with the

  8. Prognostic Value of Pre-operative Renal Insufficiency in Urothelial Carcinoma: A Systematic Review and Meta-Analysis

    PubMed Central

    Cao, Jian; Zhao, Xiaokun; Zhong, Zhaohui; Zhang, Lei; Zhu, Xuan; Xu, Ran

    2016-01-01

    The effect of pre-operative renal insufficiency on urothelial carcinoma (UC) prognosis has been investigated by numerous studies. While the majority report worse UC outcomes in patients with renal insufficiency, the results between the studies differed wildly. To enable us to better estimate the prognostic value of renal insufficiency on UC, we performed a systematic review and meta-analysis based on the published literature. A total of 16 studies which involved 5,232 patients with UC, investigated the relationship between pre-operative renal insufficiency and disease prognosis. Estimates of combined hazard ratio (HR) for bladder urothelial carcinoma recurrence, cancer-specific survival (CSS) and overall survival (OS) were 1.65 (95% CI, 1.11–2.19), 1.59 (95% CI, 1.14–2.05) and 1.45 (95% CI, 1.19–1.71), respectively; and for upper urinary tract urothelial carcinoma recurrence, CSS and OS were 2.27 (95% CI, 1.42–3.12), 1.02 (95% CI, 0.47–1.57) and 1.52 (95% CI, 1.05–1.99), respectively. Our results indicate that UC patients with pre-operative renal insufficiency tend to have higher recurrence rates and poorer survival compared to those with clinically normal renal function, thus renal function should be closely monitored in these patients. The impact of intervention for renal insufficiency on the prognosis of UC needs to be further studied. PMID:27725745

  9. [Cervical cancer staging - preoperative assessment of tumor extent (a review of the most recent ultrasound studies)].

    PubMed

    Fischerová, D

    2014-12-01

    For treatment planning of cervical cancer it is necessary preoperatively to determine the presence and size of residual tumour after the biopsy, the tumour topography within the cervix and the parametrial and lymph node status. According to current data, ultrasound is comparably accurate with magnetic resonance imaging in view of tumour presence and local extent assessment. Ultrasound, if compared with the magnetic resonance imaging, does not have known contraindications and it is a broadly available diagnostic test. Currently no advanced imaging technique exists that can reliably detect infiltrated lymph nodes in the clinically early stage of the disease, as it often manifests as micrometastatic involvement in non-enlarged lymph nodes. The sensitivity of lymph node detection using ultrasound in the early stage is around 40%, but the specificity is high (96%). For daily practice, this means that a negative ultrasound finding should be always verified by surgical staging based on systematic lymphadenectomy, while positive ultrasound finding usually changes the treatment strategy.

  10. The Importance of Preoperative Staging of Rectal Cancer Using Multiparametric MRI. A Systematic Review

    PubMed

    Bauer, Ferdinand

    2016-01-01

    A correct preoperative stadialization of rectal carcinoma has a direct influence upon its therapeutic strategy, resulting in a significant improvement of the survival rate and life quality after the treatment. The therapeutic strategy refers to the option of undergoing or not preoperative radiochemotherapy before the total mesorectal excision (TME). The technical advances in the magnetic resonance domain makes possible the multiparametric examinations (mp MRI) with medical equipments (3T models are common) good enough to obtain images having an excellent quality, which allow a correct diagnosis of the local tumour spread. These multiparametric examinations include T2 multiplan sequences and T1 sequences, which offer valuable morphological information due to the high resolution of anatomic structures and DWI functional sequences, with a decisive role in tracing residual tumours after post-surgery radiochemotherapy. The functional examination using DWI is the only highly accurate non-invasive diagnostic method which can differentiate the fibrosis from vital tumoral remnants. The dynamic contrast-enhanced examination (DCE) combined with DWI and volumetry can give supplementary information as to the complete and incomplete response to RCT, and is efficient in detecting a local recurrence after TME. Also, MRI is the only diagnostic method which has the necessary accuracy to assess the meso-rectal fascia, which represents the circumferential resection margin (CRM) in the case of TME. With the help of MRI we can measure with a precision similar to histology the minimal distance to the mesorectal fascia, essential in planning the surgical treatment, and more important than the T stadialization. This allows the selection of patients with an unfavourable prognosis factor who would benefit from radiotherapy or from RCT. The evaluation of other prognostic factors as the condition of nodes, their number and primary site, and the extramural venous invasion (EMVI) have an

  11. Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis.

    PubMed

    Fiorica, F; Di Bona, D; Schepis, F; Licata, A; Shahied, L; Venturi, A; Falchi, A M; Craxì, A; Cammà, C

    2004-07-01

    The benefit of neoadjuvant chemoradiotherapy in oesophageal cancer has been extensively studied but data on survival are still equivocal. To assess the effectiveness of chemoradiotherapy followed by surgery in the reduction of mortality in patients with resectable oesophageal cancer. Computerised bibliographic searches of MEDLINE and CANCERLIT (1970-2002) were supplemented with hand searches of reference lists. Studies were included if they were randomised controlled trials (RCTs) comparing preoperative chemoradiotherapy plus surgery with surgery alone, and if they included patients with resectable histologically proven oesophageal cancer without metastatic disease. Six eligible RCTs were identified and included in the meta-analysis. Data on study populations, interventions, and outcomes were extracted from each RCT according to the intention to treat method by three independent observers and combined using the DerSimonian and Laird method. Chemoradiotherapy plus surgery compared with surgery alone significantly reduced the three year mortality rate (odds ratio (OR) 0.53 (95% confidence interval (CI) 0.31-0.93); p = 0.03) (number needed to treat = 10). Pathological examination showed that preoperative chemoradiotherapy downstaged the tumour (that is, less advanced stage at pathological examination at the time of surgery) compared with surgery alone (OR 0.43 (95% CI 0.26-0.72); p = 0.001). The risk for postoperative mortality was higher in the chemoradiotherapy plus surgery group (OR 2.10 (95% CI 1.18-3.73); p = 0.01). In patients with resectable oesophageal cancer, chemoradiotherapy plus surgery significantly reduces three year mortality compared with surgery alone. However, postoperative mortality was significantly increased by neoadjuvant chemoradiotherapy. Further large scale multicentre RCTs may prove useful to substantiate the benefit on overall survival.

  12. Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis

    PubMed Central

    Fiorica, F; Di Bona, D; Schepis, F; Licata, A; Shahied, L; Venturi, A; Falchi, A M; Craxì, A; Cammà, C

    2004-01-01

    Background: The benefit of neoadjuvant chemoradiotherapy in oesophageal cancer has been extensively studied but data on survival are still equivocal. Objective: To assess the effectiveness of chemoradiotherapy followed by surgery in the reduction of mortality in patients with resectable oesophageal cancer. Methods: Computerised bibliographic searches of MEDLINE and CANCERLIT (1970–2002) were supplemented with hand searches of reference lists. Study selection: Studies were included if they were randomised controlled trials (RCTs) comparing preoperative chemoradiotherapy plus surgery with surgery alone, and if they included patients with resectable histologically proven oesophageal cancer without metastatic disease. Six eligible RCTs were identified and included in the meta-analysis. Data extraction: Data on study populations, interventions, and outcomes were extracted from each RCT according to the intention to treat method by three independent observers and combined using the DerSimonian and Laird method. Results: Chemoradiotherapy plus surgery compared with surgery alone significantly reduced the three year mortality rate (odds ratio (OR) 0.53 (95% confidence interval (CI) 0.31–0.93); p = 0.03) (number needed to treat = 10). Pathological examination showed that preoperative chemoradiotherapy downstaged the tumour (that is, less advanced stage at pathological examination at the time of surgery) compared with surgery alone (OR 0.43 (95% CI 0.26–0.72); p = 0.001). The risk for postoperative mortality was higher in the chemoradiotherapy plus surgery group (OR 2.10 (95% CI 1.18–3.73); p = 0.01). Conclusions: In patients with resectable oesophageal cancer, chemoradiotherapy plus surgery significantly reduces three year mortality compared with surgery alone. However, postoperative mortality was significantly increased by neoadjuvant chemoradiotherapy. Further large scale multicentre RCTs may prove useful to substantiate the benefit on overall

  13. Open Sinus Lift Surgery and the Importance of Preoperative Cone-Beam Computed Tomography Scan: A Review

    PubMed Central

    Rahpeyma, Amin; Khajehahmadi, Saeedeh

    2015-01-01

    Open sinus lift surgery is a form of pre-prosthetic surgery for increasing the quality and quantity of bone in the posterior region of the maxilla. Pre-operative assessment of the maxillary sinus is essential for the success of this surgery. PubMed search was carried out in English language literature for open sinus lift surgery and cone-beam computed tomography (CBCT). The results focused on anatomic variants, vascular anatomy, complications, osteotomy/ostectomy window dimensions and thickness of the Schneiderian Membrane. 59 articles were included in this review. Features other than the height and the width of the residual alveolar ridge that should be evaluated in preoperative CBCT scan include the thickness of the lateral maxillary sinus wall, the presence of the alveolar antral artery and its diameter, the maxillary sinus floor width and angulation, irregularity of sinus floor, intimate relation of Schneiderian membrane with the roots of the adjacent teeth, sinus septum, and the quality of subantral bone. Other conditions that occasionally may be observed in special situations are also explained. More than ten parameters should be checked in evaluating CBCT images of paranasal sinuses other than the width and the length of the residual ridge in the posterior region of the maxilla. Each of them may have a significant impact on the results of the open sinus lift surgery. PMID:26435632

  14. Open Sinus Lift Surgery and the Importance of Preoperative Cone-Beam Computed Tomography Scan: A Review.

    PubMed

    Rahpeyma, Amin; Khajehahmadi, Saeedeh

    2015-09-01

    Open sinus lift surgery is a form of pre-prosthetic surgery for increasing the quality and quantity of bone in the posterior region of the maxilla. Pre-operative assessment of the maxillary sinus is essential for the success of this surgery. PubMed search was carried out in English language literature for open sinus lift surgery and cone-beam computed tomography (CBCT). The results focused on anatomic variants, vascular anatomy, complications, osteotomy/ostectomy window dimensions and thickness of the Schneiderian Membrane. 59 articles were included in this review. Features other than the height and the width of the residual alveolar ridge that should be evaluated in preoperative CBCT scan include the thickness of the lateral maxillary sinus wall, the presence of the alveolar antral artery and its diameter, the maxillary sinus floor width and angulation, irregularity of sinus floor, intimate relation of Schneiderian membrane with the roots of the adjacent teeth, sinus septum, and the quality of subantral bone. Other conditions that occasionally may be observed in special situations are also explained. More than ten parameters should be checked in evaluating CBCT images of paranasal sinuses other than the width and the length of the residual ridge in the posterior region of the maxilla. Each of them may have a significant impact on the results of the open sinus lift surgery.

  15. The program of the ALARA Center at Brookhaven National Laboratory

    SciTech Connect

    Khan, T.A.; Baum, J.W.

    1993-01-01

    In 1984 the Brookhaven National Laboratory was asked by the Nuclear Regulatory Commission to set up a Center to monitor dose-reduction efforts in the US and abroad and to focus the industry's attention on ALARA. The paper summarizes the main work of the ALARA Center between 1984 and 1992. The Center maintains nine data bases for the NRC and the Nuclear Power Industry. These databases are constantly updated and access to them is provided through a personal computer and a modem and by periodic publications in the form of a newsletter and NUREG reports. Also described briefly are eight other projects related to dose-reduction at nuclear power plants that the Center has carried out for the NRC. Among these are projects that analyze the cost-effectiveness of engineering modifications, look at worldwide activities at dose reduction and compare US and foreign dose experience, examine high-dose worker groups and high-dose jobs, develop optimum techniques to control contamination at nuclear plants, and look at the doses being received by men and women in all sectors of the nuclear industry.

  16. The program of the ALARA Center at Brookhaven National Laboratory

    SciTech Connect

    Khan, T.A.; Baum, J.W.

    1993-04-01

    In 1984 the Brookhaven National Laboratory was asked by the Nuclear Regulatory Commission to set up a Center to monitor dose-reduction efforts in the US and abroad and to focus the industry`s attention on ALARA. The paper summarizes the main work of the ALARA Center between 1984 and 1992. The Center maintains nine data bases for the NRC and the Nuclear Power Industry. These databases are constantly updated and access to them is provided through a personal computer and a modem and by periodic publications in the form of a newsletter and NUREG reports. Also described briefly are eight other projects related to dose-reduction at nuclear power plants that the Center has carried out for the NRC. Among these are projects that analyze the cost-effectiveness of engineering modifications, look at worldwide activities at dose reduction and compare US and foreign dose experience, examine high-dose worker groups and high-dose jobs, develop optimum techniques to control contamination at nuclear plants, and look at the doses being received by men and women in all sectors of the nuclear industry.

  17. Intradural lumbar disc herniations: the role of MRI in preoperative diagnosis and review of the literature.

    PubMed

    D'Andrea, Giancarlo; Trillò, Giuseppe; Roperto, Raffaelino; Celli, Paolo; Orlando, Epimenio Ramundo; Ferrante, Luigi

    2004-04-01

    The goal of this article is to report our experience on intradural lumbar disc herniation, consider the causes of this pathology, and analyze it from clinical, diagnostic, and therapeutic perspectives with a particular emphasis on the role of MRI in preoperative diagnosis. We analyzed nine patients treated surgically for intradural lumbar disc hernia. All of them underwent surgery, and hemilaminectomy was performed. In six cases, the diagnosis of intradural herniation was definitive and, in the three remaining, it was confirmed at surgery. In five cases, CT (with no contrast medium) of the lumbar area revealed disc herniation, but none could it confirm its intradural location. Myelography was performed in two cases but also could not prove intradural extrusion. Magnetic resonance imaging study was used in four cases. In five, the postoperative outcome has been excellent. Patients 6 and 9 recovered anal function postoperatively; patient 6 suffered from occasional and mild micturition urgency. The three patients previously operated (1, 2, 7) showed good outcome. Presently, we believe that radiologic diagnosis of intradural herniation is possible in carefully selected patients, thanks to MRI with gadolinium.

  18. ALARA assessment of spent fuel and nuclear waste transportation systems

    SciTech Connect

    Sutherland, S. H.

    1980-01-01

    The effects of ALARA (as low as reasonably achievable) on transportation system costs were evaluated for LWR spent fuel, high-level commercial and defense wastes, and remotely handled TRU waste. Three dose rate specifications were used: 10 mrem/h at 2m, 5 mrem/h, and 2 mrem/h. The evaluation was done for wastes and LWR spent fuel 1, 3, 5, and 10 years old. Gamma shield materials were depleted uranium, lead, and steel; the neutron shield material was water. Results for a 7-element PWR cask show that uranium shielding is the lightest, and that the increased weight of the low dose rate casks results in 1 to 2 million dollars increase in lifetime transportation costs. 6 figures, 3 tables. (DLC)

  19. Application of ALARA principles to shipment of spent nuclear fuel

    SciTech Connect

    Greenborg, J.; Brackenbush, L.W.; Murphy, D.W. Burnett, R.A.; Lewis, J.R.

    1980-05-01

    The public exposure from spent fuel shipment is very low. In view of this low exposure and the perfect safety record for spent fuel shipment, existing systems can be considered satisfactory. On the other hand, occupational exposure reduction merits consideration and technology improvement to decrease dose should concentrate on this exposure. Practices that affect the age of spent fuel in shipment and the number of times the fuel must be shipped prior to disposal have the largest impact. A policy to encourage a 5-year spent fuel cooling period prior to shipment coupled with appropriate cask redesign to accommodate larger loads would be consistent with ALARA and economic principles. And finally, bypassing high population density areas will not in general reduce shipment dose.

  20. Ethics of randomized clinical trials and the 'ALARA' approach.

    PubMed

    Zwitter, M

    1999-01-01

    A balanced discussion on the ethics of randomized clinical trials should not be based on a single ethical aspect such as respect for the patient's autonomy. Rather, the analysis should consider the four ethical principles--respect for autonomy, non-maleficence, beneficence, and justice--as applicable to all groups of persons concerned. We present the ethical benefits and costs of the present practice of randomized clinical trials for four groups: patients involved in clinical trials, patients not involved in trials, participating physicians and society. The ALARA (As Low As Reasonably Achievable) approach is then introduced and practical measures to achieve a positive balance between ethical benefits and costs of randomized trials are proposed.

  1. Multilateral analysis of increasing collective dose and new ALARA programme.

    PubMed

    Oumi, Tadashi; Morii, Yasuki; Imai, Toshirou

    2011-07-01

    JAPC (The Japan Atomic Power Company) is the only electric power company that operates different types of nuclear reactors in Japan; it operates two BWRs (boiling water reactors), one pressurised water reactor and one gas cooled reactor. JAPC has been conducting various activities aimed at reducing radiation dose received by workers for over 45 y. Recently, the collective dose resulting from periodic maintenance has increased at each plant because of the replacement of large equipment and the unexpected extension of the outage period. In particular, the collective dose at Tokai-2 is one of the highest among Japanese BWR plants((1)), owing to the replacement and strengthening of equipment to meet earthquake-proof requirements. In this study, the authors performed a multilateral analysis of unacceptably a large collective dose and devised a new ALARA programme that includes a 3D dose prediction map and the development of machines to assist workers.

  2. Reducing patient radiation exposure during paediatric SVT ablations: use of CARTO® 3 in concert with "ALARA" principles profoundly lowers total dose.

    PubMed

    Pass, Robert H; Gates, Gregory G; Gellis, Laura A; Nappo, Lynn; Ceresnak, Scott R

    2015-06-01

    "ALARA--As Low As Reasonably Achievable" protocols reduce patient radiation dose. Addition of electroanatomical mapping may further reduce dose. From 6/11 to 4/12, a novel ALARA protocol was utilised for all patients undergoing supraventricular tachycardia ablation, including low frame rates (2-3 frames/second), low fluoro dose/frame (6-18 nGy/frame), and other techniques to reduce fluoroscopy (ALARA). From 6/12 to 3/13, use of CARTO® 3 (C3) with "fast anatomical mapping" (ALARA+C3) was added to the ALARA protocol. Intravascular echo was not utilised. Demographics, procedural, and radiation data were analysed and compared between the two protocols. A total of 75 patients were included: 42 ALARA patients, and 33 ALARA+C3 patients. Patient demographics were similar between the two groups. The acute success rate in ALARA was 95%, and 100% in ALARA+C3; no catheterisation-related complications were observed. Procedural time was 125.7 minutes in the ALARA group versus 131.4 in ALARA+C3 (p=0.36). Radiation doses were significantly lower in the ALARA+C3 group with a mean air Kerma in ALARA+C3 of 13.1±28.3 mGy (SD) compared with 93.8±112 mGy in ALARA (p<0.001). Mean dose area product was 92.2±179 uGym2 in ALARA+C3 compared with 584±687 uGym2 in ALARA (p<0.001). Of the 33 subjects (42%) in the ALARA+C3 group, 14 received ⩽1 mGy exposure. The ALARA+C3 dosages are the lowest reported for a combined electroanatomical-fluoroscopy technique. Addition of CARTO® 3 to ALARA protocols markedly reduced radiation exposure to young people undergoing supraventricular tachycardia ablation while allowing for equivalent procedural efficacy and safety.

  3. ALARA Council: Sharing our resources and experiences to reduce doses at Commonwealth Edison Facilities

    SciTech Connect

    Rescek, F.

    1995-03-01

    Commonwealth Edison Company is an investor-owned utility company supplying electricity to over three million customers (eight million people) in Chicago and northern Illinois, USA. The company operates 16 generating stations which have the capacity to produce 22,522 megawatts of electricity. Six of these generating stations, containing 12 nuclear units, supply 51% of this capacity. The 12 nuclear units are comprised of four General Electric boiling water (BWR-3) reactors, two General Electric BWR-5 reactors, and six Westinghouse four-loop pressurized water reactors (PWR). In August 1993, Commonwealth Edison created an ALARA Council with the responsibility to provide leadership and guidance that results in an effective ALARA Culture within the Nuclear Operations Division. Unlike its predecessor, the Corporate ALARA Committee, the ALARA Council is designed to bring together senior managers from the six nuclear stations and corporate to create a collaborative effort to reduce occupational doses at Commonwealth Edison`s stations.

  4. Preoperative patient education for breast reconstruction: a systematic review of the literature.

    PubMed

    Preminger, Beth Aviva; Lemaine, Valerie; Sulimanoff, Isabel; Pusic, Andrea L; McCarthy, Colleen M

    2011-06-01

    This study aims to assess the current state of patient educational tools available for the purposes of educating women about postmastectomy breast reconstruction. A systematic review of the English language literature was conducted between the years 1966 and 2009 of all studies pertaining to the use of educational materials for breast reconstruction. MEDLINE, CINAHAL, PsycINFO, EMBASE, SCOPUS, and the Science Citation Index were searched. Only studies that both employed and evaluated a patient educational tool in the setting of postmastectomy reconstruction were selected for review. Qualifying studies were then evaluated with respect to their study design, sample size, and outcome measure evaluated. Each educational tool identified was similarly evaluated with respect to its development process, content, and educational medium. A total of 497 articles were retrieved. Of these, only seven met our inclusion criteria. These publications evaluated a total of seven educational tools. Among them were employed various mediums including written, visual, and audio materials. Detailed review revealed that the development of only one educational program included an educational needs assessment. Only two of the seven studies identified evaluated the efficacy of their educational tool using a randomized controlled trial study design. Outcome measures evaluated varied among the studies identified and included: knowledge gains (n = 4), the 'yes' or 'no' decision to undergo reconstruction (n = 3), satisfaction with decision regarding reconstruction (n = 1), decisional conflict (n = 3), and type of reconstruction (n = 3). This review highlights the need for well-designed, methodologically sound research into patient education regarding breast reconstruction. Such information is invaluable in developing patient education programs and decision aids that aim at patient empowerment.

  5. Fluor hanford ALARA center -showcases- tools, equipment, and work practices used during D and D work

    SciTech Connect

    Waggoner, L.O.

    2007-07-01

    In 1996, Fluor established the ALARA Center at the Department of Energy's (DOE) Hanford Site in southeastern Washington State to 'showcase' tools and equipment used to support the principle of As Low As Reasonably Achievable (ALARA). Much of the work was being done by workers who used hand tools while dressed in multiple sets of protective clothing. The Center was opened so that workers could see and handle the latest tools and equipment and have experienced personnel to help them plan work evolutions. Experienced personnel who were familiar with the ALARA concept as well as new technology were assigned to the Center. In addition, vendors were asked to display their products so the Hanford workers could experience state-of-the-art tools and equipment for doing work in a radiological environment. Since opening, the ALARA Center has evolved into a tremendous resource - not only for Hanford, but also most of the entire DOE Complex, as well as contractors around the world. Classes in fundamental radiological work practices are presented when the facilities recognize a need. The ALARA Center has a variety of products that range from simple hand tools to robots, video scopes, and gamma cameras. The tools and equipment on display are used in these training classes to train the workers on the work practices to operate them, take them apart to determine how they work and decide how to maintain them. Many facilities invite the ALARA Center staff to attend planning meetings at the facilities and participate in job walk-downs. Generally, ALARA Center personnel provide several options on how the radiological work can be accomplished safely and recommend the option that is ALARA and safest for the workers. A few years ago, it became obvious that the work scope was changing and many facilities had a new job to clean out the facilities and demolish them. The ALARA Center began contacting vendors who had tools and equipment that could be used for D and D work. Today, the ALARA

  6. Does preoperative physiotherapy improve postoperative, patient-based outcomes in older adults who have undergone total knee arthroplasty? A systematic review.

    PubMed

    Chesham, Ross Alexander; Shanmugam, Sivaramkumar

    2017-01-01

    Knee osteoarthritis (OA) is a leading cause of disability in older adults (≥60) in the UK. If nonsurgical management fails and if OA severity becomes too great, knee arthroplasty is a preferred treatment choice. Preoperative physiotherapy is often offered as part of rehabilitation to improve postoperative patient-based outcomes. Systematically review whether preoperative physiotherapy improves postoperative, patient-based outcomes in older adults who have undergone total knee arthroplasty (TKA) and compare study interventions to best-practice guidelines. A literature search of Randomized Controlled Trials (RCTs), published April 2004-April 2014, was performed across six databases. Individual studies were evaluated for quality using the PEDro Scale. Ten RCTs met the full inclusion/exclusion criteria. RCTs compared control groups versus: preoperative exercise (n = 5); combined exercise and education (n = 2); combined exercise and acupuncture (n = 1); neuromuscular electrical stimulation (NMES; n = 1); and acupuncture versus exercise (n = 1). RCTs recorded many patient-based outcomes including knee strength, ambulation, and pain. Minimal evidence is presented that preoperative physiotherapy is more effective than no physiotherapy or usual care. PEDro Scale and critical appraisal highlighted substantial methodological quality issues within the RCTs. There is insufficient quality evidence to support the efficacy of preoperative physiotherapy in older adults who undergo total knee arthroplasty.

  7. 3D haptic modelling for preoperative planning of hepatic resection: A systematic review.

    PubMed

    Soon, David S C; Chae, Michael P; Pilgrim, Charles H C; Rozen, Warren Matthew; Spychal, Robert T; Hunter-Smith, David J

    2016-09-01

    Three dimensional (3D) printing has gained popularity in the medical field because of increased research in the field of haptic 3D modeling. We review the role of 3D printing with specific reference to liver directed applications. A literature search was performed using the scientific databases Medline and PubMed. We performed this in-line with the PRISMA [20] statement. We only included articles in English, available in full text, published about adults, about liver surgery and published between 2005 and 2015. The 3D model of a patient's liver venous vasculature and metastasis was prepared from a CT scan using Osirix software (Pixmeo, Gineva, Switzerland) and printed using our 3D printer (MakerBot Replicator Z18, US). To validate the model, measurements from the inferior vena cava (IVC) were compared between the CT scan and the 3D printed model. A total of six studies were retrieved on 3D printing directly related to a liver application. While stereolithography (STL) remains the gold standard in medical additive manufacturing, Fused Filament Fabrication (FFF), is cheaper and may be more applicable. We found our liver 3D model made by FFF had a 0.1 ± 0.06 mm margin of error (mean ± standard deviation) compared with the CT scans. 3D printing in general surgery is yet to be thoroughly exploited. The most relevant feature of interest with regard to liver surgery is the ability to view the 3D dimensional relationship of the various hepatic and portal veins with respect to tumor deposits when planning hepatic resection. Systematic review registration number: researchregistry1348.

  8. A systematic review of pre-operative predictors of post-operative depression and anxiety in individuals who have undergone coronary artery bypass graft surgery.

    PubMed

    McKenzie, Louise H; Simpson, Jane; Stewart, Marie

    2010-01-01

    In addition to the physical benefits, another important objective of coronary artery bypass graft (CABG) surgery is improvement of health-related quality of life. The aim of this systematic review is to provide an overview of the literature relating to the pre-operative prediction of post-operative depression and anxiety in individuals who have undergone CABG surgery. Forty-six studies were identified through a literature search of electronic databases conducted using explicit inclusion and exclusion criteria. The study characteristics, methodological features, and psychometric and clinical outcomes were summarised in a systematic manner. Collective appraisal of the studies indicated that symptoms of depression and anxiety exhibited after CABG surgery are best predicted by pre-operative measures of functioning in that area. Papers were inconclusive with respect to the predictive qualities of gender and age. Further research is required to clarify the predictive values of these and other factors, including pre-morbid ill health and socio-economic status. The findings of this review indicate a range of pre-operative predictors of post-operative depression and anxiety in patients with CABG. Chief among these are pre-operative depression and anxiety. These findings have clinical implications concerning the importance of pre and post-operative psychological assessment and intervention for individuals at risk of poor psychological recovery.

  9. Clinical application of 'Justification' and 'Optimization' principle of ALARA in pediatric CT imaging: "How many children can be protected from unnecessary radiation?".

    PubMed

    Sodhi, Kushaljit S; Krishna, Satheesh; Saxena, Akshay K; Sinha, Anindita; Khandelwal, Niranjan; Lee, Edward Y

    2015-09-01

    Practice of ALARA (as low as reasonably achievable) principle in the developed world is currently well established. However, there is striking lack of published data regarding such experience in the developing countries. Therefore, the goal of this study is to prospectively evaluate CT request forms to assess how many children could be protected from harmful radiation exposure if 'Justification' and 'Optimization' principles of ALARA are applied before obtaining CT imaging in a developing country. This can save children from potential radiation risks including development of brain cancer and leukemia. Consecutive CT request forms over a six month study period (May 16, 2013 to November 15, 2013) in a tertiary pediatric children's hospital in India were prospectively reviewed by two pediatric radiologists before obtaining CT imaging. First, 'Justification' of CT was evaluated and then 'Optimization' was applied for evaluation of appropriateness of the requested CT studies. The number (and percentage) of CT studies avoided by applying 'Justification' and 'Optimization' principle of ALARA were calculated. The difference in number of declined and optimized CT requests between CT requests from inpatient and outpatient departments was compared using Chi-Square test. A total of 1302 consecutive CT request forms were received during the study period. Some of the request forms (n=86; 6.61%) had requests for more than one (multiple) anatomical regions, hence, a total of 1392 different anatomical CT requests were received. Based on evaluation of the CT request forms for 'Justification' and 'Optimization' principle of ALARA by pediatric radiology reviewers, 111 individual anatomic part CT requests from 105 pediatric patients were avoided. Therefore, 8.06% (105 out of 1302 pediatric patients) were protected from unnecessary or additional radiation exposure.The rates of declined or optimized CT requests from inpatient department was significantly higher than that from outpatient

  10. Interpretation of ALARA in the Canadian regulatory framework

    SciTech Connect

    Utting, R.

    1995-03-01

    The Atomic Energy Control Board (AECB) is responsible for the regulation of all aspects of atomic energy in Canada. This includes the complete nuclear fuel cycle from uranium mining to long-term disposal of nuclear fuel, as well as the medical and industrial utilization of radioisotopes. Clearly, the regulatory approach will differ from practice to practice but, as far as possible, the AECB has attempted to minimize the degree of prescription of regulatory requirements. The traditional modus operandi of the AECB has been to have broad general principles enshrined in regulations with the requirement that licensees submit specific operating policies and procedures to the AECB for approval. In the large nuclear facilities with their sophisticated technical infrastructures, this policy has been largely successful although in a changing legal and political milieu the AECB is finding that a greater degree of proactive regulation is becoming necessary. With the smaller users, the AECB has for a long time found it necessary to have a greater degree of prescription in its regulatory function. Forthcoming General Amendments to the Atomic Energy Control Regulations will, amongst other things, formally incorporate the concept of ALARA into the Canadian regulatory framework. Within the broad range of practices licensed by the AECB it is not practical to provide detailed guidance on optimization that will be relevant and appropriate to all licensees, however the following general principles are proposed.

  11. The use of pre-operative brain natriuretic peptides as a predictor of adverse outcomes after cardiac surgery: a systematic review and meta-analysis.

    PubMed

    Litton, Edward; Ho, Kwok M

    2012-03-01

    The objective of this systematic review was to assess whether pre-operative brain natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT pro-BNP) are independent predictors of adverse outcomes after cardiac surgery. MEDLINE, Embase and the Cochrane Controlled Trials Register databases were searched. Eligible studies included observational or randomized control trials measuring natriuretic peptide concentrations before induction of anaesthesia for cardiac surgery. Two investigators independently extracted the data and assessed the validity of the included studies. The predictive ability of pre-operative BNP or NT pro-BNP on mortality, post-operative atrial fibrillation (AF) and intra-aortic balloon pump (IABP) requirement was meta-analysed. The association between BNP or NT pro-BNP and other outcomes was systematically summarized. A total of 4933 patients from 22 studies were considered in the systematic review. Ten studies with one or more outcomes of interest were included in the meta-analyses. The strength of association between pre-operative natriuretic peptide levels and adverse outcomes after surgery was variable, as was the size and quality of the included studies. The summary areas under the receiver operating characteristic curve for mortality, post-operative AF and post-operative IABP requirement were 0.61 (95% confidence interval [CI] 0.51-0.70), 0.61 (95% CI 0.58-0.64) and 0.81 (95% CI 0.73-0.89), respectively. With the limited data available, the associations between pre-operative natriuretic peptide levels and adverse outcomes after cardiac surgery were moderate. Future studies should assess whether pre-operative natriuretic peptides can provide additional independent predictive information to well-validated prognostic scores of cardiac surgery.

  12. The ALARA concept in pediatric cardiac catheterization: techniques and tactics for managing radiation dose.

    PubMed

    Justino, Henri

    2006-09-01

    The cardiac catheterization laboratory plays an important role in the management of children with congenital heart disease by not only enabling diagnosis but, in many cases, providing definitive therapy. The goal of the ALARA (As Low as Reasonably Achievable) concept as it applies to cardiac catheterization is to provide maximal diagnostic and therapeutic benefit while requiring the lowest possible radiation dose. A number of specific challenges unique to the setting of pediatric cardiac catheterization, such as higher heart rates, smaller cardiovascular structures, smaller body size, and wider variety of unusual anatomic variants with the potential need for relatively lengthy and complex studies, result in relatively high radiation doses (to the patient and, consequently, to laboratory personnel). In addition, the improved survival of patients with complex anatomy (e.g., palliated single ventricle anatomies) implies that many such children with chronic cardiac disease require frequent catheterizations within the first few years of life. These factors, coupled with the increased radiosensitivity of children and a longer lifespan ahead of them in which to possibly develop radiation-related sequelae, converge to create potentially ominous consequences. Attention to basic rules of radiation safety is, therefore, of tremendous importance in the pediatric cardiac catheterization laboratory. This review focuses on the importance of adequate planning of the study, optimizing image formation, management of fluoroscopy and cine angiography parameters, and the use of certain equipment features that might allow the cardiologist to lower the radiation dose without sacrificing image quality.

  13. A 20-year retrospective analysis of CT-based pre-operative identification of pulmonary metastases in patients with osteosarcoma: A single-center review.

    PubMed

    Heaton, Todd E; Hammond, William J; Farber, Benjamin A; Pallos, Valerie; Meyers, Paul A; Chou, Alexander J; Price, Anita P; LaQuaglia, Michael P

    2017-01-01

    Cooperative studies support complete metastasectomy in osteosarcoma (OS). Pre-operative CT is used to identify and quantify metastases and can facilitate minimally invasive techniques. Here we assess the accuracy of pre-operative CT compared to findings at thoracotomy and its change over time. We reviewed OS thoracotomies performed at our institution from 1996 to 2015. The number of metastases identified on pre-operative chest CT was compared to the number of metastases seen on pathology (both metastases with viable cells and non-viable, osteoid-only metastases). Eighty-eight patients underwent 161 thoracotomies with a median of 14days (range, 1-85) between CT and surgery, a median of 2 CT-identified lesions (range, 0-15), and a median of 4 resected lesions (range, 1-25). In 56 (34.8%) cases, more metastases were found surgically than were seen on CT, and among these, 34 (21.1%) had a greater number of viable metastases. There was poor overall correlation between CT and pathology findings (Kendall Tau-b=0.506), regardless of CT slice thickness, decade of thoracotomy, or total number of CT-identified lesions. CT accuracy in pre-operatively quantifying OS pulmonary metastases has not improved in recent decades. Consequently, we recommend an open technique with direct lung palpation for complete identification and resection of OS pulmonary metastases. Level IV, retrospective study with no comparison group. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Department of Energy ALARA implementation guide. Response to the Health Physics Society

    SciTech Connect

    Connelly, J.M.

    1995-03-01

    In the August 1993 Health Physics Society (HPS) newsletter, the HPS Scientific and Public Issues Committee published a Position Statement entitled {open_quotes}Radiation Protection of the Public and the Environment.{close_quotes}. In this article, this HPS committee made the statement that they were deeply concerned by the trend for agencies to incorporate the ALARA concept as a regulatory requirements, without providing specific guidance as to what it means and how to implement it consistently. The HPS position paper was in response to the DOE notice on proposed rulemaking for Title 10 Code of Federal Regulations Part 834, {open_quotes}Radiation Protection of the Public and the Environment{close_quotes} (10 CFR 834). In the notice of proposed rulemaking for 10 CFR 834, the Department of Energy (DOE) defined ALARA as follows: {open_quotes}As used in this part, ALARA is not a dose limit, but rather a process which has the objective of attaining doses as far below the applicable limit of this part as is reasonably achievable{close_quotes} (10 CFR 834.2, p. 16283 of the Federal Register). The HPS position paper continues, {open_quotes}The section goes on to elaborate on what is meant by a process without providing sufficient guidance to assure uniform applicability of the process.{close_quotes}. Although this concern is directed towards the ALARA process as it relates to the environment, the Office of Health, which is responsible for occupational workers, shares the same definition for ALARA.

  15. Systematic review and meta-analysis of effectiveness of preoperative embolization in surgery for metastatic spine disease.

    PubMed

    Luksanapruksa, Panya; Buchowski, Jacob M; Tongsai, Sasima; Singhatanadgige, Weerasak; Jennings, Jack W

    2017-09-16

    Preoperative embolization (PE) may decrease intraoperative blood loss (IBL) in decompressive surgery of hypervascular spinal metastases. However, no consensus has been found in other metastases and no meta-analysis which reviewed the benefit of PE in spinal metastases has been conducted. To assess IBL in spinal metastases surgery in a randomized controlled trial (RCT) and cohort studies comparing PE and a control group of non-embolized patients. A systematic search of relevant publications in PubMed and EMBASE was undertaken. Inclusion criteria were RCTs and observational studies in patients with spinal metastases who underwent spine surgery and reported IBL. Meta-analysis was performed using standardized mean difference (SMD) and mean difference (MD) of IBL. Heterogeneity was assessed using the I(2) statistic. A total of 265 abstracts (126 from PubMed and 139 from Embase) were identified through database searching. The reviewers selected six studies for qualitative synthesis and meta-analysis. The pooled SMD of the included studies was 0.58 (95% CI -0.10 to 1.25, p=0.09). Sensitivity analysis revealed that, if the study by Rehak et al was omitted, the pooled SMD was significantly changed to 0.88 (95% CI 0.39 to 1.36, p<0.001) and PE reduced the IBL significantly. The pooled MD was 708.3 mL (95% CI -224.4 to 1640.9 mL, p=0.14). If the results of the Rehak et al study were omitted, the pooled MD was significantly changed to 1226.9 mL (95% CI 345.8 to 2108.1 mL, p=0.006). PE can be effective in reducing IBL in spinal metastases surgery in both renal cell carcinoma and mixed primary tumor groups. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  16. Local advanced rectal cancer perforation in the midst of preoperative chemoradiotherapy: A case report and literature review

    PubMed Central

    Takase, Nobuhisa; Yamashita, Kimihiro; Sumi, Yasuo; Hasegawa, Hiroshi; Yamamoto, Masashi; Kanaji, Shingo; Matsuda, Yoshiko; Matsuda, Takeru; Oshikiri, Taro; Nakamura, Tetsu; Suzuki, Satoshi; Koma, Yu-Ichiro; Komatsu, Masato; Sasaki, Ryohei; Kakeji, Yoshihiro

    2017-01-01

    Standard chemoradiotherapy (CRT) for local advanced rectal cancer (LARC) rarely induce rectal perforation. Here we report a rare case of rectal perforation in a patient with LARC in the midst of preoperative CRT. A 56-year-old male was conveyed to our hospital exhibiting general malaise. Colonoscopy and imaging tests resulted in a clinical diagnosis of LARC with direct invasion to adjacent organs and regional lymphadenopathy. Preoperative 5-fluorouracil-based CRT was started. At 25 d after the start of CRT, the patient developed a typical fever. Computed tomography revealed rectal perforation, and he underwent emergency sigmoid colostomy. At 12 d after the surgery, the remaining CRT was completed according to the original plan. The histopathological findings after radical operation revealed a wide field of tumor necrosis and fibrosis without lymph node metastasis. We share this case as important evidence for the treatment of LARC perforation in the midst of preoperative CRT. PMID:28138443

  17. The Alara Metriscan phalangeal densitometer: evaluation and triage thresholds.

    PubMed

    Thorpe, J A; Steel, S A

    2008-10-01

    The Metriscan (Alara Inc, CA) is a compact digital radiographic absorptiometry device capable of determining phalangeal bone mineral density in arbitrary units (BMD(au)) from the second phalanges of the middle three digits. We have examined the utility and the in vitro and in vivo performances of the Metriscan, and established triage thresholds based on the UK's National Osteoporosis Society guidelines on peripheral densitometry. 170 white female participants (70 osteoporotic and 100 non-osteoporotic at the hip or spine) aged between 55 years and 70 years were recruited from patients attending for routine dual X-ray absorptiometry (DXA) examination. All participants underwent two scans of the non-dominant hand (with repositioning) and one of the dominant hand. An additional 10 participants were excluded owing to finger or hand deformities. Radiation exposure to the patient per scan was <0.1 microSv, and a controlled area of 1 m was established around the device. Phantom-based in vitro short-term precision (%CV) was 0.17% without, and 0.22% with, repositioning. Long-term in vitro precision was 0.31% over a 6-month period. In vivo short-term precision was 1.42% for the group as a whole, and 1.30% and 2.23% for the non-osteoporotic and osteoporotic groups, respectively. Triage thresholds for reassurance/referral or referral/treatment were 54.30 BMD(au) and 46.89 BMD(au), respectively, for the non-dominant hand, and 55.02 BMD(au) and 48.73 BMD(au) for the dominant hand. The dominant side proved superior for triage purposes, with a triage referral rate of 44%, compared with 48% for the non-dominant hand. The Metriscan is suitable for use on post-menopausal women in a community-based setting preferably in a triage role as an adjunct to axial BMD.

  18. Internet-Based Resources Frequently Provide Inaccurate and Out-of-Date Recommendations on Preoperative Fasting: A Systematic Review.

    PubMed

    Roughead, Taren; Sewell, Darreul; Ryerson, Christopher J; Fisher, Jolene H; Flexman, Alana M

    2016-12-01

    Preoperative fasting is important to avoid morbidity and surgery delays, yet recommendations available on the Internet may be inaccurate. Our objectives were to describe the characteristics and recommendations of Internet resources on preoperative fasting and assess the quality and readability of these websites. We searched the Internet for common search terms on preoperative fasting using Google® search engines from 4 English-speaking countries (Canada, the United States, Australia, and the United Kingdom). We screened the first 30 websites from each search and extracted data from unique websites that provided recommendations on preoperative fasting. Website quality was assessed using validated tools (JAMA Benchmark criteria, DISCERN score, and Health on the Net Foundation code [HONcode] certification). Readability was scored using the Flesch Reading Ease score and Flesch-Kincaid Grade Level. A total of 87 websites were included in the analysis. A total of 48 websites (55%) provided at least 1 recommendation that contradicted established guidelines. Websites from health care institutions were most likely to make inaccurate recommendations (61%). Only 17% of websites encouraged preoperative hydration. Quality and readability were poor, with a median JAMA Benchmark score of 1 (interquartile range 0-3), mean DISCERN score 39.8 (SD 12.5), mean reading ease score 49 (SD 15), and mean grade level of 10.6 (SD 2.7). HONcode certification was infrequent (10%). Anesthesia society websites and scientific articles had higher DISCERN scores but worse readability compared with websites from health care institutions. Online fasting recommendations are frequently inconsistent with current guidelines, particularly among health care institution websites. The poor quality and readability of Internet resources on preoperative fasting may confuse patients.

  19. Methodology for making environmental as low as reasonably achievable (ALARA) determinations

    SciTech Connect

    Brown, R.C.; Speer, D.R.

    1982-01-01

    An overall evaluation concept for use in making differential cost-benefit analyses in environmental as low as reasonably achievable (ALARA) determinations is being implemented by Rockwell Hanford Operations. This evaluation includes consideration of seven categories: (1) capital costs; (2) operating costs; (3) state of the art; (4) safety; (5) accident or upset consequences; (6) reliability, operability, and maintainability; and (7) decommissionability. Appropriate weighting factors for each of these categories are under development so that ALARA determinations can be made by comparing scores of alternative proposals for facility design, operations, and upgrade. This method of evaluation circumvents the traditional basis of a stated monetary sum per person-rem of dose commitment. This alternative was generated by advice from legal counsel who advised against formally pursuing this avenue of approach to ALARA for environmental and occupational dose commitments.

  20. Does preoperative heparin increase the postoperative bleeding risk in women undergoing prosthetic breast implant surgery? A review of the data from a single institution.

    PubMed

    Monsivais, Sharon E; Roehl, Kendall R; Mahabir, Raman C

    2015-01-01

    In 2008, the authors' institution adopted a policy requiring that all patients, regardless of preoperative risk, receive both sequential compression devices and a single preoperative subcutaneous 5000 unit injection of heparin. A previously published 12-year review at this same institution before this policy demonstrated a 1.5% 30-day postoperative incidence of hematoma in primary augmentation or delayed tissue expander based breast reconstructions. To determine the incidence of postoperative bleeding complications associated with preoperative administration of 5000 units of subcutaneous heparin and compare that incidence with previously published data. Patient data were collected prospectively and maintained in a secure database at a single institution with institutional review board approval. Current procedural terminology and International Classification of Diseases, Ninth Revision, coding was then used to identify all patients who received either primary breast augmentation or delayed tissue expander based breast reconstruction during a five-year period. The primary outcome was the incidence of postoperative bleeding complication. A bleeding complication was defined as any hemorrhagic event that required a return to the operating room. The overall incidence of significant postoperative bleeding was 1.47% (five of 340 [1.16% augmentation, 2.50% expander]). Comparing the current results with the previously published data, demonstrated an OR of 0.98 (95% CI 0.38 to 2.55). In women undergoing primary breast augmentation or delayed tissue expander breast reconstruction, heparin prophylaxis did not increase the risk for significant postoperative bleeding compared with historical controls.

  1. Does preoperative heparin increase the postoperative bleeding risk in women undergoing prosthetic breast implant surgery? A review of the data from a single institution

    PubMed Central

    Monsivais, Sharon E; Roehl, Kendall R; Mahabir, Raman C

    2015-01-01

    BACKGROUND: In 2008, the authors’ institution adopted a policy requiring that all patients, regardless of preoperative risk, receive both sequential compression devices and a single preoperative subcutaneous 5000 unit injection of heparin. A previously published 12-year review at this same institution before this policy demonstrated a 1.5% 30-day postoperative incidence of hematoma in primary augmentation or delayed tissue expander based breast reconstructions. OBJECTIVE: To determine the incidence of postoperative bleeding complications associated with preoperative administration of 5000 units of subcutaneous heparin and compare that incidence with previously published data. METHODS: Patient data were collected prospectively and maintained in a secure database at a single institution with institutional review board approval. Current procedural terminology and International Classification of Diseases, Ninth Revision, coding was then used to identify all patients who received either primary breast augmentation or delayed tissue expander based breast reconstruction during a five-year period. The primary outcome was the incidence of postoperative bleeding complication. A bleeding complication was defined as any hemorrhagic event that required a return to the operating room. RESULTS: The overall incidence of significant postoperative bleeding was 1.47% (five of 340 [1.16% augmentation, 2.50% expander]). Comparing the current results with the previously published data, demonstrated an OR of 0.98 (95% CI 0.38 to 2.55). CONCLUSION: In women undergoing primary breast augmentation or delayed tissue expander breast reconstruction, heparin prophylaxis did not increase the risk for significant postoperative bleeding compared with historical controls. PMID:26361622

  2. Do psychological interventions reduce preoperative anxiety?

    PubMed

    Renouf, Tessa; Leary, Alison; Wiseman, Theresa

    The systematic review investigates whether, during preoperative assessments, nurse-delivered psychological interventions reduce anxiety levels preoperatively for patients undergoing elective surgery. Seventeen studies met the inclusion criteria for data extraction and in-depth critiquing. Of these, two were discarded due to lack of validity, while the remaining studies were organised thematically in a narrative synthesis, generating two principal results: patients' preoperative anxieties were lowered by nurse-delivered general preoperative psychological interventions; and patients valued individualised preoperative interventions delivered by nurses. However, the single oncology study in the review showed an elevation in preoperative anxiety, regardless of intervention, and highlights the need for more research in this under-reviewed area. In the meantime, the authors believe that service improvements should be implemented to ensure that, where possible, psychological preoperative interventions are individualised.

  3. Preoperative anxiety in neurosurgical patients.

    PubMed

    Perks, Anna; Chakravarti, Sucharita; Manninen, Pirjo

    2009-04-01

    Anxiety is common in surgical patients, with an incidence of 60% to 92%. There is little information on the incidence and severity of preoperative anxiety in patients scheduled for neurosurgery. The aim of this study was to measure the level of preoperative anxiety in neurosurgical patients and to assess any influencing factors. After the Institutional Review Board approval and informed written consent, 100 patients booked for neurosurgery were interviewed preoperatively. Each patient was asked to grade their preoperative anxiety level on a verbal analog scale, Amsterdam Preoperative Anxiety and Information Scale, and a set of specific anxiety-related questions. The anxiety scores and the responses to the questions were compared between the sex, age, weight, diagnosis, and history of previous surgery. The mean age (+/-SD) was 50+/-13 years. The preoperative diagnosis was tumor (n=64), aneurysm (n=14), and other (n=22). Overall verbal analog scale was 5.2+/-2.7; the score was higher for female (5.8+/-2.8) than male patients (4.6+/-2.5) (P<0.05). Amsterdam Preoperative Anxiety and Information Scale anxiety and knowledge scores were greater for surgery than for anesthesia. Questionnaire results showed that the most common anxieties were waiting for surgery, physical/mental harm, and results of the operation. In conclusion, our study showed that neurosurgical patients have high levels of anxiety, with a higher incidence in females. There was a moderately high need for information, particularly in patients with a high level of preoperative anxiety.

  4. Preoperative Membranous Urethral Length Measurement and Continence Recovery Following Radical Prostatectomy: A Systematic Review and Meta-analysis.

    PubMed

    Mungovan, Sean F; Sandhu, Jaspreet S; Akin, Oguz; Smart, Neil A; Graham, Petra L; Patel, Manish I

    2017-03-01

    Membranous urethral length (MUL) measured prior to radical prostatectomy (RP) has been identified as a factor that is associated with the recovery of continence following surgery. To undertake a systematic review and meta-analysis of all studies reporting the effect of MUL on the recovery of continence following RP. A comprehensive search of PubMed, EMBASE, and Scopus databases up to September 2015 was performed. Thirteen studies comprising one randomized controlled trial and 12 cohort studies were selected for inclusion. Four studies (1738 patients) that reported hazard ratio results. Every extra millimeter (mm) of MUL was associated with a faster return to continence (hazard ratio: 1.05; 95% confidence interval [CI]: 1.02-1.08, p<0.001). Eleven studies (6993 patients) reported the OR (OR) for the return to continence at one or more postoperative time points. MUL had a significant positive effect on continence recovery at 3 mo (OR: 1.08, 95% CI: 1.03-1.14, p=0.004), 6 mo (OR: 1.12, 95% CI: 1.09-1.15, p<0.0001). and 12 mo (OR: 1.12, 95% CI: 1.03-1.22, p=0.006) following surgery. After adjusting for repeated measurements over time and studies with overlapping data, all OR data combined indicated that every extra millimeter of MUL was associated with significantly greater odds for return to continence (OR: 1.09, 95% CI: 1.05-1.15, p<0.001). A greater preoperative MUL is significantly and positively associated with a return to continence in men following RP. Magnetic resonance imaging measurement of MUL is recommended prior to RP. We examined the effect that the length of a section of the urethra (called the membranous urethra) had on the recovery of continence after radical prostatectomy surgery. Our results indicate that measuring the length of the membranous urethra via magnetic resonance imaging before surgery may be useful to predict a longer period of urinary incontinence after surgery, or to explain a delay in achieving continence after surgery. Copyright

  5. Proceedings of the Third International Workshop on the implementation of ALARA at nuclear power plants

    SciTech Connect

    Khan, T.A.; Roecklein, A.K.

    1995-03-01

    This report contains the papers presented and the discussions that took place at the Third International Workshop on ALARA Implementation at Nuclear Power Plants, held in Hauppauge, Long Island, New York from May 8--11, 1994. The purpose of the workshop was to bring together scientists, engineers, health physicists, regulators, managers and other persons who are involved with occupational dose control and ALARA issues. The countries represented were: Canada, Finland, France, Germany, Japan, Korea, Mexico, the Netherlands, Spain, Sweden, the United Kingdom and the United States. The workshop was organized into twelve sessions and three panel discussions. Individual papers have been cataloged separately.

  6. Pre-operative variables affecting final vision outcome with a critical review of ocular trauma classification for posterior open globe (zone III) injury.

    PubMed

    Agrawal, Rupesh; Ho, Sue Wei; Teoh, Stephen

    2013-10-01

    To identify pre-operative variables affecting the outcome of posterior open globe (zone III) injuries. Secondary objective was to re-look at the definition or landmarks for zone III injury and its clinical significance for predicting visual prognosis following open globe injury. Retrospective review of medical records of all hospitalized patients with surgical repair of open globe injury over last 10 years at a tertiary referral eye care center in Singapore. Out of 172 eyes with open globe injury, 28 eyes (16.3%) with zone III injury was identified and reviewed further. Pre-operative visual acuity (VA) and other variables, extent of scleral wound in reference to rectus insertion, relative afferent pupillary defect (RAPD) and final vision outcome were recorded. Median age was 37 years with male predilection (92.9%). Mean follow-up was 12.9 months. Pre-operative VA was no light perception (NLP) in 16 (57.1%) eyes. Final VA remained NLP in 14 eyes (50.0%). The factors contributing to poor post-operative vision based on univariate regression analysis were the presence of RAPD, poor pre-operative VA, blunt trauma, extent of trauma, associated traumatic cataract, hyphema, vitreous loss and associated vitreo-retinal trauma. Further on, zone III injuries with scleral wound limited anterior to rectus insertion (6 eyes) had better vision outcome than those with injuries extending beyond rectus insertion (22 eyes). Initial VA, blunt ocular trauma, visual axis involvement, loss of light perception, presence of RAPD, traumatic cataract, hyphema, vitreous loss were the important determinants for final visual outcome in patients with zone III injury. Wound extending posterior to rectus insertion has poorer outcome as those limited anterior to rectus insertion. We suggest that there may be a need to relook at zone III injuries with reference to rectus insertion for prognostic significance, and further studies are warranted.

  7. Pre-operative variables affecting final vision outcome with a critical review of ocular trauma classification for posterior open globe (zone III) injury

    PubMed Central

    Agrawal, Rupesh; Ho, Sue Wei; Teoh, Stephen

    2013-01-01

    Purpose: To identify pre-operative variables affecting the outcome of posterior open globe (zone III) injuries. Secondary objective was to re-look at the definition or landmarks for zone III injury and its clinical significance for predicting visual prognosis following open globe injury. Materials and Methods: Retrospective review of medical records of all hospitalized patients with surgical repair of open globe injury over last 10 years at a tertiary referral eye care center in Singapore. Out of 172 eyes with open globe injury, 28 eyes (16.3%) with zone III injury was identified and reviewed further. Pre-operative visual acuity (VA) and other variables, extent of scleral wound in reference to rectus insertion, relative afferent pupillary defect (RAPD) and final vision outcome were recorded. Results: Median age was 37 years with male predilection (92.9%). Mean follow-up was 12.9 months. Pre-operative VA was no light perception (NLP) in 16 (57.1%) eyes. Final VA remained NLP in 14 eyes (50.0%). The factors contributing to poor post-operative vision based on univariate regression analysis were the presence of RAPD, poor pre-operative VA, blunt trauma, extent of trauma, associated traumatic cataract, hyphema, vitreous loss and associated vitreo-retinal trauma. Further on, zone III injuries with scleral wound limited anterior to rectus insertion (6 eyes) had better vision outcome than those with injuries extending beyond rectus insertion (22 eyes). Conclusion: Initial VA, blunt ocular trauma, visual axis involvement, loss of light perception, presence of RAPD, traumatic cataract, hyphema, vitreous loss were the important determinants for final visual outcome in patients with zone III injury. Wound extending posterior to rectus insertion has poorer outcome as those limited anterior to rectus insertion. We suggest that there may be a need to relook at zone III injuries with reference to rectus insertion for prognostic significance, and further studies are warranted. PMID

  8. Impact of preoperative diabetes on long-term survival after curative resection of pancreatic adenocarcinoma: a systematic review and meta-analysis.

    PubMed

    Walter, Ulrike; Kohlert, Tobias; Rahbari, Nuh N; Weitz, Juergen; Welsch, Thilo

    2014-04-01

    Diabetes mellitus (DM) is coupled to the risk and symptomatic onset of pancreatic ductal adenocarcinoma (PDAC). The important question whether DM influences the prognosis of resected PDAC has not been systematically evaluated in the literature. We therefore performed a systematic review and meta-analysis evaluating the impact of preoperative DM on survival after curative surgery. The databases Medline, Embase, Web of Science, and the Cochrane Library were searched for studies reporting on the impact of preoperative DM on survival after PDAC resection. Hazard ratios and 95 % confidence intervals (CI) were extracted. The meta-analysis was calculated using the random-effects model. The data search identified 4,365 abstracts that were screened for relevant articles. Ten retrospective studies with a cumulative sample size of 4,471 patients were included in the qualitative review. The mean prevalence of preoperative DM was 26.7 % (1,067 patients), and all types of pancreatic resections were considered. The meta-analysis included 8 studies and demonstrated that preoperative DM is associated with a worse overall survival after curative resection of PDAC (hazard ratio 1.32, 95 % CI 1.46-1.60, P = 0.004). Only 2 studies reported separate data for new-onset and long-standing DM. To our knowledge, this is the first meta-analysis evaluating long-term survival after PDAC resection in normoglycemic and diabetic patients, demonstrating a significantly worse outcome in the latter group. The mechanism behind this observation and the question whether different antidiabetic medications or early control of DM can improve survival in PDAC should be evaluated in further studies.

  9. Systematic review and meta-analysis of preoperative chemoradiotherapy with or without oxaliplatin in locally advanced rectal cancer

    PubMed Central

    Zheng, Jiabin; Feng, Xingyu; Hu, Weixian; Wang, Junjiang; Li, Yong

    2017-01-01

    Abstract Background: Preoperative chemoradiotherapy has become the current standard regimen for locally advanced rectal cancer (LARC). However, the additional benefit of oxaliplatin to preoperative chemotherapy was still controversial. On one hand, oxaliplatin may improve the tumor response rate of even prolong the survival time. On the other hand, it can bring a series of adverse effects. Opinions vary from studies to studies. We aim to perform a meta-analysis to evaluate the efficacy, safety, and long-term survival of oxaliplatin in preoperative chemoradiotherapy for LARC. Method: To identify clinical trials fusing oxaliplatin in preoperative chemoradiotherapy for LARC published until December 2015, we searched PubMed, the Cochrane Library, and the Springer Link databases by combining various key words. We also search for relevant ASCO conferences. Data were extracted from every study to perform a meta-analysis using STATA 12.0 software. Result: Eleven articles or ASCO abstracts from 8 studies with a total of 5597 patients were included. Adding oxaliplatin to preoperative chemoradiotherapy can significantly improve the ypCR rate [risk ratio (RR) = 1.208, 95% confidence interval (95% CI): 1.070–1.364, P = 0.002, I2 = 14.5%], and decrease the preoperative metastasis (RR = 0.494, 95% CI: 0.256–0.954, P = 0.036, I2 = 53.9%) and local recurrence rate (RR = 0.761, 95% CI: 0.616–0.941, P = 0.012, I2 = 26.1%). What's more, oxaliplatin can prolong the disease-free survival (DFS) [hazard ratio (HR) = 0.867, 95% CI: 0.741–0.992, P = 0.000, I2 = 16.3%]. However, oxaliplatin can increase the chemoradiotherapy-related toxicities (RR = 1.858, 95% CI 1.427–2.419, P = 0.000, I2 = 84.7%). There was no significant difference between the groups with and without oxaliplatin in operation rate, R0 resection rate, sphincter preservation rate, permanent stoma rate, postoperative complication, mortality, and overall

  10. The utility of MRI for pre-operative T and N staging of gastric carcinoma: a systematic review and meta-analysis.

    PubMed

    Huang, Z; Xie, D H; Guo, L; Hu, C H; Fang, X; Meng, Q; Ping, X X; Lu, Z W

    2015-06-01

    To perform a meta-analysis and literature review regarding the diagnostic accuracy of MRI for pre-operative tumour depth invasion (T) and regional lymph node invasion (N) staging of gastric carcinoma (GC). Articles were identified through systematic search of Medline, PubMed, Cochrane Library, Web of Science, Springerlink and several Chinese databases. The study quality was assessed by the quality assessment for studies of diagnostic accuracy. 2 reviewers independently extracted and assessed the data from 11 eligible studies. A meta-analysis was then carried out. Subgroup and sensitivity analyses were also performed. 11 studies (439 patients) were finally included in the current review. Among these studies, the significant evidence of heterogeneity was only discovered for specificity in T4 stage (I(2) = 59.8%). Pooled sensitivity and specificity of MRI to diagnose T stage tumour (T3-4 vs T1-2) were 0.93 [95% confidence interval (CI), 0.89-0.96] and 0.91 (95% CI, 0.87-0.95), respectively. Pooled estimates of sensitivity and specificity of MRI to diagnose N stage tumour (N0 vs N+) were 0.86 (95% CI, 0.80-0.92) and 0.67 (95% CI, 0.54-0.79), respectively. Subgroup analyses showed that diffusion-weighted imaging was more helpful for T staging. The present systematic review suggests that MRI has a good diagnostic accuracy for pre-operative T staging of GC and should be widely used in clinical work. However, the ability for N staging is relatively poor on MRI. In the pre-operative staging of GC, MRI was a useful tool and may enhance accuracy for the T staging of advanced GC.

  11. The utility of MRI for pre-operative T and N staging of gastric carcinoma: a systematic review and meta-analysis

    PubMed Central

    Huang, Z; Guo, L; Hu, C H; Fang, X; Meng, Q; Ping, X X; Lu, Z W

    2015-01-01

    Objective: To perform a meta-analysis and literature review regarding the diagnostic accuracy of MRI for pre-operative tumour depth invasion (T) and regional lymph node invasion (N) staging of gastric carcinoma (GC). Methods: Articles were identified through systematic search of Medline, PubMed, Cochrane Library, Web of Science, Springerlink and several Chinese databases. The study quality was assessed by the quality assessment for studies of diagnostic accuracy. 2 reviewers independently extracted and assessed the data from 11 eligible studies. A meta-analysis was then carried out. Subgroup and sensitivity analyses were also performed. Results: 11 studies (439 patients) were finally included in the current review. Among these studies, the significant evidence of heterogeneity was only discovered for specificity in T4 stage (I2 = 59.8%). Pooled sensitivity and specificity of MRI to diagnose T stage tumour (T3–4 vs T1–2) were 0.93 [95% confidence interval (CI), 0.89–0.96] and 0.91 (95% CI, 0.87–0.95), respectively. Pooled estimates of sensitivity and specificity of MRI to diagnose N stage tumour (N0 vs N+) were 0.86 (95% CI, 0.80–0.92) and 0.67 (95% CI, 0.54–0.79), respectively. Subgroup analyses showed that diffusion-weighted imaging was more helpful for T staging. Conclusion: The present systematic review suggests that MRI has a good diagnostic accuracy for pre-operative T staging of GC and should be widely used in clinical work. However, the ability for N staging is relatively poor on MRI. Advances in knowledge: In the pre-operative staging of GC, MRI was a useful tool and may enhance accuracy for the T staging of advanced GC. PMID:25790060

  12. Preoperative Determinants of Patient-reported Pain and Physical Function Levels Following Total Knee Arthroplasty: A Systematic Review

    PubMed Central

    Lungu, E.; Vendittoli, P-A.; Desmeules, F.

    2016-01-01

    Background: A sound knowledge of the determinants of total knee arthroplasty (TKA) outcomes could help in patient selection, preparation and education. We aimed to assess the current status of the literature evaluating preoperative determinants of early and medium term patient-reported pain and disability following TKA. Method: A search in Medline, Pubmed, Embase and CINAHL until October 2014 was undertaken. Selection criteria included: 1- participants undergoing primary unilateral TKA with a follow-up from 6 months to 2 years, 2- validated disease-specific patient-reported outcome measures assessing pain and/or function used as outcome measure and 3- identification of preoperative determinants obtained via multivariate analyses. Risk of bias was assessed using a modified version of the Methodology checklist for prognostic studies. Results: Thirty-three prognostic explanatory studies were included. Mean total score of the methodological quality was 80.7±12.2 %. Sociodemographic and psychosocial determinants included greater socioeconomic deprivation (both studies), greater levels of depression and/or anxiety (7 out of 10 studies) and greater preoperative pain catastrophizing (all 3 studies). Significant clinical determinants included worse pre-operative knee related pain or disability (20 out of 22 studies), presence or greater levels of comorbidity (12 out of 23 studies), back pain (4 out of 5 studies) and lower general health (all 11 studies). Conclusion: Several significant determinants of short to medium-term pain and functional outcomes following TKA have been summarized by studies with moderate-to-high methodological quality. No conclusions can be reached regarding the strength of the associations between significant determinants and TKA results because of heterogeneity of study methodologies and results. Further high-quality research is required. PMID:27398109

  13. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE CLINICAL REVIEW: MANAGEMENT OF ACROMEGALY PATIENTS: WHAT IS THE ROLE OF PRE-OPERATIVE MEDICAL THERAPY?

    PubMed

    Fleseriu, Maria; Hoffman, Andrew R; Katznelson, Laurence

    2015-06-01

    Acromegaly is a complex disease characterized by growth hormone (GH) excess originating in most cases from a pituitary tumor. The goals of treatment include removing the tumor or reducing tumor burden, normalizing GH secretion and insulin-like growth factor 1 levels, and preserving normal pituitary function if possible. Surgery by an experienced neurosurgeon is still considered first-line therapy, especially in cases with small tumors. In the last few decades, significant progress in the development of selective pharmacologic agents has greatly facilitated the management of active acromegaly, with agents such as somatostatin-receptor ligands (SRLs), GH-receptor antagonists, and dopamine agonists. In addition to adjuvant treatment, pre-operative medical therapy and primary therapy in de novo patients are increasingly employed. A United States National Library of Medicine PubMed search (through July 2014) was conducted for the following terms: acromegaly, pre-operative medical therapy, somatostatin-receptor ligands, and somatostatin analogs. Articles not in English and those not in peer-reviewed journals were excluded. In reviewing pertinent articles, focus was placed on biochemical and other postoperative outcomes of medical therapy. An analysis of the full effect of pre-operative use of SRLs on surgical outcomes (remission rates and peri-operative complications) is limited by heterogeneity of methodology, low overall surgical cure rates, and different study designs. The assumption that SRL use prior to surgery reduces peri-operative surgical risk has yet to be proven. A variable degree of tumor shrinkage with preoperative SRLs is observed. Likewise, SRL treatment 3 months before surgery may improve surgical remission rates in the short term; however, positive results do not persist in the long term. We consider that medical therapy before surgery could play a role in carefully selected patients, but treatment should be individualized. Primary medical therapy with a

  14. Occupational dose reduction at Department of Energy contractor facilities: Study of ALARA programs. Status 1990

    SciTech Connect

    Dionne, B.J.; Meinhold, C.B.; Khan, T.A.; Baum, J.W.

    1992-08-01

    This report provides the US Department of Energy (DOE) and its contractors with information that will be useful for reducing occupational radiation doses at DOE`s nuclear facilities. In 1989 and 1990, health physicists from the Brookhaven National Laboratory`s (BNL) ALARA Center visited twelve DOE contractor facilities with annual collective dose equivalents greater than 100 person-rem (100 person-cSv). The health physicists interviewed radiological safety staff, engineers, and training personnel who were responsible for dose control. The status of ALARA practices at the major contractor facilities was compared with the requirements and recommendation in DOE Order 5480.11 ``Radiation Protection for Occupational Workers`` and PNL-6577 ``Health Physics Manual of Good Practices for Reducing Radiation Exposure to Levels that are as Low as Reasonably Achievable.`` The information and data collected are described and examples of successful practices are presented. The findings on the status of the DOE Contractor ALARA Programs are summarized and evaluated. In addition, the supplement to this report contains examples of good-practice documents associated with implementing the major elements of a formally documented ALARA program for a major DOE contractor facility.

  15. Implementation of the principle of as low as reasonably achievable (ALARA) for medical and dental personnel

    SciTech Connect

    Not Available

    1990-12-31

    This report is part of a series prepared under the auspices of Scientific Committee 46, Operational Radiation Safety. It provides guidance on the process of implementing the as low as reasonably achievable'' (ALARA) principle for the use of radiation by medical and dental personnel. The use of cost-benefit analysis is recommended as a basic method upon which to base ALARA decisions. Examples are provided to illustrate the ALARA principle as a process of optimization and to provide a starting point for the development of individualized ALARA programs. NCRP Report No. 91, Recommendations on Limits for Exposure to Ionizing Radiation, calls for the use of reference ranges for occupational exposures. This report recommends the use of 2 reference ranges, one based on individual dose equivalents, and the other based on collective dose equivalent. In accordance with the recommendations of NCRP Report No. 82, SI Units in Radiation Protection and Measurements, as of January 1990, only SI units are used in the text. Readers needing factors for conversion of SI to conventional units are encouraged to consult Report No. 82. 84 refs., 10 figs., 10 tabs.

  16. Westinghouse Hanford Company radiological protection dose summary and ALARA [As Low As Reasonably Achievable] goal report, calendar year 1989

    SciTech Connect

    Newcomb, J.L.; Hammond, D.A.

    1990-05-01

    Each year a Low As Reasonably Achievable (ALARA) goals are developed and reported to the Department of Energy, Richland Operations (DOE-RL). In addition to providing DOE-RL with goal status, these reports provide Westinghouse Hanford Company (WHC) management with a dose summary and status of annual ALARA goals. The CY-89 ALARA collective dose goal of 520 person-rem for compliance workers was easily met. A large contribution to the saved collective dose resulted from special ALARA practices and principles used by N Reactor during the tube inspection process which resulted in a significant reduction of 73 person-rem from the projected dose. No significant skin contaminations were incurred by WHC workers in CY-89. This report provide detailed information about the distribution of radiation dose and presents the apportionment of those doses to separate facilities. By combining the dose summary and the ALARA dosimetry goal status per facilities, some areas within specific WHC organizations were found no to be represented by ALARA teams. This caused some discrepancies in the report. These areas are clearly labeled in each organizational subsection with an asterisk. ALARA facility team chairs are currently investigating within their own organizations how to resolve representation for organizations. 11 figs., 6 tabs.

  17. Health physics manual of good practices for reducing radiation exposure to levels that are as low as reasonably achievable (ALARA)

    SciTech Connect

    Herrington, W.N.; Higby, D.P.; Kathren,., R.L.; Merwin, S.E.; Stoetzel, G.A.

    1988-06-01

    A primary objective of the US Department of Energy (DOE) health physics and radiation protection program has been to limit radiation exposures to those levels that are as low as reasonably achievable (ALARA). As a result, the ALARA concept developed into a program and a set of operational principles to ensure that the objective was consistently met. Implementation of these principles required that a guide be produced. The original ALARA guide was issued by DOE in 1980 to promote improved understanding of ALARA concepts within the DOE community and to assist those responsible for operational ALARA activities in attaining their goals. Since 1980, additional guidance has been published by national and international organizations to provide further definition and clarification to ALARA concepts. As basic ALARA experience increased, the value and role of the original guide prompted the DOE Office of Nuclear Safety (ONS) to support a current revision. The revised manual of good practices includes six sections: 1.0 Introduction, 2.0 Administration, 3.0 Optimization, 4.0 Setting and Evaluating ALARA Goals, 5.0 Radiological Design, and 6.0 Conduct of Operations. The manual is directed primarily to contractor and DOE staff who are responsible for conduct and overview of radiation protection and ALARA programs at DOE facilities. The intent is to provide sufficient guidance such that the manual, if followed, will ensure that radiation exposures are maintained as low as reasonably achievable and will establish the basis for a formally structured and auditable program. 118 refs., 16 figs., 3 tabs.

  18. Current perspectives on preoperative integrated treatments for locally advanced rectal cancer: a review of agreement and controversies.

    PubMed

    Cellini, Francesco; Valentini, Vincenzo

    2012-08-01

    The optimal approach to the diagnosis and treatment of locally advanced rectal cancer involves multidisciplinary, integrated management. In the past 30 years, survival and freedom from disease have increased, but the ideal multidisciplinary management remains to be determined. The preferred integrated treatment modality is preoperative radio(chemo)therapy followed by total mesorectal excision. Certain aspects of this standard are still debated, and the European and American approaches vary. The chief recommendations per international guidelines are summarized, and the next generation of integrated treatments for locally advanced rectal cancer is discussed.

  19. ALARA plan for the Old Hydrofracture Facility tanks contents removal project at Oak Ridge National Laboratory, Oak Ridge, Tennessee. Amendment 1 for Appendix B: Install flex-pipe on tank riser spools

    SciTech Connect

    1998-05-13

    This amendment to Appendix B contains the specific ALARA evaluations for installing flex-pipe on riser spools to accommodate ventilation duct connections to the north risers of each tank. The work will be a routine task that is part of the Equipment Installation and Mobilization phase of the project. The dose rates were estimated using the recent Radiological Surveillance Section radiological survey: SAAS-97-063S. Task B-6 has been added to the OHF Project ALARA review process to address a field decision to modify an approach to installing the tank ventilation system. The revised approach will incorporate 12-in. diameter, 36-in. long, stainless steel flex-pipe connected to each north riser spool to address the problem of pipe fitting multiple bends and turns expected with the 12-in. PVC duct. This improved approach will reduce the time necessary to install the duct system between the tanks and the ventilation skid. However, the task includes opening the 12-in. riser spool connections to replace the currently installed blind gaskets. Since a riser spool for each tank will be opened, there is a potential for significant personnel exposure and spread of contamination that will addressed through this ALARA review process.

  20. Systematic Review and Cost Analysis Comparing Use of Chlorhexidine with Use of Iodine for Preoperative Skin Antisepsis to Prevent Surgical Site Infection

    PubMed Central

    Lee, Ingi; Agarwal, Rajender K.; Lee, Bruce Y.; Fishman, Neil O.; Umscheid, Craig A.

    2013-01-01

    Objective To compare use of chlorhexidine with use of iodine for preoperative skin antisepsis with respect to effectiveness in preventing surgical site infections (SSIs) and cost. Methods We searched the Agency for Healthcare Research and Quality website, the Cochrane Library, Medline, and EMBASE up to January 2010 for eligible studies. Included studies were systematic reviews, meta-analyses, or randomized controlled trials (RCTs) comparing preoperative skin antisepsis with chlorhexidine and with iodine and assessing for the outcomes of SSI or positive skin culture result after application. One reviewer extracted data and assessed individual study quality, quality of evidence for each outcome, and publication bias. Meta-analyses were performed using a fixed-effects model. Using results from the meta-analysis and cost data from the Hospital of the University of Pennsylvania, we developed a decision analytic cost-benefit model to compare the economic value, from the hospital perspective, of antisepsis with iodine versus antisepsis with 2 preparations of chlorhexidine (ie, 4% chlorhexidine bottle and single-use applicators of a 2% chlorhexidine gluconate [CHG] and 70% isopropyl alcohol [IPA] solution), and also performed sensitivity analyses. Results Nine RCTs with a total of 3,614 patients were included in the meta-analysis. Meta-analysis revealed that chlorhexidine antisepsis was associated with significantly fewer SSIs (adjusted risk ratio, 0.64 [95% confidence interval, [0.51–0.80]) and positive skin culture results (adjusted risk ratio, 0.44 [95% confidence interval, 0.35–0.56]) than was iodine antisepsis. In the cost-benefit model baseline scenario, switching from iodine to chlorhexidine resulted in a net cost savings of $16–$26 per surgical case and $349,904–$568,594 per year for the Hospital of the University of Pennsylvania. Sensitivity analyses showed that net cost savings persisted under most circumstances. Conclusions Preoperative skin antisepsis

  1. Operational radiation protection in high-energy physics accelerators: implementation of ALARA in design and operation of accelerators.

    PubMed

    Fassò, A; Rokni, S

    2009-11-01

    This paper considers the historical evolution of the concept of optimisation of radiation exposures, as commonly expressed by the acronym ALARA, and discusses its application to various aspects of radiation protection at high-energy accelerators.

  2. The Relationship between Preoperative Expectations and the Short-Term Postoperative Satisfaction and Functional Outcome in Lumbar Spine Surgery: A Systematic Review

    PubMed Central

    Ellis, Daniel J.; Mallozzi, Scott S.; Mathews, Jacob E.; Moss, Isaac L.; Ouellet, Jean A.; Jarzem, Peter; Weber, Michael H.

    2015-01-01

    Study Design Systematic review. Objective To examine the relationship between the patient's preoperative expectations and short-term postoperative satisfaction and functional outcome in lumbar spine surgery. Methods The Medline, Embase, and Cochrane databases were queried using a predefined search algorithm to identify all lumbar spine studies analyzing the influence of preoperative expectations on postoperative satisfaction and functional outcome. Two independent reviewers and a third independent mediator reviewed the literature and performed study screening, selection, methodological assessment, and data extraction using an objective protocol. Results Of 444 studies identified, 13 met the inclusion criteria. Methodological quality scores ranged from 59 to 100% with the greatest variability in defining patient characteristics and the methods of assessing patient expectations. Patient expectations were assessed in 22 areas, most frequently back and leg pain expectations and general expectations. Functional outcome was assessed by 13 tools; the most common were the visual analog scale, Oswestry Disability Index (ODI), and Short Form Health Survey (SF-36). Positive expectations for symptomatology, activity, general health, and recovery correlated with satisfaction. General expectations correlated with higher SF-36 Physical Subcomponent scores, better global function, and lower ODI outcome. Conclusions on the influence of the expectations for pain were limited due to the study heterogeneity, but the evidence suggests a positive correlation between the expectation and outcome for back and leg pain. Conclusions Positive expectations correlated significantly with short-term postoperative satisfaction and functional outcome, including higher SF-36 scores, earlier return to work, and decreased ODI scores. Future expectation-based investigations will benefit from implementation of the standardized methods of expectation, satisfaction, and outcome analysis

  3. Systematic review and meta-analysis of metal versus plastic stents for preoperative biliary drainage in resectable periampullary or pancreatic head tumors.

    PubMed

    Crippa, S; Cirocchi, R; Partelli, S; Petrone, M C; Muffatti, F; Renzi, C; Falconi, M; Arcidiacono, P G

    2016-09-01

    Preoperative biliary drainage (PBD) with stenting increases complications compared with surgery without PBD. Metallic stents are considered superior to plastic stents when considering stent-related complications. Aim of the present systematic review and meta-analysis is to compare the rate of endoscopic re-intervention before surgery and postoperative outcomes of metal versus plastic stents in patients with resectable periampullary or pancreatic head neoplasms. We conducted a bibliographic research using the National Library of Medicine's PubMed database, including both randomized controlled trials (RCTs) and non-RCTs. Quantitative synthesis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Statistical heterogeneity was assessed using the I(2) tests. One RCT and four non-RCTs were selected, including 704 patients. Of these, 202 patients (29.5%) were treated with metal stents and 502 (70.5%) with plastic stents. The majority of patients (86.4%) had pancreatic cancer. The rate of endoscopic re-intervention after preoperative biliary drainage was significantly lower in the metal stent (3.4%) than in the plastic stent (14.8%) group (p < 0.0001). The rate of postoperative pancreatic fistula was significantly lower in the meta stent group as well (5.1% versus 11.8%, p = 0.04). The rate of post-operative surgical complications and of - post-operative mortality did not differ between the two groups. Although the present systematic review and meta-analysis demonstrates that metal stent are more effective than plastic stents for PBD in patients with resectable periampullary tumors, randomized controlled trials are needed in order to confirm these data with a higher level of evidence. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. ALARA database value in future outage work planning and dose management

    SciTech Connect

    Miller, D.W.; Green, W.H.

    1995-03-01

    ALARA database encompassing job-specific duration and man-rem plant specific information over three refueling outages represents an invaluable tool for the outage work planner and ALARA engineer. This paper describes dose-management trends emerging based on analysis of three refueling outages at Clinton Power Station. Conclusions reached based on hard data available from a relational database dose-tracking system is a valuable tool for planning of future outage work. The system`s ability to identify key problem areas during a refueling outage is improving as more outage comparative data becomes available. Trends over a three outage period are identified in this paper in the categories of number and type of radiation work permits implemented, duration of jobs, projected vs. actual dose rates in work areas, and accuracy of outage person-rem projection. The value of the database in projecting 1 and 5 year station person-rem estimates is discussed.

  5. FUNDAMENTAL ALARA TECHNIQUES & HAZARD ANALYSIS AT DEPARTMENT OF ENERGY (DOE) SITES

    SciTech Connect

    WAGGONER, L.O.

    2005-01-24

    There are many members of the Health Physics Society that will argue that low level of radiation are not harmful and too much money and time are spent trying to reduce dose. During this presentation we are not going to debate this issue. This presentation will cover the fundamental principles of As Low As Reasonably Achievable (ALARA) and how hazards need to be analyzed to ensure safety of the environment and the public. As radiation safety specialists, we are all bound by law to have an ALARA program in place and even though dose limits may change in the future, we need to implement programs that protect our workers, the public, and the environment.

  6. CSER 95-002: ALARA shielding for IAEA SNM container movement

    SciTech Connect

    Miller, E.M.

    1995-03-07

    This CSER qualifies use of a 5% borated, lead foil lined polyethylene 1 inch annulus as a bucket and in a small carrier to move sealed containers of plutonium. The containers are Oversize Cans or smaller containing plutonium limited in mass and H/Pu ratio by PFP storage and transportation CPS`s. These ALARA shielding units reduce personnel exposure to the radiation from the containers as they are moved for assay and other required activities.

  7. Pre-operative anaemia.

    PubMed

    Clevenger, B; Richards, T

    2015-01-01

    Pre-operative anaemia is a relatively common finding, affecting a third of patients undergoing elective surgery. Traditionally associated with chronic disease, management has historically focused on the use of blood transfusion as a solution for anaemia in the peri-operative period. Data from large series now suggest that anaemia is an independent risk associated with poor outcome in both cardiac and non-cardiac surgery. Furthermore, blood transfusion does not appear to ameliorate this risk, and in fact may increase the risk of postoperative complications and hospital length of stay. Consequently, there is a need to identify, diagnose and manage pre-operative anaemia to reduce surgical risk. Discoveries in the pathways of iron metabolism have found that chronic disease can cause a state of functional iron deficiency leading to anaemia. The key iron regulatory protein hepcidin, activated in response to inflammation, inhibits absorption of iron from the gastrointestinal tract and further reduces bioavailability of iron stores for red cell production. Consequently, although iron stores (predominantly ferritin) may be normal, the transport of iron either from the gastrointestinal tract or iron stores to the bone marrow is inhibited, leading to a state of 'functional' iron deficiency and subsequent anaemia. Since absorption from the gastrointestinal tract is blocked, increasing oral iron intake is ineffective, and studies are now looking at the role of intravenous iron to treat anaemia in the surgical setting. In this article, we review the incidence and impact of anaemia on the pre-operative patient. We explain how anaemia may be caused by functional iron deficiency, and how iron deficiency anaemia may be diagnosed and treated.

  8. Guide to reducing radiation exposure to as low as reasonably achievable (ALARA)

    SciTech Connect

    Kathren, R.L.

    1980-04-01

    This document is designed to provide DOE contractor personnel with general guidance regarding programs and techniques to reduce radiation exposures to as low as reasonably achievable (ALARA). Thus it is directed towards a broad audience, and should have special relevance and interest for operating management as well as radiation protection personnel. It is well recognized that each contractor has needs specific and critical to its radiation protection program. Hence no single set of specific and detailed criteria can be set down as a prescription for achieving the ALARA goal. Rather, general guidance in the form of broad principles is given in order to acquaint management with ALARA needs and concepts. The purpose is to encourage maximum management support of the technical personnel responsible for carrying out day-to-day radiation protection activities. Although primarily written for management, this document also contains technical guidance of potential value to those directly involved in radiation protection activities. Again it should be stressed that what is provided is guidance, and is therefore not mandatory.

  9. Current practices for maintaining occupational exposures ALARA at low-level waste disposal sites

    SciTech Connect

    Hadlock, D.E.; Herrington, W.N.; Hooker, C.D.; Murphy, D.W.; Gilchrist, R.L.

    1983-12-01

    The United States Nuclear Regulatory Commission contracted with Pacific Northwest Laboratory (PNL) to provide technical assistance in establishing operational guidelines, with respect to radiation control programs and methods of minimizing occupational radiation exposure, at Low-Level Waste (LLW) disposal sites. The PNL, through site visits, evaluated operations at LLW disposal sites to determine the adequacy of current practices in maintaining occupational exposures as low as is reasonably achievable (ALARA). The data sought included the specifics of: ALARA programs, training programs, external exposure control, internal exposure control, respiratory protection, surveillance, radioactive waste management, facilities and equipment, and external dose analysis. The results of the study indicated the following: The Radiation Protection and ALARA programs at the three commercial LLW disposal sites were observed to be adequate in scope and content compared to similar programs at other types of nuclear facilities. However, it should be noted that there were many areas that could be improved upon to help ensure the health and safety of occupationally exposed individuals.

  10. Balloon atrial septostomy and pre-operative brain injury in neonates with transposition of the great arteries: a systematic review and a meta-analysis.

    PubMed

    Polito, Angelo; Ricci, Zaccaria; Fragasso, Tiziana; Cogo, Paola E

    2012-02-01

    To perform a systematic review and a meta-analysis of the effects of balloon atrial septostomy on peri-operative brain injury in neonates with transposition of the great arteries. We conduct a systematic review of the literature to identify all observational studies that included neonates born with transposition of the great arteries who had peri-operative evidence of brain injury. The search strategy produced three prospective and two retrospective cohort studies investigating the association between balloon atrial septostomy and brain injury totalling 10,108 patients. In two studies, the outcome was represented by the presence of a coded diagnosis of a clinically evident stroke at discharge, whereas in three studies the outcome was represented by the finding of pre-operative brain injury identified by magnetic resonance scans. The overall brain injury rate for neonates who underwent balloon atrial septostomy versus control patients was 60 of 2273 (2.6%) versus 45 of 7835 (0.5%; pooled odds ratio, 1.90; 95% confidence intervals, 0.93-3.89; p = 0.08). A subgroup analysis of the three studies that used pre-operative brain injury as the primary outcome found no significant association between balloon atrial septostomy and brain injury (pooled odds ratio, 2.70; 95% confidence intervals, 0.64-11.33; p = 0.17). Balloon atrial septostomy frequency was 22.4% (2273 of 10,108), with reported rates ranging from 20% to 75%. Our analysis shows that balloon atrial septostomy is not associated with increased odds for peri-operative brain injury. Balloon atrial septostomy should still be used for those patients with significant hypoxaemia, haemodynamic instability, or both.

  11. Usefulness of DWI in preoperative assessment of deep myometrial invasion in patients with endometrial carcinoma: a systematic review and meta-analysis

    PubMed Central

    2014-01-01

    Background The objective of this study was to perform a systematic review and a meta-analysis in order to estimate the diagnostic accuracy of diffusion weighted imaging (DWI) in the preoperative assessment of deep myometrial invasion in patients with endometrial carcinoma. Methods Studies evaluating DWI for the detection of deep myometrial invasion in patients with endometrial carcinoma were systematically searched for in the MEDLINE, EMBASE, and Cochrane Library from January 1995 to January 2014. Methodologic quality was assessed by using the Quality Assessment of Diagnostic Accuracy Studies tool. Bivariate random-effects meta-analytic methods were used to obtain pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR) and receiver operating characteristic (ROC) curves. The study also evaluated the clinical utility of DWI in preoperative assessment of deep myometrial invasion. Results Seven studies enrolling a total of 320 individuals met the study inclusion criteria. The summary area under the ROC curve was 0.91. There was no evidence of publication bias (P = 0.90, bias coefficient analysis). Sensitivity and specificity of DWI for detection of deep myometrial invasion across all studies were 0.90 and 0.89, respectively. Positive and negative likelihood ratios with DWI were 8 and 0.11 respectively. In patients with high pre-test probabilities, DWI enabled confirmation of deep myometrial invasion; in patients with low pre-test probabilities, DWI enabled exclusion of deep myometrial invasion. The worst case scenario (pre-test probability, 50%) post-test probabilities were 89% and 10% for positive and negative DWI results, respectively. Conclusion DWI has high sensitivity and specificity for detecting deep myometrial invasion and more importantly can reliably rule out deep myometrial invasion. Therefore, it would be worthwhile to add a DWI sequence to the standard MRI protocols in preoperative evaluation of endometrial cancer in order to detect deep

  12. Clinical Use of Diffusion Tensor Image-Merged Functional Neuronavigation for Brain Tumor Surgeries: Review of Preoperative, Intraoperative, and Postoperative Data for 123 Cases

    PubMed Central

    Cho, Jin Mo; Kim, Eui Hyun; Kim, Jinna; Lee, Seung Koo; Kim, Sun Ho; Lee, Kyu Sung

    2014-01-01

    Purpose To achieve maximal safe resection during brain tumor surgery, functional image-merged neuronavigation is widely used. We retrospectively reviewed our cases in which diffusion tensor image (DTI)-merged functional neuronavigation was performed during surgery. Materials and Methods Between November 2008 and May 2010, 123 patients underwent surgery utilizing DTI-merged neuronavigation. Anatomical magnetic resonance images (MRI) were obtained preoperatively and fused with DTI of major white matter tracts, such as the corticospinal tract, optic radiation, or arcuate fasciculus. We used this fused image for functional neuronavigation during brain tumor surgery of eloquent areas. We checked the DTI images together with postoperative MRI images and evaluated the integrity of white matter tracts. Results A single white matter tract was inspected in 78 patients, and two or more white matter tracts were checked in 45 patients. Among the 123 patients, a grossly total resection was achieved in 90 patients (73.2%), subtotal resection in 29 patients (23.6%), and partial resection in 4 patients (3.3%). Postoperative neurologic outcomes, compared with preoperative function, included the following: 100 patients (81.3%) displayed improvement of neurologic symptoms or no change, 7 patients (5.7%) experienced postoperative permanent neurologic deterioration (additional or aggravated neurologic symptoms), and 16 patients (13.0%) demonstrated transient worsening. Conclusion DTI-merged functional neuronavigation could be a useful tool in brain tumor surgery for maximal safe resection. However, there are still limitations, including white matter tract shift, during surgery and in DTI itself. Further studies should be conducted to overcome these limitations. PMID:25048489

  13. Exploring the expectation-actuality discrepancy: a systematic review of the impact of preoperative expectations on satisfaction and patient reported outcomes in spinal surgery.

    PubMed

    Witiw, Christopher D; Mansouri, Alireza; Mathieu, Francois; Nassiri, Farshad; Badhiwala, Jetan H; Fessler, Richard G

    2016-04-07

    Quality in healthcare is increasingly graded through a patient-centric lens, using reports of satisfaction and self-perceived outcome. Preestablished expectations have been recognized to influence these measures. With this review, we aim to examine the impact of expectations on satisfaction and patient-reported outcomes (PRO) for individuals undergoing elective spine surgery. We systematically searched MEDLINE, EMBASE, CINAHL, and Cochrane Library electronic databases from inception to July 2015 for studies examining the relationship between expectations and satisfaction/PROs in the context of elective spinal surgery. Qualitative synthesis centered around three key questions: (1) Does the magnitude of preoperative expectations impact patient satisfaction and/or PRO after surgery? (2) Does the underlying spinal pathology influence this relationship? (3) What is the impact of unmet expectations on satisfaction? A total of 1489 citations were retrieved. Nineteen met our inclusion criteria. These comprised 3383 patients; 3200 had lumbar and only 183 had cervical spine surgery. Three findings prevailed: (1) high preoperative expectations appear to be associated with higher satisfaction and PROs after surgery for focal lumbar disc herniation, but not for lumbar spinal stenosis; (2) patient expectations frequently exceed actual outcome, creating an "expectation-actuality discrepancy" (E-AD); and (3) high-quality studies suggest a larger E-AD portends lower satisfaction. Limitations to the data include heterogeneous study populations and surgical indications, along with the use of non-validated assessment tools, particularly for satisfaction. Our findings highlight the potential importance of establishing realistic expectations prior to surgery and may serve to direct future research efforts.

  14. Nonsteroidal Anti-inflammatory Drugs for Managing Postoperative Endodontic Pain in Patients Who Present with Preoperative Pain: A Systematic Review and Meta-analysis.

    PubMed

    Smith, Elizabeth A; Marshall, J Gordon; Selph, Shelley S; Barker, Dale R; Sedgley, Christine M

    2017-01-01

    Nonsteroidal anti-inflammatory drugs (NSAIDs) have been commonly used to treat endodontic postoperative pain. The purpose of this study was to address the following Population, Intervention, Comparator, Outcome, Timing, Study design and setting question: in patients with preoperative pain who undergo initial orthograde endodontic treatment, what is the comparative efficacy of NSAIDS compared with non-narcotic analgesics or placebo in reducing postoperative pain and the incidence of adverse events. Ovid MEDLINE (1946-December 15, 2015), the Cochrane Database of Systematic Reviews (2005-December 15, 2015), and the Cochrane Central Register of Controlled Trials (to December 15, 2015) were searched using included drugs, indications, and study designs as search terms. Hand searches in texts were also conducted. Two independent reviewers assessed eligibility for inclusion, extracted data, and assessed quality using the risk of bias tool. L'Abbe plots were used for qualitative review. Where applicable, meta-analysis was conducted on the pooled effect size (ES). Two thousand two hundred eighty-four studies were identified through the database searches; 405 full-text articles were assessed. Fifteen articles met the inclusion criteria; qualitative analysis revealed all studies had a moderate to high risk of bias. Ibuprofen was the most studied NSAID. The L'Abbe plots showed that NSAIDS are effective at relieving postoperative endodontic pain overall. Meta-analysis showed that ibuprofen 600 mg is more effective than placebo at 6 hours postoperatively (ES = 10.50, P = .037), and ibuprofen 600 mg + acetaminophen 1000 mg combination is more effective than placebo (ES = 34.89, P = .000) but not significantly different than ibuprofen (ES = 13.94, P = .317). Five studies reported patients experiencing adverse events such as drowsiness, dizziness, nausea, and emesis; 2 studies reported that patients experienced no adverse events. A combination of ibuprofen 600

  15. Pre-operative Predictive Factors of Post-operative Pain in Patients With Hip or Knee Arthroplasty: A Systematic Review.

    PubMed

    Hernández, Clara; Díaz-Heredia, Jorge; Berraquero, María Luisa; Crespo, Pablo; Loza, Estíbaliz; Ruiz Ibán, Miguel Ángel

    2015-01-01

    To analyze pre-surgical predictive factors of post-surgical pain in patients undergoing hip or knee arthoplasty. A systematic literature review was performed. We defined a sensitive strategy on Medline, Embase and Cochrane Library up to May 2013. The inclusion criteria were: patients undertaking knee and/or hip arthroplasty, adults with moderate or severe pain (≥4 on a Visual Analog Scale) in whom predictive factors of post-surgical pain were evaluated before surgery. Systematic reviews, meta-analyses, controlled trials and observational studies were selected. We excluded animals and basic science articles, reviews of prosthesis, prosthesis due to fractures, patients with rheumatic diseases or studies with mixed population in which disaggregated data was not possible to obtain. A total 37 articles of moderate quality were selected. The articles included representative patients undergoing a knee or hip arthroplasty in our country; most of them were aged 60 years or above, with osteoarthritis, and with a high rate of obesity and comorbidities. We found great variability regarding the type of studies and predictive factors. There was a strong association between post-surgical pain and the following pre-surgical factors: female gender, low socio-economic status, higher pain, comorbidities, low back pain, poor functional status, and psychological factors (depression, anxiety or catastrophic pain). There are pre-surgical factors that might influence post-surgical pain in patients undergoing a knee or hip arthroplasty. Therefore, they should be taken into account when considering an arthroplasty. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  16. Report on the BWR owners group radiation protection/ALARA Committee

    SciTech Connect

    Aldrich, L.R.

    1995-03-01

    Radiation protection programs at U.S. boiling water reactor (BWR) stations have evolved during the 1980s and early 1990s from a regulatory adherence-based endeavor to a proactive, risk-based radiation protection and prevention mission. The objectives are no longer to merely monitor and document exposure to radiation and radioactive materials. The focus of the current programs is the optimization of radiation protection of occupational workers consistent with the purpose of producing cost-effective electric power. The newly revised 10 CFR 20 defines the term ALARA (as low as reasonably achievable) to take into account the state of technology, the economics of improvements in relation to the state of the technology, and the benefits to the public health and safety. The BWR Owners Group (BWROG) initially formed the Radiation Protection/ALARA Committee in January 1990 to evaluate methods of reducing occupational radiation exposure during refueling outages. Currently, twenty U.S. BWR owner/operators (representing 36 of the operational 37 domestic BWR units), as well as three foreign BWR operators (associate members), have broadened the scope to promote information exchange between BWR radiation protection professionals and develop good practices which will affect optimization of their radiation protection programs. In search of excellence and the challenge of becoming {open_quotes}World Class{close_quotes} performers in radiation protection, the BWROG Radiation Protection/ALARA Committee has recently accepted a role in assisting the member utilities in improving radiation protection performance in a cost-effective manner. This paper will summarize the recent activities of this Committee undertaken to execute their role of exchanging information in pursuit of optimizing the improvement of their collective radiation protection performance.

  17. ALARA Center of Technology promotes good radiological work practices at Hanford

    SciTech Connect

    Waggoner, L.O., Westinghouse Hanford, Richland, WA

    1997-10-31

    The central Radiological Control Organization, originally under the previous Management and Operations contractor (Westinghouse Hanford Company) decided that a significant improvement in ALARA implementation would result if examples of engineered controls used for radiological work were assembled in one location to provide a ``showcase`` for workers and managers. The facility would be named the ALARA Center of Technology (ACT) and would include the latest technologies used to accomplish radiological work, as well as proven techniques, tools, and equipment. A location for the Center was selected in the 200 East Area of Hanford in a central location to be easily accessible to all facilities and contractors. Since there was little money available for this project, a decision was made to contact several vendors and request loans of their tools, equipment, and materials. In return, the center would help market products on site and assist with product demonstrations when the vendors visited Hanford. Out of 28 vendors originally contacted, 16 responded with offers to loan products. This included a containment tent, several glove bags, BEPA filtered vacuum cleaners, portable ventilation systems, fixatives, temporary shielding, pumps, and several special tools. Vendors who could not provide products sent videos and brochures. Westinghouse Hanford Company began using the ACT in June 1996. Fluor Daniel Hanford, Inc., the present Management and Integrating Contractor for the Hanford Site, held the formal opening ceremony of the ALARA Center of Technology on October 1, 1996. The Center now has about 1200 ft{sup 2} of floor space fi Iled with tools, equipment and material used to perform radiological work.

  18. ALARA Analysis of Radiological Control Criteria Associated with Alternatives for Disposal of Hazardous Wastes

    SciTech Connect

    Aaberg, Rosanne L.; Bilyard, Gordon R.; Branch, Kristi M.; Lavender, Jay C.; Miller, Peter L.

    2002-05-15

    This ALARA analysis of Radiological Control Criteria (RCC) considers alternatives to continued storage of certain DOE mixed wastes. It also considers the option of treating hazardous wastes generated by DOE facilities, which have a very low concentration of radionuclide contaminants, as purely hazardous waste. Alternative allowable contaminant levels examined correspond to doses to an individual ranging from 0.01 mrem/yr to 10 to 20 mrem/yr. Generic waste inventory data and radionuclide source terms are used in the assessment. Economic issues, potential health and safety issues, and qualitative factors relating to the use of RCCs are considered.

  19. The ALARA principle in the context of a radiological or nuclear emergency.

    PubMed

    Musolino, Stephen V; DeFranco, Joseph; Schlueck, Richard

    2008-02-01

    Traditionally, the concept of As Low As Reasonably Achievable (ALARA) has been applied to the workplace and to protect the public. The goals are to minimize small incremental exposures on a daily basis or per specific task, and on a yearly basis, thereby to keep the total annual dose equivalent as far below regulatory limits as practical. In an extreme emergency caused by radiological or nuclear terrorism, or a large scale radiological accident, it is proposed that the same principles can be applied to protect First Responders against potentially large exposures.

  20. Cone-beam computed tomography: Time to move from ALARA to ALADA.

    PubMed

    Jaju, Prashant P; Jaju, Sushma P

    2015-12-01

    Cone-beam computed tomography (CBCT) is routinely recommended for dental diagnosis and treatment planning. CBCT exposes patients to less radiation than does conventional CT. Still, lack of proper education among dentists and specialists is resulting in improper referral for CBCT. In addition, aiming to generate high-quality images, operators may increase the radiation dose, which can expose the patient to unnecessary risk. This letter advocates appropriate radiation dosing during CBCT to the benefit of both patients and dentists, and supports moving from the concept of "as low as reasonably achievable" (ALARA) to "as low as diagnostically acceptable" (ALADA).

  1. Cone-beam computed tomography: Time to move from ALARA to ALADA

    PubMed Central

    Jaju, Sushma P.

    2015-01-01

    Cone-beam computed tomography (CBCT) is routinely recommended for dental diagnosis and treatment planning. CBCT exposes patients to less radiation than does conventional CT. Still, lack of proper education among dentists and specialists is resulting in improper referral for CBCT. In addition, aiming to generate high-quality images, operators may increase the radiation dose, which can expose the patient to unnecessary risk. This letter advocates appropriate radiation dosing during CBCT to the benefit of both patients and dentists, and supports moving from the concept of "as low as reasonably achievable" (ALARA) to "as low as diagnostically acceptable" (ALADA). PMID:26730375

  2. Guideline implementation: preoperative patient skin antisepsis.

    PubMed

    Cowperthwaite, Liz; Holm, Rebecca L

    2015-01-01

    Performing preoperative skin antisepsis to remove soil and microorganisms at the surgical site may help prevent patients from developing a surgical site infection. The updated AORN "Guideline for preoperative skin antisepsis" addresses the topics of preoperative patient bathing and hair removal, selection and application of skin antiseptics, and safe handling, storage, and disposal of skin antiseptics. This article focuses on key points of the guideline to help perioperative personnel develop protocols for patient skin antisepsis. The key points include the need for the patient to take a preoperative bath or shower and the need for perioperative personnel to manage hair at the surgical site, select a safe and effective antiseptic for the individual patient, perform a safe preoperative surgical site prep, and appropriately store skin antiseptics. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

  3. Occupational dose reduction at nuclear power plants: Annotated bibliography of selected readings in radiation protection and ALARA

    SciTech Connect

    Khan, T.A.; Vulin, D.S.; Lane, S.G.; Baum, J.W. )

    1991-10-01

    In the continuing effort to collect and disseminate information on radiation dose reduction at nuclear power plants, the ALARA Center at Brookhaven National Laboratory publishes a series of bibliographies of selected readings in radiation protection and ALARA. This is the sixth report in that series. The abstracts in this bibliography were selected from proceedings of technical meetings and conferences, journals, research reports, and searches of information databases of the US Department of Energy. The subject material of these abstracts relates to radiation protection and dose reduction, and ranges from the use of robotics, to operational health physics, to water chemistry. Also included is material on the design, planning, and management of nuclear power stations, as well as on decommissioning and safe storage efforts. This report contains 266 abstracts along with subject and author indices. The author index is exclusively for this volume. The subject index contains headings for this volume in bold face, as well as reference to previous volumes. All information in this and previous volumes of the series is also available through our on-line information system called ACE (ALARA Center Exchange). ACE is accessible through fax machines or personal computers interfaced with modems. The bibliography database and other databases are kept current with new abstracts, information on research projects, and recent news of international events related to ALARA at nuclear power plants. Access to the system is provided freely to the ALARA community. For password certification, manuals, and other information about our system, please contact the ALARA CENTER, Building 703M, Brookhaven National Laboratory, Upton, NY 11973, or call (516) 282-3228.

  4. Ancient schwannoma of lumbar spine and review of the literature on paraspinal tumors, the role of preoperative biopsy: a case report

    PubMed Central

    2009-01-01

    Introduction Schwannomas are rare encapsulated tumors that derive from the nerve sheath and should be removed due to their infrequent, but existent possibility of malignancy. Case presentation We report a case of a mass located in the L5 lumbar spine in a 42 year old man, presented with intermittent lumbar pain. Ultrasound, CT and MRI were used to examine the characteristics of the lesion. Fine needle aspiration showed cytologic characteristics of benign schwannoma and final histological diagnosis was ancient schwannoma. An extraperitoneal approach, through a left paramedian incision was used to approach the site of the mass. The lesion originated from the nerve root of the L4-L5 lumbar spinal space and a complete excision was achieved. Conclusion A great variety of tumors should be differentiated when a paraspinal mass is discovered, including neurogenic, neuroendocrine and vascular tumors, as well as malignancies, cystic and inflammatory masses. Fine needle aspiration is a useful and reliable tool in the preoperative evaluation of paraspinal masses. A review of the literature is also presented. PMID:20072675

  5. [Preoperative fluid management in pediatric patients].

    PubMed

    Hashimoto, Megumi; Fujii, Tomoko; Serada, Kazuyuki

    2011-07-01

    Preoperative fasting period is required in order to reducing the risk of pulmonary aspiration which may occur during pediatric general anesthesia. Overnight fasting is still prevalent in Japan. Children could be easily dehydrated or have hypoglycemia after such long fasting period. American Society of Anesthesiologists (ASA) issued a simple guideline as "practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration" in 1999. Cochrane Database evaluated this guideline twice in 2005 and in 2009. In this article, recent tactics of preoperative fasting in children is reviewed along the ASA guideline and the Cochrane report.

  6. Review: oculomotor cranial nerve palsies: symptoms, problems and non-surgical preoperative management of the resultant complex incomitant strabismus and monocular and binocular vision disturbances.

    PubMed

    Khawam, Edward; Fahed, Daoud

    2012-01-01

    The purpose of this presentation is first to describe the symptoms and problems encountered in cranial nerve palsies (CNP). The purpose is also to describe the different means of treatment during the observational preoperative period and their positive or negative impact on each of the symptoms and problems. Finally, we will present our way of handling these patients in their preoperative period: practical, inexpensive, and unsophisticated means that keep the patient comfortable and prevent the secondary untoward effects that can take place.

  7. [Preoperative fasting guidelines: an update].

    PubMed

    López Muñoz, A C; Busto Aguirreurreta, N; Tomás Braulio, J

    2015-03-01

    Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence-based preoperative fasting guidelines available. In this article, an attempt is made to review these updated guidelines, as well as the current instructions for more controversial patients such as infants, the obese, and a particular type of ophthalmic surgery. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. ALARA Controls and the Radiological Lessons Learned During the Uranium Fuel Removal Projects at the Molten Salt Reactor Experiment

    SciTech Connect

    Gilliam, B. J.; Chapman, J. A.; Jugan, M. R.

    2002-02-26

    The removal of uranium-233 (233 U) from the auxiliary charcoal bed (ACB) of the Molten Salt Reactor Experiment (MSRE), performed from January through May 2001, created both unique radiological challenges and widely-applicable lessons learned. In addition to the criticality concerns and alpha contamination, 233U has an associated intense gamma photon from the cocontaminant uranium-232 (232U) decaying to thallium-208 (208Tl). Therefore, rigorous contamination controls and significant shielding were implemented. Extensive, timed mock-up training was also imperative to minimize individual and collective personnel exposures. Back-up shielding and containment techniques (that had been previously developed for defense in depth) were used successfully to control significant, changed conditions. Additional controls were placed on tests and on recovery designs to assure a higher level of safety throughout the removal operations. This paper delineates the manner in which each difficulty was solved, while relating the relevance of the results and the methodology to other projects with high dose-rate, highly-contaminated ionizing radiation hazards. Because of the distinctive features of and current interest in molten salt technology, a brief overview is provided. Also presented is the detailed, practical application of radiological controls integrated into, rather than added after, each evolution of the project--thus demonstrating the broad-based benefits of radiological engineering and ALARA reviews. The resolution of the serious contamination-control problems caused by unexpected uranium hexafluoride (UF6) gaseous diffusion is also explicated. Several tables and figures document the preparations, equipment and operations. A comparison of the pre-job dose calculations for the various functions of the uranium deposit removal (UDR) and the post-job dose-rate data are included in the conclusion.

  9. Occupational dose reduction at Department of Energy contractor facilities: Bibliography of selected readings in radiation protection and ALARA; Volume 5

    SciTech Connect

    Dionne, B.J.; Sullivan, S.G.; Baum, J.W.

    1994-01-01

    Promoting the exchange of information related to implementation of the As Low as Reasonably Achievable (ALARA) philosophy is a continuing objective for the Department of Energy (DOE). This report was prepared by the Brookhaven National Laboratory (BNL) ALARA Center for the DOE Office of Health. It contains the fifth in a series of bibliographies on dose reduction at DOE facilities. The BNL ALARA Center was originally established in 1983 under the sponsorship of the Nuclear Regulatory Commission to monitor dose-reduction research and ALARA activities at nuclear power plants. This effort was expanded in 1988 by the DOE`s Office of Environment, Safety and Health, to include DOE nuclear facilities. This bibliography contains abstracts relating to various aspects of ALARA program implementation and dose-reduction activities, with a specific focus on DOE facilities. Abstracts included in this bibliography were selected from proceedings of technical meetings, journals, research reports, searches of the DOE Energy, Science and Technology Database (in general, the citation and abstract information is presented as obtained from this database), and reprints of published articles provided by the authors. Facility types and activities covered in the scope of this report include: radioactive waste, uranium enrichment, fuel fabrication, spent fuel storage and reprocessing, facility decommissioning, hot laboratories, tritium production, research, test and production reactors, weapons fabrication and testing, fusion, uranium and plutonium processing, radiography, and accelerators. Information on improved shielding design, decontamination, containments, robotics, source prevention and control, job planning, improved operational and design techniques, as well as on other topics, has been included. In addition, DOE/EH reports not included in previous volumes of the bibliography are in this volume (abstracts 611 to 684). This volume (Volume 5 of the series) contains 217 abstracts.

  10. High level waste tank closure project: ALARA applications at the Idaho National Engineering and Environmental Laboratory.

    PubMed

    Aitken, Steven B; Butler, Richard; Butterworth, Steven W; Quigley, Keith D

    2005-05-01

    Bechtel BWXT Idaho, Maintenance and Operating Contractor for the Department of Energy at the Idaho National Engineering and Environmental Laboratory, has emptied, cleaned, and sampled six of the eleven 1.135 x 10(6) L high level waste underground storage tanks at the Idaho Nuclear Technology and Engineering Center, well ahead of the State of Idaho Consent Order cleaning schedule. Cleaning of a seventh tank is expected to be complete by the end of calendar year 2004. The tanks, with associated vaults, valve boxes, and distribution systems, are being closed to meet Resource Conservation and Recovery Act regulations and Department of Energy orders. The use of remotely operated equipment placed in the tanks through existing tank riser access points, sampling methods and application of as-low-as-reasonably-achievable (ALARA) principles have proven effective in keeping personnel dose low during equipment removal, tank, vault, and valve box cleaning, and sampling activities, currently at 0.03 Sv.

  11. ALARA considerations for the whole body neutron irradiation facility source removal project at Brookhaven National Laboratory.

    PubMed

    Sullivan, Patrick T

    2006-02-01

    This paper describes the activities that were involved with the safe removal of fourteen PuBe sources from the Brookhaven National Laboratory (BNL) Whole Body Neutron Irradiation Facility (WBNIF). As part of a Department of Energy and BNL effort to reduce the radiological inventory, the WBNIF was identified as having no future use. In order to deactivate the facility and eliminate the need for nuclear safety management and long-term surveillance, it was decided to remove the neutron sources and dismantle the facility. In addition, the sources did not have DOT Special Form documentation so they would need to be encapsulated once removed for offsite storage or disposal. The planning and the administrative as well as engineering controls put in place enabled personnel to safely remove and encapsulate the sources while keeping exposure as low as reasonably achievable (ALARA).

  12. Preoperative simulation of the running course of the abducens nerve in a large petroclival meningioma: a case report and literature review.

    PubMed

    Yang, Kaichuang; Ikawa, Fusao; Onishi, Shumpei; Kolakshyapati, Manish; Takeda, Masaaki; Yamaguchi, Satoshi; Ishifuro, Minoru; Akiyama, Yuji; Morishige, Mizuki; Kurisu, Kaoru

    2017-04-01

    One of the most important and useful pieces of information in the preoperative evaluation of a large petroclival meningioma is the running course of the abducens nerve. The abducens nerve is small and has a long intracranial course, making it prone to compression by the tumor at various anatomical points. In relatively large tumors, it is difficult to confirm the entire course of the abducens nerve, even by heavy T2-thin slice imaging. We report a case of successful preoperative estimation of the course of the abducens nerve that aided in its complete preservation during the resection of a large petroclival tumor.

  13. Update on Preoperative Breast Localization.

    PubMed

    Hayes, Mary K

    2017-05-01

    The radiologist plays an important role in detection, diagnosis, localization, pathologic correlation, and follow-up imaging of breast cancer. A successful breast surgical treatment program relies on the image guidance tools and skills of the radiologist and surgeon. This article reviews the evolving tools available for preoperative localization. Non-wire devices provide a safe, efficient, noninferior alternative to wire localization and can be placed 0 to 30 days before scheduled surgery. This technology may evolve to other longer-term, efficient, and cost-effective applications for patients who require neoadjuvant treatment or who have findings visible only at MR imaging. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Preoperative pregabalin or gabapentin for acute and chronic postoperative pain among patients undergoing breast cancer surgery: A systematic review and meta-analysis of randomized controlled trials.

    PubMed

    Rai, Ajit S; Khan, James S; Dhaliwal, Jasneet; Busse, Jason W; Choi, Stephen; Devereaux, P J; Clarke, Hance

    2017-10-01

    Breast cancer surgery is associated with acute and chronic pain. We sought to systematically evaluate the effects of gabapentin and pregabalin on postoperative pain among patients undergoing breast cancer surgery. We searched MEDLINE, EMBASE, CENTRAL, Web of Science, and ProQuest from the inception of each database to November 2015. We included studies enrolling adult patients undergoing breast cancer surgery who were randomly assigned to preoperative gabapentin or pregabalin versus placebo or active control and assessed acute (≤24 h) or chronic (≥2 months) pain. We conducted meta-analyses when possible and rated the quality of evidence (QoE) by using the GRADE approach. Twelve studies were eligible for review, of which eight evaluated gabapentin (n = 516) and four pregabalin (n = 209). Gabapentin reduced pain scores in the recovery room (mean difference [MD] -1.68 on a 0-10 Numeric Rating Scale (NRS), 95% CI -2.59 to -0.77; minimally important difference is 1 point; relative risk [RR] for mild pain (<4/10) 1.71, 95% CI 1.33-2.02; moderate QoE) and 24 h postoperatively (MD -0.52, 95% CI -1.02 to -0.01; RR for mild pain 1.07, 95% CI 1.00-1.13; very low QoE). Pregabalin reduced pain and morphine consumption in the recovery room (MD -6.71 mg, 95% CI -10.73 to -2.70; low QoE). No significant difference was observed in pain score at 24 h (MD -0.38, 95%, CI -0.96 to 0.21; moderate QoE). Neither drug reduced the rate of chronic postoperative pain. Gabapentin and pregabalin seem to reduce opioid consumption in the recovery room. Gabapentin, but not pregabalin, reduces pain at 24 h after breast cancer surgery. Neither drug affects the development of chronic postoperative pain. Gabapentin and pregabalin administered perioperatively in patients undergoing breast cancer surgery improve acute postoperative pain as indicated by the reduction in opioid consumption. Further data are needed on reducing chronic postoperative pain. Copyright © 2017 British Association

  15. Does preoperative rehabilitation for patients planning to undergo joint replacement surgery improve outcomes? A systematic review and meta-analysis of randomised controlled trials

    PubMed Central

    Wang, Li; Lee, Myeongjong; Zhang, Zhe; Moodie, Jessica; Cheng, Davy; Martin, Janet

    2016-01-01

    Objectives The clinical impact of preoperative physiotherapy on recovery after joint replacement remains controversial. This systematic review aimed to assess the clinical impact of prehabilitation before joint replacement. Design We searched PubMed, Embase and Cochrane CENTRAL up to November 2015 for randomised controlled trials comparing prehabilitation versus no prehabilitation before joint replacement surgery. Postoperative pain and function scores were converted to Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function subscales (0–100, high scores indicate worse outcome). Random effects meta-analysis was performed to calculate weighted mean differences (WMD, 95% CI), subgrouped by hip and knee surgery. Primary and secondary outcomes Postoperative pain and function scores, time to resume activities of daily living, quality of life, length of hospital stay, total cost, patient satisfaction, postoperative complications, any adverse events and discontinuations. Results Of 22 studies (1492 patients), 18 had high risk of bias. Prehabilitation slightly reduced pain scores within 4 weeks postoperatively (WMD −6.1 points, 95% CI −10.6 to −1.6 points, on a scale of 0–100), but differences did not remain beyond 4 weeks. Prehabilitation slightly improved WOMAC function score at 6–8 and 12 weeks (WMD −4.0, 95% CI −7.5 to −0.5), and time to climbing stairs (WMD −1.4 days, 95% CI −1.9 to −0.8 days), toilet use (−0.9 days, 95% CI −1.3 to −0.5 days) and chair use (WMD −1.2 days, 95% CI −1.7 to −0.8 days). Effects were similar for knee and hip surgery. Differences were not found for SF-36 scores, length of stay and total cost. Other outcomes of interest were inadequately reported. Conclusions Existing evidence suggests that prehabilitation may slightly improve early postoperative pain and function among patients undergoing joint replacement; however, effects remain too small and short

  16. ALARA in pediatric interventional and fluoroscopic imaging: striving to keep radiation doses as low as possible during fluoroscopy of pediatric patients--a white paper executive summary.

    PubMed

    Strauss, Keith J; Kaste, Sue C

    2006-09-01

    Pediatric patients might be as much as 10 times more radiosensitive than adults. Thus, adherence to the principle of "As low as reasonably achievable" (ALARA) represents a practice mandate that minimizes ionizing radiation exposure while optimizing imaging results. This symposium is the third multidisciplinary program that focused on the ALARA principle in pediatric imaging and addressed issues associated with pediatric fluoroscopy and interventional imaging techniques.

  17. [Preoperative analysis in rhinoplasty].

    PubMed

    Nguyen, P S; Bardot, J; Duron, J B; Levet, Y; Aiach, G

    2014-12-01

    Preoperative analysis in rhinoplasty consists in analyzing individual anatomical and functional characteristics without losing sight of the initial requirements of the patient to which priority should be given. The examination is primarily clinical but it also uses preoperative photographs taken at specific accurate angles. Detecting functional disorders or associated general pathologies, which will reduce the risk of complications. All of these factors taken into account, the surgeon can work out a rhinoplasty plan which he or she will subsequently explain to the patient and obtain his or her approbation.

  18. The Preoperative Neurological Evaluation

    PubMed Central

    Probasco, John; Sahin, Bogachan; Tran, Tung; Chung, Tae Hwan; Rosenthal, Liana Shapiro; Mari, Zoltan; Levy, Michael

    2013-01-01

    Neurological diseases are prevalent in the general population, and the neurohospitalist has an important role to play in the preoperative planning for patients with and at risk for developing neurological disease. The neurohospitalist can provide patients and their families as well as anesthesiologists, surgeons, hospitalists, and other providers guidance in particular to the patient’s neurological disease and those he or she is at risk for. Here we present considerations and guidance for the neurohospitalist providing preoperative consultation for the neurological patient with or at risk of disturbances of consciousness, cerebrovascular and carotid disease, epilepsy, neuromuscular disease, and Parkinson disease. PMID:24198903

  19. Optimising renal cancer patients for nephron-sparing surgery: a review of pre-operative considerations and peri-operative techniques for partial nephrectomy.

    PubMed

    Ertemi, Hani; Khetrapal, Pramit; Pavithran, Nevil M; Mumtaz, Faiz

    2017-02-03

    Nonmodifiable factors including pre-operative renal function and amount of healthy renal tissue preserved are the most important predictive factors that determine renal function after partial nephrectomy. Ischaemia time is an important modifiable risk factor and cold ischaemia time should be used if longer ischaemia time is anticipated. New techniques may have a role in maximising postoperative kidney function, but more robust studies are required to understand their potential benefits and risks.

  20. An analysis of 170 glioma patients and systematic review to investigate the association between IDH-1 mutations and preoperative glioma-related epilepsy.

    PubMed

    Yang, Yuan; Mao, Qing; Wang, Xiang; Liu, Yanhui; Mao, Yunhe; Zhou, Qiao; Luo, Jiewen

    2016-09-01

    Seizure is a common presenting symptom of glioma, and many biomarkers have been suggested to be associated with preoperative seizure; however, the relationships between IDH (isocitrate dehydrogenase) mutations and glioma-related epilepsy only recently been studied. The authors aimed to examine the correlations between IDH mutations in glioma patients with preoperative seizures and tumor location. A series of 170 glioma samples were analyzed for IDH1 R132H mutations (amino acid change from arginine to histidine at codon 132) with immunohistochemistry (IHC) staining and for IDH mutations with direct DNA sequencing when the IHC results were negative. If either the IHC or direct DNA sequencing result was positive, the IDH status was defined as mutated. The results of the IDH mutation examinations were used to analyze the relationship between mutations and glioma-related epilepsy. The study population consisted of 64 (37.6%) World Health Organization (WHO) grade II gliomas, 58 (34.1%) grade III, and 48 (28.3%) grade IV gliomas. A total of 84 samples with IDH1 mutations were observed in our study, and 54 of these presented with seizures as the initial symptoms, whereas 28 of the patients with wild-type IDH status presented with seizures (p=0.043 for the WHO grade II gliomas, p=0.002 for the grade III gliomas and p=0.942 for the grade IV gliomas, chi-squared tests). Among the WHO grade II and III gliomas, IDH1 mutations were significantly associated with preoperative seizures, but no significant relationship between IDH mutations and preoperative seizures was found with glioblastoma multiforme.

  1. The optimisation approach of ALARA in nuclear practice: an early application of the precautionary principle. Scientific uncertainty versus legal uncertainty.

    PubMed

    Lierman, S; Veuchelen, L

    2005-01-01

    The late health effects of exposure to low doses of ionising radiation are subject to scientific controversy: one view finds threats of high cancer incidence exaggerated, while the other view thinks the effects are underestimated. Both views have good scientific arguments in favour of them. Since the nuclear field, both industry and medicine have had to deal with this controversy for many decades. One can argue that the optimisation approach to keep the effective doses as low as reasonably achievable, taking economic and social factors into account (ALARA), is a precautionary approach. However, because of these stochastic effects, no scientific proof can be provided. This paper explores how ALARA and the Precautionary Principle are influential in the legal field and in particular in tort law, because liability should be a strong incentive for safer behaviour. This so-called "deterrence effect" of liability seems to evaporate in today's technical and highly complex society, in particular when dealing with the late health effects of low doses of ionising radiation. Two main issues will be dealt with in the paper: 1. How are the health risks attributable to "low doses" of radiation regulated in nuclear law and what lessons can be learned from the field of radiation protection? 2. What does ALARA have to inform the discussion of the Precautionary Principle and vice-versa, in particular, as far as legal sanctions and liability are concerned? It will be shown that the Precautionary Principle has not yet been sufficiently implemented into nuclear law.

  2. Implementation of ALARA radiation protection on the ISS through polyethylene shielding augmentation of the Service Module Crew Quarters

    NASA Astrophysics Data System (ADS)

    Shavers, M. R.; Zapp, N.; Barber, R. E.; Wilson, J. W.; Qualls, G.; Toupes, L.; Ramsey, S.; Vinci, V.; Smith, G.; Cucinotta, F. A.

    2004-01-01

    With 5-7 month long duration missions at 51.6° inclination in Low Earth Orbit, the ionizing radiation levels to which International Space Station (ISS) crewmembers are exposed will be the highest planned occupational exposures in the world. Even with the expectation that regulatory dose limits will not be exceeded during a single tour of duty aboard the ISS, the "as low as reasonably achievable" (ALARA) precept requires that radiological risks be minimized when possible through a dose optimization process. Judicious placement of efficient shielding materials in locations where crewmembers sleep, rest, or work is an important means for implementing ALARA for spaceflight. Polyethylene (C nH n) is a relatively inexpensive, stable, and, with a low atomic number, an effective shielding material that has been certified for use aboard the ISS. Several designs for placement of slabs or walls of polyethylene have been evaluated for radiation exposure reduction in the Crew Quarters (CQ) of the Zvezda (Star) Service Module. Optimization of shield designs relies on accurate characterization of the expected primary and secondary particle environment and modeling of the predicted radiobiological responses of critical organs and tissues. Results of the studies shown herein indicate that 20% or more reduction in equivalent dose to the CQ occupant is achievable. These results suggest that shielding design and risk analysis are necessary measures for reducing long-term radiological risks to ISS inhabitants and for meeting legal ALARA requirements. Verification of shield concepts requires results from specific designs to be compared with onboard dosimetry.

  3. Implementation of ALARA radiation protection on the ISS through polyethylene shielding augmentation of the Service Module crew quarters

    NASA Astrophysics Data System (ADS)

    Shavers, M.; Zapp, N.; Barber, R.; Wilson, J.; Qualls, G.; Toupes, L.; Ramsey, S.; Vinci, V.; Smith, G.; Cucinotta, F.

    With 5 to 7-month long duration missions at 51.6° inclination in Low Earth Orbit, the ionizing radiation levels to which International Space Station (ISS) crewmembers are exposed will be the highest planned occupational exposures in the world. Even with the expectation that regulatory dose limits will not be exceeded during a single tour of duty aboard the ISS, the "as low as reasonably achievable" (ALARA) precept requires that radiological risks be minimized when possible through an dose optimization process. Judicious placement of efficient shielding materials in locations where crewmembers sleep, rest, or work is an important means for implementing ALARA for spaceflight. Polyethylene (Cn Hn ), is a relatively inexpensive, stable, and, with a low atomic number, an effective shielding material that has been certified for use aboard the ISS. Several designs for placement of slabs or walls of polyethylene have been evaluated for radiation exposure reduction in the Crew Quarters (CQ) of the Zvezda (Star) Service Module. Optimization of shield designs relies on accurate characterization of the expected primary and secondary particle environment and modeling of the predicted radiobiological responses of critical organs and tissues. Results of the studies shown herein indicate that 20% or more reduction in dose equivalent to the CQ occupant is achievable. These results suggest that shielding design and risk analysis are necessary measures for reducing long-term radiological risks to ISS inhabitants and for meeting legal ALARA requirements. Verification of shield concepts requires results from specific designs to be compared with onboard dosimetry.

  4. Music interventions for preoperative anxiety.

    PubMed

    Bradt, Joke; Dileo, Cheryl; Shim, Minjung

    2013-06-06

    Patients awaiting surgical procedures often experience significant anxiety. Such anxiety may result in negative physiological manifestations, slower wound healing, increased risk of infection, and may complicate the induction of anaesthesia and impede postoperative recovery. To reduce patient anxiety, sedatives and anti-anxiety drugs are regularly administered before surgery. However, these often have negative side effects and may prolong patient recovery. Therefore, increasing attention is being paid to a variety of non-pharmacological interventions for reduction of preoperative anxiety such as music therapy and music medicine interventions. Interventions are categorized as 'music medicine' when passive listening to pre-recorded music is offered by medical personnel. In contrast, music therapy requires the implementation of a music intervention by a trained music therapist, the presence of a therapeutic process, and the use of personally tailored music experiences. A systematic review was needed to gauge the efficacy of both music therapy and music medicine interventions for reduction of preoperative anxiety. To examine the effects of music interventions with standard care versus standard care alone on preoperative anxiety in surgical patients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 7), MEDLINE (1950 to August 2012), CINAHL (1980 to August 2012), AMED (1985 to April 2011; we no longer had access to AMED after this date), EMBASE (1980 to August 2012), PsycINFO (1967 to August 2012), LILACS (1982 to August 2012), Science Citation Index (1980 to August 2012), the specialist music therapy research database (March 1 2008; database is no longer functional), CAIRSS for Music (to August 2012), Proquest Digital Dissertations (1980 to August 2012), ClinicalTrials.gov (2000 to August 2012), Current Controlled Trials (1998 to August 2012), and the National Research Register (2000 to September 2007). We

  5. Commissioning of experimental enclosures (Hutches) at the Advanced Photon Source - A to Z ALARA.

    SciTech Connect

    Vacca, J.; Job, P. K.; Rauchas, A.; Justus, A.; Veluri, V. R.

    2000-11-01

    The Advanced Photon Source (APS), 7 GeV electron Storage Ring at the Argonne National Laboratory is designed to be a major national user facility providing high-brilliance x-ray beams. Figure 1 shows a plan view of the APS. At completion, APS will have 35 bending magnet (BM) beamlines and 35 insertion device (ID) beamlines. A typical x-ray beamline at APS comprises of a front end (FE) that confines the beam; a first optics enclosure (FOE) which houses optics to filter and monochromatize the beam; and beam transports, additional optics, and the experiment stations. Figure 2 shows a section of the storage ring with the layout of the ID and BM beamlines and typical experiment stations. The first x-ray beam was delivered to an experiment station in 1995. Ever since, to date, over 120 experimental stations (hutches) have been commissioned and are receiving intense x-ray beams of varying energies for various experiments. This paper describes in some detail the steps involved in the process of commissioning experimental stations and the implementation of the ALARA at each step.

  6. An ALARA approach to the radiological control of foodstuffs following an accidental release.

    PubMed

    Lombard, J; Coulon, R; Despres, A

    1988-06-01

    This article presents a methodology based on two complementary approaches, thus allowing a selection of maximal concentration in foodstuffs for determining appropriate countermeasures. The first approach is based on a minimal and maximal per capita intervention level and takes into account the annual intake of each product. The second one is based on a cost-benefit analysis, comparing the advantages of a countermeasure concerning those products presenting a contamination higher than a given maximal concentration (in terms of reduction of cost of the detriment associated with the risk), with its drawbacks (in terms of cost of the products) in order to select the "ALARA" maximal concentration. This second approach is used as a complement to the first one. The results obtained through these two approaches are given for four products (milk, meat, fresh vegetables, and corn) and two nuclides (Cs-137 and I-131). These are presented for various scenarios: one or various products contaminated by one or various radionuclides. It is concluded that these two approaches are complementary, the first one being related to individual risk and the second to collective risk. Therefore, these approaches are both of interest in the context of the elaboration of modalities for the radiological control of foodstuffs following an accidental release and both methods may be useful for determining appropriate countermeasures.

  7. INNOVATIVE ALARA TECHNIQUES & WORK PRACTICES USED AT HANFORD FOR D & D

    SciTech Connect

    WAGGONER, L.O.

    2005-01-05

    The Department of Energy's Hanford Site has several nuclear facilities in the process of decontamination and decommissioning (D&D) with many more to follow. These facilities contain hazardous and highly radioactive materials in plant systems, gloveboxes, hot cells, rooms, collection tanks, ventilation ducts, fuel pools and outside these facilities. Some of the radioactive isotopes are fissile material and have to be closely guarded and require special handling. To safely work in this environment, workers had to learn new skills and develop innovative techniques to decontaminate, remove all equipment and demolish these radioactive work facilities without spreading contamination to the environment. Changing the workscope and worker attitudes involves a culture change for workers, managers, Department of Energy (DOE) and support organizations. D&D involves making different types of risk-based decisions than were made when the plants were operated or sitting dormant. Management involvement, use of the Integrated Safety Management System (ISMS), communications and sharing lessons learned are essential ingredients in developing a successful D&D strategy. New technologies have to be learned including the use of robotic devices and manipulative arms due to high dose rates and amount of radioactive contamination. Minimizing the amount of Transuranic and Mixed radioactive waste and learning how to ship the large quantities of waste are additional skills the Hanford workers have had to learn. D&D work at Hanford is in progress and Hanford Contractors have completed some very difficult and intense D&D work. This presentation will provide information on the best As Low As Reasonably Achievable (ALARA) protective measures, work practices, and the lessons learned to date.

  8. Pre-operative investigations: yield and conformity to national guidelines.

    PubMed

    Juliana, H; Lim, T A; Inbasegaran, K

    2003-03-01

    Routine ordering of pre-operative investigations yields a low true positive rate and is not cost effective. In this study, case notes of 251 adults who underwent elective surgery were reviewed. Pre-operative investigations were classified as 'indicated' or 'not indicated', based on the national guidelines. Only 56% of all tests done were indicated. The overall rates of expected and unexpected abnormal values from pre-operative blood investigations were 51.1% and 34.4% respectively. This study found that selective testing based on guidelines was beneficial. However, the results also suggest that the local guidelines need to be reviewed.

  9. Implementation of ALARA radiation protection on the ISS through polyethylene shielding augmentation of the Service Module Crew Quarters

    NASA Technical Reports Server (NTRS)

    Shavers, M. R.; Zapp, N.; Barber, R. E.; Wilson, J. W.; Qualls, G.; Toupes, L.; Ramsey, S.; Vinci, V.; Smith, G.; Cucinotta, F. A.

    2004-01-01

    With 5-7 month long duration missions at 51.6 degrees inclination in Low Earth Orbit, the ionizing radiation levels to which International Space Station (ISS) crewmembers are exposed will be the highest planned occupational exposures in the world. Even with the expectation that regulatory dose limits will not be exceeded during a single tour of duty aboard the ISS, the "as low as reasonably achievable" (ALARA) precept requires that radiological risks be minimized when possible through a dose optimization process. Judicious placement of efficient shielding materials in locations where crewmembers sleep, rest, or work is an important means for implementing ALARA for spaceflight. Polyethylene (CnHn) is a relatively inexpensive, stable, and, with a low atomic number, an effective shielding material that has been certified for use aboard the ISS. Several designs for placement of slabs or walls of polyethylene have been evaluated for radiation exposure reduction in the Crew Quarters (CQ) of the Zvezda (Star) Service Module. Optimization of shield designs relies on accurate characterization of the expected primary and secondary particle environment and modeling of the predicted radiobiological responses of critical organs and tissues. Results of the studies shown herein indicate that 20% or more reduction in equivalent dose to the CQ occupant is achievable. These results suggest that shielding design and risk analysis are necessary measures for reducing long-term radiological risks to ISS inhabitants and for meeting legal ALARA requirements. Verification of shield concepts requires results from specific designs to be compared with onboard dosimetry. c2004 COSPAR. Published by Elsevier Ltd. All rights reserved.

  10. Implementation of ALARA radiation protection on the ISS through polyethylene shielding augmentation of the Service Module Crew Quarters

    NASA Technical Reports Server (NTRS)

    Shavers, M. R.; Zapp, N.; Barber, R. E.; Wilson, J. W.; Qualls, G.; Toupes, L.; Ramsey, S.; Vinci, V.; Smith, G.; Cucinotta, F. A.

    2004-01-01

    With 5-7 month long duration missions at 51.6 degrees inclination in Low Earth Orbit, the ionizing radiation levels to which International Space Station (ISS) crewmembers are exposed will be the highest planned occupational exposures in the world. Even with the expectation that regulatory dose limits will not be exceeded during a single tour of duty aboard the ISS, the "as low as reasonably achievable" (ALARA) precept requires that radiological risks be minimized when possible through a dose optimization process. Judicious placement of efficient shielding materials in locations where crewmembers sleep, rest, or work is an important means for implementing ALARA for spaceflight. Polyethylene (CnHn) is a relatively inexpensive, stable, and, with a low atomic number, an effective shielding material that has been certified for use aboard the ISS. Several designs for placement of slabs or walls of polyethylene have been evaluated for radiation exposure reduction in the Crew Quarters (CQ) of the Zvezda (Star) Service Module. Optimization of shield designs relies on accurate characterization of the expected primary and secondary particle environment and modeling of the predicted radiobiological responses of critical organs and tissues. Results of the studies shown herein indicate that 20% or more reduction in equivalent dose to the CQ occupant is achievable. These results suggest that shielding design and risk analysis are necessary measures for reducing long-term radiological risks to ISS inhabitants and for meeting legal ALARA requirements. Verification of shield concepts requires results from specific designs to be compared with onboard dosimetry. c2004 COSPAR. Published by Elsevier Ltd. All rights reserved.

  11. Implementation of ALARA radiation protection on the ISS through polyethylene shielding augmentation of the Service Module Crew Quarters.

    PubMed

    Shavers, M R; Zapp, N; Barber, R E; Wilson, J W; Qualls, G; Toupes, L; Ramsey, S; Vinci, V; Smith, G; Cucinotta, F A

    2004-01-01

    With 5-7 month long duration missions at 51.6 degrees inclination in Low Earth Orbit, the ionizing radiation levels to which International Space Station (ISS) crewmembers are exposed will be the highest planned occupational exposures in the world. Even with the expectation that regulatory dose limits will not be exceeded during a single tour of duty aboard the ISS, the "as low as reasonably achievable" (ALARA) precept requires that radiological risks be minimized when possible through a dose optimization process. Judicious placement of efficient shielding materials in locations where crewmembers sleep, rest, or work is an important means for implementing ALARA for spaceflight. Polyethylene (CnHn) is a relatively inexpensive, stable, and, with a low atomic number, an effective shielding material that has been certified for use aboard the ISS. Several designs for placement of slabs or walls of polyethylene have been evaluated for radiation exposure reduction in the Crew Quarters (CQ) of the Zvezda (Star) Service Module. Optimization of shield designs relies on accurate characterization of the expected primary and secondary particle environment and modeling of the predicted radiobiological responses of critical organs and tissues. Results of the studies shown herein indicate that 20% or more reduction in equivalent dose to the CQ occupant is achievable. These results suggest that shielding design and risk analysis are necessary measures for reducing long-term radiological risks to ISS inhabitants and for meeting legal ALARA requirements. Verification of shield concepts requires results from specific designs to be compared with onboard dosimetry. c2004 COSPAR. Published by Elsevier Ltd. All rights reserved.

  12. Reducing patient radiation dosage during pediatric SVT ablations using an "ALARA" radiation reduction protocol in the modern fluoroscopic era.

    PubMed

    Gellis, Laura A; Ceresnak, Scott R; Gates, Gregory J; Nappo, Lynn; Pass, Robert H

    2013-06-01

    Ablation for supraventricular tachycardia (SVT) relies upon fluoroscopy (fluoro), which exposes the patient and staff to ionizing radiation. The objective of this work was to present a new "ALARA--As Low As Reasonably Achievable" protocol with alterations to fluoroscopic x-ray parameters to reduce dose without an electroanatomical (EAM) approach. All patients <21 years of age undergoing ablation of SVT at our institution from June 2011 to April 2012 were included. EAM was not utilized in any case. An ALARA protocol of low frame rates (2 or 3 fps), low fluoro dose/frame (10-18 nGy/frame), and other techniques aimed at reducing use of fluoroscopy were employed. Demographics, procedural, and radiation data were analyzed. Forty-two patients underwent ablation and were studied. Median age was 14.1 years (range 4.8-21.1 years), weight was 51 kg (range 18.2-75 kg), and body surface area was 1.51 m(2) (range 0.72- 1.94 m(2)). Seventeen (41%) had Wolff-Parkinson-White syndrome, 14 (33%) atrioventricular nodal reentrant tachycardia, and 11 (26%) concealed pathways. Median procedural time was 114 minutes (57-246 minutes). Median dose area product (DAP) for posterioanterior and lateral fluoroscopy was 343.2 uGym(2) (range 38.2-3,172 uGym(2)); the median air Kerma product (K) was 45.4 mGy (range 6.7-567.5 mGy). DAP and K are lower than prior data from EAM and fluoroscopy techniques. The acute success rate was 95%; no procedural complications. An ALARA protocol for ablation of SVT reduced radiation to below levels previously reported for combined EAM/fluoro approaches. Success rates were excellent with no complications and without the costs of EAM. ©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.

  13. Value and impact factors of multidetector computed tomography in diagnosis of preoperative lymph node metastasis in gastric cancer: A PRISMA-compliant systematic review and meta-analysis.

    PubMed

    Luo, Mingxu; Lv, You; Guo, Xiuyu; Song, Hongmei; Su, Guoqiang; Chen, Bo

    2017-08-01

    Multidetector computed tomography (MDCT) exhibited wide ranges of sensitivities and specificities for lymph node assessment of gastric cancer (GC) in several individual studies. This present meta-analysis was carried out to evaluate the value of MDCT in diagnosis of preoperative lymph node metastasis (LNM) and to explore the impact factors that might explain the heterogeneity of its diagnostic accuracy in GC. A comprehensive search was conducted to collect all the relevant studies about the value of MDCT in assessing LNM of GC within the PubMed, Cochrane library and Embase databases up to Feb 2, 2016. Two investigators independently screened the studies, extracted data, and evaluated the quality of included studies. The sensitivity, specificity, and area under ROC curve (AUC) were pooled to estimate the overall accuracy of MDCT. Meta-regression and subgroup analysis were carried out to identify the possible factors influencing the heterogeneity of the accuracy. A total of 27 studies with 6519 subjects were finally included. Overall, the pooled sensitivity, specificity, and AUC were 0.67 (95% CI: 0.56-0.77), 0.86 (95% CI: 0.81-0.90), and 0.86 (95% CI: 0.83-0.89), respectively. Meta-regression revealed that MDCT section thickness, proportion of serosal invasion, and publication year were the main significant impact factors in sensitivity, and MDCT section thickness, multiplanar reformation (MPR), and reference standard were the main significant impact factors in specificity. After the included studies were divided into 2 groups (Group A: studies with proportion of serosa-invasive GC subjects ≥50%; Group B: studies with proportion of serosa-invasive GC subjects <50%), the pooled sensitivity in Group A was significantly higher than in Group B (0.84 [95% CI: 0.75-0.90] vs 0.55 [95% CI: 0.41-0.68], P < .01). For early gastric cancer (EGC), the pooled sensitivity, specificity, and AUC were 0.34 (95% CI: 0.15-0.61), 0.91 (95% CI: 0.84-0.95), and 0.83 (95% CI: 0

  14. Preoperative imaging diagnosis of carotid body tumors.

    PubMed

    Pacheco-Ojeda, Luis A; Martínez-Viteri, Miguel A

    2010-01-01

    Carotid body tumors (CBTs) are relatively frequent lesions encountered at high altitudes, such in as the Andean Mountains. A correct preoperative diagnosis is essential for surgical planning and performance. For this reason, we have reviewed the evolution of our experience in the imaging diagnosis of these tumors. Between 1980 and June 2008, 160 CBTs were diagnosed. A total of 138 tumors were operated on, 4 are waiting for surgery, and 18 were not operated on because of age, medical conditions, or patient refusal. We have reviewed retrospectively the modalities of imaging diagnosis in our patients who underwent operation. Among the 138 tumors operated on, a correct preoperative diagnosis was done in 127 cases (92%). The preoperative diagnosis of the remaining 11 patients was unspecified benign tumor for 6 patients and neck lymph node for 5 patients. The imaging methods performed by different radiologists were conventional ultrasound, color Doppler ultrasound, carotid conventional angiography (CA), axial tomography, magnetic resonance and magnetic resonance angiography, and computed tomographic angiography (CTA). Most patients had more than one image study. Review of radiologist reports revealed a correct diagnosis in all carotid CA, magnetic resonance studies, and CTA. Additionally, CTA appeared to be a valuable method to predict the Shamblin group. Clinical suspicion and current image techniques permit a correct diagnosis in practically all cases of CBT.

  15. Occupational dose reduction at Department of Energy contractor facilities: Bibliography of selected readings in radiation protection and ALARA

    SciTech Connect

    Dionne, B.J.; Sullivan, S.G.; Baum, J.W.

    1993-12-01

    This bibliography contains abstracts relating to various aspects of ALARA program implementation and dose reduction activities, with a focus on DOE facilities. Abstracts included in this bibliography were selected from proceedings of technical meetings, journals, research reports, searches of the DOE Energy, Science and Technology Database (in general, the citation and abstract information is presented as obtained from this database), and reprints of published articles provided by the authors. Facility types and activities covered in the scope of this report include: radioactive waste, uranium enrichment, fuel fabrication, spent fuel storage and reprocessing, facility decommissioning, hot laboratories, tritium production, research, test and production reactors, weapons fabrication and testing, fusion, uranium and plutonium processing, radiography, and aocelerators. Information on improved shielding design, decontamination, containments, robotics, source prevention and control, job planning, improved operational and design techniques, as well as on other topics, has been included. In addition, DOE/EH reports not included in previous volumes of the bibliography are in this volume (abstracts 611 to 684). This volume (Volume 5 of the series) contains 217 abstracts. An author index and a subject index are provided to facilitate use. Both indices contain the abstract numbers from previous volumes, as well as the current volume. Information that the reader feels might be included in the next volume of this bibliography should be submitted to the BNL ALARA Center.

  16. Occupational dose reduction at nuclear power plants: Annotated bibliography of selected readings in radiation protection and ALARA. Volume 7

    SciTech Connect

    Kaurin, D.G.; Khan, T.A.; Sullivan, S.G.; Baum, J.W.

    1993-07-01

    The ALARA Center at Brookhaven National Laboratory publishes a series of bibliographies of selected readings in radiation protection and ALARA in the continuing effort to collect and disseminate information on radiation dose reduction at nuclear power plants. This is volume 7 of the series. The abstracts in this bibliography were selected from proceedings of technical meetings and conferences, journals, research reports, and searches of the Energy Science and Technology database of the US Department of Energy. The subject material of these abstracts relates to radiation protection and dose reduction, and ranges from use of robotics to operational health physics, to water chemistry. Material on the design, planning, and management of nuclear power stations is included, as well as information on decommissioning and safe storage efforts. Volume 7 contains 293 abstract, an author index, and a subject index. The author index is specific for this volume. The subject index is cumulative and lists all abstract numbers from volumes 1 to 7. The numbers in boldface indicate the abstracts in this volume; the numbers not in boldface represent abstracts in previous volumes.

  17. Occupational dose reduction at nuclear power plants: Annotated bibliography of selected readings in radiation protection and ALARA. Volume 8

    SciTech Connect

    Sullivan, S.G.; Khan, T.A.; Xie, J.W.

    1995-05-01

    The ALARA Center at Brookhaven National Laboratory publishes a series of bibliographies of selected readings in radiation protection and ALARA in a continuing effort to collect and disseminate information on radiation dose reduction at nuclear power plants. This volume 8 of the series. The abstracts in this bibliography were selected form proceedings of technical meetings and conference journals, research reports, and searches of the Energy Science and Technology database of the US Department of Energy. The subject material of these abstracts relates to the many aspects of radiation protection and dose reduction, and ranges form use of robotics, to operational health physics, to water chemistry. Material on the design, planning, and management of nuclear power stations is included, as well as information on decommissioning and safe storage efforts. Volume 8 contains 232 abstracts, an author index, and a subject index. The author index is specific for this volume. The subject index is cumulative and lists all abstract numbers from volumes 1 to 8. The numbers in boldface indicate the abstracts in this volume; the numbers not in boldface represent abstracts in previous volumes.

  18. Preoperative chlorhexidine reduces the incidence of surgical site infections in total knee and hip arthroplasty: A systematic review and meta-analysis.

    PubMed

    Cai, Yuanzhen; Xu, Ke; Hou, Weikun; Yang, Zhi; Xu, Peng

    2017-03-01

    This meta-analysis aims to assess the incidences of surgical site infection of patients who applied preadmission chlorhexidine skin preparation, versus those who applied the traditional skin preparation before undergoing total knee and hip arthroplasty. A systematic search is carried out through Medline (1966-2016.11), PubMed (1966-2016.11), Embase (1980-2016.11), ScienceDirect (1985-2016.11) and the Cochrane Library. Only high quality studies are identified. Meta-analysis is conducted with the use of Stata 11.0 software. One RCT and five retrospective studies, published between 2010 and 2016, are included in the present meta-analysis. The present meta-analysis indicates that there are significant differences in surgical site infection rate (RD = -0.02, 95% CI: -0.02 to -0.01, P < 0.00001), revision surgery rate (RD = -0.01, 95% CI: -0.01 to -0.01, P < 0.00001) and length of stay (MD = -0.29, 95% CI: -0.48 to -0.11, P = 0.002) between groups. Preoperative chlorhexidine skin preparation appears to reduce the risk of infection, the incidence of revision surgery, and the length of stay for patients undergoing total knee and hip arthroplasty. No adverse effects, such as DVT or PE, appear to be related to chlorhexidine preparation. Due to the limited quality of the evidence currently available, high quality RCTs with better study designs, larger sample sizes and longer follow-ups are needed. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  19. Breast cancer electron intraoperative radiotherapy: assessment of preoperative selection factors from a retrospective analysis of 758 patients and review of literature.

    PubMed

    Takanen, S; Gambirasio, A; Gritti, G; Källi, M; Andreoli, S; Fortunato, M; Feltre, L; Filippone, F R; Iannacone, E; Maffioletti, L; Muni, R; Piccoli, F; Mauri, E M P; Paludetti, A; Giovanelli, M; Burgoa, L; Valerii, C; Palamara, F; Ferro, M; Fenaroli, P; Tondini, C A; Cazzaniga, L F

    2017-09-01

    To report our experience with full-dose 21 Gy IORT in early breast cancer patients after breast-conserving surgery to define most important selection factors. Seven hundred and fifty eight patients, subjected to conserving surgery and IORT, were retrospectively analyzed evaluating most important clinical outcomes. Median follow up was 5.2 years. Results from Cox analyses defined 2 groups of patients, "suitable" (age > 50 years, non lobular histology, tumour size ≤ 2 cm, pN0 or pNmic, ki67 ≤ 20%, non triple negative receptor status and G1-G2) and "unsuitable" for IORT, with a higher rate of breast related events moving from "suitable" to "unsuitable" group. The 5 year rate of IBR is 1.8% in suitable group with significant differences versus unsuitable (1.8 vs. 11.6%, p < 0.005). Same differences between two groups were evidenced in true local relapse (0.6 vs. 6.9%, p < 0.005) and in new ipsilateral BC (1.1 vs. 4.7%, p < 0.015). In our current practice we consider the following preoperative factors to select patients suitable for IORT: age > 50 years, absence of lobular histology, tumor size ≤ 2 cm, pN0 or pNmic, according to APBI consensus statement, including also ki67 ≤ 20%, non triple negative receptor status and G1-G2.

  20. Preoperative malalignment increases risk of failure after total knee arthroplasty.

    PubMed

    Ritter, Merrill A; Davis, Kenneth E; Davis, Peter; Farris, Alex; Malinzak, Robert A; Berend, Michael E; Meding, John B

    2013-01-16

    Implant survival after total knee arthroplasty has historically been dependent on postoperative knee alignment, although failure may occur when alignment is correct. Preoperative knee alignment has not been thoroughly evaluated as a possible risk factor for implant failure after arthroplasty. The purpose of this study was to analyze the effect of preoperative knee alignment on implant survival after total knee arthroplasty. We performed a retrospective review of 5342 total knee arthroplasties performed with use of cemented Anatomic Graduated Component implants from 1983 to 2006. Each knee was independently measured preoperatively and postoperatively for overall coronal alignment. Neutral ranges for preoperative and postoperative alignment were defined by means of Cox proportional hazards regression. The overall failure rate was 1.0% (fifty-four of 5342 prostheses); failure was defined as aseptic loosening of the femoral and/or tibial component. The average preoperative anatomical alignment (and standard deviation) was 0.1° ± 7.7° of varus (range, 25° of varus to 35° of valgus), and the average postoperative anatomical alignment (and standard deviation) was 4.7° ± 2.5° of valgus (range, 12° of varus to 20° of valgus). The failure rate in knees in >8° of varus preoperatively (2.2%; p = 0.0005) or >11° of valgus preoperatively (2.4%; p = 0.0081) was elevated when compared with knees in neutral preoperatively (0.71%). Knees with preoperative deformities corrected to postoperative neutral alignment (2.5° through 7.4°) had a lower failure rate (1.9%) than undercorrected or overcorrected knees (3.0%) (p = 0.0103). Knees with postoperative neutral alignment, regardless of preoperative alignment, had a lower failure rate (0.74%) than knees with postoperative alignment of <2.5° or >7.4° of anatomic valgus (1.7%) (p < 0.0001). Patients with excessive preoperative alignment (>8° of varus or >11° of valgus) have a greater risk of failure (2.3%). Neutral

  1. Pre-operative nutritional assessment.

    PubMed

    Corish, C A

    1999-11-01

    Protein-energy undernutrition, or the possibility of its development, has been documented to occur frequently in surgical patients admitted to hospital. Nutritional status is known to deteriorate over the course of the hospital stay, with poor awareness by medical and nursing staff as to the deleterious effects of impaired nutritional status on clinical outcome and hospital costs. While there is no consensus on the best method for assessment of the nutritional status of surgical patients pre-operatively, there are a number of techniques available. These techniques can be divided into two types, those suitable for screening for nutrition risk on admission to hospital and those used to fully assess nutritional status. Both techniques have their limitations, but if used correctly, and their limitations recognized, should identify the appropriate degree of nutritional intervention for an individual patient in a timely and cost-effective manner. The techniques currently available for nutritional screening and nutritional assessment are reviewed, and their applicability to the Irish setting are discussed in the present paper.

  2. Nurses' perceptions of preoperative teaching for ambulatory surgical patients.

    PubMed

    Tse, Kar-yee; So, Winnie Kwok-wei

    2008-09-01

    This paper is a report of a study to examine nurses' perceptions of the importance of providing preoperative information to ambulatory surgical patients, and factors that might influence their provision of such teaching. Ambulatory surgery is now widespread and creates a challenge for nurses to provide preoperative teaching in the limited contact time they have with patients. Although nurses act as key educators in patient teaching, little is known about their perceptions of the importance of preoperative teaching, or about current practice in the provision of such teaching for ambulatory surgical patients. A self-administered questionnaire including demographics and the Preoperative Teaching Questionnaire was completed by 91 of the 169 eligible nurses (response rate 53.8%) working in day-surgery units, operating theatres or outpatient clinics providing ambulatory surgery services in two public hospitals in Hong Kong in 2005. A discrepancy between nurses' perceptions and practice in relation to the provision of preoperative information was found. Limited teaching aids, tight operation schedules and language barriers affected the delivery of preoperative information to ambulatory surgical patients. The results highlight the importance of reviewing current preoperative teaching methods and improving the effectiveness of such teaching to enhance the quality of care for ambulatory surgical patients.

  3. Risk assessment and optimization (ALARA) analysis for the environmental remediation of Brookhaven National Laboratory`s hazardous waste management facility

    SciTech Connect

    Dionne, B.J.; Morris, S. III; Baum, J.W.

    1998-03-01

    The Department of Energy`s (DOE) Office of Environment, Safety, and Health (EH) sought examples of risk-based approaches to environmental restoration to include in their guidance for DOE nuclear facilities. Extensive measurements of radiological contamination in soil and ground water have been made at Brookhaven National Laboratory`s Hazardous Waste Management Facility (HWMF) as part of a Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) remediation process. This provided an ideal opportunity for a case study. This report provides a risk assessment and an {open_quotes}As Low as Reasonably Achievable{close_quotes} (ALARA) analysis for use at other DOE nuclear facilities as an example of a risk-based decision technique.

  4. Risk assessment and optimization (ALARA) analysis for the environmental remediation of Brookhaven National Laboratory`s hazardous waste management facility

    SciTech Connect

    Dionne, B.J.; Morris, S.C. III; Baum, J.W.

    1998-01-01

    The Department of Energy`s (DOE) Office of Environment, Safety, and Health (EH) sought examples of risk-based approaches to environmental restoration to include in their guidance for DOE nuclear facilities. Extensive measurements of radiological contamination in soil and ground water have been made at Brookhaven National Laboratory`s Hazardous Waste Management Facility (HWMF) as part of a Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) remediation process. This provided an ideal opportunity for a case study. This report provides a risk assessment and an {open_quotes}As Low as Reasonably Achievable{close_quotes} (ALARA) analysis for use at other DOE nuclear facilities as an example of a risk-based decision technique. This document contains the Appendices for the report.

  5. Lessons Learned at Envirocare of Utah's Containerized Waste Facility (CWF): Dose Minimization Through ALARA Techniques and Tools

    SciTech Connect

    Heckman, J.; Gardner, J.; Ledoux, M. R.

    2003-02-24

    Envirocare of Utah, Inc. (Envirocare) commenced operation of its Class A Containerized Waste Facility (CWF) on October 25, 2001. The opening of this facility began a new era for Envirocare, in that; their core business had always been low level, high volume, bulk radioactive waste. The CWF commenced operations to dispose of low level, low volume, high activity, containerized radioactive waste. Due to the potential for high dose rates on the waste disposal containers, the ALARA principle (As Low As Reasonably Achievable) plays an important role in the operation of the CWF and its mission to properly dispose of waste while minimizing doses to the workers, public, and the environment. This paper will enumerate some of the efforts made by the management and staff of the CWF that have contributed to significant dose reductions.

  6. [Place of the radiation safety officer in the implementation of the ALARA principle through European directive 97-43 items].

    PubMed

    Mozziconacci, J G; Ayivi, J; Loat, A; Ifergan, J; Mourbrun, M; Drevet, B

    2005-05-01

    The purpose of this article is to define the role of the radiation safety officer in raising the awareness of the radiology staff to the ALARA (As low as reasonable achievable) principle specified in European directive 97-43. The actions taken and the techniques used in our hospital, as well as the potential improvements that could be achieved with extra funding, will be presented. The didactic value of flow charts recording technical factors and fluoroscopy times for quality improvement will be demonstrated. In the future, a dosimeter incorporated on the new equipment could allow direct recording of the dose. The different items presented in this paper should allow routine implementation of the required elements described in the law 2003-270, i.e the French translation of European Directive 97-43.

  7. The importance of preoperative diagnosis of blister aneurysms.

    PubMed

    Russin, Jonathan J; Kramer, Daniel R; Thomas, Debi; Hasson, Denise; Liu, Charles Y; Amar, Arun P; Mack, William J; Giannotta, Steven L

    2015-09-01

    We describe a series of 14 surgical blister aneurysm (BA) patients and compare outcomes in those with known cerebral BA to those lacking preoperative BA diagnosis/recognition. BA are broad, fragile, pathologic dilatations of the intracranial arteries. They have a low prevalence but are associated with substantially higher surgical morbidity and mortality rates than saccular aneurysms. A confirmed, preoperative BA diagnosis can alter operative management and technique. We performed a retrospective review of prospectively collected data on aneurysm patients undergoing surgery at a major academic institution. All patients from 1990 to 2011 with a postoperative BA diagnosis were included. Chart reviews were performed to identify patients with preoperative BA diagnoses and collect descriptive data. We identified 14 patients, 12 of whom presented with subarachnoid hemorrhage. The age of the cohort (mean ± standard deviation: 41.8 ± 13.9 years) was lower than that generally reported for saccular aneurysm populations. Preoperatively diagnosed BA had an intraoperative rupture (IOR) rate of 28.6% (2/7) compared to a 57.1% (4/7) rate in the undiagnosed patients. The mortality rate in the preoperatively diagnosed cohort was 14.3% (1/7) while that of the undiagnosed group was 42.8% (3/7). BA remain a diagnostic and treatment challenge with morbidity and mortality rates exceeding those of saccular aneurysms. Preoperative BA diagnosis may decrease IOR and mortality rates and improve patient outcomes. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Preoperative blood transfusions for sickle cell disease

    PubMed Central

    Estcourt, Lise J; Fortin, Patricia M; Trivella, Marialena; Hopewell, Sally

    2016-01-01

    Background Sickle cell disease is one of the commonest severe monogenic disorders in the world, due to the inheritance of two abnormal haemoglobin (beta globin) genes. Sickle cell disease can cause severe pain, significant end-organ damage, pulmonary complications, and premature death. Surgical interventions are more common in people with sickle cell disease, and occur at much younger ages than in the general population. Blood transfusions are frequently used prior to surgery and several regimens are used but there is no consensus over the best method or the necessity of transfusion in specific surgical cases. This is an update of a Cochrane review first published in 2001. Objectives To determine whether there is evidence that preoperative blood transfusion in people with sickle cell disease undergoing elective or emergency surgery reduces mortality and perioperative or sickle cell-related serious adverse events. To compare the effectiveness of different transfusion regimens (aggressive or conservative) if preoperative transfusions are indicated in people with sickle cell disease. Search methods We searched for relevant trials in The Cochrane Library, MEDLINE (from 1946), Embase (from 1974), the Transfusion Evidence Library (from 1980), and ongoing trial databases; all searches current to 23 March 2016. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register: 18 January 2016. Selection criteria All randomised controlled trials and quasi-randomised controlled trials comparing preoperative blood transfusion regimens to different regimens or no transfusion in people with sickle cell disease undergoing elective or emergency surgery. There was no restriction by outcomes examined, language or publication status. Data collection and analysis Two authors independently assessed trial eligibility and the risk of bias and extracted data. Main results Three trials with 990 participants were eligible for inclusion in the review. There were no

  9. The role of preoperative prophylactic antibiotics in hypospadias repair

    PubMed Central

    Baillargeon, Emilie; Duan, Kai; Brzezinski, Alex; Jednak, Roman; El-Sherbiny, Mohamed

    2014-01-01

    Introduction: We sought to determine whether the use of preoperative antibiotics is effective in reducing postoperative wound infections and urinary tract infections (UTI) in hypospadias repair. Methods: We retrospectively reviewed all hypospadias repairs performed at the Montreal Children’s Hospital between March 2009 and September 2012. All types of primary hypospadias repairs and redo cases were included. Patients with no adequate follow-up or with missing records of antibiotics were excluded. Preoperative antibiotics were given in the form of cefazolin (50 mg/kg intravenously) when appropriate. Postoperative oral antibiotics were administered as decided by the pediatric urologist. Primary outcomes included postoperative wound infection and UTI. Secondary outcomes included the need for reoperation of hypospadias due to urethrocutaneous fistula, meatal stenosis, urethral stricture and wound dehiscence. Results: In total, 157 cases of hypospadias repair were reviewed; of these 7 were excluded due to lack of follow-up. Of the remaining 150 patients, 62 received preoperative antibiotics and 88 did not. The groups were well-matched for age, hypospadias characteristics, type of repair and repair of curvature. The group that received preoperative antibiotics had a significantly higher number of stented cases (82% vs. 52% of the non-preoperative antibiotic group). Two cases of wound infection were reported (1 in the pre-operative antibiotic group and 1 in the non-preoperative antibiotic group). There was no symptomatic UTI or culture-demonstrated UTI in either group. Moreover, there was no statistically significant difference between the 2 groups in terms of primary outcomes. The complication rate was 11% (17/150 repairs) and all patients needed reoperation. This study’s important limitations include the rarity of studied end points combined with the small sample and the retrospective nature of our study. Conclusion: Our findings do not support the routine use of

  10. Can fMRI safely replace the Wada test for preoperative assessment of language lateralisation? A meta-analysis and systematic review.

    PubMed

    Bauer, Prisca R; Reitsma, Johannes B; Houweling, Bernard M; Ferrier, Cyrille H; Ramsey, Nick F

    2014-05-01

    Recent studies have shown that fMRI (functional magnetic resonance imaging) may be of value for pre-surgical assessment of language lateralisation. The aim of this study was to systematically review and analyse the available literature. A systematic electronic search for studies comparing fMRI with Wada testing was conducted in the PubMed database between March 2009 and November 2011. Studies involving unilateral Wada testing, study population consisting exclusively of children younger than 12 years of age or involving five patients or fewer were excluded. 22 studies (504 patients) were included. A random effects meta-analysis was conducted to obtain pooled estimates of the positive and negative predictive values of the fMRI using the Wada test as the reference standard. The impact of several study features on the performance of fMRI was assessed. The results showed that 81% of patients were correctly classified as having left or right language dominance or mixed language representation. Techniques were discordant in 19% of patients. fMRI and Wada test agreed in 94% for typical language lateralisation and in 51% for atypical language lateralisation. Language production or language comprehension tasks and different regions of interest did not yield statistically significant different results. It can be concluded that fMRI is reliable when there is strong left-lateralised language. The Wada test is warranted when fMRI fails to show clear left-lateralisation.

  11. Magnetic resonance imaging in the preoperative assessment of patients with primary breast cancer: systematic review of diagnostic accuracy and meta-analysis.

    PubMed

    Plana, María Nieves; Carreira, Carmen; Muriel, Alfonso; Chiva, Miguel; Abraira, Víctor; Emparanza, Jose Ignacio; Bonfill, Xavier; Zamora, Javier

    2012-01-01

    To estimate the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting additional lesions and contralateral cancer not identified using conventional imaging in primary breast cancer. We have conducted a systematic review and meta-analyses to estimate diagnostic accuracy indices and the impact of MRI on surgical management. Fifty articles were included (n = 10,811 women). MRI detected additional disease in 20% of women and in the contralateral breast in 5.5%. The summary PPV of ipsilateral additional disease was 67% (95% CI 59-74%). For contralateral breast, the PPV was 37% (95% CI 27-47%). For ipsilateral lesions, MRI devices ≥1.5 Tesla (T) had higher PPV (75%, 95% CI 64-83%) than MRI with <1.5 T (59%, 95% CI 53-71%). Similar results were found for contralateral cancer, PPV 40% (95% CI 29-53%) and 19% (95% CI 8-39%) for high- and low-field equipments, respectively. True positive MRI findings prompted conversion from wide local excision (WLE) to more extensive surgery in 12.8% of women while in 6.3% this conversion was inappropriate. MRI shows high diagnostic accuracy, but MRI findings should be pathologically verified because of the high FP rate. Future research on this emerging technology should focus on patient outcome as the primary end-point.

  12. Short review on face rejuvenation procedures: focus on preoperative antiseptic and anesthetic delivery by JetPeel™-3 (a high pressure oxygen delivery device).

    PubMed

    Iannitti, T; Capone, S; Palmieri, B

    2011-06-01

    Nowadays there is great attention in trying to slow and reverse the facial aging process. Esthetic medicine has been primarily based on the surgical approach for many years, but now, in order to solve the problem of aging skin, there is an increasing interest into non-invasive, possibly painless, procedures that can guarantee the patient a quick recovery. In this perspective the use of chemical peeling and dermabrasion, to achieve skin rejuvenation, is growing worldwide. These techniques are also relevant to treat skin pigmentation irregularities and to remove keratoses, lentigines, acne and other skin related conditions. One of the most interesting, safe and painless devices, useful for the effective antiaging face treatment, is JetPeel™-3. The aim of this study was to assess the device efficacy starting from a short review on face rejuvenation procedures. The basic action mechanism of this medical device is a constant high pressure air flux delivery, including oxygen, mixed with different chemical compounds such as peeling molecules, antioxidants, vitamins and hyaluronic acid, which are mechanically forced across the skin surface. Here we report a new approach in the clinical use of JetPeel™-3, tested in 20 adult volunteers, consisting in the addition to the standard protocol of an anesthetic, carbocaine and a sterilizing and disinfectant agent, that is chlorexidine. In fact disinfection and sterilization of the skin surface is a peculiar step for every antiaging or therapeutic procedure. The procedure has been completed with multiple hyaluronic acid injections of the skin in order to achieve face rejuvenation. The anesthetic power of the JetPeel™-3-carbocaine protocol has been compared to the Emla cream one. The spontaneous pain sensation perceived by the patients in the hemiface treated with JetPeel™-3 was significantly lower compared to the hemiface treated with Emla cream (P<0.001) showing, consequently, that JetPeel™-3-carbocaine protocol had the

  13. Iron therapy for pre-operative anaemia.

    PubMed

    Ng, Oliver; Keeler, Barrie D; Mishra, Amitabh; Simpson, Alastair; Neal, Keith; Brookes, Matthew J; Acheson, Austin G

    2015-12-22

    Pre-operative anaemia is common and occurs in up to 76% of patients. It is associated with increased peri-operative allogeneic blood transfusions, longer hospital lengths of stay and increased morbidity and mortality. Iron deficiency is one of the most common causes of this anaemia. Oral iron therapy has traditionally been used to treat anaemia but newer, safer parenteral iron preparations have been shown to be more effective in other conditions such as inflammatory bowel disease, chronic heart failure and post-partum haemorrhage. A limited number of studies look at iron therapy for the treatment of pre-operative anaemia. The aim of this Cochrane review is to summarise the evidence for use of iron supplementation, both enteral and parenteral, for the management of pre-operative anaemia. The objective of this review is to evaluate the effects of pre-operative iron therapy (enteral or parenteral) in reducing the need for allogeneic blood transfusions in anaemic patients undergoing surgery. We ran the search on 25 March 2015. We searched the Cochrane Injuries Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), EMBASE Classic and EMBASE (Ovid), CINAHL Plus (EBSCO), PubMed, clinical trials registries, conference abstracts, and we screened reference lists. We included all randomised controlled trials (RCTs) which compared pre-operative iron monotherapy to placebo, no treatment, standard of care or another form of iron therapy for anaemic adults undergoing surgery. Anaemia was defined by haemoglobin values less than 13 g/dL for males and 12 g/dL for non-pregnant females. Data were collected by two authors on the proportion of patients who receive a blood transfusion, amount of blood transfused per patient (units) and haemoglobin measured as continuous variables at pre-determined time-points: pre

  14. Preoperative staging of rectal cancer.

    PubMed

    Smith, Neil; Brown, Gina

    2008-01-01

    Detailed preoperative staging using high resolution magnetic resonance imaging (MRI) enables the selection of patients that require preoperative therapy for tumour regression. This information can be used to instigate neoadjuvant therapy in those patients with poor prognostic features prior to disturbing the tumour bed and potentially disseminating disease. The design of trials incorporating MR assessment of prognostic factors prior to therapy has been found to be of value in assessing treatment modalities and outcomes that are targeted to these preoperative prognostic subgroups and in providing a quantifiable assessment of the efficacy of particular chemoradiation treatment protocols by comparing pre-treatment MR staging with post therapy histology assessment. At present, we are focused on achieving clear surgical margins of excision (CRM) to avoid local recurrence. We recommend that all patients with rectal cancer should undergo pre-operative MRI staging. Of these, about half will have good prognosis features (T1-T3b, N0, EMVI negative, CRM clear) and may safely undergo primary total mesorectal excision. Of the remainder, those with threatened or involved margins will certainly benefit from pre-operative chemoradiotherapy with the aim of downstaging to permit safe surgical excision. In the future, our ability to recognise features predicting distant failure, such as extramural vascular invasion (EMVI) may be used to stratify patients for neo-adjuvant systemic chemotherapy in an effort to prevent distant relapse. The optimal pre-operative treatment regimes for these patients (radiotherapy alone, systemic chemotherapy alone or combination chemo-radiotherapy) is the subject of current and future trials.

  15. Preoperative Psychological Preparation of Children

    PubMed Central

    Güleç, Ersel; Özcengiz, Dilek

    2015-01-01

    Surgery and anaesthesia are significant sources of anxiety for children. In the preoperative period, reducing anxiety helps in preventing the negative consequences that may occur after surgery. The predetermined high-risk children in terms of the development of anxiety play an important role in reducing the negative consequences. Recently featured approaches are modelling and coping techniques, although many techniques are used in the preoperative psychological preparation. The use of computer programs in this area may facilitate important achievements, and it needs to support new studies to be performed. PMID:27366525

  16. [Value of preoperative planning in total hip arthroplasty].

    PubMed

    De Thomasson, E; Mazel, C; Guingand, O; Terracher, R

    2002-05-01

    Preoperative planning enables an assessment of the size of the implants needed before total hip replacement. Eggli and Müller demonstrated the reproduciblity of preoperative planning but did not evaluate its contribution to reducing limb length discrepancy. As femur lateralization and the position of the prosthetic center of rotation affect joint mechanics, it would be useful to assess their contribution to the efficacy of preoperative planning. We reviewed the files of 57 patients who underwent total hip arthroplasty for primary joint degeneration or necrosis limited to one hip. The healthy hip served as a control. The surgical plan was elaborated from the preoperative pelvis x-rays (AP and lateral views) and anatomic measurements on films obtained three months postoperatively. In 49 cases, preoperative planning predicted a restoration of the normal anatomy of the operated hip (center of rotation, femur lateralization, length of the operated limb). This objective was achieved in only 22.5% of the cases. Femur lateralization was the most difficult objective to achieve (59.2%). Equal limb length and good position of the center of rotation was achieved in 70% of the cases. For eight patients (14%) preoperative planning was not satisfactory, the implant offset not being adapted to the patient's anatomy. There are limits to preoperative planning, particularly for restitution of adequate femur lateralization. This difficulty appears to be related to three factors: inadequate adaptation of the implant to hip anatomy (14% of the cases in our experience), stiff rotation in degenerative hips inhibiting proper assessment of the length of the femoral neck, and relative imprecision of operative evaluation of femoral anteversion affecting femur lateralization and the level of the femoral cut. Although imperfect, preoperative planning is, in our opinion, essential before total hip arthroplasty in order to avoid major positioning errors and operative difficulties.

  17. An ICU Preanesthesia Evaluation Form Reduces Missing Preoperative Key Information

    PubMed Central

    Chuy, Katherine; Yan, Zhe; Fleisher, Lee; Liu, Renyu

    2013-01-01

    Background A comprehensive preoperative evaluation is critical for providing anesthetic care for patients from the intensive care unit (ICU). There has been no preoperative evaluation form specific for ICU patients that allows for a rapid and focused evaluation by anesthesia providers, including junior residents. In this study, a specific preoperative form was designed for ICU patients and evaluated to allow residents to perform the most relevant and important preoperative evaluations efficiently. Methods The following steps were utilized for developing the preoperative evaluation form: 1) designed a new preoperative form specific for ICU patients; 2) had the form reviewed by attending physicians and residents, followed by multiple revisions; 3) conducted test releases and revisions; 4) released the final version and conducted a survey; 5) compared data collection from new ICU form with that from a previously used generic form. Each piece of information on the forms was assigned a score, and the score for the total missing information was determined. The score for each form was presented as mean ± standard deviation (SD), and compared by unpaired t test. A P value < 0.05 was considered statistically significant. Results Of 52 anesthesiologists (19 attending physicians, 33 residents) responding to the survey, 90% preferred the final new form; and 56% thought the new form would reduce perioperative risk for ICU patients. Forty percent were unsure whether the form would reduce perioperative risk. Over a three month period, we randomly collected 32 generic forms and 25 new forms. The average score for missing data was 23 ± 10 for the generic form and 8 ± 4 for the new form (P = 2.58E-11). Conclusions A preoperative evaluation form designed specifically for ICU patients is well accepted by anesthesia providers and helped to reduce missing key preoperative information. Such an approach is important for perioperative patient safety. PMID:23853741

  18. Anxiety in preoperative anesthetic procedures.

    PubMed

    Valenzuela Millán, Jaquelyn; Barrera Serrano, José René; Ornelas Aguirre, José Manuel

    2010-01-01

    Preoperative anxiety is a common and poorly evaluated condition in patients who will undergo an anesthetic and surgical intervention. The objective of this study was to determine the prevalence of anxiety in a group of patients undergoing elective surgery, as assessed by the Amsterdam Anxiety Preoperative and Information (AAPI) scale. We studied 135 patients scheduled for elective surgery applying the AAPI scale 24 h before the surgical procedure to evaluate the presence of anxiety and patient characteristics. A descriptive analysis with mean +/- standard deviation for categorical variables was done. For intragroup differences, chi(2) test was used. Pearson correlation for the association between anxiety and postoperative complications was carried out. A value of p =0.05 was considered significant. One hundred six patients were surgically treated, 88% were female (average age 44 +/- 12 years). Some degree of preoperative anxiety was present in 72 patients (76%; p = 0.001) with a grade point average on the AAPI scale equal to 17 +/- 7 points, of which 95 (70%, OR = 5.08; p = 0.002) were females. Results of this study suggest the presence of high levels of preoperative anxiety in patients scheduled for elective surgery. The origin of the anxiety appears to be related to many factors that can be evaluated in pre-anesthetic consultation. Further study is needed to prevent the presence of this disorder.

  19. Health physics aspects of advanced reactor licensing reviews

    SciTech Connect

    Hinson, C.S.

    1995-03-01

    The last Construction Permit to be issued by the U.S. Nuclear Regulatory Commission (NRC) for a U.S. light water reactor (LWR) was granted in the late 1970s. In 1989 the NRC issued 10 CFR Part 52 which is intended to serve as a framework for the licensing of future reactor designs. The NRC is currently reviewing four different future on {open_quotes}next-generation{close_quotes} reactor designs. Two of these designs are classified as evolutionary designs (modified versions of current generation LWRs) and two are advanced designs (reactors incorporating simplified designs and passive means for accident mitigation). These {open_quotes}next-generation{close_quotes} reactor designs incorporate many innovative design features which are intended to maintain personnel doses ALARA and ensure that the annual average collective dose at these reactors does not exceed 100 person-rems (1 person-sievert) per year. This paper discusses some of the ALARA design features which are incorporated in the four {open_quotes}next-generation{close_quotes} reactor designs incorporate many innovative design features which are intended to maintain personnel doses ALARA and ensure that the annual average collective dose at these reactors does not exceed 100 person-rems (1 person-sievert) per year. This paper discusses some of the ALARA design features which are incorporated in the four {open_quotes}next-generation{close_quotes} reactor designs currently being reviewed by the NRC.

  20. IMPROVED WELL PLUGGING EQUIPMENT AND WASTE MANGEMENT TECHNIQUES EXCEED ALARA GOALS AT THE OAK RIDGE NATIONAL LABORATORY

    SciTech Connect

    Whiteside, R.; Pawlowicz, R.; Whitehead, L.; Arnseth, R.

    2002-02-25

    In 2000, Bechtel Jacobs Company LLC (BJC) contracted Tetra Tech NUS, Inc. (TtNUS) and their sub-contractor, Texas World Operations, Inc. (TWO), to plug and abandon (P&A) 111 wells located in the Melton Valley area of Oak Ridge National Laboratory (ORNL). One hundred and seven of those wells were used to monitor fluid movement and subsurface containment of the low level radioactive liquid waste/grout slurry that was injected into the Pumpkin Valley Shale Formation, underlying ORNL. Four wells were used as hydrofracture injection wells to emplace the waste in the shale formation. Although the practice of hydrofracturing was and is considered by many to pose no threat to human health or the environment, the practice was halted in 1982 after the Federal Underground Injection Control regulations were enacted by United States Environmental Protection Agency (USEPA) making it necessary to properly close the wells. The work is being performed for the United States Department of Energy Oak Ridge Operations (DOE ORO). The project team is using the philosophy of minimum waste generation and the principles of ALARA (As Low As Reasonably Achievable) as key project goals to minimize personnel and equipment exposure, waste generation, and project costs. Achievement of these goals was demonstrated by the introduction of several new pieces of custom designed well plugging and abandonment equipment that were tested and used effectively during field operations. Highlights of the work performed and the equipment used are presented.

  1. A systematic examination of preoperative surgery warm-up routines.

    PubMed

    Pike, T W; Pathak, S; Mushtaq, F; Wilkie, R M; Mon-Williams, M; Lodge, J P A

    2017-05-01

    Recent evidence indicates that a preoperative warm-up is a potentially useful tool in facilitating performance. But what factors drive such improvements and how should a warm-up be implemented? In order to address these issues, we adopted a two-pronged approach: (1) we conducted a systematic review of the literature to identify existing studies utilising preoperative simulation techniques; (2) we performed task analysis to identify the constituent parts of effective warm-ups. We identified five randomised control trials, four randomised cross-over trials and four case series. The majority of these studies reviewed surgical performance following preoperative simulation relative to performance without simulation. Four studies reported outcome measures in real patients and the remainder reported simulated outcome measures. All but one of the studies found that preoperative simulation improves operative outcomes-but this improvement was not found across all measured parameters. While the reviewed studies had a number of methodological issues, the global data indicate that preoperative simulation has substantial potential to improve surgical performance. Analysis of the task characteristics of successful interventions indicated that the majority of these studies employed warm-ups that focused on the visual motor elements of surgery. However, there was no theoretical or empirical basis to inform the design of the intervention in any of these studies. There is an urgent need for a more rigorous approach to the development of "warm-up" routines if the potential value of preoperative simulation is to be understood and realised. We propose that such interventions need to be grounded in theory and empirical evidence on human motor performance.

  2. Minimizing preoperative anxiety with alternative caring-healing therapies.

    PubMed

    Norred, C L

    2000-11-01

    This article reviews holistic caring-healing therapies that may decrease preoperative anxiety for the surgical patient, based on the philosophy and science of caring developed by Jean Watson, RN, PhD, FAAN. Dr Watson reveals a new paradigm emerging in health care that blends the compassion and caring of nursing in harmony with the curative therapies of medicine. Hypnosis, aromatherapy, music, guided imagery, and massage are integrative caring-healing therapies that may minimize preoperative anxiety. Alternative therapies offer a high-touch balance when integrated with high-tech conventional surgical treatments.

  3. [Importance of preoperative and intraoperative imaging for operative strategies].

    PubMed

    Nitschke, P; Bork, U; Plodeck, V; Podlesek, D; Sobottka, S B; Schackert, G; Weitz, J; Kirsch, M

    2016-03-01

    Recent advances in preoperative and postoperative imaging have an increasing influence on surgical decision-making and make more complex surgical interventions possible. This improves the possibilities for frequently occurring challenges and promoting improved functional and oncological outcome. This manuscript reviews the role of preoperative and intraoperative imaging in surgery. Various techniques are explained based on examples from hepatobiliary surgery and neurosurgery, in particular real-time procedures, such as the online use of augmented reality and in vivo fluorescence, as well as new and promising optical techniques including imaging of intrinsic signals and vibrational spectroscopy.

  4. Preoperative psychological testing--another form of prejudice.

    PubMed

    Ashton, David; Favretti, Franco; Segato, Gianni

    2008-10-01

    Preoperative psychological screening of bariatric surgery candidates has become routine, and a significant proportion of patients have their surgery deferred as a consequence. If psychological testing is being used as a form of preoperative triage, both patients and surgeons are entitled to know whether there is sufficient evidence to justify its use in this way. We define the argument for psychological screening as consisting of four premises (p1-p4) and a conclusion (C) as follows: (p1) A significant minority of obese patients will not be successful in losing weight following bariatric surgery-the "failure" group; (p2) A significant minority of patients will exhibit abnormal psychological profiles during preoperative testing; (p3) The majority of individuals referred to in (p2) will be found in group (p1) i.e., abnormal psychological profiles identified preoperatively predict less favorable weight loss outcomes postoperatively; (p4) Identifying patients with adverse psychological profiles preoperatively would allow either exclusion of those at high risk of failure or provide a more secure rationale for targeted pre- and postoperative support; (C) Psychological screening should be part of the routine preoperative assessment for patients undergoing obesity surgery. We reviewed the literature to find evidence to support the premises and show that (p1) can be justified but that (p2) is problematic and can only be accepted in a heavily qualified version. We find no evidence for (p3) and since (p4) and (C) are predicated on (p3), the argument clearly fails. There is no evidence to suggest that preoperative psychological screening can predict postoperative outcomes and no justification for using such testing as a means of discriminating between candidates presenting themselves for bariatric surgery.

  5. Preoperative evaluation for lung cancer resection.

    PubMed

    Spyratos, Dionysios; Zarogoulidis, Paul; Porpodis, Konstantinos; Angelis, Nikolaos; Papaiwannou, Antonios; Kioumis, Ioannis; Pitsiou, Georgia; Pataka, Athanasia; Tsakiridis, Kosmas; Mpakas, Andreas; Arikas, Stamatis; Katsikogiannis, Nikolaos; Kougioumtzi, Ioanna; Tsiouda, Theodora; Machairiotis, Nikolaos; Siminelakis, Stavros; Argyriou, Michael; Kotsakou, Maria; Kessis, George; Kolettas, Alexander; Beleveslis, Thomas; Zarogoulidis, Konstantinos

    2014-03-01

    During the last decades lung cancer is the leading cause of death worldwide for both sexes. Even though cigarette smoking has been proved to be the main causative factor, many other agents (e.g., occupational exposure to asbestos or heavy metals, indoor exposure to radon gas radiation, particulate air pollution) have been associated with its development. Recently screening programs proved to reduce mortality among heavy-smokers although establishment of such strategies in everyday clinical practice is much more difficult and unknown if it is cost effective compared to other neoplasms (e.g., breast or prostate cancer). Adding severe comorbidities (coronary heart disease, COPD) to the above reasons as cigarette smoking is a common causative factor, we could explain the low surgical resection rates (approximately 20-30%) for lung cancer patients. Three clinical guidelines reports of different associations have been published (American College of Chest Physisians, British Thoracic Society and European Respiratory Society/European Society of Thoracic Surgery) providing detailed algorithms for preoperative assessment. In the current mini review, we will comment on the preoperative evaluation of lung cancer patients.

  6. FFTF preoperational survey. Program report

    SciTech Connect

    Twitty, B.L.; Bicehouse, H.J.

    1980-12-01

    The FFTF will become operational with criticality early in 1980. This facility is composed of the test reactor, fuel examination cells, expended fuel storage systems and fuel handling systems. The reactor and storage systems are sodium-cooled with the heat load dumped to the ambient air through heat exchangers. In order to assure that the operation of the FFTF has minimal impact on the environment, a monitoring program has been established. Prior to operation of a new facility, a preoperational environmental survey is required. It is the purpose of this report to briefly describe the environmental survey program and to provide the background data obtained during the preoperational phase of the survey program. Nine stations in the program of particular importance to FFTF are discussed in detail with results of monitoring given. No unexplained trends were noted.

  7. [Algorithm for treating preoperative anemia].

    PubMed

    Bisbe Vives, E; Basora Macaya, M

    2015-06-01

    Hemoglobin optimization and treatment of preoperative anemia in surgery with a moderate to high risk of surgical bleeding reduces the rate of transfusions and improves hemoglobin levels at discharge and can also improve postoperative outcomes. To this end, we need to schedule preoperative visits sufficiently in advance to treat the anemia. The treatment algorithm we propose comes with a simple checklist to determine whether we should refer the patient to a specialist or if we can treat the patient during the same visit. With the blood count test and additional tests for iron metabolism, inflammation parameter and glomerular filtration rate, we can decide whether to start the treatment with intravenous iron alone or erythropoietin with or without iron. With significant anemia, a visit after 15 days might be necessary to observe the response and supplement the treatment if required. The hemoglobin objective will depend on the type of surgery and the patient's characteristics.

  8. Juvenile angiofibroma: major and minor complications of preoperative embolization.

    PubMed

    Ogawa, A I; Fornazieri, M A; da Silva, L V; Pinna, F R; Voegels, R L; Sennes, L U; Junior, P P; Caldas, J G

    2012-06-01

    Juvenile angiofibromas (JA) are highly vascular, benign tumours for which surgery is the treatment of choice. In most services, embolisation is performed prior to resection. Nevertheless, there are few data on the complications of preoperative embolisation for JA. To describe major and minor complications of preoperative embolisation in a 32-year experience of patients undergoing surgical resection of JA at a tertiary hospital. Retrospective chart review study of 170 patients who underwent surgical resection of JA at a tertiary hospital between September 1976 and July 2008. All patients were male. Age ranged from 9 to 26 years. Ninety-one patients had no complications after embolisation. Overall, 105 complication events occurred of which four major and 101 minor. In our series, preoperative embolisation for JA produced no irreversible complications and no aesthetic or functional sequelae. The vast majority of complications were transient and amenable to clinical management.

  9. Pre-operative preparation for otologic surgery: temporal bone simulation

    PubMed Central

    Sethia, Rishabh; Wiet, Gregory J.

    2015-01-01

    Purpose of review The field of temporal bone simulation (TBS) has largely focused on the development and validation of simulators as training and assessment tools. However, as technology has progressed over the years, researchers have envisioned new clinical applications for simulators extending to pre-operative surgical planning and case rehearsal. The purpose of this article is to review the current state of the art in TBS and to highlight recent advancements in the field. Due to space limitations, we will limit our discussion to computer-based virtual reality (VR) simulators. Recent findings A review of the recent literature on TBS revealed very limited application of VR simulators for pre-operative preparation. Current evidence suggests limitations in fidelity preclude successful patient-specific case rehearsal using VR simulation. Further investigation and clinical evaluation are required to validate its use outside of training and skill assessment. Summary This article provides an overview of the current use of VR simulators with emphasis on pre-operative planning. We evaluate the limitations of the technology, and discuss potential areas of improvement for the future. More studies are necessary to assess the value of VR simulation for pre-operative preparation. PMID:26339966

  10. Preoperative therapy for localized prostate cancer: a comprehensive overview.

    PubMed

    Hu, Jensen; Hsu, JoAnn; Bergerot, Paulo G; Yuh, Bertram E; Stein, Cy A; Pal, Sumanta K

    2013-01-01

    At the 2012 American Society of Clinical Oncology (ASCO) Annual Meeting, two studies of preoperative systemic therapy for localized prostate cancer garnered significant attention. In the first, investigators evaluated various permutations of conventional hormonal therapies prior to prostatectomy, with detailed biomarker studies focused on tissue androgens. In the second, investigators assessed the novel CYP17 lyase inhibitor abiraterone prior to prostatectomy. Both studies provide a wealth of biological information, but the question remains - will preoperative systemic therapy ultimately be incorporated into clinical algorithms for prostate cancer? Herein, the existing literature for both preoperative hormonal and chemotherapeutic approaches is reviewed. We performed a MEDLINE search of published prospective and retrospective clinical studies assessing preoperative systemic therapy for prostate cancer from 1982 onwards, revealing a total of 75 publications meeting these criteria. Of these, 55 possessed a number of patients (i.e., greater than 10) deemed worth of the current analysis. Beyond outlining these datasets, we discuss the relevance of clinical and pathologic endpoints in assessing preoperative therapy. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  11. Impact of preoperative narcotic use on outcomes in migraine surgery.

    PubMed

    Adenuga, Paul; Brown, Matthew; Reed, Deborah; Guyuron, Bahman

    2014-07-01

    This study focuses on the impact of preoperative narcotic medication use on outcomes of surgical treatment of migraine headaches. A retrospective comparative review was conducted with patients undergoing migraine surgery. Data gathered included demographic information, baseline migraine headache characteristics, migraine surgery sites, postoperative migraine headache characteristics 1 year or more following surgery, and preoperative migraine medication use. Patients were grouped based on preoperative narcotic medication use. The narcotic users were subdivided into low and high narcotic user groups. Preoperative migraine characteristics were comparable between groups and the outcomes of migraine surgery were compared between the groups. Outcomes in 90 narcotic users were compared with those for 112 patients not using narcotic medications preoperatively. Narcotic users showed statistically significantly less reduction in frequency, severity, and duration of migraine headaches after surgery. Narcotic users had clinical improvement in 66.7 percent of patients and elimination in 18.9 percent versus 86.6 and 36.6 percent, respectively, in the nonnarcotic group. The group that consumed narcotics had significantly lower rates of improvement in all migraine indices. Previous studies have discouraged the routine use of narcotic medications in the management of migraine medications. The authors' study demonstrates that narcotic medication use before migraine headache surgery may predispose patients to worse outcomes postoperatively. Because pain cannot be objectively documented, the question remains of whether this failure to improve the pain was indeed a suboptimal response to surgery or the need for narcotic substances. Risk, II.

  12. Preoperative antibiotics for septic arthritis in children: delay in diagnosis.

    PubMed

    MacLean, Simon B M; Timmis, Christopher; Evans, Scott; Lawniczak, Dominik; Nijran, Amit; Bache, Edward

    2015-04-01

    To review the records of 50 children who underwent open joint washout for septic arthritis with (n=25) or without (n=25) preoperative antibiotics. Records of 50 children who underwent open joint washout for presumed septic arthritis with (n=25) or without (n=25) preoperative antibiotics were reviewed. 17 boys and 8 girls aged 3 weeks to 16 years (median, 1.5 years) who were prescribed preoperative antibiotics before joint washout were compared with 12 boys and 13 girls aged one month to 14 years (median, 2 years) who were not. Following arthrotomy and washout, all patients were commenced on high-dose intravenous antibiotics. Patients were followed up for 6 to 18 months until asymptomatic. Patients who were referred from places other than our emergency department were twice as likely to have been prescribed preoperative antibiotics (p=0.0032). Patients prescribed preoperative antibiotics had a longer median (range) time from symptom onset to joint washout (8 [2-23] vs. 4 [1-29] days, p=0.05) and a higher mean erythrocyte sedimentation rate (93.1 vs. 54.3 mm/h, p=0.023) at presentation. Nonetheless, the 2 groups were comparable for weight bearing status, fever, and positive culture, as well as the mean (range) duration of antibiotic treatment (4.9 [4-7] vs. 4.7 [1-8] weeks, p=0.586). Preoperative antibiotics should be avoided in the management of septic arthritis in children. Their prescription delays diagnosis and definitive surgery, and leads to additional washouts and complications. A high index of suspicion and expedite referral to a specialist paediatric orthopaedic unit is needed if septic arthritis is suspected.

  13. Pancoast tumors: characteristics and preoperative assessment

    PubMed Central

    Panagopoulos, Nikolaos; Leivaditis, Vasilios; Koletsis, Efstratios; Prokakis, Christos; Alexopoulos, Panagiotis; Baltayiannis, Nikolaos; Hatzimichalis, Antonios; Tsakiridis, Kosmas; Zarogoulidis, Konstantinos; Katsikogiannis, Nikolaos; Kougioumtzi, Ioanna; Machairiotis, Nikolaos; Tsiouda, Theodora; Kesisis, Georgios; Siminelakis, Stavros; Madesis, Athanasios; Dougenis, Dimitrios

    2014-01-01

    Superior sulcus tumors (SSTs), or as otherwise known Pancoast tumors, make up a clinically unique and challenging subset of non-small cell carcinoma of the lung (NSCLC). Although the outcome of patients with this disease has traditionally been poor, recent developments have contributed to a significant improvement in prognosis of SST patients. The combination of severe and unrelenting shoulder and arm pain along the distribution of the eighth cervical and first and second thoracic nerve trunks, Horner’s syndrome (ptosis, miosis, and anhidrosis) and atrophy of the intrinsic hand muscles comprises a clinical entity named as “Pancoast-Tobias syndrome”. Apart NSCLC, other lesions may, although less frequently, result in Pancoast syndrome. In the current review we will present the main characteristics of the disease and focus on the preoperative assessment. PMID:24672686

  14. The effects of preoperative cardiology consultation prior to elective abdominal aortic aneurysm repair on patient morbidity.

    PubMed

    Boniakowski, Anna E; Davis, Frank M; Phillips, Amanda R; Robinson, Adina B; Coleman, Dawn M; Henke, Peter K

    2017-08-01

    Objectives The relationship between preoperative medical consultations and postoperative complications has not been extensively studied. Thus, we investigated the impact of preoperative consultation on postoperative morbidity following elective abdominal aortic aneurysm repair. Methods A retrospective review was conducted on 469 patients (mean age 72 years, 20% female) who underwent elective abdominal aortic aneurysm repair from June 2007 to July 2014. Data elements included detailed medical history, preoperative cardiology consultation, and postoperative complications. Primary outcomes included 30-day morbidity, consult-specific morbidity, and mortality. A bivariate probit regression model accounting for the endogeneity of binary preoperative medical consult and patient variability was estimated with a maximum likelihood function. Results Eighty patients had preoperative medical consults (85% cardiology); thus, our analysis focuses on the effect of cardiac-related preoperative consults. Hyperlipidemia, increased aneurysm size, and increased revised cardiac risk index increased likelihood of referral to cardiology preoperatively. Surgery type (endovascular versus open repair) was not significant in development of postoperative complications when controlling for revised cardiac risk index ( p = 0.295). After controlling for patient comorbidities, there was no difference in postoperative cardiac-related complications between patients who did and did not undergo cardiology consultation preoperatively ( p = 0.386). Conclusions When controlling for patient disease severity using revised cardiac risk index risk stratification, preoperative cardiology consultation is not associated with postoperative cardiac morbidity.

  15. Preoperative optimization and risk assessment.

    PubMed

    Nicholas, Joseph A

    2014-05-01

    Because most older adults with hip fractures require urgent surgical intervention, the preoperative medical evaluation focuses on the exclusion of the small number of contraindications to surgery, and rapid optimization of patients for operative repair. Although many geriatric fracture patients have significant chronic medical comorbidities, most patients can be safely stabilized for surgery with medical and orthopedic comanagement by anticipating a small number of common physiologic responses and perioperative complications. In addition to estimating perioperative risk, the team should focus on intravascular volume restoration, pain control, and avoidance of perioperative hypotension. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Preoperative Evaluation for Noncardiac Surgery.

    PubMed

    Cohn, Steven L

    2016-12-06

    This issue provides a clinical overview of preoperative evaluation for noncardiac surgery, focusing on risk factors, elements of evaluation, medication management, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

  17. Preoperation anxiety: a qualitative analysis

    PubMed Central

    Bodley, P. O.; Jones, H. V. R.; Mather, M. D.

    1974-01-01

    Twenty-eight patients were investigated psychologically before surgery. The purposes of the study were (1) to discover the nature of preoperative anxiety, and (2) to compare direct questioning with an indirect method. The merits and shortcomings of the two types of assessment emerged. The findings suggest that, in addition to worries about the operation and the anaesthetic, there was concern about leaving the home and family, which was accentuated by lack of communication and contact with hospital staff, including the surgical team. Pain was found to have a variety of implications including loneliness. These and other findings are discussed in relation to psychological theories. PMID:4819911

  18. Is a pre-operative brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide measurement an independent predictor of adverse cardiovascular outcomes within 30 days of noncardiac surgery? A systematic review and meta-analysis of observational studies.

    PubMed

    Karthikeyan, Ganesan; Moncur, Ross A; Levine, Oren; Heels-Ansdell, Diane; Chan, Matthew T V; Alonso-Coello, Pablo; Yusuf, Salim; Sessler, Daniel; Villar, Juan Carlos; Berwanger, Otavio; McQueen, Matthew; Mathew, Anna; Hill, Stephen; Gibson, Simon; Berry, Colin; Yeh, Huei-Ming; Devereaux, P J

    2009-10-20

    We conducted a systematic review and meta-analysis to determine if pre-operative brain natriuretic peptide (BNP) (i.e., BNP or N-terminal pro-B-type natriuretic peptide [NT-proBNP]) is an independent predictor of 30-day adverse cardiovascular outcomes after noncardiac surgery. Pre-operative clinical cardiac risk indices have only modest predictive power. BNP predicts adverse cardiovascular outcomes in a variety of nonsurgical settings and may similarly predict these outcomes in the perioperative setting. We employed 5 search strategies (e.g., searching bibliographic databases), and we included all studies that assessed the independent prognostic value of pre-operative BNP measurement as a predictor of cardiovascular complications after noncardiac surgery. We determined study eligibility and conducted data abstraction independently and in duplicate. We calculated a pooled odds ratio using a random effects model. Nine studies met eligibility criteria, and included a total of 3,281 patients, among whom 314 experienced 1 or more perioperative cardiovascular complications. The average proportion of patients with elevated BNP was 24.8% (95% confidence interval [CI]: 20.1 to 30.4%; I(2) = 89%). All studies showed a statistically significant association between an elevated pre-operative BNP level and various cardiovascular outcomes (e.g., a composite of cardiac death and nonfatal myocardial infarction; atrial fibrillation). Data pooled from 7 studies demonstrated an odds ratio (OR) of 19.3 (95% CI: 8.5 to 43.7; I(2) = 58%). The pre-operative BNP measurement was an independent predictor of perioperative cardiovascular events among studies that only considered the outcomes of death, cardiovascular death, or myocardial infarction (OR: 44.2, 95% CI: 7.6 to 257.0, I(2) = 51.6%), and those that included other outcomes (OR: 14.7, 95% CI: 5.7 to 38.2, I(2) = 62.2%); the p value for interaction was 0.28. These results suggest that an elevated pre-operative BNP or NT

  19. Preoperative fasting for preventing perioperative complications in children.

    PubMed

    Brady, Marian; Kinn, Sue; Ness, Valerie; O'Rourke, Keith; Randhawa, Navdeep; Stuart, Pauline

    2009-10-07

    Children, like adults, are required to fast before general anaesthesia with the aim of reducing the volume and acidity of their stomach contents. It is thought that fasting reduces the risk of regurgitation and aspiration of gastric contents during surgery. Recent developments have encouraged a shift from the standard 'nil-by-mouth-from-midnight' fasting policy to more relaxed regimens. Practice has been slow to change due to questions relating to the duration of a total fast, the type and amount of intake permitted. To systematically assess the effects of different fasting regimens (duration, type and volume of permitted intake) and the impact on perioperative complications and patient well being (aspiration, regurgitation, related morbidity, thirst, hunger, pain, comfort, behaviour, nausea and vomiting) in children. We searched Cochrane Wounds Group Specialised Register (searched 25/6/09), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2 2009), Ovid MEDLINE (1950 to June Week 2 2009), Ovid EMBASE (1980 to 2009 Week 25), EBSCO CINAHL (1982 to June Week 3 2009), the National Research Register, relevant conference proceedings and article reference lists and contacted experts. Randomised and quasi randomised controlled trials of preoperative fasting regimens for children were identified. Data extraction and trial quality assessment was conducted independently by three authors. Trial authors were contacted for additional information including adverse events. This first update of the review identified two additional eligible studies, bringing the total number of included studies to 25 (forty seven randomised controlled comparisons involving 2543 children considered to be at normal risk of regurgitation or aspiration during anaesthesia). Only one incidence of aspiration and regurgitation was reported.Children permitted fluids up to 120 minutes preoperatively were not found to experience higher gastric volumes or lower gastric pH values

  20. Preoperative Antihypertensive Medication in Relation to Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery: A Meta-Analysis

    PubMed Central

    Zhou, Ai-Guo; Chen, An-ji; Zhang, Xiong-fei; Deng, Hui-wei

    2017-01-01

    Background. We undertake a systematic review and meta-analysis to evaluate the effect of preoperative hypertension and preoperative antihypertensive medication to postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery. Methods. We searched PubMed, Embase, and Cochrane Library (from inception to March 2016) for eligible studies. The outcomes were the effects of preoperative hypertension, preoperative calcium antagonists regimen, preoperative ACE inhibitors regimen, and preoperative beta blocking agents regimen with POAF. We calculated pooled risk ratios (OR) and 95% CIs using random- or fixed-effects models. Results. Twenty-five trials involving 130087 patients were listed. Meta-analysis showed that the number of preoperative hypertension patients in POAF group was significantly higher (P < 0.05), while we found that there are no significant differences between two groups in Asia patients by subgroup analysis, which is in contrast to other outcomes. Compared with the Non-POAF group, the number of patients who used calcium antagonists and ACE inhibitors preoperatively in POAF group was significantly higher (P < 0.05). And we found that there were no significant differences between two groups of preoperative beta blocking agents used (P = 0.08). Conclusions. Preoperative hypertension and preoperative antihypertensive medication in patients undergoing cardiac operations seem to be associated with higher risk of POAF. PMID:28286753

  1. Preoperative anemia and postoperative outcomes after hepatectomy

    PubMed Central

    Tohme, Samer; Varley, Patrick R.; Landsittel, Douglas P.; Chidi, Alexis P.; Tsung, Allan

    2015-01-01

    Background Preoperative anaemia is associated with adverse outcomes after surgery but outcomes after liver surgery specifically are not well established. We aimed to analyze the incidence of and effects of preoperative anemia on morbidity and mortality in patients undergoing liver resection. Methods All elective hepatectomies performed for the period 2005–2012 recorded in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database were evaluated. We obtained anonymized data for 30-day mortality and major morbidity (one or more major complication), demographics, and preoperative and perioperative risk factors. We used multivariable logistic regression models to assess the adjusted effect of anemia, which was defined as (hematocrit <39% in men, <36% in women), on postoperative outcomes. Results We obtained data for 12,987 patients, of whom 4260 (32.8%) had preoperative anemia. Patients with preoperative anemia experienced higher postoperative major morbidity and mortality rates compared to those without anemia. After adjustment for predefined variables, preoperative anemia was an independent risk factor for postoperative major morbidity (adjusted OR 1.21, 1.09–1.33). After adjustment, there was no significant difference in postoperative mortality for patients with or without preoperative anemia (adjusted OR 0.88, 0.66–1.16). Conclusion Preoperative anemia is independently associated with an increased risk of major morbidity in patients undergoing hepatectomy. Therefore, it is crucial to readdress preoperative blood management in anemic patients prior to hepatectomy. PMID:27017165

  2. Frequency of Resection After Preoperative Chemotherapy or Chemoradiotherapy for Gastric Adenocarcinoma.

    PubMed

    Badgwell, Brian; Blum, Mariela; Elimova, Elena; Estrella, Jeannelyn; Chiang, Yi-Ju; Das, Prajnan; Mansfield, Paul; Ajani, Jaffer

    2016-06-01

    The purpose of this study was to determine differences in stage and resection rates for patients with gastric adenocarcinoma managed with upfront surgery, preoperative chemotherapy, or preoperative chemoradiation therapy . The medical records of 8382 patients with gastric or gastroesophageal cancer treated from January 1995 to November 2014 were reviewed. Chi square and logistic regression analysis was used to identify differences in treatment groups and variables associated with resection. Of 533 patients evaluated for gastrectomy, 174 patients underwent upfront surgery, 90 underwent preoperative chemotherapy, and 269 underwent preoperative chemoradiation therapy. Patients treated with preoperative therapy had more advanced endoscopic ultrasound and computed tomography imaging findings. Preoperative treatment was completed in 81 % of patients administered chemotherapy and 93 % of patients administered chemoradiation. Progressive, unresectable, or metastatic disease was identified in 27 % of preoperative chemotherapy and 26 % of chemoradiation patients. Toxicity or worsening comorbidities associated with an inability to undergo resection were identified in 2 % of chemotherapy patients and 6 % of chemoradiation patients. Potentially curative resection was performed in 92, 71, and 64 % of patients treated with upfront surgery, preoperative chemotherapy, and preoperative chemoradiation, respectively. For patients treated with chemoradiation, the absence of regional lymphadenopathy on imaging was the only pretreatment variable associated with resection (odds ratio 1.77, 95 % confidence interval 1.04-3.03; p = 0.04). Patients treated with preoperative therapy often have more advanced disease prior to treatment initiation and therefore potential for disease progression. However, toxicity that prevents resection is rare, which is an important consideration in selecting preoperative treatment.

  3. Preoperative vascular access evaluation for haemodialysis patients.

    PubMed

    Kosa, Sarah D; Al-Jaishi, Ahmed A; Moist, Louise; Lok, Charmaine E

    2015-09-30

    Haemodialysis treatment requires reliable vascular access. Optimal access is provided via functional arteriovenous fistula (fistula), which compared with other forms of vascular access, provides superior long-term patency, requires few interventions, has low thrombosis and infection rates and cost. However, it has been estimated that between 20% and 60% of fistulas never mature sufficiently to enable haemodialysis treatment. Mapping blood vessels using imaging technologies before surgery may identify vessels that are most suitable for fistula creation. We compared the effect of conducting routine radiological imaging evaluation for vascular access creation preoperatively with standard care without routine preoperative vessel imaging on fistula creation and use. We searched Cochrane Kidney and Transplant's Specialised Register to 14 April 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. We included randomised controlled trials (RCTs) that enrolled adult participants (aged ≥ 18 years) with chronic or end-stage kidney disease (ESKD) who needed fistulas (both before dialysis and after dialysis initiation) that compared fistula maturation rates relating to use of imaging technologies to map blood vessels before fistula surgery with standard care (no imaging). Two authors assessed study quality and extracted data. Dichotomous outcomes, including fistula creation, maturation and need for catheters at dialysis initiation, were expressed as risk ratios (RR) with 95% confidence intervals (CI). Continuous outcomes, such as numbers of interventions required to maintain patency, were expressed as mean differences (MD). We used the random-effects model to measure mean effects. Four studies enrolling 450 participants met our inclusion criteria. Overall risk of bias was judged to be low in one study, unclear in two, and high in one.There was no significant differences in the number of fistulas that were successfully created (4

  4. The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery: B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: a systematic review and individual patient data meta-analysis.

    PubMed

    Rodseth, Reitze N; Biccard, Bruce M; Le Manach, Yannick; Sessler, Daniel I; Lurati Buse, Giovana A; Thabane, Lehana; Schutt, Robert C; Bolliger, Daniel; Cagini, Lucio; Cardinale, Daniela; Chong, Carol P W; Chu, Rong; Cnotliwy, Miłosław; Di Somma, Salvatore; Fahrner, René; Lim, Wen Kwang; Mahla, Elisabeth; Manikandan, Ramaswamy; Puma, Francesco; Pyun, Wook B; Radović, Milan; Rajagopalan, Sriram; Suttie, Stuart; Vanniyasingam, Thuvaraha; van Gaal, William J; Waliszek, Marek; Devereaux, P J

    2014-01-21

    The objective of this study was to determine whether measuring post-operative B-type natriuretic peptides (NPs) (i.e., B-type natriuretic peptide [BNP] and N-terminal fragment of proBNP [NT-proBNP]) enhances risk stratification in adult patients undergoing noncardiac surgery, in whom a pre-operative NP has been measured. Pre-operative NP concentrations are powerful independent predictors of perioperative cardiovascular complications, but recent studies have reported that elevated post-operative NP concentrations are independently associated with these complications. It is not clear whether there is value in measuring post-operative NP when a pre-operative measurement has been done. We conducted a systematic review and individual patient data meta-analysis to determine whether the addition of post-operative NP levels enhanced the prediction of the composite of death and nonfatal myocardial infarction at 30 and ≥180 days after surgery. Eighteen eligible studies provided individual patient data (n = 2,179). Adding post-operative NP to a risk prediction model containing pre-operative NP improved model fit and risk classification at both 30 days (corrected quasi-likelihood under the independence model criterion: 1,280 to 1,204; net reclassification index: 20%; p < 0.001) and ≥180 days (corrected quasi-likelihood under the independence model criterion: 1,320 to 1,300; net reclassification index: 11%; p = 0.003). Elevated post-operative NP was the strongest independent predictor of the primary outcome at 30 days (odds ratio: 3.7; 95% confidence interval: 2.2 to 6.2; p < 0.001) and ≥180 days (odds ratio: 2.2; 95% confidence interval: 1.9 to 2.7; p < 0.001) after surgery. Additional post-operative NP measurement enhanced risk stratification for the composite outcomes of death or nonfatal myocardial infarction at 30 days and ≥180 days after noncardiac surgery compared with a pre-operative NP measurement alone. Copyright © 2014 American College of Cardiology

  5. Symptomatic spinal metastasis: A systematic literature review of the preoperative prognostic factors for survival, neurological, functional and quality of life in surgically treated patients and methodological recommendations for prognostic studies

    PubMed Central

    Nater, Anick; Martin, Allan R.; Sahgal, Arjun; Choi, David

    2017-01-01

    Purpose While several clinical prediction rules (CPRs) of survival exist for patients with symptomatic spinal metastasis (SSM), these have variable prognostic ability and there is no recognized CPR for health related quality of life (HRQoL). We undertook a critical appraisal of the literature to identify key preoperative prognostic factors of clinical outcomes in patients with SSM who were treated surgically. The results of this study could be used to modify existing or develop new CPRs. Methods Seven electronic databases were searched (1990–2015), without language restriction, to identify studies that performed multivariate analysis of preoperative predictors of survival, neurological, functional and HRQoL outcomes in surgical patients with SSM. Individual studies were assessed for class of evidence. The strength of the overall body of evidence was evaluated using GRADE for each predictor. Results Among 4,818 unique citations, 17 were included; all were in English, rated Class III and focused on survival, revealing a total of 46 predictors. The strength of the overall body of evidence was very low for 39 and low for 7 predictors. Due to considerable heterogeneity in patient samples and prognostic factors investigated as well as several methodological issues, our results had a moderately high risk of bias and were difficult to interpret. Conclusions The quality of evidence for predictors of survival was, at best, low. We failed to identify studies that evaluated preoperative prognostic factors for neurological, functional, or HRQoL outcomes in surgical patients with SSM. We formulated methodological recommendations for prognostic studies to promote acquiring high-quality evidence to better estimate predictor effect sizes to improve patient education, surgical decision-making and development of CPRs. PMID:28225772

  6. Preoperative diagnosis of a pulmonary artery sarcoma.

    PubMed Central

    Velebit, V.; Christenson, J. T.; Simonet, F.; Maurice, J.; Schmuziger, M.; Hauser, H.; Didier, D.

    1995-01-01

    A pulmonary artery sarcoma was diagnosed preoperatively by magnetic resonance imaging enhanced with gadolinium and confirmed by percutaneous computed tomographic guided needle biopsy. Accurate preoperative diagnosis allowed planned curative surgery with removal of the right ventricular outflow tract and reconstructive surgery using a cryopreserved homograft. Images PMID:8539663

  7. Preoperative nuclear renal scan underestimates renal function after radical nephrectomy.

    PubMed

    Bachrach, Laurie; Negron, Edris; Liu, Joceline S; Su, Yu-Kai; Paparello, James J; Eggener, Scott; Kundu, Shilajit D

    2014-12-01

    To compare expected and actual renal function after nephrectomy. Nuclear renal scan estimates differential kidney function and is commonly used to calculate expected postoperative renal function after radical nephrectomy. However, the observed postoperative renal function is often different from the expected. A retrospective review was performed on 136 patients who underwent radical nephrectomy or nephroureterectomy and had a preoperative renal scan with calculated differential function. Glomerular filtration rate (GFR) values, preoperative and postoperative, were calculated with the Modification of Diet in Renal Disease (MDRD) equation. The expected postoperative GFR based on renal scan was compared with the actual postoperative GFR. The average age of patients undergoing surgery was 58.6 years, and the indication for surgery was for benign causes in 59 (44%) patients and cancer in 76 (56%) patients. The average preoperative creatinine and estimated GFR were 1.0 mg/dL and 69.9 mL/min/1.73 m(2). At a median follow-up of 3.3 months, the actual postoperative GFR exceeded the expected GFR by an average of 12.1% (interquartile range, 2.6%-25.2%). When stratified by preoperative GFR >90, 60-90, and <60 mL/min/1.73 m(2), respectively, the observed GFR exceeded the expected GFR by 4.3%, 12.6%, and 14.9%, respectively (P = .16). This trend was maintained when GFR was plotted over time. After nephrectomy, the remaining kidney exceeded the expected postoperative GFR by 12% in this cohort of patients with preoperative renal scans. Patients with existing renal insufficiency had the greatest compensatory response, and this was durable over time. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Preoperative Optimization of the Heart Failure Patient Undergoing Cardiac Surgery.

    PubMed

    Pichette, Maxime; Liszkowski, Mark; Ducharme, Anique

    2017-01-01

    Heart failure patients who undergo cardiac surgery are exposed to significant perioperative complications and high mortality. We herein review the literature concerning preoperative optimization of these patients. Salient findings are that end-organ dysfunction and medication should be optimized before surgery. Specifically: (1) reversible causes of anemia should be treated and a preoperative hemoglobin level of 100 g/L obtained; (2) renal function and volume status should be optimized; (3) liver function must be carefully evaluated; (4) nutritional status should be assessed and cachexia treated to achieve a preoperative albumin level of at least 30 g/L and a body mass index > 20; and (5) medication adjustments performed, such as withholding inhibitors of the renin-angiotensin-aldosterone system before surgery and continuing, but not starting, β-blockers. Levels of natriuretic peptides (brain natriuretic peptide [BNP] and N-terminal proBNP) provide additional prognostic value and therefore should be measured. In addition, individual patient's risk should be objectively assessed using standard formulas such as the EuroSCORE-II or Society of Thoracic Surgeons risk scores, which are simple and validated for various cardiac surgeries, including left ventricular assist device implantation. When patients are identified as high risk, preoperative hemodynamic optimization might be achieved with the insertion of a pulmonary artery catheter and hemodynamic-based tailored therapy. Finally, a prophylactic intra-aortic balloon pump might be considered in certain circumstances to decrease morbidity and even mortality, like in some high risk heart failure patients who undergo cardiac surgery, whereas routine preoperative inotropes are not recommended and should be reserved for patients in shock, except maybe for levosimendan.

  9. The use of pre-operative halo traction to minimize risk for correction of severe scoliosis in a patient with Fontan circulation: a case report and review of literature.

    PubMed

    Chan, Chris Yin Wei; Lim, Chiao Yee; Shahnaz Hasan, M; Kwan, Mun Keong

    2016-05-01

    Patients with Fontan circulation have increased cardio-respiratory risk during major spinal surgery. We report a case of severe scoliosis with a Cobb angle of 123.3° in a 16-year-old boy with Fontan circulation treated with single stage posterior segmental pedicle screw instrumentation and fusion. Case report. The use pre-operative halo-ring traction for a duration of 6 weeks in this case lead to improvement in cobb angle from 123.3°, kyphotic angle 87.1° to cobb angle of 78.0°, kyphotic angle 57.2° (on bending and stress films). The operation was completed in 150 min, blood loss 1050 ml (25 ml/kg), and cell salvage of 490 ml. He was immediately extubated post correction, but monitored in ICU for a day. Total length of stay was 8 days without any perioperative morbidity or allogeneic blood transfusion. Final post-operative radiograph showed a cobb angle of 44.2°, kyphotic angle 22.8°. Follow up at 27 months showed solid union with no significant loss of correction. From this case experience, pre-operative halo traction is a useful surgical strategy in patients with Fontan circulation with severe kyposcoliosis to achieve adequate correction without additional osteotomies to minimize the risk of surgical correction.

  10. ALARA notes, Number 8

    SciTech Connect

    Khan, T.A.; Baum, J.W.; Beckman, M.C.

    1993-10-01

    This document contains information dealing with the lessons learned from the experience of nuclear plants. In this issue the authors tried to avoid the `tyranny` of numbers and concentrated on the main lessons learned. Topics include: filtration devices for air pollution abatement, crack repair and inspection, and remote handling equipment.

  11. TRITIUM EXTRACTION FACILITY ALARA

    SciTech Connect

    Joye, BROTHERTON

    2005-04-19

    The primary mission of the Tritium Extraction Facility (TEF) is to extract tritium from tritium producing burnable absorber rods (TPBARs) that have been irradiated in a commercial light water reactor and to deliver tritium-containing gas to the Savannah River Site Facility 233-H. The tritium extraction segment provides the capability to deliver three (3) kilograms per year to the nation's nuclear weapons stockpile. The TEF includes processes, equipment and facilities capable of production-scale extraction of tritium while minimizing personnel radiation exposure, environmental releases, and waste generation.

  12. Pediatric patient radiation dosage during endomyocardial biopsies and right heart catheterization using a standard "ALARA" radiation reduction protocol in the modern fluoroscopic era.

    PubMed

    Sutton, Nicole J; Lamour, Jacqueline; Gellis, Laura A; Pass, Robert H

    2014-01-01

    Surveillance endomyocardial biopsy (EMB) with right heart catheterization (RHC) is the standard of care for the assessment of post cardiac transplantation rejection. This procedure has traditionally relied upon fluoroscopy, which exposes both patient and staff to the risks of ionizing radiation. These risks may be of particular concern in the transplant patient who must undergo many such procedures lifelong. We present data on a new "ALARA - As Low As Reasonably Achievable" protocol to reduce radiation exposure during the performance of RHC with EMB. All cardiac transplantation patients < 21 years of age who underwent RHC with EMB at The Children's Hospital at Montefiore from 6/11-12/11 were included. EMB was performed after all right heart pressures including wedge pressure and thermodilution cardiac output were measured. A novel ALARA protocol consisting of multiple features including ultra-low frame rates (2-3 fps), low fluoro dose/frame (10-18 nGy/frame), use of the "air-gap" technique for patients < 20 kg, and multiple other techniques aimed at minimizing use of fluoroscopy were employed in all cases. Demographics, procedural data and patient radiation exposure levels were collected and analyzed. 18 patients underwent 45 surveillance RHC with EMB in the study period and were the subject of this analysis. The mean age was 5.9 ± 6.1 years, weight was 20.4 kg ± 16.6 kg, and BSA was 0.75 ± 45 m(2) . PA fluoroscopy was used exclusively in 45/45. Vascular access was RFV (21/45; 47%), RIJV (17/45; 38%), LFV (4/45; 9%) and LIJV (3/45; 7%). The median number of EMB specimens obtained was 5 (range, 4-7). The median fluoroscopy time was 3.7 min (range, 1.2-9). The median air Kerma product (K) was 1.4 mGy (range, 0.4-14), and dose area product (DAP) was 15.8 uGym(2) (range, 3.5-144.5). The K and DAP are substantially lower than any prior published data for RHC/EMB in this patient group. There were no procedural complications. The use of a novel ALARA protocol for RHC

  13. Preoperative Radiographic Evaluation of Patients With Pelvic Discontinuity.

    PubMed

    Martin, J Ryan; Barrett, Ian J; Sierra, Rafael J; Lewallen, David G; Berry, Daniel J

    2016-05-01

    Pelvic discontinuity (PD) is a rare but devastating mechanism of failure in total hip arthroplasty. Radiographic findings have been described for the identification of PD. However, no study has specifically examined radiographic parameters and the utility of specific views in the preoperative identification of PD. We performed a retrospective review of 133 patients who underwent acetabular revision for PD. Preoperative radiographic studies were reviewed including anteroposterior pelvis (AP; n = 133), true lateral hip (n = 132), Judet (n = 47), false profile (n = 4), and computed tomography scans (n = 14). Radiographs were read by the senior authors to identify the following parameters suggestive of PD: visible fracture line, medial migration of the inferior hemipelvis, and obturator ring asymmetry. Using only the AP view, the fracture line was visible in 116 (87%), medial migration of the inferior hemipelvis in 126 (95%), and obturator ring asymmetry in 114 (86%). A fracture line was visualized in 65 of 132 hips (49%) evaluated with laterals, 36 of 47 hips (77%) evaluated with Judet views, 3 of 4 (75%) evaluated with a false profile view, and 10 of 14 (71%) evaluated with computed tomography. Preoperative evaluation with a combination of an AP pelvis radiograph, plus a true lateral radiograph of the hip, plus Judet films in combination with the criteria for discontinuity defined in this article, allowed for identification of PD in a 100% of patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Is there a relationship between preoperative shaving (hair removal) and surgical site infection?

    PubMed

    Jose, Binu; Dignon, Andrée

    2013-01-01

    The preoperative preparation of patients for surgery has traditionally included the routine hair removal at the operating site as a part of cleanliness. This literature review will investigate the relationship between preoperative hair removal and surgical site infection. It aims to identify the best method of hair removal to reduce the infection if hair removal is necessary, and to apply the evidence findings into nursing practice.

  15. The Preoperative Patient With a Systolic Murmur

    PubMed Central

    Cowie, Brian

    2015-01-01

    Context: Patients with undifferentiated systolic murmurs present commonly during the perioperative period. Traditional bedside assessment and auscultation has not changed significantly in almost 200 years and relies on interpreting indirect acoustic events as a means of evaluating underlying cardiac pathology. This is notoriously inaccurate, even in expert cardiology hands, since many different valvular and cardiac diseases present with a similar auditory signal. Evidence Acquisition: The data on systolic murmurs, physical examination, perioperative valvular disease in the setting of non-cardiac surgery is reviewed. Results: Significant valvular heart disease increases perioperative risk in major non-cardiac surgery and increases long term patient morbidity and mortality. We propose a more modern approach to physical examination that incorporates the use of focused echocardiography to allow direct visualization of cardiac structure and function. This improves the diagnostic accuracy of clinical assessment, allows rational planning of surgery and anaesthesia technique, risk stratification, postoperative monitoring and appropriate referral to physicians and cardiologists. Conclusions: With a thorough preoperative assessment incorporating focused echocardiography, anaesthetists are in the unique position to enhance their role as perioperative physicians and influence short and long term outcomes of their patients. PMID:26705529

  16. New strategies for preoperative skin antisepsis.

    PubMed

    Ulmer, Miriam; Lademann, Juergen; Patzelt, Alexa; Knorr, Fanny; Kramer, Axel; Koburger, Torsten; Assadian, Ojan; Daeschlein, Georg; Lange-Asschenfeldt, Bernhard

    2014-01-01

    During the past decades, encouraging progress has been made in the prevention of surgical site infections (SSI). However, as SSI still occur today, strategic prevention measures such as standardized skin antisepsis must be implemented and rigorously promoted. Recent discoveries in skin physiology necessitate the development of novel antiseptic agents and procedures in order to ameliorate their efficacy. In particular, alternate target structures in the skin need to be taken into consideration for the development of the next generation of antiseptics. Recent investigations have shown that a high number of microorganisms are located within and in the close vicinity of the hair follicles. This suggests that these structures are an important reservoir of bacterial growth and activity in human skin. To date, it has not been fully elucidated to what extent conventional liquid antiseptics sufficiently target the hair follicle-related microbial population. Modern technologies such as tissue-tolerable plasma (TTP) have been tested for their potential antiseptic efficiency by reducing the bacterial load in the skin and in the hair follicles. First experiments using liposomes to deliver antiseptics into the hair follicles have been evaluated for their potential clinical application. The present review evaluates these two innovative methods for their efficacy and applicability in preoperative skin antiseptics.

  17. Research evidence for the use of preoperative exercise in patients preparing for total hip or total knee arthroplasty.

    PubMed

    Barbay, Kathryn

    2009-01-01

    Preoperative exercise/rehabilitation is currently being considered to improve outcomes for orthopaedic surgery. This article presents an evidence-based practice review of the current research literature from 1998 to 2008 to determine whether preoperative exercise alone will be beneficial to patients preparing for total knee or hip arthroplasty. Only 3 studies met the inclusion criteria of preoperative exercise as the sole intervention. Each of these studies indicated that preoperative exercise had some postoperative benefit to total knee or hip arthroplasty patients. In general, the results are inconclusive due to the lack of strong research evidence, and only a pragmatic recommendation for preoperative exercise prior to total hip or knee arthroplasty is supported. More research is needed in the area of preoperative exercise for persons preparing for total hip or knee arthroplasty.

  18. Identifying and assessing anxiety in pre-operative patients.

    PubMed

    Pritchard, Michael John

    Increasing demands for hospitals to be more efficient mean that patients attending for an operation are generally admitted on the day of surgery. As a result, healthcare professionals have little time to talk to the patient to ascertain his or her wellbeing, to check for any signs of anxiety and ask whether the patient requires further information about the forthcoming procedure. Healthcare professionals should be encouraged to use appropriate interventions to identify and assess anxious patients. There are several instruments available to measure the patient's level of pre-operative anxiety. This article reviews the Amsterdam Preoperative Anxiety and Information Scale, which is easy for patients to complete and may help to identify which individuals need extra support.

  19. Preoperative Drug Induced Sleep Endoscopy Improves the Surgical Approach to Treatment of Obstructive Sleep Apnea.

    PubMed

    Huntley, Colin; Chou, David; Doghramji, Karl; Boon, Maurits

    2017-06-01

    Drug induced sleep endoscopy (DISE) allows for preoperative evaluation of the specific site and character of upper airway obstruction in obstructive sleep apnea (OSA). We aim to assess the impact DISE has on customizing the surgical plan and evaluate its role in surgical success. We retrospectively reviewed patients undergoing surgery for OSA. We compared those patients undergoing preoperative DISE to those that did not to assess procedures performed and surgical outcomes. We found 87 patients undergoing surgery for OSA who had postoperative polysomnogram results. Of the group undergoing preoperative DISE, 8% had multilevel surgery. This compared to 59.5% in those not undergoing DISE ( p = .0004). The success rate of patients who had preoperative DISE was 86% compared to 51.4% in those who did not have preoperative DISE ( p < .001). We found no difference in age, gender, preoperative apnea-hypopnea index (AHI), oxygen nadir, Epworth sleepiness scale score (ESS), body mass index (BMI) and postoperative oxygen nadir, ESS, or BMI in the DISE and no DISE cohorts. The addition of DISE to our preoperative workup has contributed to a decreased rate of multilevel surgery and increased rate of surgical success through identification of the individual patient's OSA architecture and customization of the surgical plan.

  20. Association Between Preoperative Nutritional Status and Postoperative Outcome in Head and Neck Cancer Patients.

    PubMed

    Leung, John S L; Seto, Alfred; Li, George K H

    2017-04-01

    Head and neck cancer patients treated with surgery often experience significant postoperative morbidities. Administering preoperative nutritional intervention may improve surgical outcomes, but there is currently a paucity of data reviewing the association between preoperative nutritional status and postoperative outcome. It is therefore of importance to investigate this association among head and neck cancer patients. To assess the association between preoperative nutritional status and postoperative outcome in head and neck cancer patients treated with surgery, a retrospective study of 70 head and neck cancer patients who were surgically treated between 2013 and 2014 in a tertiary referral head and neck surgery center in Hong Kong was conducted. Clinical data regarding preoperative nutritional status and postoperative outcome were retrieved from a computer record system. Logistic and linear regressions were used to analyze the appropriate parameters. A higher preoperative albumin level was associated with lower rates of postoperative complications and better wound healing (P < 0.05). In contrast, preoperative body mass index, hemoglobin level, and absolute lymphocyte count did not demonstrate significant associations with postoperative outcome. As high albumin levels are associated with better surgical outcome in head and neck cancer patients, preoperative intervention strategies that boost albumin levels could be considered for improving surgical outcome.

  1. A fresh look at preoperative body washing

    PubMed Central

    Tanner, Judith; Gould, Dinah; Jenkins, Philip; Hilliam, Rachel; Mistry, Neetesh; Walsh, Susannah

    2012-01-01

    National guidelines do not support preoperative body washing to reduce surgical site infections, instead recommending bathing or showering with soap. Yet preoperative body washing continues to be widely used in many hospitals across Europe. This paper suggests that existing trials of preoperative body washing, upon which guidelines are based, are dated and proposes a new investigation of preoperative body washing using modern definitions of surgical site infection with standardised patient follow up, modern surgical techniques and well designed trials. This paper provides a critique of existing guidelines and describes a randomised trial with 60 participants to compare the effect of soap and two antiseptic washing products on colony forming units (CFUs) for up to six hours. Chlorhexidine gluconate and octenidine were significantly more effective than soap in reducing CFUs in the underarm, and chlorhexidine was significantly more effective than soap in reducing CFUs in the groin. PMID:22448182

  2. Preoperative antisepsis: critiquing a research article.

    PubMed

    Lipp, Allyson; Edwards, Peggy

    2010-11-01

    A critique of a research article on preoperative skin antisepsis was undertaken using a recognised framework. This critique drew out issues which may be of use for clinicians in making a judgement regarding implementing change into their clinical practice.

  3. Preoperative prediction of severe postoperative pain.

    PubMed

    Kalkman, C J; Visser, K; Moen, J; Bonsel, G J; Grobbee, D E; Moons, K G M

    2003-10-01

    We developed and validated a prediction rule for the occurrence of early postoperative severe pain in surgical inpatients, using predictors that can be easily documented in a preoperative setting. A cohort of surgical inpatients (n=1416) undergoing various procedures except cardiac surgery and intracranial neurosurgery in a University Hospital were studied. Preoperatively the following predictors were collected: age, gender, type of scheduled surgery, expected incision size, blood pressure, heart rate, Quetelet index, the presence and severity of preoperative pain, health-related quality of life the (SF-36), Spielberger's State-Trait Anxiety Inventory (STAI) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS). The outcome was the presence of severe postoperative pain (defined as Numeric Rating Scale > or =8) within the first hour postoperatively. Multivariate logistic regression in combination with bootstrapping techniques (as a method for internal validation) was used to derive a stable prediction model. Independent predictors of severe postoperative pain were younger age, female gender, level of preoperative pain, incision size and type of surgery. The area under the receiver operator characteristic (ROC) curve was 0.71 (95% CI: 0.68-0.74). Adding APAIS scores (measures of preoperative anxiety and need for information), but not STAI, provided a slightly better model (ROC area 0.73). The reliability of this extended model was good (Hosmer and Lemeshow test p-value 0.78). We have demonstrated that severe postoperative pain early after awakening from general anesthesia can be predicted with a scoring rule, using a small set of variables that can be easily obtained from all patients at the preoperative visit. Before this internally validated preoperative prediction rule can be applied in clinical practice to support anticipatory pain management, external validation in other clinical settings is necessary.

  4. Cardiopulmonary exercise testing (CPET) as preoperative test before lung resection.

    PubMed

    Kallianos, Anastasios; Rapti, Aggeliki; Tsimpoukis, Sotirios; Charpidou, Andriani; Dannos, Ioannis; Kainis, Elias; Syrigos, Konstantinos

    2014-01-01

    Lung resection is still the only potentially curative therapy for patients with localized non-small lung cancer (NSCLC). However, the presence of cardiovascular comorbidities and underlying lung disease increases the risk of postoperative complications. Various studies have evaluated the use of different preoperative tests in order to identify patients with an increased risk for postoperative complications, associated with prolonged hospital stay and increased morbidity and mortality. In this topic review, we discuss the role of cardiopulmonary exercise testing (CPET) as one of the preoperative tests suggested for lung cancer patients scheduled for lung resection. We describe different types of exercise testing techniques and present algorithms of preoperative evaluation in lung cancer patients. Overall, patients with maximal oxygen consumption (VO2max) <10 mL/kg/min or those with VO2max <15 mL/kg/min and both postoperative FEV1 and DLCO<40% predicted, are at high risk for perioperative death and postoperative cardiopulmonary complications, and thus should be offered an alternative medical treatment option. Copyright © 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  5. Effectiveness of pre-operative cefazolin in obese patients.

    PubMed

    Unger, Nathan R; Stein, Bradley J

    2014-08-01

    Cefazolin remains the preferred preoperative antibiotic for the majority of surgical procedures. However, outcome evidence supporting current dosing recommendations for pre-operative prophylaxis is scarce, particularly for obese patients. With more than 33% of adults in the United States classified as obese, it is crucial that we determine the correct dosing regimen in order to maximize the potential to prevent surgical site infections (SSIs). The purpose of this study was to evaluate whether surgical prophylaxis with cefazolin 2 g, as recommended by practice guidelines, is as effective in preventing SSIs in obese as compared to non-obese patients. In retrospective fashion, data were collected from the electronic medical records of patients who received 2 g of cefazolin preoperatively during a 13-mo period. Patients who met the inclusion criteria were allocated to an obese (n=99) and non-obese (n=96) group according to body mass index (BMI). Charts were reviewed for identification of SSIs as defined by the U.S. Centers for Disease Control and Prevention. For the primary outcome, the numbers of SSIs in the two groups were compared using the Pearson χ(2) test. Patient characteristics were similar in the two groups with the expected exception of weight (mean 90 vs. 110 kg; p<0.001) and BMI (27 vs. 35 kg/m(2); p<0.001). The highest patient weight was 182 kg with a BMI of 55 kg/m(2). The most common surgical service was orthopedics/hand, accounting for 35% of patients. No significant difference was found in the number of SSIs in the two groups (7 vs. 5; p=0.56). No differences between weight and BMI were seen in patients with or without a SSI. Obese patients may continue to receive 2 g of cefazolin preoperatively until large-scale controlled trials show differently.

  6. Preoperative easily misdiagnosed telangiectatic osteosarcoma: clinical–radiologic–pathologic correlations

    PubMed Central

    Gao, Zhen-Hua; Yin, Jun-Qiang; Liu, Da-Wei; Meng, Quan-Fei

    2013-01-01

    Abstract Purpose: To describe the clinical, imaging, and pathologic characteristics and diagnostic methods of telangiectatic osteosarcoma (TOS) for improving the diagnostic level. Materials and methods: The authors retrospectively reviewed patient demographics, serum alkaline phosphatase (AKP) levels, preoperative biopsy pathologic reports, pathologic materials, imaging findings, and treatment outcomes from 26 patients with TOS. Patient images from radiography (26 cases) and magnetic resonance (MR) imaging (22 cases) were evaluated by 3 authors in consensus for intrinsic characteristics. There were 15 male and 11 female patients in the study, with an age of 9–32 years (mean age 15.9 years). Results: Eighteen of 26 patients died of lung metastases within 5 years of follow-up. The distal femur was affected more commonly (14 cases, 53.8%). Regarding serum AKP, normal (8 cases) or mildly elevated (18 cases) levels were found before preoperative chemotherapy. Radiographs showed geographic bone lysis without sclerotic margin (26 cases), cortical destruction (26 cases), periosteal new bone formation (24 cases), soft-tissue mass (23 cases), and matrix mineralization (4 cases). The aggressive radiographic features of TOS simulated the appearance of conventional high-grade intramedullary osteosarcoma, though different from aneurysmal bone cyst. MR images demonstrated multiple big (16 cases) or small (6 cases) cystic spaces, fluid-fluid levels (14 cases), soft-tissue mass (22 cases), and thick peripheral and septal enhancement (22 cases). Nine of 26 cases were misdiagnosed as aneurysmal bone cysts by preoperative core-needle biopsy, owing to the absence of viable high-grade sarcomatous cells in the small tissue samples. Conclusion: The aggressive growth pattern with occasional matrix mineralization, and multiple big or small fluid-filled cavities with thick peripheral, septal, and nodular tissue surrounding the fluid-filled cavities are characteristic imaging features of

  7. Definitive, Preoperative, and Palliative Radiation Therapy of Esophageal Cancer

    PubMed Central

    Fokas, Emmanouil; Rödel, Claus

    2015-01-01

    Summary Background Long-term survival in patients with esophageal cancer remains dismal despite the recent improvements in surgery, the advances in radiotherapy (RT) technology, and the refinement of systemic treatments, including the advent of targeted therapies. Although surgery constitutes the treatment of choice for early-stage disease (stage I), a multimodal approach, including preoperative or definitive chemoradiotherapy (CRT) and perioperative chemotherapy, is commonly pursued in patients with locally advanced disease. Methods A review of the literature was performed to assess the role of RT, alone or in combination with chemotherapy, in the management of esophageal cancer. Results Evidence from large, randomized phase III trials and meta-analyses supports the application of perioperative chemotherapy alone or preoperative concurrent CRT in patients with lower esophageal and esophagogastric junction adenocarcinomas. Preoperative CRT but not preoperative chemotherapy alone is now routinely used in patients with locally advanced squamous cell carcinoma (SCC). Additionally, definitive CRT without surgery has also emerged as a valuable approach in the management of resectable esophageal SCC to avoid surgery-related morbidity and mortality, whereas salvage surgery is reserved for those with persistent disease. Furthermore, brachytherapy offers a valuable option in the palliative treatment of patients with locally advanced, unresponsive disease. Fluorodeoxyglucose-positron emission tomography (FDG-PET) can facilitate a more accurate treatment response assessment and patient selection. Finally, the development of modern RT techniques, such as intensity-modulated and image-guided RT as well as FDG-PET-based RT planning, could further increase the therapeutic ratio of CRT. Conclusion Altogether, CRT constitutes an important tool in the treatment armamentarium for esophageal cancer. Further optimization of CRT using modern technology and imaging, targeted therapies

  8. Planning to avoid trouble in the operating room: experts' formulation of the preoperative plan.

    PubMed

    Zilbert, Nathan R; St-Martin, Laurent; Regehr, Glenn; Gallinger, Steven; Moulton, Carol-Anne

    2015-01-01

    The purpose of this study was to capture the preoperative plans of expert hepato-pancreato-biliary (HPB) surgeons with the goal of finding consistent aspects of the preoperative planning process. HPB surgeons were asked to think aloud when reviewing 4 preoperative computed tomography scans of patients with distal pancreatic tumors. The imaging features they identified and the planned actions they proposed were tabulated. Surgeons viewed the tabulated list of imaging features for each case and rated the relevance of each feature for their subsequent preoperative plan. Average rater intraclass correlation coefficients were calculated for each type of data collected (imaging features detected, planned actions reported, and relevance of each feature) to establish whether the surgeons were consistent with one another in their responses. Average rater intraclass correlation coefficient values greater than 0.7 were considered indicative of consistency. Division of General Surgery, University of Toronto. HPB surgeons affiliated with the University of Toronto. A total of 11 HPB surgeons thought aloud when reviewing 4 computed tomography scans. Surgeons were consistent in the imaging features they detected but inconsistent in the planned actions they reported. Of the HPB surgeons, 8 completed the assessment of feature relevance. For 3 of the 4 cases, the surgeons were consistent in rating the relevance of specific imaging features on their preoperative plans. These results suggest that HPB surgeons are consistent in some aspects of the preoperative planning process but not others. The findings further our understanding of the preoperative planning process and will guide future research on the best ways to incorporate the teaching and evaluation of preoperative planning into surgical training. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  9. [Chronic medications in the preoperative period: should they be stopped?].

    PubMed

    López-Álvarez, A; Román-Fernández, A; Fernández-Vieitez, M B; Fossati-Puertas, S

    2014-03-01

    As different specialists are becoming increasingly involved in the preoperative management of our patients (for two main reasons; Primary Care doctors have to perform minor surgical procedures, and as coordination between Primary Care and In-hospital Care is more and more necessary in order to improve their outcomes), we believe that an update is needed as regards the management of chronic medications in this period. We will try to review the current literature dealing with the recommendations about withdrawing or continuing these drugs.

  10. [Valvular heart disease: preoperative assessment and postoperative care].

    PubMed

    Nägele, Reto; Kaufmann, Beat A

    2013-10-30

    Patients with valvular heart disease or with a prosthetic heart valve replacement are seen with increasing frequency in clinical practice. The medical care and evaluation of patients with valvular heart disease before valve surgery, but also the post-operative treatment is complex and managed by general practitioners, cardiologists and cardiac surgeons. In this mini-review we will first discuss the preoperative assessment of the two most common valvulopathies, aortic stenosis and mitral regurgitation. Then we will discuss the post-operative care, which includes the management of anticoagulation, serial follow up and as well as the diagnostic assessment of complications such as thromboembolism, hemolysis, endocarditis and valve dysfunction.

  11. Preoperative and postoperative care in cosmetic laser resurfacing

    NASA Astrophysics Data System (ADS)

    Ross, Adam T.; Becker, Daniel G.

    2001-05-01

    Advances in laser technology have allowed the application of lasers to cosmetic facial skin resurfacing. While this application has been extremely advantageous to patients, the development of pre- and postoperative therapeutic regimens was necessary to mitigate potential complications associated with laser resurfacing. Potential complications of laser resurfacing include prolonged postoperative erythema, hyperpigmentation, hypopigmentation, herpetic, bacterial or candidal infection, and other concerns including scarring and abnormal wound healing. In this report we review the state of the art of preoperative and postoperative care for cosmetic laser resurfacing.

  12. Benefits of pre-operative information programmes.

    PubMed

    Garretson, Sharon

    Thousands of patients undergo surgical procedures daily. Research has shown the benefits of giving pre-operative information to patients, which include decreased length of stay, less demand for analgesia post-operatively and increased patient satisfaction. However, despite this evidence, there are still many facilities with no formal policy or programme for giving pre-operative information. Nurses and managers should be made aware of the benefits and potential financial savings of pre-operative information programmes. Once education takes place, a concerted multidisciplinary effort should be made to implement a programme. This will help to ensure that patients no longer arrive at the operating theatre frightened and unaware of what will happen to them.

  13. Flexible ureteroscopy for renal stone without preoperative ureteral stenting shows good prognosis

    PubMed Central

    Zhang, Jiaqiao; Xu, Chuou; He, Deng; Lu, Yuchao; Hu, Henglong; Qin, Baolong; Wang, Yufeng; Wang, Qing; Li, Cong; Liu, Jihong

    2016-01-01

    Purpose To clarify the outcome of flexible ureteroscopy (fURS) for management of renal calculi without preoperative stenting. Methods A total of 171 patients who received 176 fURS procedures for unilateral renal stones were reviewed. All procedures were divided into two groups depending on whether they received ureteral stenting preoperatively. Baseline characteristics of patients, stone burden, operation time, stone-free rates, and complications were compared between both groups. Results Successful primary access to the renal pelvis was achieved in 104 of 114 (91.2%) patients without preoperative stenting, while all procedures with preoperative stenting (n = 62) were successfully performed. A total of 156 procedures were included for further data analysis (56 procedures in stenting group and 100 in non-stenting group). No significant differences was found regardless of a preoperative stent placement in terms of stone-free rate (73.2% with stenting vs. 71.0% without, P = 0.854), operative time (70.4 ± 32.8 with stenting vs. 70.2 ± 32.1 without, P = 0.969). Conclusions fURS for management of renal stone without preoperative ureteral stenting are associated with well outcome in short term follow-up. Our study may help patients and doctors to decide if an optional stent is placed or not. PMID:27917317

  14. [Preoperative correction of volemic disorders in thyrotoxicosis].

    PubMed

    Lukomskiĭ, G I; Ivanova, N A; Krivenko, N G

    1976-01-01

    The investigations conducted by the authors enabled them to pinpoint further the complex of symptoms determining a phase character of volemic disturbances in thyrotoxicosis. The phases somewhat reveal the volemic substrate of thyrotoxicosis, allowing an aimed management of some stages of the preoperative preparation. The latter is conventionally divided according to Sh. Milk into three periods: initial, intermediate and final. The main aim of the preoperative correction is to normalize hydration correlations, that is likely to be gained by excreting excessive sodium and replenishment of potassium deficit.

  15. Is extended preoperative antibiotic prophylaxis for high-risk patients necessary before percutaneous nephrolithotomy?

    PubMed Central

    Park, Alyssa M.; Bauman, Tyler M.; Larson, Jeffrey A.; Vetter, Joel M.; Benway, Brian M.; Desai, Alana C.

    2016-01-01

    Purpose The goal of this study was to compare the rate of systemic inflammatory response syndrome (SIRS) in high-risk patients undergoing percutaneous nephrolithotomy (PCNL) between patients who received 7, 2, or 0 days of preoperative antibiotics. Materials and Methods We retrospectively reviewed a series of consecutive PCNLs performed at our institution. Patients with infected preoperative urine cultures were excluded. High-risk patients were defined as those with a history of previous urinary tract infection (UTI), hydronephrosis, or stone size ≥2 cm. Patients were treated with 7, 2, or 0 days of preoperative antibiotic prophylaxis prior to PCNL. All patients received a single preoperative dose of antibiotics within 60 minutes of the start of surgery. Fisher exact test was used to compare the rate of SIRS by preoperative antibiotic length. Results Of the 292 patients identified, 138 (47.3%) had sterile urine and met high-risk criteria, of which 27 (19.6%), 39 (28.3%), and 72 (52.2%) received 7, 2, and 0 days of preoperative antibiotics, respectively. The 3 groups were similar in age, sex, and duration of surgery (p>0.05). There was no difference in the rate of SIRS between the groups, with 1 of 27 (3.7%), 2 of 39 (5.1%) and 3 of 72 patients (4.2%) meeting criteria in the 7, 2, and 0 days antibiotic groups (p=~1). Conclusions Extended preoperative antibiotic prophylaxis was not found to reduce the risk of SIRS after PCNL in our institutional experience of high-risk patients. For these patients, a single preoperative dose of antibiotics is sufficient. PMID:27847915

  16. Preoperative physical therapy for elective cardiac surgery patients.

    PubMed

    Hulzebos, Erik H J; Smit, Yolba; Helders, Paul P J M; van Meeteren, Nico L U

    2012-11-14

    After cardiac surgery, physical therapy is a routine procedure delivered with the aim of preventing postoperative pulmonary complications. To determine if preoperative physical therapy with an exercise component can prevent postoperative pulmonary complications in cardiac surgery patients, and to evaluate which type of patient benefits and which type of physical therapy is most effective. Searches were run on the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library (2011, Issue 12 ); MEDLINE (1966 to 12 December 2011); EMBASE (1980 to week 49, 2011); the Physical Therapy Evidence Database (PEDro) (to 12 December 2011) and CINAHL (1982 to 12 December 2011). Randomised controlled trials or quasi-randomised trials comparing preoperative physical therapy with no preoperative physical therapy or sham therapy in adult patients undergoing elective cardiac surgery. Data were collected on the type of study, participants, treatments used, primary outcomes (postoperative pulmonary complications grade 2 to 4: atelectasis, pneumonia, pneumothorax, mechanical ventilation > 48 hours, all-cause death, adverse events) and secondary outcomes (length of hospital stay, physical function measures, health-related quality of life, respiratory death, costs). Data were extracted by one review author and checked by a second review author. Review Manager 5.1 software was used for the analysis. Eight randomised controlled trials with 856 patients were included. Three studies used a mixed intervention (including either aerobic exercises or breathing exercises); five studies used inspiratory muscle training. Only one study used sham training in the controls. Patients that received preoperative physical therapy had a reduced risk of postoperative atelectasis (four studies including 379 participants, relative risk (RR) 0.52; 95% CI 0.32 to 0.87; P = 0.01) and pneumonia (five studies including 448 participants, RR 0.45; 95% CI 0.24 to 0.83; P = 0.01) but not of

  17. Influence of preoperative musculotendinous junction position on rotator cuff healing using single-row technique.

    PubMed

    Tashjian, Robert Z; Hung, Man; Burks, Robert T; Greis, Patrick E

    2013-11-01

    The purpose of this study was to evaluate the correlation of rotator cuff musculotendinous junction (MTJ) retraction with healing after rotator cuff repair and with preoperative sagittal tear size. We reviewed preoperative and postoperative magnetic resonance imaging (MRI) studies of 51 patients undergoing arthroscopic single-row rotator cuff repair between March 1, 2005, and February 20, 2010. Preoperative MRI studies were evaluated for anteroposterior tear size, tendon retraction, tendon length, muscle quality, and MTJ position with respect to the glenoid. The position of the MTJ was referenced off the glenoid face as either lateral or medial. Postoperative MRI studies obtained at a minimum of 1 year postoperatively (mean, 25 ± 13.9 months) were evaluated for healing, tendon length, and MTJ position. We found that 39 of 51 tears (76%) healed, with 26 of 30 small/medium tears (87%) and 13 of 21 large/massive tears (62%) healing. Greater tendon retraction, worse preoperative muscle quality, and a more medialized MTJ were all associated with worse tendon healing (P < .05). Of tears that had a preoperative MTJ lateral to the face of the glenoid, 93% healed, whereas only 55% of tears that had a preoperative MTJ medial to the face of the glenoid healed (P < .05). Healed repairs that had limited tendon lengthening (<1 cm) and limited MTJ position change (<1 cm) from preoperative were found to be smaller, had less preoperative tendon retraction, had less preoperative MTJ medialization, and had less preoperative rotator cuff fatty infiltration (P < .05). Preoperative MTJ medialization, tendon retraction, and muscle quality are all predictive of tendon healing postoperatively when using a single-row rotator cuff repair technique. The position of the MTJ with respect to the glenoid face can be predictive of healing, with over 90% healing if lateral and 50% if medial to the face. Lengthening of the tendon accounts for a significant percentage of the musculotendinous unit

  18. Chewing gum in the preoperative fasting period: an analysis of de-identified incidents reported to webAIRS.

    PubMed

    Shanmugam, S; Goulding, G; Gibbs, N M; Taraporewalla, K; Culwick, M

    2016-03-01

    The role of preoperative fasting is well established in current anaesthetic practice with different guidelines for clear fluids and food. However, chewing gum may not be categorised as either food or drink by some patients, and may not always be specified in instructions given to patients about preoperative fasting. The aim of this paper was to review anaesthesia incidents involving gum chewing reported to webAIRS to obtain information on the risks, if any, of gum chewing during the preoperative fasting period. There were nine incidents involving chewing gum reported between late 2009 and early 2015. There were no adverse outcomes from the nine incidents other than postponement of surgery in three cases and cancellation in one. In particular, there were no reports of aspiration or airway obstruction. Nevertheless, there were five cases in which the gum was not detected preoperatively and was found in the patient's mouth either intraoperatively or postoperatively. These cases of undetected gum occurred despite patient and staff compliance with their current preoperative checklists. While the risk of increased gastric secretions related to chewing gum preoperatively are not known, the potential for airway obstruction if the gum is not detected and removed preoperatively is very real. We recommend that patients should be specifically advised to avoid gum chewing once fasting from clear fluids is commenced, and that a specific question regarding the presence of chewing gum should be added to all preoperative checklists.

  19. Preoperational test report, vent building ventilation system

    SciTech Connect

    Clifton, F.T.

    1997-11-04

    This represents a preoperational test report for Vent Building Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides Heating, Ventilation, and Air Conditioning (HVAC) for the W-030 Ventilation Building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  20. Preoperational test report, primary ventilation system

    SciTech Connect

    Clifton, F.T.

    1997-11-04

    This represents a preoperational test report for Primary Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides vapor space filtered venting of tanks AY101, AY102, AZ101, AZ102. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  1. Reducing the preoperative ecological footprint in otolaryngology.

    PubMed

    Lui, Justin T; Rudmik, Luke; Randall, Derrick R

    2014-11-01

    To (1) evaluate the potential for recycling uncontaminated preoperative waste and (2) identify recycling differences within otolaryngology-head and neck surgery subspecialties. Prospective study. Three university-affiliated tertiary level hospitals. Otolaryngology-head and neck surgery operative procedures. A total of 97 operative procedures were evaluated. Preoperative waste products were sorted into recyclable and nonrecyclable materials; intraoperative waste was weighed for volume but not sorted. The preoperative period was defined as the opening of the surgical supply cart for operating room preparation until procedure initiation. Mass and volume of each type of waste were recorded upon the conclusion of the case. Approximately 23.1% of total operative waste mass (36.7% by volume) was derived from the preoperative set-up, of which 89.7% was recyclable. Pediatric procedures produced the least recyclable material per operation as a proportion of total waste, which was statistically different than the 2 highest recyclable subspecialties, general and rhinology (P = .006); the remaining subspecialties did not statistically differ in proportion of recyclable material produced. This study identified a source of clean recyclable materials that could eliminate 21% of operating room waste mass. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2014.

  2. Preoperational test, vent building ventilation system

    SciTech Connect

    Clifton, F.T., Westinghouse Hanford

    1996-08-20

    Preoperational Test Procedure for Vent Building Ventilation System, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The Vent Building ventilation system provides ventilation, heating, cooling, and zone confinement control for the W-030 Project Vent Building. The tests verify correct System operation and correct indications displayed by the central Monitor and Control system.

  3. Citrus aurantium blossom and preoperative anxiety.

    PubMed

    Akhlaghi, Mahmood; Shabanian, Gholamreza; Rafieian-Kopaei, Mahmoud; Parvin, Neda; Saadat, Mitra; Akhlaghi, Mohsen

    2011-01-01

    Reducing anxiety is very important before operation. Preoperative visit and use of premedication are popular methods to achieve this goal, but the role of anxiolytic premedication remains unclear and postoperative side-effects may result from routine premedication. Citrus aurantium is used as an alternative medicine in some countries to treat anxiety, and recently the anxiolytic role of this medicinal plant was established in an animal model study. The aim of this study was to assess the anxiolytic effect of Citrus aurantium blossomon preoperative anxiety. We studied 60 ASA I patients undergoing minor operation. In a randomized double-blind design, two groups of 30 patients received one of the following oral premedication two hours before induction of anesthesia: 1) Citrus aurantium blossom distillate 1mL.kg(-1) (C-group); 2) Saline solution 1mL.kg(-1) as placebo (P-group). Anxiety was measured before and after premedication using the Spielberger state-trait anxiety inventory (STAI-state) and the Amsterdam preoperative anxiety and information scale (APAIS) before operation. After premedication, both the STAI-state and the APAIS scales were decreased in C-group (p<0.05); while exhibiting no significant changes in P-group. Citrus aurantium blossom may be effective in terms of reduction in preoperative anxiety before minor operation. Copyright © 2011 Elsevier Editora Ltda. All rights reserved.

  4. Does Obstructive Sleep Apnea Influence Perioperative Outcome? A Qualitative Systematic Review for the Society of Anesthesia and Sleep Medicine Task Force on Preoperative Preparation of Patients with Sleep-Disordered Breathing.

    PubMed

    Opperer, Mathias; Cozowicz, Crispiana; Bugada, Dario; Mokhlesi, Babak; Kaw, Roop; Auckley, Dennis; Chung, Frances; Memtsoudis, Stavros G

    2016-05-01

    Obstructive sleep apnea (OSA) is a commonly encountered problem in the perioperative setting even though many patients remain undiagnosed at the time of surgery. The objective of this systematic review was to evaluate whether the diagnosis of OSA has an impact on postoperative outcomes. We performed a systematic review of studies published in PubMed-MEDLINE, MEDLINE In-Process, and other nonindexed citations, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Health Technology Assessment up to November 2014. Studies of adult patients with a diagnosis of OSA or high risk thereof, published in the English language, undergoing surgery or procedures under anesthesia care, and reporting ≥1 postoperative outcome were included. Overall, the included studies reported on 413,304 OSA and 8,556,279 control patients. The majority reported worse outcomes for a number of events, including pulmonary and combined complications, among patients with OSA versus the reference group. The association between OSA and in-hospital mortality varied among studies; 9 studies showed no impact of OSA on mortality, 3 studies suggested a decrease in mortality, and 1 study reported increased mortality. In summary, the majority of studies suggest that the presence of OSA is associated with an increased risk of postoperative complications.

  5. Preoperative embolization in carotid body tumor surgery: is it required?

    PubMed

    Zeitler, Daniel M; Glick, Joelle; Har-El, Gady

    2010-05-01

    We compared estimated blood loss (EBL) in patients who underwent surgical excision of carotid body tumors (CBTs) after preoperative superselective angiography with embolization (PSE) with that in patients who underwent excision of CBTs without PSE. We performed a retrospective chart review of a consecutive case series in a single surgeon's practice within an academic tertiary care medical center. Twenty-five patients underwent surgical resection of a CBT from 1989 to 2009. From 1989 to 1996, 10 consecutive patients had PSE of the CBT, whereas the subsequent 15 patients (1996 to 2009) had no PSE. Demographic data including age, sex, and tumor size were collected. The EBL was obtained from intraoperative records and operative notes dictated at the time of surgery. Tumor size was based on preoperative radiographic measurements by a senior radiologist and the surgeon. In the 10 patients with PSE, the mean age was 41 years (range, 22 to 72 years) and the mean tumor size was 4.8 cm (range, 2.9 to 8.3 cm). The mean EBL was 305 mL (range, 50 to 1,000 mL); 2 patients had an EBL of more than 400 mL. In the 15 patients without PSE, the mean age was 43.7 years (range, 20 to 75 years) and the mean tumor size was 4.4 cm (range, 2.8 to 7.9 cm). The mean EBL was 265.6 mL (range, 40 to 900 mL); 2 patients had an EBL of more than 400 mL. There were no significant differences between the 2 groups with regard to age, tumor size, or EBL. Preoperative superselective angiography with embolization of a CBT does not lead to a significant reduction in intraoperative EBL.

  6. Stage I carcinoma of the endometrium: a 5-year experience utilizing preoperative cesium

    SciTech Connect

    Belinson, J.L.; Spirou, B.; McClure, M.; Badger, G.; Pretorius, R.G.; Roland, T.A.

    1985-03-01

    A treatment protocol for the management of stage I endometrial carcinoma utilizing preoperative cesium is evaluated. One hundred and twelve consecutive patients were treated according to this protocol over a 5-year period. Based on this experience and a literature review a new protocol is recommended. The significant changes include primary surgery without preoperative cesium, primary treatment based on grade without regard to uterine size, modified radical hysterectomy for G3 tumors, pelvic radiotherapy for clear cell carcinoma confined to the pelvis regardless of depth of invasion, cytoxan, adriamycin, and cis-platinum for papillary serous tumors, and postoperative vaginal cuff cesium for G2 and G3 tumors not requiring pelvic radiotherapy.

  7. Complications associated with preoperative radiation therapy and Iodine-125 brachytherapy for localized prostatic carcinoma

    SciTech Connect

    Flanigan, R.C.; Patterson, J.; Mendiondo, O.A.; Gee, W.F.; Lucas, B.A.; McRoberts, J.W.

    1983-08-01

    Twenty-five consecutive patients with localized adenocarcinoma of the prostate treated with 1,050 rad preoperative radiation therapy and Iodine-125 seed brachytherapy are reviewed. Significant long-term postoperative complications included radiation cystitis (12%), radiation proctitis (4%), genital and leg edema (12%), stress incontinence (8%), total incontinence (4%), and impotence (26%). Complications occurred in 75 per cent of patients who received additional postoperative radiation. Improved staging with CT scan, lymphangiography, and Chiba needle biopsy of any possibly abnormal lymph nodes provided excellent preoperative staging with only 1 patient (6%) upstaged at surgery to Stage D1.

  8. Assessing the Role of Preoperative Embolization in the Surgical Management of Cerebral Arteriovenous Malformations.

    PubMed

    Luksik, Andrew S; Law, Jody; Yang, Wuyang; Garzon-Muvdi, Tomas; Caplan, Justin M; Colby, Geoffrey; Coon, Alexander L; Tamargo, Rafael J; Huang, Judy

    2017-08-01

    Preoperative embolization is established as an advantageous adjunct in multimodality treatment of cerebral arteriovenous malformations (AVMs). However, the benefit of preoperative embolization in AVMs with favorable surgical risk profile is debatable, because it has yet to be supported by evidence in comparative studies. In this study, we assessed outcome of surgically treated patients in a comparative setting. Our institutional AVM database of retrospectively and prospectively collected data between 1990 and 2015 was reviewed. Patients with complete clinical data who underwent surgical resection for AVMs were included. We performed a 1:1 ratio propensity score match for baseline variables that differed between patients with or without preoperative embolization. Differences in surgical risk and outcomes were evaluated between these 2 groups. AVM size, eloquence, deep drainage, middle cerebral artery feeder, and ruptured presentation differed significantly between the 2 groups. Forty-eight patients without preoperative embolization were matched to 48 with embolization, with no significant differences in baseline variables or AVM characteristics between the 2 groups. We found no significant differences in AVM obliteration and postoperative modified Rankin Scale (mRS) score between embolized and nonembolized patients, respectively. Change in mRS score from preoperative score was also not significant, although more embolized patients had a decline in mRS score. Secondary outcome measures including duration of surgery (P = 0.172), intraoperative bleeding (P = 0.280), duration of hospitalization (P = 0.368), and postoperative symptoms were also similar between both groups. Our data do not support substantial benefit of preoperative embolization for patients with a favorable surgical risk profile. Because of risks and costs with this intervention, the prudent use of preoperative embolization should be individually considered. Copyright © 2017 Elsevier Inc. All

  9. Characterization and Preoperative Risk Analysis of Leiomyosarcomas at a High-Volume Tertiary Care Center.

    PubMed

    Peters, Ann; Sadecky, Amanda M; Winger, Daniel G; Guido, Richard S; Lee, Ted T M; Mansuria, Suketu M; Donnellan, Nicole M

    2017-07-01

    Uterine morcellation in minimally invasive surgery has recently come under scrutiny because of inadvertent dissemination of malignant tissue, including leiomyosarcomas commonly mistaken for fibroids. Identification of preoperative risk factors is crucial to ensure that oncologic care is delivered when suspicion for malignancy is high, while offering minimally invasive hysterectomies to the remaining patients. The aim of this study was to characterize risk factors for uterine leiomyosarcomas by reviewing preoperative, intraoperative, and postoperative data with an emphasis on the presence of concurrent fibroids. A retrospective case-control study of women undergoing hysterectomy with pathologic diagnosis of uterine leiomyosarcoma at a tertiary care center between January 2005 and April 2014. Thirty-one women were identified with leiomyosarcoma and matched to 124 controls. Cases with leiomyosarcoma were more likely to have undergone menopause and to present with larger uteri (19- vs 9-week sized), with the most common presenting complaint being a pelvic mass (35.5% vs 8.9%). Controls were ten times more likely to have undergone a tubal ligation (30.6% vs 3.2%). Endometrial sampling detected malignancy preoperatively in only 50% of cases. Leiomyosarcomas were more commonly present when pelvic masses were identified in addition to fibroids on preoperative imaging. Most leiomyosarcoma cases (77.4%) were performed by oncologists via an abdominal approach (83.9%), with only 2 of 31 leiomyosarcomas being morcellated. Comparative analysis of preoperative imaging and postoperative pathology showed that in patients with leiomyosarcoma, fibroids were misdiagnosed 58.1% of the time, and leiomyosarcomas arose directly from fibroids in only 6.5% of cases. Leiomyosarcoma risk factors include older age/postmenopausal status, enlarged uteri of greater than 10 weeks, and lack of previous tubal ligation. Preoperative testing failed to definitively identify leiomyosarcomas, although

  10. Treatment Guidelines for Preoperative Radiation Therapy for Retroperitoneal Sarcoma: Preliminary Consensus of an International Expert Panel

    SciTech Connect

    Baldini, Elizabeth H.; Wang, Dian; Haas, Rick L.M.; Catton, Charles N.; Indelicato, Daniel J.; Kirsch, David G.; Roberge, David; Salerno, Kilian; Deville, Curtiland; Guadagnolo, B. Ashleigh; O'Sullivan, Brian; Petersen, Ivy A.; Le Pechoux, Cecile; Abrams, Ross A.; DeLaney, Thomas F.

    2015-07-01

    Purpose: Evidence for external beam radiation therapy (RT) as part of treatment for retroperitoneal sarcoma (RPS) is limited. Preoperative RT is the subject of a current randomized trial, but the results will not be available for many years. In the meantime, many practitioners use preoperative RT for RPS, and although this approach is used in practice, there are no radiation treatment guidelines. An international expert panel was convened to develop consensus treatment guidelines for preoperative RT for RPS. Methods and Materials: An expert panel of 15 academic radiation oncologists who specialize in the treatment of sarcoma was assembled. A systematic review of reports related to RT for RPS, RT for extremity sarcoma, and RT-related toxicities for organs at risk was performed. Due to the paucity of high-quality published data on the subject of RT for RPS, consensus recommendations were based largely on expert opinion derived from clinical experience and extrapolation of relevant published reports. It is intended that these clinical practice guidelines be updated as pertinent data become available. Results: Treatment guidelines for preoperative RT for RPS are presented. Conclusions: An international panel of radiation oncologists who specialize in sarcoma reached consensus guidelines for preoperative RT for RPS. Many of the recommendations are based on expert opinion because of the absence of higher level evidence and, thus, are best regarded as preliminary. We emphasize that the role of preoperative RT for RPS has not been proven, and we await data from the European Organization for Research and Treatment of Cancer (EORTC) study of preoperative radiotherapy plus surgery versus surgery alone for patients with RPS. Further data are also anticipated pertaining to normal tissue dose constraints, particularly for bowel tolerance. Nonetheless, as we await these data, the guidelines herein can be used to establish treatment uniformity to aid future assessments of efficacy

  11. Preoperative Embolization of Extra-axial Hypervascular Tumors with Onyx

    PubMed Central

    Fusco, Matthew R.; Salem, Mohamed M.; Reddy, Arra S.; Ogilvy, Christopher S.; Kasper, Ekkehard M.; Thomas, Ajith J.

    2016-01-01

    Objective Preoperative endovascular embolization of intracranial tumors is performed to mitigate anticipated intraoperative blood loss. Although the usage of a wide array of embolic agents, particularly polyvinyl alcohol (PVA), has been described for a variety of tumors, literature detailing the efficacy, safety and complication rates for the usage of Onyx is relatively sparse. Materials and Methods We reviewed our single institutional experience with pre-surgical Onyx embolization of extra-axial tumors to evaluate its efficacy and safety and highlight nuances of individualized cases. Results Five patients underwent pre-surgical Onyx embolization of large or giant extra-axial tumors within 24 hours of surgical resection. Four patients harbored falcine or convexity meningiomas (grade I in 2 patients, grade II in 1 patient and grade III in one patient), and one patient had a grade II hemangiopericytoma. Embolization proceeded uneventfully in all cases and there were no complications. Conclusion This series augments the expanding literature confirming the safety and efficacy of Onyx in the preoperative embolization of extra-axial tumors, underscoring its advantage of being able to attain extensive devascularization via only one supplying pedicle. PMID:27114961

  12. Preoperative Embolization of Extra-axial Hypervascular Tumors with Onyx.

    PubMed

    Fusco, Matthew R; Salem, Mohamed M; Gross, Bradley A; Reddy, Arra S; Ogilvy, Christopher S; Kasper, Ekkehard M; Thomas, Ajith J

    2016-03-01

    Preoperative endovascular embolization of intracranial tumors is performed to mitigate anticipated intraoperative blood loss. Although the usage of a wide array of embolic agents, particularly polyvinyl alcohol (PVA), has been described for a variety of tumors, literature detailing the efficacy, safety and complication rates for the usage of Onyx is relatively sparse. We reviewed our single institutional experience with pre-surgical Onyx embolization of extra-axial tumors to evaluate its efficacy and safety and highlight nuances of individualized cases. Five patients underwent pre-surgical Onyx embolization of large or giant extra-axial tumors within 24 hours of surgical resection. Four patients harbored falcine or convexity meningiomas (grade I in 2 patients, grade II in 1 patient and grade III in one patient), and one patient had a grade II hemangiopericytoma. Embolization proceeded uneventfully in all cases and there were no complications. This series augments the expanding literature confirming the safety and efficacy of Onyx in the preoperative embolization of extra-axial tumors, underscoring its advantage of being able to attain extensive devascularization via only one supplying pedicle.

  13. [Preoperative assessment of patients with diabetes mellitus].

    PubMed

    Takeda, Kiyoshi

    2010-07-01

    The perioperative morbidity of diabetic patients is related to preoperative end-organ damage. Due to the microvascular pathology, autonomic neuropathy is common and cardiovascular abnormalities such as hypertension, painless myocardial ischemia, and orthostatic hypotension may predispose patients to perioperative cardiovascular instability. Autonomic dysfunction also contributes to delayed gastric emptying, and preoperative administration of a histamine antagonist and a gastric emptying agent is needed. Chronic hyperglycemia leads to glycosylation of tissue proteins and the accumulation of abnormal collagen can cause stiff joint syndrome resulting in difficult tracheal intubation. The primary goal of pre and intraoperative blood glucose control is to avoid hypoglycemia and ketosis. Moreover, the tight glycemic control has been reported to improve survival in critically ill patients who were treated in the intensive care unit.

  14. Perineovulvovaginal preoperative preparation in minor gynecological surgery.

    PubMed

    Adeleye, J A

    1976-09-01

    Fifty consecutive patients underwent minor elective gynecologic surgery. Most of them were from the low socioeconomic class. Twenty-five patients had their pubic, vulval and perineal hair shaved as part of the preoperative preparation. All patients underwent the same routine perineal, vulval and vaginal swabbing in the operating room. All patients were then examined for postoperative complications. Only two women (who were shaved) complained of mild lower abdominal pain 48 hours after operation, but neither had any clinical evidence of genital or urinary infection. Their symptoms disappeared with the use of analgesics. Even in developing countries where patients with poor personal hygiene are common, preoperative vulval, pubic and perineal hair shaving prior to minor gynecologic surgery is unnecessary. We suggest that this procedure should be discontinued.

  15. Preoperative Embolization of Cervical Spine Tumors

    SciTech Connect

    Vetter, Sylvia C.; Strecker, Ernst-Peter; Ackermann, Ludwig W.; Harms, Juergen

    1997-09-15

    Purpose: To assess the technical success rate, complications, and effect on intraoperative blood loss of preoperative transarterial embolization of cervical spine tumors. Methods: A retrospective analysis was performed on 38 patients with tumors of the cervical spine; 69 vertebrae were affected. Polyvinyl alcohol particles, coils, gelfoam particles, either alone or in combination, were used for preoperative tumor embolization. After embolization a total of 57 corporectomies with titanium basket implantation were performed. Results: In 36 of 38 patients, complete (n= 27) or partial (n= 9) embolization was achieved. In 23 patients one vertebral artery was completely occluded by coil placement, and in one patient the ipsilateral internal and external carotid arteries were occluded in addition. No neurological complications could be directly related to the embolization, but two postoperative brain stem infarctions occurred. The mean intraoperative blood loss was 2.4 L. Conclusion: Transarterial embolization of cervical spine tumors is a safe and effective procedure to facilitate extensive surgery.

  16. Preoperative Planning for ACL Revision Surgery.

    PubMed

    Osti, Leonardo; Buda, Matteo; Osti, Raffaella; Massari, Leo; Maffulli, Nicola

    2017-03-01

    The number of patients undergoing revision surgery following failure of anterior cruciate ligament (ACL) reconstruction has increased over the recent past, following the overall increased number of primary ACL reconstruction performed. Failure of primary ACL reconstruction can be attributed to technical errors, biological failures, or new traumatic injuries. Technical errors include femoral and/or tibial tunnels malposition, untreated associated ligaments insufficiencies, uncorrected lower limb malalignment, and graft fixation failures. Candidates for revision surgery should be carefully selected, and the success of ACL revision requires precise preoperative planning to obtain successful results. Preoperative planning begins with the analysis of the mechanisms of ACL reconstruction failure, and information regarding previous surgery, such as the type of graft implanted, and the position of existing hardware. Appropriate imaging is necessary to evaluate the position of the femoral and tibial tunnels, and abnormal tunnel widening. On the basis of clinical examination and imaging, surgeon can perform an ACL revision procedure in 1 or 2 stages.

  17. [Preoperative lung function tests using impulse oscillometry].

    PubMed

    Fujiwara, Kumiko

    2010-02-01

    Preoperative lung function tests are useful to evaluate the preoperative pulmonary condition and to detect a high risk of postoperative pulmonary complications. However, maximum expiratory effort by patients is necessary to determine lung function using spirometry and flow-volume curve measurements. When patients are not able to expire completely during the measurement, incorrect data regarding their respiratory system is obtained. On the other hand, respiratory system impedance using an impulse oscillatory system (IOS) can evaluate total airway resistance (R5), large airway resistance (R20), small airway resistance (R5-20) and reactance (X5) under breathing at rest within a few minutes. There are few reports that indicate the standard values for IOS. In addition, the effects of age on IOS value are not clear. In this study preoperative lung functions using IOS were studied to examine the standard value and effect of aging. Subjects were 420 patients aged from 20 to 89 years with normal pulmonary function (%VC > or = 80%, %FEV(1.0) > or = 70%), and scheduled for an elective surgery. Lung function measurements such as IOS, spirometry, maximum expiratory flow-volume curve and single N2 washout were done preoperatively. Subjects were divided into seven groups in decades from 20 to 80. Although there was no statistical change in R5, R20, R5-R20, Z5 and X5 in the decades from 20 to 60, there were statistically significant changes during the 70s and 80s. There were significant differences in IOS parameters between the adult group and the aged group. Changes due to aging were stronger on V25/Ht than those of IOS. This study indicates that there are differences between V25/Ht and IOS values because of the difference in breathing conditions during measurements.

  18. Anaphylactic reaction secondary to topical preoperative moxifloxacin.

    PubMed

    Ullman, Michael A; Midgley, Kirsten J; Kim, Jocelyn; Ullman, Saul

    2016-12-01

    We report a case of anaphylactic shock following topical administration of moxifloxacin for endophthalmitis prophylaxis prior to cataract surgery. Immunoglobulin E (IgE) serology and IgE skin testing confirmed the anaphylactic etiology. Phacoemulsification with posterior chamber intraocular lens implantation was later performed with identical preoperative preparation except for the exclusion of moxifloxacin; no anaphylactic response occurred. To our knowledge, this is the first report of an anaphylactic response to topical moxifloxacin.

  19. Role of Ultrasonography in the Preoperative Assessment of Impalpable Testes: A Single Center Experience

    PubMed Central

    Abbas, Tariq O.; Al-Shahwani, Noora; Hayati, Ahmed; Hady Samaha, Abdul; Bassiouny, Ibrahim E.; Ali, Mansour

    2012-01-01

    Background. Abdominoscrotal sonogram is often used in boys with a nonpalpable testis to determine the presence of the testis. We describe our experience with the use of ultrasonography in boys with a nonpalpable testis. Methods. We retrospectively reviewed the medical records of boys aged less than 14 years, who underwent preoperative ultrasonography for an impalpable undescended testis (IUDT) between 2006 and 2010 in our institution. The results of sonography and laparoscopy were compared. Results. A total of 26 impalpable testes in 22 patients, including 4 with bilateral impalpable testes, were preoperatively assessed by ultrasonography for their localization. Sonography localized only 6 of the 26 (23%) testes, which were laparoscopically explored and followed by orchiopexy. Conclusion. Ultrasound is not reliable in the preoperative assessment of patients with impalpable testes. PMID:22567419

  20. Locally advanced breast cancer in Jamaica: prevalence, disease characteristics and response to preoperative therapy.

    PubMed

    Chin, Sheray Nicole; Green, Cheryl May Antoinette; Gordon-Strachan, Georgiana Marie; Wharfe, Gilian Helen Frances

    2014-01-01

    Breast cancer is the most common cancer in Jamaican women. Locally advanced breast cancer (LABC) is associated with aggressive biology and poor prognosis, and has a predilection for African-American women. In this retrospective review, we assessed the prevalence of LABC as a breast cancer presentation in a population of mainly Afro-centric ethnicity, and determined disease characteristics and response to pre-operative chemotherapy. LABC was prevalent (20%), and had a low pathological response rate to pre-operative chemotherapy, with a high risk of disease recurrence. Increased utilization of breast cancer screening may help detect cancer at less advanced stages, and optimizing pre-operative chemotherapy is recommended to improve response rates and ultimately survival.

  1. Preoperative computerized dynamic posturography as a prognostic indicator of balance function in patients with acoustic neuroma.

    PubMed

    Bergson, Eric; Sataloff, Robert T

    2005-03-01

    We conducted a study to determine the prognostic reliability of preoperative computerized dynamic posturography (CDP) in patients undergoing surgical excision of an acoustic neuroma. Our goal was to determine the correlation between objective preoperative assessments of balance function and subjective postoperative patient self-assessments. To that end, we retrospectively reviewed the records of 21 adults who had undergone preoperative CDP, and we subsequently obtained their subjective assessments of balance function by follow-up telephone surveys at least 1 year postoperatively. We conclude that although CDP has proven to be useful in many aspects of balance evaluation, it did not appear to be a valuable predictor of subjective postoperative balance function in these patients.

  2. Pre-operative patient preparation in the prevention of surgical site infections.

    PubMed

    McBride, Tara; Beamer, Jennifer

    2007-12-01

    In 1999 the Ontario Ministry of Health and Long-Term Care granted funding to St. Mary's General Hospital for a Regional Cardiac Care Center. In July 2003 the cardiac surgery program opened. During the program-planning phase, protocols and procedures related to patient preparation for cardiac surgery were developed. To share policies, protocols and patient teaching tools developed from research driven, evidenced based standards of practice. To complete a one-year review (January to December 2004) and assess the compliance rates with pre-operative patient preparation procedures on all Coronary Artery Bypass Graft (CABG) cardiac surgery patients. Retrospective chart review. 191 bed community-based Regional Cardiac Care Centre. All adult patients undergoing Coronary Artery Bypass Graft (CABG) surgery from January 1st 2004 to December 31st 2004. Compliance rate following patient education related to pre-operative washes, assessing completion of pre-operative washes, and location of clipping relative to the Cardiovascular Operating Room (CVOR). A team of Registered Nurses was able to effectively implement policies and protocols within a cardiac surgery program that meet the recommended standards of care of the Centers for Disease Control and Prevention (CDC), Operating Room Nurses Association of Canada (ORNAC) and Safer Health Care Now! Initiative. A retrospective chart review has demonstrated that staff consistently apply and document care in accordance with the developed pre-operative wash and hair clipping protocols.

  3. Three-Dimensional Surface Imaging and the Continuous Evolution of Preoperative and Postoperative Assessment in Rhinoplasty.

    PubMed

    Lekakis, Garyfalia; Claes, Peter; Hamilton, Grant S; Hellings, P W

    2016-02-01

    During the preoperative assessment in rhinoplasty, the surgeon takes a thorough history, performs a complete examination by assessing functional and aesthetic aspects of the nose, obtains a clear understanding of the patient's wishes, conducts facial analysis based on standardized photography, and communicates to the patient the goals and pitfalls of surgery. Computer imaging or morphing of the preoperative pictures of the nose has drawn a lot of interest in the last decade, and it is a sign of evolution of the preoperative consultation. Technological advances, also in the context of rhinoplasty, have led to the development of three-dimensional (3D) imaging techniques, and have completely revolutionized the way that surgeons manage their patients preoperatively and evaluate postoperative results today. The accurate 3D surface imaging aids the surgeon to communicate with the patient adequately before surgery, to set an appropriate surgical plan, and to measure the shape and volume changes of the patient's nose that result from the intervention. The present review provides an analysis on the current knowledge of 3D surface imaging in rhinoplasty derived from the literature, and highlights future directions of preoperative and postoperative assessment in the field. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  4. Incidence of underlying biliary neoplasm in patients after major hepatectomy for preoperative benign hepatolithiasis

    PubMed Central

    Park, Hyeong Min; Cho, Chol Kyoon; Koh, Yang Seok; Kim, Hee Joon; Park, Eun Kyu

    2016-01-01

    Backgrounds/Aims Despite hepatolithiasis being a risk factor for biliary neoplasm including cholangiocarcinoma, the incidence of underlying biliary neoplasm is unknown in patients with preoperative benign hepatolithiasis. The aim of this study was to evaluate the incidence of underlying biliary neoplasm in patients who underwent major hepatectomy for preoperative benign hepatolithiasis. Methods Between March 2005 and December 2015, 73 patients who underwent major hepatectomy for preoperative benign hepatolithiasis were enrolled in this study. The incidence and pathological differentiation of concomitant biliary neoplasm were retrospectively determined by review of medical records. Postoperative complications after major hepatectomy were evaluated. Results Concomitant biliary neoplasm was pathologically confirmed in 20 patients (27.4%). Biliary intraepithelial neoplasia (BIN) was detected in 12 patients (16.4%), and 1 patient (1.4%) had intraductal papillary mucinous neoplasm (IPMN), as the premalignant lesion. Cholangiocarcinoma was pathologically confirmed in 7 patients (9.6%). Preoperative imaging of the 73 patients revealed biliary stricture at the first branch of bile duct in 31 patients (42.5%), and at the second branch of bile duct in 39 patients (53.4%). Postoperative complications developed in 14 patients (19.1%). Almost all patients recovered from complications, including intra-abdominal abscess (9.6%), bile leakage (4.1%), pleural effusion (2.7%), and wound infection (1.4%). Only 1 patient (1.4%) died from aspiration pneumonia. Conclusions The incidence of underlying biliary neoplasm was not negligible in the patients with hepatolithiasis, despite meticulous preoperative evaluations. PMID:28261696

  5. The effect of preoperative keratometry on visual outcomes after moderate myopic LASIK.

    PubMed

    Christiansen, Steven M; Neuffer, Marcus C; Sikder, Shameema; Semnani, Rodmehr T; Moshirfar, Majid

    2012-01-01

    To evaluate visual outcomes in moderately myopic eyes with flat and steep corneas (preoperatively) that have been treated with laser-assisted in situ keratomileusis (LASIK). Records of ninety-six eyes with average preoperative keratometry (K) values between 39.9 and 42.0 diopters (D) (flat) were matched with 103 eyes with preoperative K values between 46.0 and 47.2 D (steep) that underwent LASIK between March 2007 and March 2010 for moderate myopia, and were retrospectively reviewed. The primary outcome measures used to determine the effect of preoperative keratometry on visual prognosis were refraction, visual acuity, change in keratometry (ΔK), and change in spherical equivalent (ΔSE), measured at 1, 3, 6, and 12 months postoperatively. Significant differences were found at 6 months postoperatively between the flat group and steep group in SE (P = 0.029), sphere (P = 0.018), ΔK (P = 0.002), percentage of eyes achieving SE of -0.25 to + 0.25 D (P = 0.0125), -0.26 to -0.50 D (P = 0.003), -0.51 to -1.00 D (P = 0.044), and the percentage of eyes achieving uncorrected distance visual acuity of 20/15 or better (P = 0.0006). Moderately myopic eyes with flatter corneas preoperatively have better visual prognosis following LASIK compared with moderately myopic eyes with steeper corneas.

  6. The effect of preoperative keratometry on visual outcomes after moderate myopic LASIK

    PubMed Central

    Christiansen, Steven M; Neuffer, Marcus C; Sikder, Shameema; Semnani, Rodmehr T; Moshirfar, Majid

    2012-01-01

    Purpose To evaluate visual outcomes in moderately myopic eyes with flat and steep corneas (preoperatively) that have been treated with laser-assisted in situ keratomileusis (LASIK). Patients and methods Records of ninety-six eyes with average preoperative keratometry (K) values between 39.9 and 42.0 diopters (D) (flat) were matched with 103 eyes with preoperative K values between 46.0 and 47.2 D (steep) that underwent LASIK between March 2007 and March 2010 for moderate myopia, and were retrospectively reviewed. The primary outcome measures used to determine the effect of preoperative keratometry on visual prognosis were refraction, visual acuity, change in keratometry (ΔK), and change in spherical equivalent (ΔSE), measured at 1, 3, 6, and 12 months postoperatively. Results Significant differences were found at 6 months postoperatively between the flat group and steep group in SE (P = 0.029), sphere (P = 0.018), ΔK (P = 0.002), percentage of eyes achieving SE of −0.25 to + 0.25 D (P = 0.0125), −0.26 to −0.50 D (P = 0.003), −0.51 to −1.00 D (P = 0.044), and the percentage of eyes achieving uncorrected distance visual acuity of 20/15 or better (P = 0.0006). Conclusion Moderately myopic eyes with flatter corneas preoperatively have better visual prognosis following LASIK compared with moderately myopic eyes with steeper corneas. PMID:22536037

  7. Management of Rectal Cancer: Short- vs. Long-Course Preoperative Radiation

    SciTech Connect

    Mohiuddin, Mohammed Marks, John; Marks, Gerald

    2008-11-01

    There is considerable debate on the optimum approach to neoadjuvant therapy in rectal cancer. This review of major published studies of short-course preoperative radiation and the more conventional approach of long-course neoadjuvant chemoradiation was undertaken in an effort to understand the potential advantages and disadvantages of each of these approaches. Studies were evaluated with regard to patient selection, clinical outcomes, and toxicities. Short-course preoperative radiation has shown a clear advantage over surgery alone in reducing local recurrence rates and improving survival of patients with rectal cancer. However, studies using short-course preoperative treatment have included a significant number of early (30%; Stage I/II) and more proximal cancers yet appear to have higher positive margin rates, higher abdominoperineal resection rates, and lower aggregate survival than patients treated with long-course neoadjuvant chemoradiation. Although long-course preoperative chemoradiation is associated with higher rates of reversible acute toxicity, there appears to be more significant and a higher rate of late gastrointestinal toxicity observed in short-course preoperative radiation studies. Patient convenience and lower cost of treatment, however, can be a significant advantage in using a short-course treatment schedule. Selective utilization of either of these approaches should be based on extent of disease and goals of treatment. Patients with distal cancers or more advanced disease (T3/T4) appear to have better outcomes with neoadjuvant chemoradiation, especially where downstaging of disease is critical for more complete surgical resection and sphincter preservation.

  8. Total knee arthroplasty in Asian subjects: preoperative range of motion determines postoperative range of motion?

    PubMed

    Bin Abd Razak, Hamid Rahmatullah; Han, Xinyun Audrey; Chong, Hwei Chi; Tan, Hwee Chye Andrew

    2014-02-01

    To evaluate whether preoperative range of motion is a key determinant of postoperative range of motion in Asian patients undergoing conventional total knee arthroplasty. A retrospective review of 302 patients who underwent primary total knee arthroplasty performed by a single surgeon was conducted. Patients who had a fixed flexion deformity of ≥15° were excluded. Postoperative range of motion (ROM) was measured prospectively. Patients were stratified into two groups: preoperative ROM < 110° and preoperative ROM ≥ 110°. Postoperative ROM and mean change in ROM at 6 months and 2 years of follow-up were then compared using Student's t-test. Group of ROM < 110° had a poorer postoperative range of motion at both 6-months and 2-years of follow-up than Group of ROM ≥ 110° (P < 0.001). Postoperatively, Group of ROM < 110° had gained range of motion whereas Group of ROM ≥ 110° had lost range of motion (P < 0.001). Similar to the Western population, preoperative range of motion is a key determinant of postoperative range of motion in Asian patients. This should be taken into consideration by surgeons during preoperative planning and in managing patients' expectations. © 2014 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  9. Influence of preoperative velar closing ratio and lateral wall movement on outcomes of Furlow palatoplasty for velopharyngeal incompetence

    PubMed Central

    Muzaffar, Arshad R; Rice, Gale; Hubbard, Bradley; Killion, Elizabeth

    2014-01-01

    Currently, there is no consensus regarding how to determine the optimal surgical procedure for a patient with velopharyngeal incompetence (VPI) post-primary palate repair. The purpose of the present study was to assess the effect of preoperative velar closing ratio (VCR) and lateral wall movement (LWM) on nasal emission and hypernasality after Furlow double-opposing Z-plasty. A retrospective analysis involving patients with VPI post-primary palatoplasty whose VPI was treated with double-opposing Z-plasty by a single surgeon was performed. Ten consecutive patients with VPI postpalatoplasty were reviewed. Videonasendoscopy, videofluoroscopy and perceptual speech examinations were performed preoperatively and postoperatively. VCR improved from an mean of 0.5 preoperatively (range 0.1 to 0.95) to 0.9 postoperatively (range 0.55 to 1.0). Postoperative mean LWM was 0.5 (range 0.3 to 0.9), unchanged from preoperative ratings. A trend toward an inverse relationship between preoperative VCR and improvement in hypernasality and resolution of nasal emission was observed. No relationship was noted between the degree of preoperative LWM and mean improvement in hypernasality. However, patients with worse preoperative LWM experienced better resolution of nasal emission postoperatively. PMID:25535457

  10. Maintaining radiation exposures as low as reasonably achievable (ALARA) for dental personnel operating portable hand-held x-ray equipment.

    PubMed

    McGiff, Thomas J; Danforth, Robert A; Herschaft, Edward E

    2012-08-01

    Clinical experience indicates that newly available portable hand-held x-ray units provide advantages compared to traditional fixed properly installed and operated x-ray units in dental radiography. However, concern that hand-held x-ray units produce higher operator doses than fixed x-ray units has caused regulatory agencies to mandate requirements for use of hand-held units that go beyond those recommended by the manufacturer and can discourage the use of this technology. To assess the need for additional requirements, a hand-held x-ray unit and a pair of manikins were used to measure the dose to a simulated operator under two conditions: exposures made according to the manufacturer's recommendations and exposures made according to manufacturer's recommendation except for the removal of the x-ray unit's protective backscatter shield. Dose to the simulated operator was determined using an array of personal dosimeters and a pair of pressurized ion chambers. The results indicate that the dose to an operator of this equipment will be less than 0.6 mSv y⁻¹ if the device is used according to the manufacturer's recommendations. This suggests that doses to properly trained operators of well-designed, hand-held dental x-ray units will be below 1.0 mSv y⁻¹ (2% of the annual occupational dose limit) even if additional no additional operational requirements are established by regulatory agencies. This level of annual dose is similar to those reported as typical dental personnel using fixed x-ray units and appears to satisfy the ALARA principal for this class of occupational exposures.

  11. Single center experience with application of the ALARA concept to serial imaging studies after blunt renal trauma in children--is ultrasound enough?

    PubMed

    Eeg, Kurt R; Khoury, Antoine E; Halachmi, Sarel; Braga, Luis H P; Farhat, Walid A; Bägli, Darius J; Pippi Salle, Joao L; Lorenzo, Armando J

    2009-04-01

    After properly staged renal injury many children will undergo radiological reevaluation with computerized tomography, the modality frequently favored for its widespread availability and anatomical detail. The ALARA (as low as reasonably achievable) concept attempts to balance the potential future risk of radiation induced malignancy with the added information obtained by the study. At our institution ultrasound has been increasingly adopted as the followup imaging technique of choice. We sought to evaluate this practice in pediatric blunt renal trauma management. We retrospectively analyzed the trauma database of a pediatric referral center for patients treated between 1997 and 2007. A total of 73 children with blunt renal trauma were identified. Associated injuries, mechanism of trauma, type of management, imaging studies, complications and delayed/missed injuries were evaluated. Mean patient age was 10.5 years and the male-to-female ratio was 3:2. In all patients the mechanism was blunt trauma. Average grade of injury at hospitalization was 2.4, with high grade injury observed in 32% of patients. Repeat computerized tomography was obtained in 11 patients (9 for nonurological injuries). Three nephrectomies were done in the setting of hemodynamic instability and 1 pseudoaneurysm was embolized. Four enlarging symptomatic urinomas were suspected by ultrasound. No clinically important injuries or complications due to delayed diagnosis were detected in patients followed with ultrasound. Our experience suggests that after initial computerized tomography for accurate staging of pediatric blunt renal trauma monitoring can be performed with ultrasound in most patients (excluding those with hemodynamic instability or deemed to require computerized tomography for associated injuries). Selective reevaluation with computerized tomography can be reserved for those with serial or ambiguous abnormalities detected on ultrasound, thus decreasing exposure to radiation.

  12. Biochemical Diagnosis and Preoperative Imaging of GEP NETs

    PubMed Central

    Maxwell, Jessica E.; O’Dorisio, Thomas M.; Howe, James R.

    2015-01-01

    SYNOPSIS Neuroendocrine tumors (NETs) are a diverse group of neoplasms that can arise in a variety of locations throughout the body and often metastasize early. A patient’s only chance for cure is surgical removal of the primary tumor and all associated metastases, although even when surgical cure is unlikely, patients can benefit from surgical debulking of their disease. A thorough preoperative workup will often require multiple clinical tests and imaging studies to locate the primary tumor, delineate the extent of the disease, and assess tumor functionality. This review will discuss the biomarkers important for the diagnosis of these unique tumors and the imaging modalities that are most helpful for surgical planning. PMID:26610781

  13. Preoperative evaluation and risk factors of lung cancer.

    PubMed

    Gaballo, Annarita; Corbo, Giuseppe M; Valente, Salvatore; Ciappi, Giuliano

    2004-01-01

    Based on a review of the literature on resectable lung cancer, pulmonary risk factors before, during and after surgery are discussed. The role of preoperative evaluation in order to determine the patient ability to withstand radical resection is considered. Spirometric indexes as forced expired volume (FEV1) and diffusing lung carbon monoxide capacity (DLCO) should be measured first. If FEV1 and DLCO are > 60% of predicted, patients are at low risk for complications and can undergo pulmonary resection. However, if FEV1 and DLCO are <60% of predicted, further evaluation with a quantitative lung scan is required. If predicted postoperative values for FEV1 and DLCO are >40%, patients can undergo lung resection, otherwise exercise testing is necessary. If the latter shows maximal oxygen uptake (VO2max) of > 15ml/Kg, surgery can be performed; if VO2max is <15 ml/Kg, patients are inoperable.

  14. Preoperative Localization and Surgical Margins in Conservative Breast Surgery

    PubMed Central

    Corsi, F.; Sorrentino, L.; Bossi, D.; Sartani, A.; Foschi, D.

    2013-01-01

    Breast-conserving surgery (BCS) is the treatment of choice for early breast cancer. The adequacy of surgical margins (SM) is a crucial issue for adjusting the volume of excision and for avoiding local recurrences, although the precise definition of an adequate margins width remains controversial. Moreover, other factors such as the biological behaviour of the tumor and subsequent proper systemic therapies may influence the local recurrence rate (LRR). However, a successful BCS requires preoperative localization techniques or margin assessment techniques. Carbon marking, wire-guided, biopsy clips, radio-guided, ultrasound-guided, frozen section analysis, imprint cytology, and cavity shave margins are commonly used, but from the literature review, no single technique proved to be better among the various ones. Thus, an association of two or more methods could result in a decrease in rates of involved margins. Each institute should adopt its most congenial techniques, based on the senologic equipe experience, skills, and technologies. PMID:23986868

  15. Can we preoperatively risk stratify ovarian masses for malignancy?

    PubMed

    Oltmann, Sarah C; Garcia, Nilda; Barber, Robert; Huang, Rong; Hicks, Barry; Fischer, Anne

    2010-01-01

    Given a 10% malignancy rate in pediatric ovarian masses, what preoperative factors are helpful in distinguishing those at higher risk to risk stratify accordingly? After institutional review board approval (IRB#022008-095), a 15(1/2)-year retrospective review of operative ovarian cases was performed. A total of 424 patients were identified, with a mean age 12.5 years (range, 1 day to 19 years), without an age disparity between benign (12.54 years, 89%) and malignant (11.8 years, 11%) cases. The 1- to 8-year age group had the highest percentage of malignancies (22%; odds ratio [OR], 3.02; 95% confidence interval [CI], 1.33-6.86). A chief complaint of mass or precocious puberty versus one of pain had an OR for malignancy of 4.84 and 5.67, respectively (95% CI, 2.48-9.45 and 1.60-20.30). Imaging of benign neoplasms had a mean size of 8 cm (range, 0.9-36 cm) compared with malignancies at 17.3 cm (6.2-50 cm, P < .001). An ovarian mass size of 8 cm or longer on preoperative imaging had an OR of 19.0 for malignancy (95% CI, 4.42-81.69). Ultrasound or computed tomographic findings of a solid mass, although infrequent, were most commonly associated with malignancy (33%-60%), compared with reads of heterogeneous (15%-21%) or cystic (4%-5%) lesions. The malignancies (n = 46) included germ cell (50%, n = 23), stromal (28%, n = 13), epithelial (17%, n = 8), and other (4%, n = 2). Tumor markers obtained in 71% of malignancies were elevated in only 54%, whereas 6.5% of those sent in benign cases were similarly elevated. Elevated beta-human chorionic gonadotropin (beta-HCG), alpha fetoprotein (alphaFP), and cancer antigen 125 (CA-125) were significantly associated with malignancy (P < .02) and an elevated carcinoembryonic antigen (CEA) was not (P = .1880). This reported series of pediatric ovarian masses demonstrates that preoperative indicators that best predict an ovarian malignancy are a complaint of a mass or precocious puberty, a mass exceeding 8 cm or a mass with solid

  16. Outcome of cardiac surgery in patients with low preoperative ejection fraction.

    PubMed

    Pieri, Marina; Belletti, Alessandro; Monaco, Fabrizio; Pisano, Antonio; Musu, Mario; Dalessandro, Veronica; Monti, Giacomo; Finco, Gabriele; Zangrillo, Alberto; Landoni, Giovanni

    2016-10-18

    In patients undergoing cardiac surgery, a reduced preoperative left ventricular ejection fraction (LVEF) is common and is associated with a worse outcome. Available outcome data for these patients address specific surgical procedures, mainly coronary artery bypass graft (CABG). Aim of our study was to investigate perioperative outcome of surgery on patients with low pre-operative LVEF undergoing a broad range of cardiac surgical procedures. Data from patients with pre-operative LVEF ≤40 % undergoing cardiac surgery at a university hospital were reviewed and analyzed. A subgroup analysis on patients with pre-operative LVEF ≤30 % was also performed. A total of 7313 patients underwent cardiac surgery during the study period. Out of these, 781 patients (11 %) had a pre-operative LVEF ≤40 % and were included in the analysis. Mean pre-operative LVEF was 33.9 ± 6.1 % and in 290 patients (37 %) LVEF was ≤30 %. The most frequently performed operation was CABG (31 % of procedures), followed by mitral valve surgery (22 %) and aortic valve surgery (19 %). Overall perioperative mortality was 5.6 %. Mitral valve surgery was more frequent among patients who did not survive, while survivors underwent more frequently CABG. Post-operative myocardial infarction occurred in 19 (2.4 %) of patients, low cardiac output syndrome in 271 (35 %). Acute kidney injury occurred in 195 (25 %) of patients. Duration of mechanical ventilation was 18 (12-48) hours. Incidence of complications was higher in patients with LVEF ≤30 %. Stepwise multivariate analysis identified chronic obstructive pulmonary disease, pre-operative insertion of intra-aortic balloon pump, and pre-operative need for inotropes as independent predictors of mortality among patients with LVEF ≤40 %. We confirmed that patients with low pre-operative LVEF undergoing cardiac surgery are at higher risk of post-operative complications. Cardiac surgery can be performed with acceptable mortality rates

  17. Preoperative opioid use and outcomes after reverse shoulder arthroplasty.

    PubMed

    Morris, Brent J; Laughlin, Mitzi S; Elkousy, Hussein A; Gartsman, Gary M; Edwards, T Bradley

    2015-01-01

    The potential adverse effect of preoperative opioid use on outcomes after reverse shoulder arthroplasty (RSA) has not been investigated. The purpose of this study was to evaluate outcomes after RSA in patients with a history of preoperative opioid use and compare them with a control group without a history of preoperative opioid use. Sixty-eight RSAs performed for rotator cuff tear arthropathy (CTA) with a minimum of 2 years of follow-up were identified in a prospective shoulder arthroplasty registry. Thirty-two patients with a history of preoperative opioid use for shoulder pain were compared with a control group of 36 patients who did not use opioids preoperatively. Shoulder function scores and range of motion measurements were assessed preoperatively and at the final follow-up. No differences were noted between the 2 groups in age, gender, duration of follow-up, depression, smoking, chronic back pain, diabetes, heart disease, or body mass index. Preoperative opioid use was associated with significantly lower preoperative shoulder function scores. Both groups significantly improved on all shoulder function scores and for range of motion measurements from the preoperative to the final follow-up assessment; however, the nonopioid group had significantly better outcomes. The magnitude of change between the groups from preoperatively to the final follow-up was nearly identical. Improvements can be expected in patients with a history of preoperative opioid use; however, patients with preoperative opioid use have a lower preoperative baseline and should not expect to reach the same peak outcome scores after RSA as patients without a history of preoperative opioid use. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  18. Preoperative haemoglobin cut-off values for the prediction of post-operative transfusion in total knee arthroplasty.

    PubMed

    Yeh, Jared Ze Yang; Chen, Jerry Yongqiang; Bin Abd Razak, Hamid Rahmatullah; Loh, Bryan Huai Gu; Hao, Ying; Yew, Andy Khye Soon; Chia, Shi-Lu; Lo, Ngai Nung; Yeo, Seng Jin

    2016-10-01

    The purpose of this study is to determine preoperative haemoglobin cut-off values that could accurately predict post-operative transfusion outcome in patients undergoing primary unilateral total knee arthroplasty (TKA). This will allow surgeons to provide selective preoperative type and screen to only patients at high risk of transfusion. A total of 1457 patients diagnosed with osteoarthritis and underwent primary unilateral TKA between January 2012 and December 2014 were retrospectively reviewed. Logistic regression analyses were applied to identify factors that could predict transfusion outcome. A total of 37 patients (2.5 %) were transfused postoperatively. Univariate analysis revealed preoperative haemoglobin (p < 0.001), age (p < 0.001), preoperative haematocrit (p < 0.001), and preoperative creatinine (p < 0.001) to be significant predictors. In the multivariate analysis with patients dichotomised at 70 years of age, preoperative haemoglobin remained significant with adjusted odds ratio of 0.33. Receiver operating characteristic curve identified the preoperative haemoglobin cut-off values to be 12.4 g/dL (AUC = 0.86, sensitivity = 87.5 %, specificity = 77.2 %) and 12.1 g/dL (AUC = 0.85, sensitivity = 69.2 %, specificity = 87.1 %) for age above and below 70, respectively. The authors recommend preoperative haemoglobin cut-off values of 12.4 g/dL for age above 70 and 12.1 g/dL for age below 70 to be used to predict post-operative transfusion requirements in TKA. To maximise the utilisation of blood resources, the authors recommend that only patients with haemoglobin level below the cut-off should receive routine preoperative type and screen before TKA. IV.

  19. Histopathology Discrepancy of Preoperative Endometrial Sampling and Final Specimen: How Does This Influence Selective Lymph Node Dissection?

    PubMed

    Corr, Bradley R; Carrubba, Aakriti; Sheeder, Jeanelle; Cheng, Georgina; Guntupalli, Saketh R

    2017-02-01

    Preoperative histology is a major component in the perioperative selective lymph node (LN) dissection decision process. Discrepancy between preoperative endometrial sampling and final specimen histopathology is generally accepted. The goals of this project are to determine if discrepancy of histopathology is associated with alteration of adjuvant treatment or outcome. We performed a retrospective cross-sectional analysis of all patients undergoing surgery for endometrial cancer at a single institution from 2010 to 2014. All patients had preoperative endometrial sampling. Histopathology discrepancy was evaluated for potential in variation of perioperative LN dissection. Criteria for not performing LN dissection was defined as preoperative endometrioid histology, grade 1 or 2 lesion, myometrial invasion of 50% or less, and primary tumor diameter 2 cm or less. A total of 352 patients were identified; 44 were excluded because of no preoperative pathology or no residual disease on final pathology. Discrepancy of histopathology was noted in 64/308 (20.8%; 95% confidence interval [CI], 16.2%-25.3%) patients. Preoperative endometrioid histology was noted in 272 patients, and 17/272 (6.3%; 95% CI, 3.4%-9.1%) had preoperative sampling reviewed as a grade 1 or 2 endometrioid lesion and final specimen was upgraded to grade 3. Downstaging occurred in 3/272 (1.1%; 95% CI, 0%-2.3%) patients with preoperative grade 3 lesion and final specimen demonstrated grade 1 or 2 disease. All 3 patients' primary tumor diameter was greater than 2 cm and therefore received LN dissection. Histopathological discrepancy that would alter perioperative LN dissection decision based on the aforementioned criteria occurred in 2/272 (0.7%; 95% CI, 0%-1.8%). Despite a 20% discrepancy of preoperative and postoperative histopathology, discrepancy that would alter a perioperative decision for LN dissection occurs in only 0.7% of cases in this retrospective single-institutional experience. Myometrial

  20. Impact of value based breast cancer care pathway implementation on pre-operative breast magnetic resonance imaging utilization

    PubMed Central

    McCray, Devina K. S.; Grobmyer, Stephen R.

    2017-01-01

    Background Bilateral breast magnetic resonance imaging (MRI) is commonly used in the diagnostic workup of breast cancer (BC) to assess extent of disease and identify occult foci of disease. However, evidence for routine use of pre-operative MRI is lacking. Breast MRI is costly and can lead to unnecessary tests and treatment delays. Clinical care pathways (care paths) are value-based guidelines, which define management recommendations derived by expert consensus and available evidence based data. At Cleveland Clinic, care paths created for newly diagnosed BC patients recommend selective use of pre-operative MRI. We evaluated the number of pre-operative MRIs ordered before and after implementing an institution wide BC care paths in April 2014. Methods A retrospective review was conducted of BC cases during the years 2012, 2014, and part of 2015. Patient, tumor and treatment characteristics were collected. Pre-operative MRI utilization was compared before and after care path implementation. Results We identified 1,515 BC patients during the study period. Patients were more likely to undergo pre-operative MRI in 2012 than 2014 (OR: 2.77; P<0.001; 95% CI: 1.94–3.94) or 2015 (OR: 4.14; P<0.001; 95% CI: 2.51–6.83). There was a significant decrease in pre-operative MRI utilization between 2012 and 2014 (P<0.001) after adjustment for pre-operative MRIs ordered for care path indications. Conclusions Implementation of online BC care paths at our institution was associated with a decreased use of pre-operative MRI overall and in patients without a BC care path indication, driving value based care through the reduction of pre-operative breast MRIs. PMID:28210553

  1. Preoperative Cardiac, Pulmonary and Digestive Comorbidities of Morbidly Obese Patients Undergoing Bariatric Surgery: Morbidity, Assessment and Management.

    PubMed

    Du, Xiao; Zhang, Si-Qin; Cheng, Zhong; Li, Yang; Tian, Hao-Ming; Hu, Jian-Kun; Zhou, Zong-Guang

    2014-05-01

    To investigate a proper preoperative assessment and management of preoperative cardiac, pulmonary and digestive comorbidities in morbidly obese patients undergoing bariatric surgery. A general description of comorbidities in bariatric patients was reviewed and a clinical practice path in assessment and management of comorbidities was summarized. Morbidly obese patients frequently carried serious comorbidities in cardiovascular, pulmonary and digestive systems. The most common abnormalities included hypertension, left ventricular wall hypertrophy, ST and T wave abnormalities, obstructive sleep apnea, ventilatory dysfunction, and nonalcoholic fatty liver disease. A routine specialized preoperative evaluation could find the potential abnormality and screen the appropriate patients. Prophylactic treatments obviously reduced the morbidity of peri-operative complications Comprehensive preoperative evaluation and proper management is essential to appropriately select and prepare bariatric patients, and minimize surgical risk.

  2. Preoperative mental health status may not be predictive of improvements in patient-reported outcomes following an anterior cervical discectomy and fusion.

    PubMed

    Mayo, Benjamin C; Massel, Dustin H; Bohl, Daniel D; Narain, Ankur S; Hijji, Fady Y; Long, William W; Modi, Krishna D; Basques, Bryce A; Yacob, Alem; Singh, Kern

    2017-02-01

    OBJECTIVE Prior studies have correlated preoperative depression and poor mental health status with inferior patient-reported outcomes following lumbar spinal procedures. However, literature regarding the effect of mental health on outcomes following cervical spinal surgery is limited. As such, the purpose of this study is to test for the association of preoperative SF-12 Mental Component Summary (MCS) scores with improvements in Neck Disability Index (NDI), SF-12 Physical Component Summary (PCS), and neck and arm pain following anterior cervical discectomy and fusion (ACDF). METHODS A prospectively maintained surgical database of patients who underwent a primary 1- or 2-level ACDF during 2014-2015 was reviewed. Patients were excluded if they did not have complete patient-reported outcome data for the preoperative or 6-week, 12-week, or 6-month postoperative visits. At baseline, preoperative SF-12 MCS score was assessed for association with preoperative NDI, neck visual analog scale (VAS) score, arm VAS score, and SF-12 PCS score. The preoperative MCS score was then tested for association with changes in NDI, neck VAS, arm VAS, and SF-12 PCS scores from the preoperative visit to postoperative visits. These tests were conducted using multivariate regression controlling for baseline characteristics as well as for the preoperative score for the patient-reported outcome being assessed. RESULTS A total of 52 patients were included in the analysis. At baseline, a higher preoperative MCS score was negatively associated with a lower preoperative NDI (coefficient: -0.74, p < 0.001) and preoperative arm VAS score (-0.06, p = 0.026), but not preoperative neck VAS score (-0.03, p = 0.325) or SF-12 PCS score (0.04, p = 0.664). Additionally, there was no association between preoperative MCS score and improvement in NDI, neck VAS, arm VAS, or SF-12 PCS score at any of the postoperative time points (6 weeks, 12 weeks, and 6 months, p > 0.05 for each). The percentage of patients

  3. Preoperative urinary tract obstruction in scoliosis patients.

    PubMed

    Suzuki, Shigeru; Kotani, Toshiaki; Mori, Kazuetsu; Kawamura, Ken; Ohtake, Akira

    2017-01-01

    While the association between scoliosis and cardiac and respiratory function impairments has been well characterized in clinical practice and research, the potential effect of scoliosis on urinary tract structure and renal function has received little attention. Therefore, the purpose of this study was to evaluate the preoperative clinical characteristics of urinary tract structure and renal function in pediatric patients with idiopathic scoliosis, using a combination of blood tests, urinalysis, and imaging. Preoperative measures of urinary tract structure and renal function were obtained for 16 patients, 13-17 years old, scheduled for corrective surgery for idiopathic scoliosis. Preoperative assessment included blood test and urinalysis, combined with structural imaging on ultrasound (US), magnetic resonance imaging (MRI), magnetic resonance urography (MRU), and radioisotope tracing (RI), using technetium-99 m mercaptoacetyltriglycine ((99m) Tc-MAG3). Differences in blood and urine tests between patients with and without urinary tract obstruction (UTO) were evaluated for significance using Mann-Whitney U test. For all 16 patients, blood tests and MRU were within normal limits. Dilatation of the renal pelvis was identified on US in eight patients (50.0%). UTO was identified on RI in six patients (37.5%). UTO was associated with elevated β2-microglobulin concentration. Urinary β2-microglobulin concentration >0.7 μg/mg Cr differentiated patients with UTO from those without UTO, with a sensitivity of 100% and specificity of 70%. β2-Microglobulin concentration may be a useful marker to screen for asymptomatic UTO in patients with idiopathic scoliosis. © 2016 Japan Pediatric Society.

  4. Development of a preoperative neuroscience educational program for patients with lumbar radiculopathy.

    PubMed

    Louw, Adriaan; Butler, David S; Diener, Ina; Puentedura, Emilio J

    2013-05-01

    Postoperative rehabilitation for lumbar radiculopathy has shown little effect on reducing pain and disability. Current preoperative education programs with a focus on a biomedical approach feature procedural and anatomical information, and these too have shown little effect on postoperative outcomes. This report describes the development of an evidence-based educational program and booklet for patients undergoing lumbar surgery for radiculopathy using a recently conducted systematic review of neuroscience education for musculoskeletal pain. The previous systematic review produced evidence for neuroscience education as well as best-evidence synthesis of the content and delivery methods for neuroscience education for musculoskeletal pain. These evidence statements were extracted and developed into patient-centered messages and a booklet, which was then evaluated by peer and patient review. The neuroscience educational booklet and preoperative program convey key messages from the previous systematic review aimed at reducing fear and anxiety before surgery and assist in developing realistic expectations regarding pain after surgery. Key topics include the decision to undergo surgery, pain processing, peripheral nerve sensitization, effect of anxiety and stress on pain, surgery and the nervous system, and decreasing nerve sensitization. Feedback from the evaluations of the booklet and preoperative program was favorable from all review groups, suggesting that this proposed evidence-based neuroscience educational program may be ready for clinical application.

  5. Management of Unplanned Excision for Soft-Tissue Sarcoma With Preoperative Radiotherapy Followed by Definitive Resection.

    PubMed

    Jones, Daniel A; Shideman, Charles; Yuan, Jianling; Dusenbery, Kathryn; Carlos Manivel, J; Ogilvie, Christian; Clohisy, Denis R; Cheng, Edward Y; Shanley, Ryan; Chinsoo Cho, L

    2016-12-01

    The purpose of this study was to review the outcomes after preoperative radiotherapy and definitive surgery for patients who initially had inadvertent excision for sarcoma. Treatment records of 44 consecutive patients, who initially underwent unplanned excision of soft-tissue sarcoma between January 2004 and January 2012, were reviewed. All patients had clinically localized disease before treatment and received preoperative external-beam radiotherapy followed by definitive oncologic surgery at our institution. The median follow-up was 36 months. Residual tumor after preoperative radiotherapy and wound bed excision was identified in 39% (17/44) of the cases. Kaplan-Meier estimates for 5-year local control, recurrence-free survival, and overall survival are 95% (95% confidence interval [CI], 80-99), 86% (95% CI, 69-94), and 94% (95% CI, 79-99) respectively. Perioperative morbidity occurred in 25% of patients (11/44.) All patients with perioperative wound complications had lower extremity sarcomas. Optimal management for unplanned excision of soft-tissue sarcoma is unknown. Our institution has adopted the approach of preoperative radiotherapy, followed by definitive surgery. In our series of 44 patients, local control was excellent at 95%, with perioperative complications seen only in patients with lower extremity sarcomas, suggesting that this is a reasonable approach to manage inadvertently resected sarcoma.

  6. Preoperative evaluation: screening using a questionnaire.

    PubMed

    Mendes, Florentino Fernandes; Machado, Eduardo Lopes; de Oliveira, Maurício; Brasil, Fernando Rudem; Eizerik, Gibrahn; Telöken, Patrick

    2013-01-01

    Prior to elective surgery it is essential to know in advance the patient’s clinical condition. The aim of this study was to compare the preoperative evaluation (POE) through questionnaire responses with preanesthetic evaluation by the anesthesiologist. Prior to their preoperative evaluation, patients answered a questionnaire with information regarding age, weight, height, scheduled surgery, past medical and surgical history, allergies, medications and doses used, social history (illicit drugs, alcohol, smoking), functional capacity and exercise tolerance. Preoperative evaluation was performed by an anesthesiologist who had no access to the questionnaire data or knowledge about the research. The questionnaire data were compared with the preoperative evaluation by two independent investigators, in order to answer the questions: 1) Was the questionnaire evaluation effective - could the patient undergo surgery without the need for face-to-face consultation? 2) Has been there any relevant information - ability to change the anesthetic approach - not assessed by the questionnaire, but assessed by the face-to-face consultation? 3) Has been there any information added by the health questionnaire that was missed by face-to-face consultation? For statistical analysis, the paired Student’s t-test was used for parametric data and chi-square test for categorical data, with p < 0.05 considered significant. Of the 269 eligible patients there was one refusal, and four agreed to participate but did not complete the questionnaire, in addition to 52 losses, totaling 212 participants. Questionnaire data added to the consultation in 109 cases (51.4%). The screening questionnaire alone was effective for 144 patients (67.93%), with no need for consultation. The anesthesiologist evaluation referred patients for surgery on their fi rst visit in 178 opportunities (84%). In the identification of cases of non-referral to surgery, the questionnaire showed a negative predictive value of 94

  7. Preoperative evaluation: screening using a questionnaire.

    PubMed

    Mendes, Florentino Fernandes; Machado, Eduardo Lopes; de Oliveira, Maurício; Brasil, Fernando Rudem; Eizerik, Gibrahn; Telöken, Patrick

    2013-01-01

    Prior to elective surgery it is essential to know in advance the patient's clinical condition. The aim of this study was to compare the preoperative evaluation (POE) through questionnaire responses with preanesthetic evaluation by the anesthesiologist. Prior to their preoperative evaluation, patients answered a questionnaire with information regarding age, weight, height, scheduled surgery, past medical and surgical history, allergies, medications and doses used, social history (illicit drugs, alcohol, smoking), functional capacity and exercise tolerance. Preoperative evaluation was performed by an anesthesiologist who had no access to the questionnaire data or knowledge about the research. The questionnaire data were compared with the preoperative evaluation by two independent investigators, in order to answer the questions: 1) Was the questionnaire evaluation effective - could the patient undergo surgery without the need for face-to-face consultation? 2) Has been there any relevant information - ability to change the anesthetic approach - not assessed by the questionnaire, but assessed by the face-to-face consultation? 3) Has been there any information added by the health questionnaire that was missed by face-to-face consultation? For statistical analysis, the paired Student's t-test was used for parametric data and chi-square test for categorical data, with p < 0.05 considered significant. Of the 269 eligible patients there was one refusal, and four agreed to participate but did not complete the questionnaire, in addition to 52 losses, totaling 212 participants. Questionnaire data added to the consultation in 109 cases (51.4%). The screening questionnaire alone was effective for 144 patients (67.93%), with no need for consultation. The anesthesiologist evaluation referred patients for surgery on their first visit in 178 opportunities (84%). In the identification of cases of non-referral to surgery, the questionnaire showed a negative predictive value of 94

  8. Fundoplication for laryngopharyngeal reflux despite preoperative dysphagia.

    PubMed

    Falk, G L; Van der Wall, H; Burton, L; Falk, M G; O'Donnell, H; Vivian, S J

    2017-03-01

    INTRODUCTION Fundoplication for laryngopharyngeal disease with oesophageal dysmotility has led to mixed outcomes. In the presence of preoperative dysphagia and oesophageal dysmotility, this procedure has engendered concern in certain regards. METHODS This paper describes a consecutive series of laryngopharyngeal reflux (LPR) patients with a high frequency of dysmotility. Patients were selected for surgery with 24-hour dual channel pH monitoring, oesophageal manometry and standardised reflux scintigraphy. RESULTS Following careful patient selection, 33 patients underwent fundoplication by laparoscopy. Surgery had high efficacy in symptom control and there was no adverse dysphagia. CONCLUSIONS Evidence of proximal reflux can select a group of patients for good results of fundoplication for atypical symptoms.

  9. Preoperational test report, recirculation ventilation systems

    SciTech Connect

    Clifton, F.T.

    1997-11-11

    This represents a preoperational test report for Recirculation Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides vapor space cooling of tanks AY1O1, AY102, AZ1O1, AZ102 and supports the ability to exhaust air from each tank. Each system consists of a valved piping loop, a fan, condenser, and moisture separator; equipment is located inside each respective tank farm in its own hardened building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  10. Preoperative irradiation and cystectomy for bladder cancer.

    PubMed

    Smith, J A; Batata, M; Grabstald, H; Sogani, P C; Herr, H; Whitmore, W F

    1982-03-01

    Between 1971 and 1974, 101 patients at Memorial Sloan-Kettering Cancer Center underwent planned integrated treatment for bladder cancer with 2000 rads by megavoltage delivered to the whole pelvis over five consecutive days followed by radical cystectomy within a week. The overall five-year survival rate was 39%; the hospital mortality rate was 2%. In the pelvis alone tumor recurred in 9% of the patients. These results support other studies demonstrating the efficacy of this and other regimens of preoperative irradiation and cystectomy.

  11. Preoperative Evaluation: Estimation of Pulmonary Risk.

    PubMed

    Lakshminarasimhachar, Anand; Smetana, Gerald W

    2016-03-01

    Postoperative pulmonary complications (PPCs) are common after major non-thoracic surgery and associated with significant morbidity and high cost of care. A number of risk factors are strong predictors of PPCs. The overall goal of the preoperative pulmonary evaluation is to identify these potential, patient and procedure-related risks and optimize the health of the patients before surgery. A thorough clinical examination supported by appropriate laboratory tests will help guide the clinician to provide optimal perioperative care. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Electronic Care Coordination From the Preoperative Clinic.

    PubMed

    Chow, Vinca W; Hepner, David L; Bader, Angela M

    2016-12-01

    Fragmented and variable perioperative care exposes patients to unnecessary risks and handoff errors. The perioperative surgical home aims to optimize quality, value-based care. We performed a retrospective evaluation of how a preoperative assessment center could coordinate care through e-mails sent to a patient's healthcare team that initiate discussion on critical clinical information. During 100 clinic days on which 8122 patients were evaluated, 606 triggered e-mails, with a potential impact on 19 elements across the perioperative care spectrum. Four cases were canceled, and 42 cases were rescheduled. By fostering information exchange, these communications could advance patient-centered, value-enhanced quality and safety outcomes.

  13. Predicting Meningioma Consistency on Preoperative Neuroimaging Studies

    PubMed Central

    Shiroishi, Mark S.; Cen, Steven Y.; Tamrazi, Benita; D'Amore, Francesco; Lerner, Alexander; King, Kevin S.; Kim, Paul E.; Law, Meng; Hwang, Darryl H.; Boyko, Orest B.; Liu, C. Jason

    2016-01-01

    Synopsis This article provides an overview of the neuroimaging literature focused on pre-operative prediction of meningioma consistency. A validated, non-invasive neuroimaging method to predict tumor consistency can provide valuable information regarding neurosurgical planning and patient counseling. Most of the neuroimaging literature indicates conventional MRI using T2-weighted imaging (T2WI) may be helpful to predict meningioma consistency, however, further rigorous validation is necessary. Much less is known about advanced MRI techniques such as diffusion MRI, MR elastography (MRE) and MR spectroscopy (MRS). Of these methods, MRE and DTI appear particularly promising. PMID:27012379

  14. Preoperative breast marking in reduction mammaplasty.

    PubMed

    Gasperoni, C; Salgarello, M

    1987-10-01

    A simple method of preoperative marking for reduction mammaplasty is described. This method may be used in macromastias when the technique chosen implies a postoperative scar with the shape of an inverted T. The marking sequence follows standard steps, but the drawing is always different because it is a consequence of the shape of the breast. This marking method reduces the chance of making mistakes due to excessive personal evaluations or to the use of standard drawing patterns that may be not suitable for all breast shapes.

  15. Incidental sinonasal findings identified during preoperative evaluation for endoscopic transsphenoidal approaches

    PubMed Central

    Laury, Adrienne M.; Oyesiku, Nelson M.; Hadjipanayis, Costas G.; DelGaudio, John M.

    2013-01-01

    Background: The endoscopic transsphenoidal approach (eTSA) to lesions of the sellar region is typically performed jointly by neurosurgeons and otolaryngologists. Occasionally, the approach is significantly altered by sinonasal disease, anatomic variants, or previous surgery. However, there are no current guidelines that describe which physical or radiological findings should prompt a change in the plan of care. The purpose of this study was to determine the incidence of sinonasal pathology or anatomic variants noted endoscopically or by imaging that altered preoperative or intraoperative management. Methods: A retrospective review was performed of 355 consecutive patients who underwent combined neurosurgery–otolaryngology endoscopic sella approach from August 1, 2007 to April 1, 2011. Our practice in these patients involves preoperative otolaryngology clinical evaluation and MRI review. Intraoperative image guidance is not routinely used in uncomplicated eTSA. Results: The most common management alteration was the addition of image guidance based on anatomic variants on MRI, which occurred in 81 patients (35.0%). Eight patients (2.9%) were preoperatively treated with antibiotics and surgery was postponed secondary to acute or chronic purulent rhinosinusitis; two (0.7%) required functional endoscopic sinus surgery for medically refractory disease before eTSA. Five patients (1.8%) required anterior septoplasty intraoperatively for severe nasal septal deviation. Two patients (0.7%) had inverted papilloma and one patient had esthesioneuroblastoma identified preoperatively during rigid nasal endoscopy. Conclusion: This is one of the larger reviews of patients undergoing eTSA for sellar lesions and the only study that describes how intraoperative management may be altered by preoperative sinonasal evaluation. We found a significant incidence of sinonasal pathology and anatomic variants that altered routine operative planning; therefore, a thorough sinonasal evaluation

  16. Association of Preoperative Biliary Drainage With Postoperative Outcome Following Pancreaticoduodenectomy

    PubMed Central

    Povoski, Stephen P.; Karpeh, Martin S.; Conlon, Kevin C.; Blumgart, Leslie H.; Brennan, Murray F.

    1999-01-01

    Objective To determine whether preoperative biliary instrumentation and preoperative biliary drainage are associated with increased morbidity and mortality rates after pancreaticoduodenectomy. Summary Background Data Pancreaticoduodenectomy is accompanied by a considerable rate of postoperative complications and potential death. Controversy exists regarding the impact of preoperative biliary instrumentation and preoperative biliary drainage on morbidity and mortality rates after pancreaticoduodenectomy. Methods Two hundred forty consecutive cases of pancreaticoduodenectomy performed between January 1994 and January 1997 were analyzed. Multiple preoperative, intraoperative, and postoperative variables were examined. Pearson chi square analysis or Fisher’s exact test, when appropriate, was used for univariate comparison of all variables. Logistic regression was used for multivariate analysis. Results One hundred seventy-five patients (73%) underwent preoperative biliary instrumentation (endoscopic, percutaneous, or surgical instrumentation). One hundred twenty-six patients (53%) underwent preoperative biliary drainage (endoscopic stents, percutaneous drains/stents, or surgical drainage). The overall postoperative morbidity rate after pancreaticoduodenectomy was 48% (114/240). Infectious complications occurred in 34% (81/240) of patients. Intraabdominal abscess occurred in 14% (33/240) of patients. The postoperative mortality rate was 5% (12/240). Preoperative biliary drainage was determined to be the only statistically significant variable associated with complications (p = 0.025), infectious complications (p = 0.014), intraabdominal abscess (p = 0.022), and postoperative death (p = 0.037). Preoperative biliary instrumentation alone was not associated with complications, infectious complications, intraabdominal abscess, or postoperative death. Conclusions Preoperative biliary drainage, but not preoperative biliary instrumentation alone, is associated with increased

  17. Perioperative Complications of Total En Bloc Spondylectomy: Adverse Effects of Preoperative Irradiation

    PubMed Central

    Yokogawa, Noriaki; Murakami, Hideki; Demura, Satoru; Kato, Satoshi; Yoshioka, Katsuhito; Hayashi, Hiroyuki; Ishii, Takayoshi; Igarashi, Takashi; Fang, Xiang; Tsuchiya, Hiroyuki

    2014-01-01

    Background Total en bloc spondylectomy (TES) is associated with a high complication rate because it is technically demanding and involves patients compromised by cancer. Specifically, perioperative complications are more likely to occur in patients receiving preoperative irradiation. We examined the perioperative complications associated with TES in patients receiving preoperative irradiation. Methods Seventy-seven patients underwent TES between May 2010 and April 2013. We performed a retrospective review of prospectively collected data for 50 patients with metastatic tumors of the thoracic spine, excluding patients with primary spinal tumors, lumbar spinal metastasis, and combined anterior and posterior approach TES. Patients were divided into 2 groups: those with preoperative irradiation (RT-TES group, 18 patients) and those without preoperative irradiation (TES group, 32 patients). The following perioperative complications, occurring within 2 months of surgery, were compared between the groups: intraoperative dural injuries, epidural hematomas, deep surgical-site infections, postoperative cerebrospinal fluid leakage, wound dehiscence, pleural effusions, and neurological deficits. Results Significant differences in patient characteristics were not observed between the RT-TES and TES groups. Perioperative TES complications occurred in 20/50 patients (40.0%). The complication rate in the RT-TES group was 77.8% (14 out of 18), threefold higher than the 18.8% (6 out of 32) in the TES group (P<0.01). The incidence of complications, including intraoperative dural injuries, postoperative cerebrospinal fluid leakage, wound dehiscence, and pleural effusions, was significantly higher in the RT-TES group (P<0.01). Conclusion The perioperative complication rate associated with TES for spinal metastasis was significantly higher among patients receiving preoperative irradiation than among those not receiving preoperative irradiation. PMID:24893004

  18. Brotizolam as a pre-operative hypnotic

    PubMed Central

    Ahmad, F.; Rittmeyer, P.; Goetzke, Edda; Köster, J.

    1983-01-01

    1 Efficacy of and tolerance to brotizolam when used as a preoperative hypnotic were studied in two double-blind, randomised parallel group studies. 2 Brotizolam (0.25 and 0.50 mg) was superior to placebo. Efficacy was assessed as good-to-satisfactory in 73.0% of patients with 0.25 mg and in 88.0% with 0.5 mg. A similar assessment was reached in 40.0% of patients with placebo. Brotizolam 0.5 mg was superior to 0.25 mg, and with the higher dose subjective assessments of anxiety were reduced. 3 Efficacy of tolerance to 0.5 mg brotizolam and 2.0 mg flunitrazepam were compared, and both drugs were found to be effective and well tolerated. Brotizolam maintained sleep throughout the night more effectively than flunitrazepam. 4 A dose range of 0.25-0.5 mg brotizolam is recommended as a pre-operative hypnotic. PMID:6362702

  19. Preoperative Preparation and Anesthesia for Trabeculectomy

    PubMed Central

    2016-01-01

    ABSTRACT Preoperative preparation should improve the likelihood of successful trabeculectomy surgery. The team can reconsider the appropriateness of the proposed surgery, and steps can be taken to maximize the chance of a good outcome. For example, adjustments to anti-hypertensive or anti-coagulant medications may be made, and topical ocular medications adjusted. Choice of anesthesia technique is of particular relevance to the trabeculectomy patient. Some anesthesia techniques are more likely to have serious complications, and glaucoma patients may be at higher risk of some sight-threatening complications, because the optic nerve is already damaged and vulnerable. Posterior placement of local anesthesia (retrobulbar, peribulbar, posterior sub-Tenon’s techniques) could potentially damage the optic nerve, and thereby cause “wipe-out” of vision. Anesthesia technique may influence the likelihood of vitreous bulge and surgical difficulty. Regarding long-term control of intraocular pressure, there is no good evidence to indicate that any particular anesthesia technique is better than another. There is little high-quality evidence on this topic. The author’s preferred technique for trabeculectomy is subconjunctival-intracameral anesthesia without sedation. How to cite this article: Eke T. Preoperative Preparation and Anesthesia for Trabeculectomy. J Curr Glaucoma Pract 2016; 10(1):21-35. PMID:27231416

  20. Effect of Preoperative Sagittal Balance on Cervical Laminoplasty Outcomes.

    PubMed

    Oshima, Yasushi; Takeshita, Katsushi; Taniguchi, Yuki; Matsubayashi, Yoshitaka; Doi, Toru; Ohya, Junichi; Soma, Kazuhito; Kato, So; Oka, Hiroyuki; Chikuda, Hirotaka; Tanaka, Sakae

    2016-11-01

    Retrospective case series. To clarify how preoperative global sagittal imbalance influences outcomes in patients with cervical compression myelopathy undergoing cervical laminoplasty. The influence of sagittal balance on outcomes of cervical laminoplasty remains uncertain. The authors retrospectively reviewed data of 106 patients who underwent double-door cervical laminoplasty between 2004 and 2011 and investigated the influence of the C7 sagittal vertical axis (SVA) on outcome scores. Primary outcomes used were Japanese Orthopedic Association (JOA) scores, Numerical Rating Scale for neck or arm pain, the Short Form 36 Health Survey (physical and mental component summary scores ), and the Neck Disability Index (NDI). Ninety-two patients with complete data were eligible for inclusion. The preoperative C7 SVA was ≤5 cm in 64 patients (69.6%) and > 5 cm in 28 (30.4%). We compared each parameter by the magnitude of spinal sagittal balance (preoperative C7 SVA > 5 cm vs. C7 SVA ≤ 5 cm) after adjusting for age via the least square mean analysis because the average age was significantly higher in patients with C7 SVA > 5 cm. As for the radiographic parameters, both C2-7 SVA and C7 SVA were larger in patients when the C7 SVA was > 5 cm. Numerical Rating Scale for postoperative arm pain, postoperative JOA scores, and both pre- and postoperative physical component summary and NDI were worse in patients with C7 SVA > 5 cm; however, the JOA score recovery rate and changes in physical component summary and NDI were not significantly different. Postoperative functional outcome scores were significantly lower in patients with C7 SVA > 5 cm, although the improvement after cervical laminoplasty was not greatly affected. The involvement of global sagittal balance and cervical regional alignment should be considered in evaluating surgical outcomes for patients undergoing cervical laminoplasty. 4.

  1. Preoperative pulmonary rehabilitation for marginal-function lung cancer patients.

    PubMed

    Hashmi, Asra; Baciewicz, Frank A; Soubani, Ayman O; Gadgeel, Shirish M

    2017-01-01

    Background This study aimed to evaluate the impact of preoperative pulmonary rehabilitation in lung cancer patients undergoing pulmonary resection surgery with marginal lung function. Methods Short-term outcomes of 42 patients with forced expiratory volume in 1 s < 1.6 L who underwent lung resection between 01/2006 and 12/2010 were reviewed retrospectively. They were divided into group A (no preoperative pulmonary rehabilitation) and group B (receiving pulmonary rehabilitation). In group B, a second set of pulmonary function tests was obtained. Results There were no significant differences in terms of sex, age, race, pathologic stage, operative procedure, or smoking years. Mean forced expiratory volume in 1 s and diffusing capacity for carbon monoxide in group A was 1.40 ± 0.22 L and 10.28 ± 2.64 g∙dL(-1) vs. 1.39 ± 0.13 L and 10.75 ± 2.08 g∙dL(-1) in group B. Group B showed significant improvement in forced expiratory volume in 1 s from 1.39 ± 0.13 to 1.55 ± 0.06 L ( p = 0.02). Mean intensive care unit stay was 6 ± 5 days in group A vs. 9 ± 9 days in group B ( p = 0.22). Mean hospital stay was 10 ± 4 days in group A vs. 14 ± 9 days in group B ( p = 0.31). There was no significant difference in morbidity or mortality between groups. Conclusion Preoperative pulmonary rehabilitation can significantly improve forced expiratory volume in 1 s in some marginal patients undergoing lung cancer resection. However, it does not improve length of stay, morbidity, or mortality.

  2. Measuring preoperative anxiety in patients with intracranial tumors: the Amsterdam preoperative anxiety and information scale.

    PubMed

    Goebel, Simone; Kaup, Lea; Mehdorn, Hubertus Maximilian

    2011-10-01

    Preoperative anxiety is a major problem in patients with brain tumors and is of high clinical relevance. However, to date no instruments have been validated for the assessment of preoperative anxiety for this patient group. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) has shown promising results for the assessment of preoperative anxiety. The aim of this study was to determine its psychometric properties and the optimal cutoff score for patients with intracranial tumors to make it applicable in the neurosurgical setting. The sample totaled 180 neurosurgical patients with intracranial tumors. Patients were administered the APAIS along with the Hospital Anxiety and Depression Scale as the gold standard against which the APAIS was compared. Patients scoring 11 or above in the anxiety subscale of the Hospital Anxiety and Depression Scale were defined as clinical cases having anxiety. The psychometric properties of the APAIS were evaluated for a postulated 2-factor structure, Cronbach α, and correlations. The postulated 2-factor structure could not be replicated. Instead, we found a 3-factor solution (anxiety about the operation, anxiety about the anesthesia, information requirement). The area under the receiver operating characteristics curve ranged from ≥0.65 to ≥0.77. Optimal cutoff scores were calculated. The cutoff score for the anxiety scale was ≥10 for the whole sample and men only, and was ≥11 for women only. Analysis of the psychometric properties yielded satisfactory results (eg. Cronbach α for the anxiety scale >0.84). Despite its brevity, the APAIS is valid and recommendable for the assessment of preoperative anxiety in patients with intracranial tumors. As this is the first validation study focusing on patients with severe diseases and major surgeries, we recommend the application of our cutoff scores also for patients similar to our study population with regard to disease and surgery severity.

  3. Preoperative spinal tumor embolization: an institutional experience with Onyx.

    PubMed

    Ghobrial, George M; Chalouhi, Nohra; Harrop, James; Dalyai, Richard T; Tjoumakaris, Stavropoula; Gonzalez, L Fernando; Hasan, David; Rosenwasser, Robert H; Jabbour, Pascal

    2013-12-01

    Preoperative embolization has the potential to decrease intraoperative blood loss and facilitate spinal cord decompression and tumor resection. We report our institutional experience with the embolization of hypervascular extradural spinal tumors with Onyx as well as earlier embolic agents in a series of 28 patients. A retrospective case review was conducted on patients undergoing preoperative transarterial embolization of a spinal tumor between 1995 and 2012 at our institution. Twenty-eight patients met the inclusion criteria, with a mean age of 60.6 years. Twenty-eight patients had metastatic tumors. In 14 (50%) patients the metastases were from renal cell carcinomas. Fifty-four vessels were embolized using PVA, NBCA, Onyx, coils, or embospheres. Sixteen patients were treated with Onyx, 6 patients with PVA, 3 patients with embospheres, 2 patients with NBCA, and 3 patients with a combination of embolic agents. The average decrease in tumor blush was 97.8% with Onyx versus 92.7% with the rest of the embolic agents (p=0.08). The estimated blood loss was 1616ml (range 350-5000ml). Blood loss was 750cm(3) on average with Onyx versus 1844 with the rest of the embolic agents (p=0.14). The mean length of stay was 16 days. The mortality rate was zero. Pre- and post-operative modified Rankin Score (mRS) did not differ significantly in the series (3.12 versus 3.10, respectively, p=0.9). In our experience, the use of transarterial tumor embolization as an adjunct for spinal surgery is a safe and feasible option. Copyright © 2013 Elsevier B.V. All rights reserved.

  4. Pre-operative nutrition support in patients undergoing gastrointestinal surgery.

    PubMed

    Burden, Sorrel; Todd, Chris; Hill, James; Lal, Simon

    2012-11-14

    Post-operative management in gastrointestinal (GI) surgery is becoming well established with 'Enhanced Recovery After Surgery' protocols starting 24 hours prior to surgery with carbohydrate loading and early oral or enteral feeding given to patients the first day following surgery. However, whether or not nutritional intervention should be initiated earlier in the preoperative period remains unclear. Poor pre-operative nutritional status has been linked consistently to an increase in post-operative complications and poorer surgical outcome. To review the literature on preoperative nutritional support in patients undergoing gastrointestinal surgery (GI). The searches were initially run in March 2011 and subsequently updated in February 2012. Databases including all EBM Reviews (Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA and NHSEED) MEDLINE, EMBASE, AMED, British Nursing Index Archive using OvidSP were included and a search was run on each database separately after which duplicates were excluded. The inclusion criteria were randomised controlled trials that evaluated pre-operative nutritional support in GI surgical participants using a nutritional formula delivered by a parenteral, enteral or oral route. The primary outcomes included post-operative complications and length of hospital stay. Two observers screened the abstracts for inclusion in the review and performed data extraction. Bias was assessed for each of the included studies using the bias assessment tables in the Cochrane Software Review Manager (version 5.1, Cochrane Collaboration). The trials were analysed using risk ratios with Mantel-Haenszel in fixed effects methods displayed with heterogeneity. Meta-analyses were undertaken on trials evaluating immune enhancing (IE) nutrition, standard oral supplements, enteral and parenteral nutrition (PN) which were administered pre-operatively.Study characteristics were summarised in tables. Dichotomous and ratio data were entered into meta-analyses for

  5. Can radiological characteristics of preoperative cerebral lesions predict postoperative intracranial haemorrhage in endocarditis patients?

    PubMed

    Diab, Mahmoud; Guenther, Albrecht; Scheffel, Philipp; Sponholz, Christoph; Lehmann, Thomas; Hedderich, Johannes; Faerber, Gloria; Brunkhorst, Frank; Pletz, Mathias W; Doenst, Torsten

    2016-05-01

    Infective endocarditis (IE) is associated with high mortality (20-40%) and neurological complications (20-50%). Postoperative intracranial haemorrhage (ICH) is a feared complication especially in patients with preoperative cerebral infarcts. The aim of this study was to determine the radiological characteristics of cerebral lesions that could predict the occurrence of postoperative ICH in IE patients. We retrospectively reviewed all charts, brain imaging and follow-up data from patients operated for left-sided endocarditis between January 2007 and April 2013. A total of 308 patients (age 62.0 ± 13.9) underwent surgery for IE. Preoperative cerebrovascular complications were present in 122 patients (39.6%), representing stroke in 87, silent cerebral infarctions in 31 patients and transient ischaemic attacks in 4 patients. Among 118 patients with cerebral lesions, the aetiological classification of the lesions was ischaemic in 63.6%, ischaemic with haemorrhagic transformation (HT) in 17.8%, ischaemic with concomitant microbleeds in 16.1% and intracerebral bleeding in 2.5%. Postoperative ICH occurred in 17 patients and its incidence was slightly higher in patients with preoperative cerebral infarcts compared with those without preoperative cerebral infarcts [7.6 vs 4.2%, respectively, odds ratio (OR) 1.88, 95% confidence interval (CI) 0.70-5.02, P = 0.21]. However, the difference was not statistically significant. Similarly, the incidence of postoperative ICH was higher in cases of HT of ischaemic infarcts than in cases of ischaemic infarcts not complicated with HT (19.0 vs 5.3%). However, the difference was not statistically significant (P = 0.24). The radiological pattern of preoperative cerebral lesions was single in 35.6% and multiple in 60.0% of cases. Multiple cerebral lesions were associated with a non-significantly lower incidence of postoperative ICH than single lesions (5.6 vs 11.9%, respectively, OR: 0.44, CI: 0.11-1.73, P = 0.29). The results suggest that

  6. Preoperative Embolization of Cerebral Arteriovenous Malformations with Silk Suture and Particles: Technical Considerations and Outcomes

    PubMed Central

    Conger, Jordan R.; Raper, Daniel M.; Starke, Robert M.; Durst, Christopher R.; Liu, Kenneth C.; Jensen, Mary E.

    2016-01-01

    Objective Embolization of cerebral arteriovenous malformations (AVMs) is commonly performed prior to surgical resection in order to reduce intraoperative bleeding and improve the safety of resection. Although most modern embolization procedures utilize permanent embolic agents, silk suture and polyvinyl alcohol (PVA) particles may offer unique advantages for preoperative devascularization. The aims of this retrospective cohort study are to describe the technical considerations and determine the outcomes for preoperative silk suture and PVA particle embolization (SPE) of AVMs. Materials and Methods We performed a retrospective review of our AVM embolization database. AVM patients who underwent preoperative SPE and subsequent surgical resection were included for analysis. Baseline patient demographics, AVM characteristics, embolization and operative records, and post-treatment outcomes were reviewed. Results A total of 11 patients who underwent 12 preoperative SPE procedures were included for analysis. Five AVMs were ruptured (45%), and the median nidus volume was 3.0 cm3 (range: 1.3-42.9 cm3). The Spetzler-Martin grade was I-II in seven patients (64%) and III-IV in four patients (36%). The degree of nidal obliteration was less than 25% in two procedures (17%), 25-50% in one procedure (8%), 50-75% in eight procedures (67%), and greater than 75% in one procedure (8%). The rates of post-embolization AVM hemorrhage and mortality were 8% and 0%, respectively. The postoperative angiographic obliteration rate was 100%, and the modified Rankin Scale score improved or stable in 91% of patients (median follow-up duration 2 months). Conclusion Preoperative AVM SPE affords a reasonable risk to benefit profile for appropriately selected patients. PMID:27790398

  7. Electronic Rapid Fitness Assessment: A Novel Tool for Preoperative Evaluation of the Geriatric Oncology Patient.

    PubMed

    Shahrokni, Armin; Tin, Amy; Downey, Robert J; Strong, Vivian; Mahmoudzadeh, Sanam; Boparai, Manpreet K; McMillan, Sincere; Vickers, Andrew; Korc-Grodzicki, Beatriz

    2017-02-01

    Background: The American College of Surgeons and American Geriatrics Society recommend performing a geriatric assessment (GA) in the preoperative evaluation of older patients. To address this, we developed an electronic GA, the Electronic Rapid Fitness Assessment (eRFA). We reviewed the feasibility and clinical utility of the eRFA in the preoperative evaluation of geriatric patients. Methods: We performed a retrospective review of our experience using the eRFA in the preoperative assessment of geriatric patients. The rate and time to completion of the eRFA were recorded. The first 50 patients who completed the assessment were asked additional questions to assess their satisfaction. Descriptive statistics of patient-reported geriatric-related data were used for analysis. Results: In 2015, 636 older patients with cancer (median age, 80 years) completed the eRFA during preoperative evaluation. The median time to completion was 11 minutes (95% CI, 11-12 minutes). Only 13% of patients needed someone else to complete the assessment for them. Of the first 50 patients, 88% (95% CI, 75%-95%) responded that answering questions using the eRFA was easy. Geriatric syndromes were commonly identified through the performance of the GA: 16% of patients had a positive screening for cognitive impairment, 22% (95% CI, 19%-26%) needed a cane to ambulate, and 26% (95% CI, 23%-30%) had fallen at least once during the previous year. Conclusions: Implementation of the eRFA was feasible. The eRFA identified relevant geriatric syndromes in the preoperative setting that, if addressed, could lead to improved outcomes. Copyright © 2017 by the National Comprehensive Cancer Network.

  8. Sensitivity of 3-Dimensional Sonography in Preoperative Evaluation of Parathyroid Glands in Patients With Primary Hyperparathyroidism.

    PubMed

    Frank, Susan J; Goldman-Yassen, Adam E; Koenigsberg, Tova; Libutti, Steven K; Koenigsberg, Mordecai

    2017-09-01

    Preoperative localization of parathyroid adenomas in patients with primary hyperparathyroidism facilitates targeted surgery. We assessed the sensitivity of 3-dimensional (3D) sonography for preoperative localization of abnormal parathyroid glands. We conducted a retrospective review of patients who underwent parathyroidectomy for primary hyperparathyroidism at a single site at our institution. We compared preoperative 2-dimensional (2D) sonography, 3D sonography, and sestamibi scans with final gland localization at surgery. Two readers reviewed the sonograms to assess inter-reader variability. From January 2010 through April 2015, 52 patients underwent parathyroidectomy after preoperative 2D sonography, 3D sonography, and sestamibi scans. Three-dimensional sonography had sensitivity of 88-92% compared with 69-71% for 2D sonography for gland localization. In patients in whom sonography and sestamibi scans localized abnormalities to the same side, the sensitivities were 100% (43 of 43) for 3D sonography and 96% (48 of 50) for 2D sonography. Three-dimensional sonography had significantly higher sensitivity for localization of glands smaller than 500 mg compared with 2D sonography (88% versus 58%; P = .012). There was better inter-reader agreement between the radiologists when using 3D sonography (κ = 0.65) compared with 2D sonography (κ = 0.41). We found a significantly higher sensitivity and better inter-reader agreement for 3D sonography compared with 2D sonography for preoperative identification of abnormal parathyroid glands, especially among smaller glands. © 2017 by the American Institute of Ultrasound in Medicine.

  9. A quality management approach to optimizing delivery and administration of preoperative antibiotics.

    PubMed

    Welch, L; Teague, A C; Knight, B A; Kenney, A; Hernandez, J E

    1998-01-01

    To optimize the process for delivering and administering preoperative antibiotics in order to prevent potential adverse patient outcomes. Using a multidisciplinary quality-improvement team, an evaluation of the preoperative medication order and delivery process was conducted. Charts were reviewed by selected time periods, with winter 1994 discharges for orthopedic surgeries (n = 97) and spring 1995 discharges for open heart procedures (n = 50) being used to arrive at baseline data (n = 147). A plan was devised to mainstream the medication-use process so that it would be standardized hospitalwide. A goal of administering preoperative antibiotics within 30 to 60 minutes prior to cut time was established. Following redesign and education, a repeat chart review of orthopedic surgeries (n = 33) and open heart procedures (n = 168) was conducted during April 1997 for discharges from the same diagnosis-related groups to total (n = 201). A nearly 1,000-bed tertiary referral center and teaching hospital with three separate campuses. We identified multiple ordering mechanisms, multiple medication sources and delivery sites, multiple administration sites and administering personnel, and other logistical conflicts. Thirty-one percent of cases received antibiotics less than 30 minutes prior to start time, 39% between 30 to 60 minutes, and 30% greater than 60 minutes before start time. Following the multidisciplinary redesign and education, an increase from 39% to 61% receiving preoperative antibiotics between 30 to 60 minutes prior to surgery start time and a decrease from 31% to 18% receiving them in less than 30 minutes was documented. The percentage of patients receiving preoperative antibiotics in 60 minutes or less increased from 70% to 80%. A continuous quality-improvement approach that engages all departments involved in patient care is necessary to achieve meaningful change in complicated hospital processes.

  10. Jejunioleal Bypass Procedures in Morbid Obesity: Preoperative Psychological Findings

    ERIC Educational Resources Information Center

    Webb, Warren W.; And Others

    1976-01-01

    Seventy patients who averaged 155 percent overweight and requested jejunioleal bypass surgery as a treatment intervention for morbid obesity were studied preoperatively for prominent psychological characteristics. (Author)

  11. Lower Learning Difficulty and Fluoroscopy Reduction of Transforaminal Percutaneous Endoscopic Lumbar Discectomy with an Accurate Preoperative Location Method.

    PubMed

    Fan, Guoxin; Gu, Xin; Liu, Yifan; Wu, Xinbo; Zhang, Hailong; Gu, Guangfei; Guan, Xiaofei; He, Shisheng

    2016-01-01

    Transforaminal percutaneous endoscopic lumbar discectomy (tPELD) poses great challenges for junior surgeons. Beginners often require repeated attempts using fluoroscopy causing more punctures, which may significantly undermine their confidence and increase the radiation exposure to medical staff and patients. Moreover, the impact of an accurate location on the learning curve of tPELD has not been defined. The study aimed to investigate the impact of an accurate preoperative location method on learning difficulty and fluoroscopy time of tPELD. Retrospective evaluation. Patients receiving tPELD by one surgeon with a novel accurate preoperative location method were regarded as Group A, and those receiving tPELD by another surgeon with a conventional fluoroscopy method were regarded as Group B. From January 2012 to August 2014, we retrospectively reviewed the first 80 tPELD cases conducted by 2 junior surgeons. The operation time, fluoroscopy times, preoperative location time, and puncture-channel time were thoroughly analyzed. The operation time of the first 20 patients were 99.75 ± 10.38 minutes in Group A and 115.7 ± 16.46 minutes in Group B, while the operation time of all 80 patients was 88.36 ± 11.56 minutes in Group A and 98.26 ± 14.90 minutes in Group B. Significant differences were detected in operation time between the 2 groups, both for the first 20 patients and total 80 patients (P < 0.05). The fluoroscopy times were 26.78 ± 4.17 in Group A and 33.98 ± 2.69 in Group B (P < 0.001). The preoperative location time was 3.43 ± 0.61 minutes in Group A and 5.59 ± 1.46 minutes in Group B (P < 0.001). The puncture-channel time was 27.20 ± 4.49 minutes in Group A and 34.64 ± 8.35 minutes in Group B (P < 0.001). There was a moderate correlation between preoperative location time and puncture-channel time (r = 0.408, P < 0.001), and a moderate correlation between preoperative location time and fluoroscopy times (r = 0.441, P < 0.001). Mild correlations were

  12. Pre-operative serum alkaline phosphatase as a predictive indicator of post-operative hypocalcaemia in patients undergoing total thyroidectomy.

    PubMed

    Miah, M S; Mahendran, S; Mak, C; Leese, G; Smith, D

    2015-11-01

    This study aimed to evaluate whether a pre-operative elevated serum alkaline phosphatase level is a potential predictor of post-operative hypocalcaemia after total thyroidectomy. Data was retrospectively collected from the case notes of patients who had undergone total thyroidectomy. Patients were divided into Graves' disease and non-Graves' groups. Pre-operative and post-operative biochemical markers, including serum calcium, alkaline phosphatase and parathyroid hormone levels, were reviewed. A total of 225 patients met the inclusion criteria. Graves' disease was the most common indication (n = 134; 59.5 per cent) for thyroidectomy. Post-operative hypocalcaemia developed in 48 patients (21.3 per cent) and raised pre-operative serum alkaline phosphatase was noted in 94 patients (41.8 per cent). Raised pre-operative serum alkaline phosphatase was significantly associated with post-operative hypocalcaemia, particularly in Graves' disease patients (p < 0.05). Pre-operative serum alkaline phosphatase measurements help to predict post-thyroidectomy hypocalcaemia, especially in patients who do not develop hypoparathyroidism. Ascertaining the pre-operative serum alkaline phosphatase level in patients undergoing total thyroidectomy may help surgeons to identify at-risk patients.

  13. Preoperative planning for revision total hip arthroplasty.

    PubMed

    Barrack, Robert L; Burnett, R Stephen J

    2006-01-01

    Revision total hip arthroplasty is associated with more perioperative complications and unexpected findings than are encountered during primary total hip arthroplasty. Special instruments, implants, bone grafts, and other accessories may be required to treat complex problems that arise during revision surgery. Preoperative planning is important to anticipate potential complications and to ensure that all possible needed materials are readily available during surgery. Patients and their families also should be counseled on the specific additional risk factors involved in this complex surgery. An organized approach to revision total hip arthroplasty helps to reduce surgical time, minimize risks, decrease the stress level of the entire surgical team, and to increase the rate of successful outcomes for patients.

  14. Predictors of preoperative anxiety in children.

    PubMed

    Wollin, S R; Plummer, J L; Owen, H; Hawkins, R M F; Materazzo, F

    2003-02-01

    This study aimed to identify factors contributing to anxiety at induction of anaesthesia in children. One hundred and twenty children aged five to twelve years and scheduled for surgery requiring general anaesthesia were included. Children were interviewed and assessed prior to surgery. Parents completed anxiety measures prior to surgery and were interviewed after the induction of anaesthesia. The level of children's anxiety was determined at the time of induction of anaesthesia by the modified Yale Preoperative Anxiety Scale. Factors associated with increased levels of anxiety in the children included increased number of people in the room at induction of anaesthesia; longer waiting time between admission at the hospital and induction of anaesthesia; negative memories of previous hospital experiences; and having a mother who does not practise a religion. Suggestions for implementation of the findings and for future research are provided.

  15. Preoperational test report, recirculation condenser cooling systems

    SciTech Connect

    Clifton, F.T.

    1997-11-04

    This represents a preoperational test report for Recirculation Condenser Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The four system provide condenser cooling water for vapor space cooling of tanks AY1O1, AY102, AZ1O1, AZ102. Each system consists of a valved piping loop, a pair of redundant recirculation pumps, a closed-loop evaporative cooling tower, and supporting instrumentation; equipment is located outside the farm on concrete slabs. Piping is routed to the each ventilation condenser inside the farm via below-grade concrete trenches. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  16. Preoperative nuclear scans in patients with melanoma

    SciTech Connect

    Au, F.C.; Maier, W.P.; Malmud, L.S.; Goldman, L.I.; Clark, W.H. Jr.

    1984-05-15

    One hundred forty-one liver scans, 137 brain scans, and 112 bone scans were performed in 192 patients with clinical Stage 1 melanoma. One liver scan was interpreted as abnormal; liver biopsy of that patient showed no metastasis. There were 11 suggestive liver scans; three of the patients with suggestive liver scans had negative liver biopsies. The remaining eight patients were followed from 4 to 6 years and none of those patients developed clinical evidence of hepatic metastases. All of the brain scans were normal. Five patients had suggestive bone scans and none of those patients had manifested symptoms of osseous metastases with a follow-up of 2 to 4.5 years. This study demonstrates that the use of preoperative liver, brain and bone scan in the evaluation of patients with clinical Stage 1 melanoma is virtually unproductive.

  17. Pre-operative optimisation of lung function

    PubMed Central

    Azhar, Naheed

    2015-01-01

    The anaesthetic management of patients with pre-existing pulmonary disease is a challenging task. It is associated with increased morbidity in the form of post-operative pulmonary complications. Pre-operative optimisation of lung function helps in reducing these complications. Patients are advised to stop smoking for a period of 4–6 weeks. This reduces airway reactivity, improves mucociliary function and decreases carboxy-haemoglobin. The widely used incentive spirometry may be useful only when combined with other respiratory muscle exercises. Volume-based inspiratory devices have the best results. Pharmacotherapy of asthma and chronic obstructive pulmonary disease must be optimised before considering the patient for elective surgery. Beta 2 agonists, inhaled corticosteroids and systemic corticosteroids, are the main drugs used for this and several drugs play an adjunctive role in medical therapy. A graded approach has been suggested to manage these patients for elective surgery with an aim to achieve optimal pulmonary function. PMID:26556913

  18. The Impact of Preoperative Magnetic Resonance Imaging on Surgical Treatment and Outcomes for Ductal Carcinoma In Situ

    PubMed Central

    Itakura, Kaoru; Lessing, Juan; Sakata, Theadora; Heinzerling, Amy; Vriens, Eline; Wisner, Dorota; Alvarado, Michael; Esserman, Laura; Ewing, Cheryl; Hylton, Nola; Hwang, E. Shelley

    2014-01-01

    Background Although magnetic resonance imaging (MRI) is a useful imaging modality for invasive cancer, its role in preoperative surgical planning for ductal carcinoma in situ (DCIS) has not been established. We sought to determine whether preoperative MRI affects surgical treatment and outcomes in women with pure DCIS. Patients and Methods We reviewed consecutive records of women diagnosed with pure DCIS on core biopsy between 2000 and 2007. Patient characteristics, surgical planning, and outcomes were compared between patients with and without preoperative MRI. Multivariable regression was performed to determine which covariates were independently associated with mastectomy or sentinel lymph node biopsy (SLNB). Results Of 149 women diagnosed with DCIS, 38 underwent preoperative MRI. On univariate analysis, patients undergoing MRI were younger (50 years vs. 59 years; P < .001) and had larger DCIS size on final pathology (1.6 cm vs. 1.0 cm; P = .007) than those without MRI. Mastectomy and SLNB rates were significantly higher in the preoperative MRI group (45% vs. 14%, P < .001; and 47% vs. 23%, P = .004, respectively). However, there were no differences in number of re-excisions, margin status, and margin size between the two groups. On multivariate analysis, preoperative MRI and age were independently associated with mastectomy (OR, 3.16, P = .018; OR, 0.95, P = .031, respectively), while multifocality, size, and family history were not significant predictors. Conclusion We found a strong association between preoperative MRI and mastectomy in women undergoing treatment for DCIS. Additional studies are needed to examine the increased rates of mastectomy as a possible consequence of preoperative MRI for DCIS. PMID:21421520

  19. Withholding Preoperative Antibiotic Prophylaxis in Knee Prosthesis Revision: A Retrospective Analysis on Culture Results and Risk of Infection.

    PubMed

    Wouthuyzen-Bakker, Marjan; Tornero, Eduard; Claret, Guillem; Bosch, Jordi; Martinez-Pastor, Juan Carlos; Combalia, Andreu; Soriano, Alex

    2017-09-01

    A significant amount of patients undergoing revision surgery of a prosthetic joint turn out to have an infection. Withholding preoperative antibiotic prophylaxis in these patients to optimize culture yield during revision surgery remains a matter of debate. The aim of our study was to determine (1) the rate of positive intraoperative cultures with or without preoperative antibiotic prophylaxis and (2) the incidence of a prosthetic joint infection (PJI) during the follow-up in the 2 groups. Medical files of patients in whom preoperative antibiotic prophylaxis was withheld until culture samples were taken (2007-2010, n = 284) and in whom antibiotic prophylaxis was given during the induction of anesthesia (2010-2013, n = 141) were retrospectively reviewed. The percentage of ≥1 positive cultures was the same in the group without (26%) and with preoperative prophylaxis (27%; P value, .7). PJI was diagnosed during revision surgery according to the Musculoskeletal Infection Society criteria in 6.7% patients not receiving preoperative prophylaxis and in 7.0% receiving it (P value, .79). We found no important differences in the type of microorganisms that were isolated in both groups. During a 3-month follow-up, an early PJI developed in patients undergoing total revision surgery in 6.4% of the nonpreoperative prophylaxis group vs 1.6% in the preoperative prophylaxis group (P value, .1). Preoperative antibiotic prophylaxis does not reduce culture yield in patients undergoing knee revision surgery. Our data show a trend toward a higher PJI rate in the postoperative period of total revision surgery when preoperative prophylaxis is withheld. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Preoperative use of statins is associated with reduced early delirium rates after cardiac surgery.

    PubMed

    Katznelson, Rita; Djaiani, George N; Borger, Michael A; Friedman, Zeev; Abbey, Susan E; Fedorko, Ludwik; Karski, Jacek; Mitsakakis, Nicholas; Carroll, Jo; Beattie, W Scott

    2009-01-01

    Delirium is an acute deterioration of brain function characterized by fluctuating consciousness and an inability to maintain attention. Use of statins has been shown to decrease morbidity and mortality after major surgical procedures. The objective of this study was to determine an association between preoperative administration of statins and postoperative delirium in a large prospective cohort of patients undergoing cardiac surgery with cardiopulmonary bypass. After Institutional Review Board approval, data were prospectively collected on consecutive patients undergoing cardiac surgery with cardiopulmonary bypass from April 2005 to June 2006 in an academic hospital. All patients were screened for delirium during their hospitalization using the Confusion Assessment Method in the intensive care unit. Multivariable logistic regression analysis was used to identify independent perioperative predictors of delirium after cardiac surgery. Statins were tested for a potential protective effect. Of the 1,059 patients analyzed, 122 patients (11.5%) had delirium at any time during their cardiovascular intensive care unit stay. Administration of statins had a protective effect, reducing the odds of delirium by 46%. Independent predictors of postoperative delirium included older age, preoperative depression, preoperative renal dysfunction, complex cardiac surgery, perioperative intraaortic balloon pump support, and massive blood transfusion. The model was reliable (Hosmer-Lemeshow test, P = 0.3) and discriminative (area under receiver operating characteristic curve = 0.77). Preoperative administration of statins is associated with the reduced risk of postoperative delirium after cardiac surgery with cardiopulmonary bypass.

  1. Potential absence of prognostic implications of severe preoperative hypercalcitoninemia in medullary thyroid carcinoma.

    PubMed

    Zangeneh, Farhad; Gharib, Hossein; Goellner, John R; Kao, Pai Chih

    2003-01-01

    To evaluate preoperative hypercalcitonine-mia further as a marker of prognosis in patients with medullary thyroid carcinoma (MTC). We reviewed the clinical and laboratory data in six patients (four men and two women, 39 to 76 years old)--three with sporadic MTC, one with familial MTC, and two with multiple endocrine neoplasia type 2A--who had preoperative basal serum calcitonin levels of 400 to 16,000 pg/mL (normal, 0 to 19). Pentagastrin stimulation was performed in patients who had preoperative basal calcitonin levels less than 1,000 pg/mL, and responses ranged from 2,600 to 8,500 pg/mL. Thyroidectomy revealed intrathyroidal MTC in four patients; MTC and nodal metastatic lesions were present in two. The tumor cells were immunoreactive with anti-calcitonin immunoperoxidase staining. Serum calcitonin and carcinoembryonic antigen levels were normal postoperatively. In serial postoperative evaluation during a follow-up period of 2 to 9 years, stimulated peak plasma calcitonin levels after pentagastrin or calcium infusion were normal (in five patients) or near normal (in one patient), without clinical evidence of recurrent disease. The two patients with nodal metastatic disease have had normal calcitonin levels during a mean duration of follow-up of approximately 3 years. Pronounced preoperative hypercalci-toninemia does not necessarily preclude a favorable short-term outcome in patients with MTC.

  2. Preoperative Nutritional Therapy Reduces the Risk of Anastomotic Leakage in Patients with Crohn's Disease Requiring Resections

    PubMed Central

    Guo, Zhen; Guo, Dong; Gong, Jianfeng; Zhu, Weiming; Zuo, Lugen; Sun, Jing; Li, Ning; Li, Jieshou

    2016-01-01

    Background. The rate of anastomotic leakage is high in surgeries for Crohn's disease, and therefore a temporary diverting stoma is often needed. We conducted this study to investigate whether preoperative nutritional therapy could reduce the risk of anastomotic leakage while decreasing the frequency of temporary stoma formation. Methods. This was a retrospective study. Patients requiring bowel resections due to Crohn's disease were reviewed. The rate of anastomotic leakage and temporary diverting stoma was compared between patients who received preoperative nutritional therapy and those on a normal diet before surgery. Possible predictive factors for anastomotic leakage were also analyzed. Results. One hundred and fourteen patients undergoing 123 surgeries were included. Patients in nutritional therapy (NT) group had a significantly lower level of C-reactive protein on the day before surgery. Patients in NT group suffered less anastomotic leakage (2.3% versus 17.9%, P = 0.023) and less temporary diverting stoma (22.8% versus 40.9%, P = 0.036). Serum albumin of the day before surgery ≤35 g/L and preoperative nutritional therapy were identified as factors which independently affected the rate of anastomotic leakage. Conclusion. Preoperative nutritional therapy reduced the risk of anastomotic leakage and the frequency of temporary diverting stoma formation in patients with Crohn's disease requiring resections. PMID:26858749

  3. Effect of preoperative autologous blood donation on patients undergoing bimaxillary orthognathic surgery: a retrospective analysis.

    PubMed

    Oh, A Y; Seo, K S; Lee, G E; Kim, H J

    2016-04-01

    The efficacy of preoperative autologous blood donation (PABD) was evaluated according to preoperative haemoglobin (Hb) values. The records of 295 patients who underwent bimaxillary orthognathic surgery between July 2007 and August 2008 were reviewed. The records for autologous blood donation, intraoperative transfusion, and related laboratory studies were also evaluated. The transfusion trigger used during this period was Hb < 10 g/dl. A total of 189 patients (64.1%) made a PABD and 106 patients (35.9%) did not. The incidence of allogeneic blood transfusion was significantly lower in the PABD group than in the no PABD group (15.9% vs. 29.2%, P = 0.007). This difference was greater in patients with a preoperative Hb < 14 g/dl (20.3% vs. 62.5%, P < 0.0001), and no difference was found in patients with Hb ≥ 14 g/dl (13.3% vs. 14.9%, P = 0.83). PABD reduced the incidence of allogeneic blood transfusion in patients undergoing bimaxillary orthognathic surgery, particularly in patients with a preoperative Hb < 14 g/dl. PABD could be used to reduce the frequency of intraoperative allogeneic blood transfusion in these patients. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  4. Congenital hip disease in adults: terminology, classification, pre-operative planning and management.

    PubMed

    Karachalios, T; Hartofilakidis, G

    2010-07-01

    This paper reviews the current knowledge relating to the management of adult patients with congenital hip disease. Orthopaedic surgeons who treat these patients with a total hip replacement should be familiar with the arguments concerning its terminology, be able to recognise the different anatomical abnormalities and to undertake thorough pre-operative planning in order to replace the hip using an appropriate surgical technique and the correct implants and be able to anticipate the clinical outcome and the complications.

  5. The Amsterdam preoperative anxiety and information scale provides a simple and reliable measure of preoperative anxiety.

    PubMed

    Boker, Abdulaziz; Brownell, Laurence; Donen, Neil

    2002-10-01

    To compare three anxiety scales; the anxiety visual analogue scale (VAS), the anxiety component of the Amsterdam preoperative anxiety and information scale (APAIS), and the state portion of the Spielburger state-trait anxiety inventory (STAI), for assessment of preoperative anxiety levels in same day admission patients. Patients completed the three anxiety assessment scales both before and after seeing the anesthesiologist preoperatively. The scales used were the STAI, the six-question APAIS, and the VAS. APAIS was further subdivided to assess anxiety about anesthesia (sum A), anxiety about surgery (sum S) and a combined anxiety total (i.e., sum C = sum A + sum S). These scales were compared to one another. Pearson's correlation (pair-wise deletion) was used for validity testing. Cronbach's alpha analysis was used to test internal validity of the various components of the APAIS scale. A correlation co-efficient (r) > or = 0.6 and P < 0.05 were considered significant. Four hundred and sixty three scale sets were completed by 197 patients. There was significant and positive correlation between VAS and STAI r = 0.64, P < 0.001), VAS and APAIS r = 0.6, P < 0.001), sum C and STAI r = 0.63, P < 0.001) and between VAS and sum C r = 0.61, P < 0.001). Sum C and STAI r value were consistent with repeated administration. Cronbach's alpha-levels for the anxiety components of the APAIS (sum C) and desire for information were 0.84 and 0.77 respectively. In addition to VAS, the anxiety component of APAIS (sum C) is a promising new practical tool to assess preoperative patient anxiety levels.

  6. Prevention and Intervention Strategies to Alleviate Preoperative Anxiety in Children

    ERIC Educational Resources Information Center

    Wright, Kristi D.; Stewart, Sherry H.; Finley, G. Allen; Buffett-Jerrott, Susan E.

    2007-01-01

    Preoperative anxiety (anxiety regarding impending surgical experience) in children is a common phenomenon that has been associated with a number of negative behaviors during the surgery experience (e.g., agitation, crying, spontaneous urination, and the need for physical restraint during anesthetic induction). Preoperative anxiety has also been…

  7. Prevention and Intervention Strategies to Alleviate Preoperative Anxiety in Children

    ERIC Educational Resources Information Center

    Wright, Kristi D.; Stewart, Sherry H.; Finley, G. Allen; Buffett-Jerrott, Susan E.

    2007-01-01

    Preoperative anxiety (anxiety regarding impending surgical experience) in children is a common phenomenon that has been associated with a number of negative behaviors during the surgery experience (e.g., agitation, crying, spontaneous urination, and the need for physical restraint during anesthetic induction). Preoperative anxiety has also been…

  8. [Preoperative information for paediatric patients. The anaesthesiologist's point of view].

    PubMed

    Orliaguet, G

    2006-04-01

    Medical information is mandatory before any medical procedure, including pediatric anesthesia. Preoperative information covers many aspects, including medico-psychologic and judicial aspects. When the patient is a child, information must be delivered to the parents in priority. However, the French law has given a particular attention to the opinion of the child. In 70% of the cases, preoperative anxiety of the parents is more related to anesthesia than to the surgical procedure itself. We have to explain the most frequent adverse effects, as well as the more severe and well known complications to the parents, even though they are very infrequent. The only cases where preoperative information is not required are: emergency cases and refusal of the patient or the parents to be informed. While information is necessarily oral, it may be completed using a written document. The quality of the preoperative information directly influences the quality of the psychological preoperative preparation of the parents, and thereafter of the child. Preoperative preparation programs have been developed, but controversial results have been observed. The great majority of the studies on preoperative programs were performed in the USA, where the demand for preoperative information is very important. It is far from sure that the results of all these studies may be extrapolated to French parents, and French studies are needed.

  9. Amyloid goiter: preoperative scintigraphic diagnosis using Tc-99m pyrophosphate

    SciTech Connect

    Lee, V.W.; Rubinow, A.; Pehrson, J.; Skinner, M.; Cohen, A.S.

    1984-04-01

    Amyloid goiter is a rare clinical entity. The diagnosis is rarely made preoperatively because clinical and laboratory findings are nonspecific. The authors report two cases of amyloid goiter in whom the diagnosis was made preoperatively using Tc-99m pyrophosphate scintigraphy.

  10. Recent advances in preoperative management of esophageal adenocarcinoma

    PubMed Central

    Harada, Kazuto; Mizrak Kaya, Dilsa; Baba, Hideo; Ajani, Jaffer A.

    2017-01-01

    Esophageal cancer is an aggressive malignancy with increasing incidence, and the prognosis of patients treated by surgery alone remains dismal. Preoperative treatment can modestly prolong overall survival. Preoperative chemotherapy or chemoradiation is the standard of care for resectable esophageal cancer (greater than clinical stage I and less than clinical stage IV). One of the challenges is to predict complete response in the surgical specimen from preoperative therapy and to avoid surgery in some patients but also predict ineffectiveness of preoperative therapy if the tumor is resistant and avoid such therapies altogether. In-depth understanding of the molecular biology could lead to personalized therapy, and in the future, clinical trials designed according to molecular features are expected. Here, we summarize preoperative treatment for esophageal adenocarcinoma and their potential. PMID:28491289

  11. Recent advances in preoperative management of esophageal adenocarcinoma.

    PubMed

    Harada, Kazuto; Mizrak Kaya, Dilsa; Baba, Hideo; Ajani, Jaffer A

    2017-01-01

    Esophageal cancer is an aggressive malignancy with increasing incidence, and the prognosis of patients treated by surgery alone remains dismal. Preoperative treatment can modestly prolong overall survival. Preoperative chemotherapy or chemoradiation is the standard of care for resectable esophageal cancer (greater than clinical stage I and less than clinical stage IV). One of the challenges is to predict complete response in the surgical specimen from preoperative therapy and to avoid surgery in some patients but also predict ineffectiveness of preoperative therapy if the tumor is resistant and avoid such therapies altogether. In-depth understanding of the molecular biology could lead to personalized therapy, and in the future, clinical trials designed according to molecular features are expected. Here, we summarize preoperative treatment for esophageal adenocarcinoma and their potential.

  12. Preoperative Sleep Disruption and Postoperative Delirium

    PubMed Central

    Leung, Jacqueline M.; Sands, Laura P.; Newman, Stacey; Meckler, Gabriela; Xie, Yimeng; Gay, Caryl; Lee, Kathryn

    2015-01-01

    Study Objectives: To describe preoperative and postoperative sleep disruption and its relationship to postoperative delirium. Design: Prospective cohort study with 6 time points (3 nights pre-hospitalization and 3 nights post-surgery). Setting: University medical center. Patients: The sample consisted of 50 English-speaking patients ≥ 40 years of age scheduled for major non-cardiac surgery, with an anticipated hospital stay ≥ 3 days. Interventions: None. Measurements and results: Sleep was measured before and after surgery for a total of 6 days using a wrist actigraph to quantify movement in a continuous fashion. Postoperative delirium was measured by a structured interview using the Confusion Assessment Method. Sleep variables for patients with (n = 7) and without (n = 43) postoperative delirium were compared using the unpaired Student t-tests or χ2 tests. Repeated measures analysis of variance for the 6 days was used to examine within-subject changes over time and between group differences. The mean age of the patients was 66 ± 11 years (range 43–91 years), and it was not associated with sleep variables or postoperative delirium. The incidence of postoperative delirium observed during any of the 3 postoperative days was 14%. For the 7 patients who subsequently developed postoperative delirium, wake after sleep onset (WASO) as a percentage of total sleep time was significantly higher (44% ± 22%) during the night before surgery compared to the patients who did not subsequently developed delirium (21% ± 20%, p = 0.012). This sleep disruption continued postoperatively, and to a greater extent, for the first 2 nights after surgery. Patients with WASO < 10% did not experience postoperative delirium. Self-reported sleep disturbance did not differ between patients with vs. without postoperative delirium. Conclusions: In this pilot study of adults over 40 years of age, sleep disruption was more severe before surgery in the patients who experienced postoperative

  13. Positive Surgical Margins in Soft Tissue Sarcoma Treated With Preoperative Radiation: Is a Postoperative Boost Necessary?

    SciTech Connect

    Al Yami, Ali; Griffin, Anthony M.; Ferguson, Peter C.; Catton, Charles N.; Chung, Peter W.M.

    2010-07-15

    Purpose: For patients with an extremity soft tissue sarcoma (STS) treated with preoperative radiotherapy and surgically excised with positive margins, we retrospectively reviewed whether a postoperative radiation boost reduced the risk of local recurrence (LR). Methods and Materials: A total of 216 patients with positive margins after resection of an extremity STS treated between 1986 and 2003 were identified from our institution's prospectively collected database. Patient demographics, radiation therapy parameters including timing and dose, classification of positive margin status, reasons for not administering a postoperative boost, and oncologic outcome were collected and evaluated. Results: Of the 216 patients with a positive surgical margin, 52 patients were treated with preoperative radiation therapy alone (50 Gy), whereas 41 received preoperative radiation therapy plus a postoperative boost (80% received 16 Gy postoperatively for a total of 66 Gy). There was no difference in baseline tumor characteristics between the two groups. Six of 52 patients in the group receiving preoperative radiation alone developed a LR compared with 9 of 41 in the boost group. Five-year estimated LR-free survivals were 90.4% and 73.8%, respectively (p = 0.13). Conclusions: We found that including the postoperative radiation boost after preoperative radiation and a margin-positive excision did not provide an advantage in preventing LR for patients treated with external beam radiotherapy. Given that higher radiation doses placed patients at greater risk for late complications such as fracture, fibrosis, edema, and joint stiffness, judicious avoidance of the postoperative boost while maintaining an equivalent rate of local control can reduce the risk of these difficult-to-treat morbidities.

  14. The clinical significance of preoperative brain magnetic resonance imaging in pediatric cochlear implant recipients.

    PubMed

    Moon, Il Joon; Kim, Eun Yeon; Park, Ga-Young; Jang, Min Seok; Kim, Ji Hye; Lee, Jeehun; Chung, Won-Ho; Cho, Yang-Sun; Hong, Sung Hwa

    2012-01-01

    Although central nervous system abnormalities are incidentally detected in preoperative brain magnetic resonance imaging (MRI) studies in pediatric cochlear implant (CI) candidates, the clinical significance of the abnormalities remains unclear. We aimed to assess post-implantation auditory and speech performance in patients with brain lesions seen on MRI. Pediatric CI recipients (n = 177) who underwent preoperative MRI scans of the brain between January 2002 and June 2009 were included in this study. Patients with brain lesions on MRI were reviewed and categorized into the following groups: brain parenchymal lesions (focal vs. diffuse), ventriculomegaly, and extra-axial lesion. The main communication mode as well as progress in auditory perception and speech production were evaluated preoperatively and at 3, 6, 12, and 24 months postoperatively. Performance in patients with brain lesions was compared with the age- and sex-matched control group. Various brain lesions were found in 27 out of 177 patients. Children with brain lesions who received CIs showed gradual progress in auditory and speech outcomes for 2 years, though performance was reduced compared with the control group. In addition, there was a significant difference in the main communication mode between the two groups at 2 years following cochlear implantation. This difference was especially significant in patients with diffuse brain parenchymal lesions after further stratification of the brain lesion group. Preoperative brain MRI may have a role in improving the prediction of adverse outcomes in pediatric CI recipients. In particular, children with diffuse brain parenchymal lesions should be counseled regarding the poor prognosis preoperatively, and followed up with special attention.

  15. Evaluation of Preoperative Predictors of 30-Day Mortality in Patients with Ruptured Abdominal Aortic Aneurysm.

    PubMed

    Jang, Ha Nee; Park, Hyun Oh; Yang, Jun Ho; Yang, Tae Won; Byun, Joung Hun; Moon, Seong Ho; Kim, Sung Hwan; Kim, Jong Woo; Lee, Chung Eun

    2017-09-01

    Ruptured abdominal aortic aneurysm (RAAA) is a rare, extremely dangerous condition. Previous studies have published preoperative, intraoperative, and postoperative data; however, there are not enough studies on the preoperative factors alone. Here we studied the preoperative predictors of 30-day mortality in patients with RAAA. We conducted a retrospective, consecutive review of the medical records of 57 patients who received management for RAAA between February 2005 and December 2016. We analyzed the association between preoperative predictors and 30-day mortality in patients with RAAA. The initial systolic blood pressure (SBP) and hemoglobin level (HbL), which were proven as significant predictors by multivariate logistic regression analysis, were compared using receiver operating characteristic curves. Overall, early mortality was 29.8%. Results of logistic regression analysis found that 30-day mortality in patients with RAAA was associated with the initial SBP (odds ratio [OR], 0.922; 95% confidence interval [CI], 0.874-0.973; P=0.003) and initial HbL (OR, 0.513; 95% CI, 0.289-0.91; P=0.023). Area under the curves were 0.89 for the initial SBP and 0.78 for the initial HbL. The initial SBP with a cut-off value of 90 mmHg had a sensitivity of 85% and specificity of 88.2%. At a cut-off of 10.5, the sensitivity and specificity of HbL for death were 75% and 70.6%, respectively. The initial SBP and HbL are independent preoperative predictors of early mortality in patients with RAAA.

  16. Texture Analysis of Preoperative CT Images for Prediction of Postoperative Hepatic Insufficiency: A Preliminary Study

    PubMed Central

    Simpson, Amber L; Adams, Lauryn B; Allen, Peter J; D’Angelica, Michael I; DeMatteo, Ronald P; Fong, Yuman; Kingham, T Peter; Leung, Universe; Miga, Michael I; Parada, E Patricia; Jarnagin, William R; Do, Richard K G

    2015-01-01

    Background Texture analysis is a promising method of analyzing imaging data to potentially enhance diagnostic capability. This approach involves automated measurement of pixel intensity variation that may offer further insight into disease progression than standard imaging techniques alone. We postulate that postoperative liver insufficiency, a major source of morbidity and mortality, correlates with preoperative heterogeneous parenchymal enhancement that can be quantified with texture analysis of cross-sectional imaging. Study Design A retrospective case-matched study (waiver of informed consent and HIPAA authorization, approved by the institutional review board) was performed comparing patients who underwent major hepatic resection and developed liver insufficiency (n=12) to a matched group of patients with no postoperative liver insufficiency (n=24) by procedure, remnant volume, and year of procedure. Texture analysis (with gray-level co-occurrence matrices) was used to quantify the heterogeneity of liver parenchyma on preoperative computed tomography (CT) scans. Statistical significance was evaluated using Wilcoxon’s signed rank and Pearson’s chi-squared tests. Results No statistically significant differences were found between study groups for preoperative patient demographics and clinical characteristics, with the exception of gender (p<0.05). Two texture features differed significantly between the groups: correlation (linear dependency of gray levels on neighboring pixels) and entropy (randomness of brightness variation) (p<0.05). Conclusions In this preliminary study, the texture of liver parenchyma on preoperative CT, was significantly more varied, less symmetric, and less homogeneous in patients with postoperative liver insufficiency; thus texture analysis has the potential to provide an additional means of preoperative risk stratification. PMID:25537305

  17. Preoperative nomogram to predict the likelihood of complications after radical nephroureterectomy.

    PubMed

    Raman, Jay D; Lin, Yu-Kuan; Shariat, Shahrokh F; Krabbe, Laura-Maria; Margulis, Vitaly; Arnouk, Alex; Lallas, Costas D; Trabulsi, Edouard J; Drouin, Sarah J; Rouprêt, Morgan; Bozzini, Gregory; Colin, Pierre; Peyronnet, Benoit; Bensalah, Karim; Bailey, Kari; Canes, David; Klatte, Tobias

    2017-02-01

    To construct a nomogram based on preoperative variables to better predict the likelihood of complications occurring within 30 days of radical nephroureterectomy (RNU). The charts of 731 patients undergoing RNU at eight academic medical centres between 2002 and 2014 were reviewed. Preoperative clinical, demographic and comorbidity indices were collected. Complications occurring within 30 days of surgery were graded using the modified Clavien-Dindo scale. Multivariate logistic regression determined the association between preoperative variables and post-RNU complications. A nomogram was created from the reduced multivariate model with internal validation using the bootstrapping technique with 200 repetitions. A total of 408 men and 323 women with a median age of 70 years and a body mass index of 27 kg/m(2) were included. A total of 75% of the cohort was white, 18% had an Eastern Cooperative Oncology Group (ECOG) performance status ≥2, 20% had a Charlson comorbidity index (CCI) score >5 and 50% had baseline chronic kidney disease (CKD) ≥ stage III. Overall, 279 patients (38%) experienced a complication, including 61 events (22%) with Clavien grade ≥ III. A multivariate model identified five variables associated with complications, including patient age, race, ECOG performance status, CKD stage and CCI score. A preoperative nomogram incorporating these risk factors was constructed with an area under curve of 72.2%. Using standard preoperative variables from this multi-institutional RNU experience, we constructed and validated a nomogram for predicting peri-operative complications after RNU. Such information may permit more accurate risk stratification on an individual cases basis before major surgery. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

  18. PROJECT HEAVEN: Preoperative Training in Virtual Reality.

    PubMed

    Iamsakul, Kiratipath; Pavlovcik, Alexander V; Calderon, Jesus I; Sanderson, Lance M

    2017-01-01

    A cephalosomatic anastomosis (CSA; also called HEAVEN: head anastomosis venture) has been proposed as an option for patients with neurological impairments, such as spinal cord injury (SCI), and terminal medical illnesses, for which medicine is currently powerless. Protocols to prepare a patient for life after CSA do not currently exist. However, methods used in conventional neurorehabilitation can be used as a reference for developing preparatory training. Studies on virtual reality (VR) technologies have documented VR's ability to enhance rehabilitation and improve the quality of recovery in patients with neurological disabilities. VR-augmented rehabilitation resulted in increased motivation towards performing functional training and improved the biopsychosocial state of patients. In addition, VR experiences coupled with haptic feedback promote neuroplasticity, resulting in the recovery of motor functions in neurologically-impaired individuals. To prepare the recipient psychologically for life after CSA, the development of VR experiences paired with haptic feedback is proposed. This proposal aims to innovate techniques in conventional neurorehabilitation to implement preoperative psychological training for the recipient of HEAVEN. Recipient's familiarity to body movements will prevent unexpected psychological reactions from occurring after the HEAVEN procedure.

  19. PROJECT HEAVEN: Preoperative Training in Virtual Reality

    PubMed Central

    Iamsakul, Kiratipath; Pavlovcik, Alexander V.; Calderon, Jesus I.; Sanderson, Lance M.

    2017-01-01

    A cephalosomatic anastomosis (CSA; also called HEAVEN: head anastomosis venture) has been proposed as an option for patients with neurological impairments, such as spinal cord injury (SCI), and terminal medical illnesses, for which medicine is currently powerless. Protocols to prepare a patient for life after CSA do not currently exist. However, methods used in conventional neurorehabilitation can be used as a reference for developing preparatory training. Studies on virtual reality (VR) technologies have documented VR's ability to enhance rehabilitation and improve the quality of recovery in patients with neurological disabilities. VR-augmented rehabilitation resulted in increased motivation towards performing functional training and improved the biopsychosocial state of patients. In addition, VR experiences coupled with haptic feedback promote neuroplasticity, resulting in the recovery of motor functions in neurologically-impaired individuals. To prepare the recipient psychologically for life after CSA, the development of VR experiences paired with haptic feedback is proposed. This proposal aims to innovate techniques in conventional neurorehabilitation to implement preoperative psychological training for the recipient of HEAVEN. Recipient's familiarity to body movements will prevent unexpected psychological reactions from occurring after the HEAVEN procedure. PMID:28540125

  20. [Preoperative corticosteroid treatment and nasal polyposis].

    PubMed

    Giordano, J; Darras, J; Chevalier, D; Mortuaire, G

    2009-06-01

    Impairment of the surgical view by bleeding in endoscopic ethmoidectomy for chronic rhinosinusitis with nasal polyps (CRSwNP) contributes to the risk of skull base injuries. The aim of this study was to investigate the effect of a short course of a systemic corticoid treatment on bleeding and surgical field quality during endoscopic ethmoidectomy for CRSwNP. A prospective study was conducted on 40 patients. Before surgery, 21 of them (group B) were treated with 1 mg/kg per day of prednisolone for seven days. They were compared with the 19 other patients (group A) on intraoperative blood loss and surgery duration. The two groups shared identical clinical features (Lidholdt endoscopic grading). There was no statistical difference in terms of bleeding, although the Lund-Mackay CT score was higher in group B (19/24 vs. 21/24, p=0.05). The surgical procedure was shorter in group B (72 min vs. 85 min, p=0.05). Preoperative treatment with systemic corticosteroids does not seem to reduce surgical blood loss. However, we noted a decrease in the procedure's duration. By reducing mucous inflammation, this treatment could improve the local conditions and help the surgeon in the mucous eradication.

  1. Preoperative Computed Tomography Findings for Patients with Nasolacrimal Duct Obstruction or Stenosis

    PubMed Central

    Choi, Seong Chan; Lee, Saem; Choi, Hye Sun; Jang, Jae Woo; Kim, Sung Joo

    2016-01-01

    Purpose To identify and analyze the role of preoperative computed tomography (CT) in patients with tearing symptoms with nasolacrimal duct obstruction (NLDO). Methods We retrospectively reviewed the medical records and CT results on 218 patients who complained of tearing symptoms with NLDO between January 2014 and December 2014. All patients were recruited from Kim's Eye Hospital's outpatient clinic and assessed by clinical history, examination, and CT to evaluate periocular pathology and nasolacrimal drainage system. Patients with abnormal findings assessed by preoperative CT were further reviewed. Results CT was performed on 218 patients (average age, 58.2 ± 11.9 years). Of these, 196 (89.9%) had endonasal dacryocystorhinostomy, 14 (6.4%) declined surgery, and 8 (3.7%) were inoperable due to abnormal CT findings. Soft tissue opacity was the most common finding which 243 cases (85.9%) of 283 obstructed nasolacrimal duct and 89 cases (81.7%) of 109 non-obstructed nasolacrimal duct showed it. Thirty-nine (17.8%) of 218 patients showed either maxillary sinusitis or ethmoidal sinusitis and 32 (14.7%) of 218 patients presented with periocular inflammation. Other abnormal CT findings included septal deviations, previous fractures, masses, and structural abnormalities of nasal cavity. Conclusions Preoperative CT imaging is useful in the assessment of both nasolacrimal drainage and nearby anatomical structures. This information will be helpful in planning surgical interventions and management of NLDO. PMID:27478350

  2. Pre-operative stroke and neurological disability do not independently affect short- and long-term mortality in infective endocarditis patients.

    PubMed

    Diab, Mahmoud; Guenther, Albrecht; Sponholz, Christoph; Lehmann, Thomas; Faerber, Gloria; Matz, Anna; Franz, Marcus; Witte, Otto W; Pletz, Mathias W; Doenst, Torsten

    2016-10-01

    Infective endocarditis (IE) is still associated with high morbidity and mortality. The impact of pre-operative stroke on mortality and long-term survival is controversial. In addition, data on the severity of neurological disability due to pre-operative stroke are scarce. We analysed the impact of pre-operative stroke and the severity of its related neurological disability on short- and long-term outcome. We retrospectively reviewed our data from patients operated for left-sided IE between 01/2007 and 04/2013. We performed univariate (Chi-Square and independent samples t test) and multivariate analyses. Among 308 consecutive patients who underwent cardiac surgery for left-sided IE, pre-operative stroke was present in 87 (28.2 %) patients. Patients with pre-operative stroke had a higher pre-operative risk profile than patient without it: higher Charlson comorbidity index (8.1 ± 2.6 vs. 6.6 ± 3.3) and higher incidence of Staphylococcus aureus infection (43 vs. 17 %) and septic shock (37 vs. 19 %). In-hospital mortality was equal but 5-year survival was significantly worse with pre-operative stroke (33.1 % vs. 45 %, p = 0.006). 5-year survival was worst in patients with severe neurological disability compared to mild disability (19.0 vs. 0.58 %, p = 0.002). However, neither pre-operative stroke nor the degree of neurological disability appeared as an independent risk factor for short or long-term mortality by multivariate analysis. Pre-operative stroke and the severity of neurological disability do not independently affect short- and long-term mortality in patients with infective endocarditis. It appears that patients with pre-operative stroke present with a generally higher risk profile. This information may substantially affect decision-making.

  3. Severity of Preoperative Aortic Regurgitation Does Not Impact Valve Durability of Aortic Valve Repair Following the David V Valve Sparing Aortic Root Replacement.

    PubMed

    Keeling, W Brent; Leshnower, Bradley G; Binongo, Jose; Lasanajak, Yi; McPherson, LaRonica; Chen, Edward P

    2017-03-01

    The David V valve-sparing aortic root replacement (VSRR) is an established and durable method of root reconstruction for varying pathologies. However, the impact of the severity of preoperative aortic regurgitation (AR) on long-term durability remains unclear. The purpose of this research was to investigate the impact of the degree of preoperative AR on midterm durability following VSRR. A retrospective review of the adult cardiac surgical database at a single academic center was undertaken from 2005 to 2015 for 223 adult patients who underwent VSRR. Patients were followed annually with echocardiograms, and a prospectively maintained database kept track of patient data. Follow-up was 97.7% complete, and the median echocardiographic follow-up was 25.5 months (range, 1 to 123 months). Patients with preoperative AR less than or equal to 2 were compared with patients with AR greater than 2 to determine the impact of preoperative AR upon valve repair durability. There were 223 patients who underwent VSRR during the study period, including 114 (51.1%) who required concomitant cusp repair. The operative mortality was 5 (2.2%). Ninety-seven patients (43.5%) had preoperative AR greater than 2. A total of 213 patients (95.5%) were available for long-term follow-up; of these patients, 7 (3.3%) had AR greater than 2. Fifty-two patients had a bicuspid aortic valve (22 AR ≤2 and 30 AR >2; p = 0.02). Patients with preoperative AR greater than 2 experienced greater reverse left ventricular remodeling and increases in left ventricular ejection fraction than did patients with preoperative AR less than or equal to 2 (p < 0.01). The midterm freedom from AR greater than 2 was similar for both preoperative AR groups (p = 0.57). The 8-year freedom from AR greater than 2 was 89.1% (95% confidence interval, 55.3% to 97.8%) for patients with preoperative AR less than or equal to 2 and 92.7% (95% confidence interval, 78.8% to 97.6%) for preoperative AR greater than 2. Five patients (2

  4. MRI for the preoperative evaluation of femoroacetabular impingement.

    PubMed

    Li, Angela E; Jawetz, Shari T; Greditzer, Harry G; Burge, Alissa J; Nawabi, Danyal H; Potter, Hollis G

    2016-04-01

    Femoroacetabular impingement (FAI) refers to a condition characterized by impingement of the femoral head-neck junction against the acetabular rim, often due to underlying osseous and/or soft tissue morphological abnormalities. It is a common cause of hip pain and limited range of motion in young and middle-aged adults. Hip preservation surgery aims to correct the morphological variants seen in FAI, thereby relieving pain and improving function, and potentially preventing early osteoarthritis. The purpose of this article is to review the mechanisms of chondral and labral injury in FAI to facilitate an understanding of patterns of chondrolabral injury seen on MRI. Preoperative MRI evaluation of FAI should include assessment of osseous morphologic abnormalities, labral tears, cartilage status, and other associated compensatory injuries of the pelvis. As advanced chondral wear is the major relative contraindication for hip preservation surgery, MRI is useful in the selection of patients likely to benefit from surgery. Teaching points • The most common anatomical osseous abnormalities predisposing to FAI include cam and pincer lesions. • Morphological abnormalities, labral lesions, and cartilage status should be assessed. • In cam impingement, chondral wear most commonly occurs anterosuperiorly.• Pre-existing advanced osteoarthritis is the strongest predictor of poor outcomes after FAI surgery. • Injury to muscles and tendons or other pelvic structures can coexist with FAI.

  5. Preoperative therapeutic plasma exchange in patients with thyrotoxicosis.

    PubMed

    Ezer, Ali; Caliskan, Kenan; Parlakgumus, Alper; Belli, Sedat; Kozanoglu, Ilknur; Yildirim, Sedat

    2009-01-01

    The purpose of this report was to determine the effectiveness of therapeutic plasma exchange (TPE) in preoperative preparation of patients with thyrotoxicosis scheduled for either thyroid or nonthyroid surgery. We retrospectively reviewed 11 patients with thyrotoxicosis and those who prepared surgery with plasmapheresis between 1999 and 2008 at our institution. Ten patients underwent thyroid surgery and one patient was operated for femur fracture during antithyroid drug treatment. The indications for plasmapheresis in all patients with severe thyrotoxicosis were poor response to medical treatment (seven patients), agronulocytosis due to antithyroid drugs (three patients), iodine-induced thyrotoxicosis (Jodd Basedow effect in one patient), and rapid preparation for urgent orthopedic operation (one patient). After TPE, we observed a marked decrease in free thyroxin (FT3) and free triiodothyronin (FT4) levels; however, the decline in the biochemical values were not statically significant (P > 0.62, P > 0.15). Although both FT3 and FT4 levels remained above the normal limits in two of 11 patients, the signs and symptoms of thyrotoxicosis improved in all patients and no thyroid storm observed during the perioperative period. TPE can be considered a safe and effective alternative to prepare patients with thyrotoxicosis for surgery when drug treatment fails or is contraindicated and when emergency surgery is required.

  6. Influence of Preoperative Musculotendinous Junction Position on Rotator Cuff Healing After Double-Row Repair.

    PubMed

    Tashjian, Robert Z; Erickson, Gregory A; Robins, Richard J; Zhang, Yue; Burks, Robert T; Greis, Patrick E

    2017-06-01

    The primary purpose of this study was to determine the effect of the preoperative position of the musculotendinous junction (MTJ) on rotator cuff healing after double-row arthroscopic rotator cuff repair. A secondary purpose was to evaluate how tendon length and MTJ position change when the rotator cuff heals. Preoperative and postoperative magnetic resonance imaging (MRI) scans of 42 patients undergoing arthroscopic double-row rotator cuff repair were reviewed. Patients undergoing repairs with other constructs or receiving augmented repairs (platelet-rich fibrin matrix) who had postoperative MRI scans were excluded. Preoperative MRI scans were evaluated for anteroposterior tear size, tendon retraction, tendon length, muscle quality, and MTJ position with respect to the glenoid in the coronal plane. The position of the MTJ was referenced off the glenoid face as either lateral or medial. Postoperative MRI scans were evaluated for healing, tendon length, and MTJ position. Of 42 tears, 36 (86%) healed, with 27 of 31 small to medium tears (87%) and 9 of 11 large to massive tears (82%) healing. Healing occurred in 94% of tears that had a preoperative MTJ lateral to the face of the glenoid but only 56% of tears that had a preoperative MTJ medial to the glenoid face (P = .0135). The measured tendon length increased an average of 14.4 mm in patients whose tears healed compared with shortening by 6.4 mm in patients with tears that did not heal (P < .001). The MTJ lateralized an average of 6.1 mm in patients whose tears healed compared with medializing 1.9 mm in patients whose tears did not heal (P = .026). The overall follow-up period of the study was from April 2005 to September 2014 (113 months). The preoperative MTJ position is predictive of postoperative healing after double-row rotator cuff repair. The position of the MTJ with respect to the glenoid face is a reliable, identifiable marker on MRI scans that can be predictive of healing. Level IV, retrospective

  7. Preoperative psychological assessment of patients seeking weight-loss surgery: identifying challenges and solutions

    PubMed Central

    Edwards-Hampton, Shenelle A; Wedin, Sharlene

    2015-01-01

    Preoperative psychosocial assessment is the standard of care for patients seeking weight-loss surgery (WLS). However, the assessment procedure varies widely by surgery site. Comprehensive assessments can provide a wealth of information that assists both the patient and the treatment team, anticipate and prepare for challenges associated with extensive behavioral and lifestyle changes that are required postsurgery. In this review, we provide an overview of the purpose of the preoperative psychosocial assessment and domains to be included. Challenges commonly identified in the assessment are discussed, including maladaptive eating behaviors, psychiatric comorbidities, and alcohol use. Potential solutions and approaches to these challenges are provided. Additionally, patient populations requiring special consideration are presented to include adolescents, those with cognitive vulnerabilities, and aging adults. PMID:26604844

  8. Pre-operative Identification and Surgical Management of the Appendiceal Mucocele: A Case Report.

    PubMed

    Lynch, Kevin; Cho, Sung; Andres, Robert; Knight, Jennifer; Con, Jorge

    2016-01-01

    An appendiceal mucocele (AM) is an uncommon differential in the patient being evaluated for acute appendicitis. Although often asymptomatic, AMs can clinically mimic acute appendicitis, and preoperative distinction between these processes facilitates optimal management. We report the case of a 60-year-old male with an AM presenting with nausea and periumbilical pain radiating to the right lower quadrant. Literature relevant to the diagnosis and treatment of AMs is reviewed, with emphasis on diagnosis through radiographic imaging and surgical management. Abdominal CT scan or ultrasound are useful in identifying AMs preoperatively. A decision to perform a right hemicolectomy should be influenced by the criteria reported by Gonzalez-Moreno. The safety of the laparoscopic resection relative to an open appendectomy is debated.

  9. Preoperative prediction of failure following two-stage revision for knee prosthetic joint infections.

    PubMed

    Sabry, Fady Youssef; Buller, Leonard; Ahmed, Sarim; Klika, Alison K; Barsoum, Wael K

    2014-01-01

    While two-stage revision is the gold standard for treatment of knee prosthetic joint infection (PJI), it is not without risk. The purpose of this study was to develop a tool to preoperatively predict the probability that a two-stage revision would fail to eradicate knee PJI. 3,809 surgical cases were retrospectively reviewed and data were collected from 314 charts. Overall, 105 (33.4%) cases failed to eradicate PJI using this procedure. Univariate analysis identified multiple variables independently associated with reinfection. Logistic regression was used to generate a model (bootstrap-corrected concordance index of 0.773) predicting failure of infection eradication. Preoperative knowledge of a high probability of failure may improve risk assessment, lead to more aggressive management, and allow for time to consider alternative therapies.

  10. Preoperative pain level and patient expectation predict hospital length of stay after total hip arthroplasty.

    PubMed

    Halawi, Mohamad J; Vovos, Tyler J; Green, Cindy L; Wellman, Samuel S; Attarian, David E; Bolognesi, Michael P

    2015-04-01

    The purpose of this study was to identify preoperative predictors of length of stay after primary total hip arthroplasty in a patient population reflecting current trends toward shorter hospitalization and using readily obtainable factors that do not require scoring systems. A retrospective review of 112 consecutive patients was performed. High preoperative pain level and patient expectation of discharge to extended care facilities (ECFs) were the only significant multivariable predictors of hospitalization extending beyond 2 days (P=0.001 and P<0.001 respectively). Patient expectation remained significant after adjusting for Medicare's 3-day requirement for discharge to ECFs (P<0.001). The study was adequately powered to analyze the variables in the multivariable logistic regression model, which had a concordance index of 0.857.

  11. Pre-Operative Assessment and Post-Operative Care in Elective Shoulder Surgery

    PubMed Central

    Akhtar, Ahsan; MacFarlane, Robert J; Waseem, Mohammad

    2013-01-01

    Pre-operative assessment is required prior to the majority of elective surgical procedures, primarily to ensure that the patient is fit to undergo surgery, whilst identifying issues that may need to be dealt with by the surgical or anaesthetic teams. The post-operative management of elective surgical patients begins during the peri-operative period and involves several health professionals. Appropriate monitoring and repeated clinical assessments are required in order for the signs of surgical complications to be recognised swiftly and adequately. This article examines the literature regarding pre-operative assessment in elective orthopaedic surgery and shoulder surgery, whilst also reviewing the essentials of peri- and post-operative care. The need to recognise common post-operative complications early and promptly is also evaluated, along with discussing thromboprophylaxis and post-operative analgesia following shoulder surgery. PMID:24093051

  12. Pre-operative respiratory evaluation and management of patients for upper abdominal surgery.

    PubMed Central

    Davies, J. M.

    1991-01-01

    Patients presenting for surgery, be it on an elective or emergency basis, do so in the hope that the anesthetic will be without risk. Yet complications which arise are not always due to anesthesia. More often, the surgical process and factors intrinsic to the patient are major determinants of outcome. Pre-operative assessment allows review of the patient and the proposed surgery, and formation of a plan of management for the pre-, intra-, and post-operative anesthetic care. This paper provides an overview of the pre-operative assessment and management of patients who are to undergo upper abdominal surgery, with the aim of minimizing their risk of post-operative pulmonary complications. In particular, factors which contribute to the development of post-operative respiratory problems are described. PMID:1814053

  13. Preoperative MRSA Screening in Pediatric Spine Surgery: A Helpful Tool or a Waste of Time and Money?

    PubMed

    Luhmann, Scott J; Smith, June C

    2016-07-01

    To review the use of preoperative screening for Staphylococcus aureus for all pediatric spine procedures that was instituted at our facility in a multimodal approach to decrease the frequency of postoperative wound infections. Four years ago at our facility, a multimodal approach to decrease the frequency of postoperative infections after pediatric spine surgery was instituted. A single-center, single-surgeon pediatric spine surgery database was queried to identify all patients who had preoperative S. aureus nasal swab screening. Data collected included demographic data, diagnoses, methicillin-resistant S. aureus (MRSA) swab findings, bacterial antibiotic sensitivities, and outcome of the spine surgery. A total of 339 MRSA screenings were performed. Twenty (5.9%) were MRSA positive, and 55 (16.2%) were methicillin-sensitive S. aureus (MSSA) positive. In the MRSA-positive group, 13 were neuromuscular, 5 were adolescent idiopathic scoliosis (AIS), 1 congenital, and 1 infantile idiopathic scoliosis. Of the MRSA-positive screenings, 13 (65.0% of MRSA-positive screenings; 3.8% of entire cohort) of were newly identified cases (9 neuromuscular, 3 AIS, and 1 congenital diagnoses). In the 55 MSSA-positive, 6 documented resistance to either cefazolin or clindamycin. Hence, in up to 22 of the preoperative screenings (6.5% of entire cohort; 16 MRSA and 6 MSSA showed antibiotic resistance), the preoperative antibiotic regimen could be altered to appropriately cover the identified bacterial resistances. During the study period, there were 11 patients who were diagnosed with a postoperative deep wound infection, none of them having positive screenings. The use of preoperative nasal swab MRSA screening permitted adjustment of the preoperative antibiotic regimen in up to 6.5% of patients undergoing pediatric spine surgery. This inexpensive, noninvasive tool can be used in preoperative surgical planning for all patients undergoing spinal procedures. Level IV. Copyright © 2016

  14. Risk Factors for Preoperative Seizures and Loss of Seizure Control in Patients Undergoing Surgery for Metastatic Brain Tumors.

    PubMed

    Wu, Adela; Weingart, Jon D; Gallia, Gary L; Lim, Michael; Brem, Henry; Bettegowda, Chetan; Chaichana, Kaisorn L

    2017-08-01

    Metastatic brain tumors are the most common brain tumors in adults. Patients with metastatic brain tumors have poor prognoses with median survival of 6-12 months. Seizures are a major presenting symptom and cause of morbidity and mortality. In this article, risk factors for the onset of preoperative seizures and postoperative seizure control are examined. Adult patients who underwent resection of one or more brain metastases at a single institution between 1998 and 2011 were reviewed retrospectively. Of 565 patients, 114 (20.2%) patients presented with seizures. Factors independently associated with preoperative seizures were preoperative headaches (P = 0.044), cognitive deficits (P = 0.031), more than 2 intracranial metastatic tumors (P = 0.013), temporal lobe location (P = 0.031), occipital lobe location (P = 0.010), and bone involvement by tumor (P = 0.029). Factors independently associated with loss of seizure control after surgical resection were preoperative seizures (P = 0.001), temporal lobe location (P = 0.037), lack of postoperative chemotherapy (P = 0.010), subtotal resection of tumor (P = 0.022), and local recurrence (P = 0.027). At last follow-up, the majority of patients (93.8%) were seizure-free. Thirty patients (5.30%) in total had loss of seizure control, and only 8 patients (1.41%) who did not have preoperative seizures presented with new-onset seizures after surgical resection of their metastases. The brain is a common site for metastases from numerous primary cancers, such as breast and lung. The identification of factors associated with onset of preoperative seizures as well as seizure control postoperatively could aid management strategies for patients with metastatic brain tumors. Patients with preoperative seizures who underwent resection tended to have good seizure control after surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Is preoperative radiation therapy as effective as postoperative radiation therapy for heterotopic ossification prevention in acetabular fractures?

    PubMed

    Archdeacon, Michael T; d'Heurle, Albert; Nemeth, Nicole; Budde, Bradley

    2014-11-01

    Prophylactic approaches to prevent heterotopic ossification after acetabular fracture surgery have included indomethacin and/or single-dose external beam radiation therapy administered after surgery. Although preoperative radiation has been used for heterotopic ossification prophylaxis in the THA population, to our knowledge, no studies have compared preoperative and postoperative radiation therapy in the acetabular fracture population. We determined whether heterotopic ossification frequency and severity were different between patients with acetabular fracture treated with prophylactic radiation therapy preoperatively and postoperatively. Between January 2002 and December 2009, we treated 320 patients with a Kocher-Langenbeck approach for acetabular fractures, of whom 50 (34%) were treated with radiation therapy preoperatively and 96 (66%) postoperatively. Thirty-four (68%) and 71 (74%), respectively, had 6-month radiographs available for review and were included. For hospital logistical reasons, patients who underwent operative treatment on a Friday or Saturday received radiation therapy preoperatively, and all others received it postoperatively. The treatment groups were comparable in terms of most demographic parameters, injury severity, and fracture patterns. Six-month postoperative radiographs were reviewed and graded according to Brooker. Followup ranged from 6 to 93 months and 6 to 97 months for the preoperative and postoperative groups, respectively. Post hoc power analysis showed our study was powered to detect a difference of 22% or more between patients with severe heterotopic ossification. Sample size calculations showed 915 subjects would be needed to detect a 5% relative difference in severe heterotopic ossification status between groups. We detected no difference in heterotopic ossification frequency between the preoperative (eight of 36, 22%) and postoperative (19 of 71, 27%) groups (p=0.609). There was also no difference in heterotopic

  16. Preoperative Medical Testing in Medicare Patients Undergoing Cataract Surgery

    PubMed Central

    Chen, Catherine L.; Lin, Grace A.; Bardach, Naomi S.; Clay, Theodore H.; Boscardin, W. John; Gelb, Adrian W.; Maze, Mervyn; Gropper, Michael A.; Dudley, R. Adams

    2017-01-01

    BACKGROUND Routine preoperative testing is not recommended for patients undergoing cataract surgery, because testing neither decreases adverse events nor improves outcomes. We sought to assess adherence to this guideline, estimate expenditures from potentially unnecessary testing, and identify patient and health care system characteristics associated with potentially unnecessary testing. METHODS Using an observational cohort of Medicare beneficiaries undergoing cataract surgery in 2011, we determined the prevalence and cost of preoperative testing in the month before surgery. We compared the prevalence of preoperative testing and office visits with the mean percentage of beneficiaries who underwent tests and had office visits during the preceding 11 months. Using multivariate hierarchical analyses, we examined the relationship between preoperative testing and characteristics of patients, health system characteristics, surgical setting, care team, and occurrence of a preoperative office visit. RESULTS Of 440,857 patients, 53% had at least one preoperative test in the month before surgery. Expenditures on testing during that month were $4.8 million higher and expenditures on office visits $12.4 million higher (42% and 78% higher, respectively) than the mean monthly expenditures during the preceding 11 months. Testing varied widely among ophthalmologists; 36% of ophthalmologists ordered preoperative tests for more than 75% of their patients. A patient’s probability of undergoing testing was associated mainly with the ophthalmologist who managed the preoperative evaluation. CONCLUSIONS Preoperative testing before cataract surgery occurred frequently and was more strongly associated with provider practice patterns than with patient characteristics. (Funded by the Foundation for Anesthesia Education and Research and the Grove Foundation.) PMID:25875258

  17. [Preoperative screening and nutritional support of nutritional deficiencies].

    PubMed

    Zazzo, J-F

    2004-01-01

    Nutritional deficiencies have to be considered as an independent risk factor for postoperative morbidity. Peri-operative nutritional support reduce this risk in elective abdominal surgery for cancer and cardiac surgery. Preoperative nutritional support for 7-10 days reduce postoperative complications in undernourished patients by 10% but is not operant when administered after surgery. Enteral route is as effective. Recent studies using immunonutrients conclude that a short preoperative oral intake is able to reduce complications even in well-nourished patients. Then, a preoperative nutritional screening must be routinely performed leading to a nutritional programme.

  18. [Spectrum and susceptibility of preoperative conjunctival bacteria].

    PubMed

    Fernández-Rubio, M E; Cuesta-Rodríguez, T; Urcelay-Segura, J L; Cortés-Valdés, C

    2013-12-01

    To describe the conjunctival bacterial spectrum of our patients undergoing intraocular surgery and their antibiotic sensitivity during the study period. A retrospective study of preoperative conjunctival culture of patients consecutively scheduled for intraocular surgery from 21 February 2011 to 1 April 2013. Specimens were directly seeded onto blood-agar and MacConkey-agar (aerobiosis incubation, 2 days), and on chocolate-agar (6% CO2 incubation, 7 days). The identified bacteria were divided into 3 groups according to their origin; the bacteria susceptibility tests were performed on those more pathogenic and on some of the less pathogenic when more than 5 colonies were isolated. The sensitivity of the exigent growing bacteria was obtained with disk diffusion technique, and for of the non-exigent bacteria by determining their minimum inhibitory concentration. The Epidat 3.1 program was used for statistical calculations. A total of 13,203 bacteria were identified in 6,051 cultures, with 88.7% being typical colonizers of conjunctiva (group 1), 8.8% typical of airways (group 2), and the remaining 2.5% of undetermined origin (group 3). 530 cultures (8.8%) were sterile. The sensitivity of group 1 was: 99% vancomycin, 95% rifampicin, 87% chloramphenicol, 76% tetracycline. Levels of co-trimoxazole, aminoglycosides, quinolones, β-lactams and macrolides decreased since 2007. The group 2 was very sensitive to chloramphenicol, cefuroxime, rifampicin, ciprofloxacin and amoxicillin/clavulanate. In group 3, to levofloxacin 93%, ciprofloxacin 89%, tobramycin 76%, but ceftazidime 53% and cefuroxime 29% decreased. None of the tested antibiotics could eradicate all possible conjunctival bacteria. Bacteria living permanently on the conjunctiva (group 1) have achieved higher resistance than the eventual colonizers. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  19. [Use of preoperative glucocorticoid to risk reduction of complications after esophagectomy by esophagus carcinoma: meta-analysis].

    PubMed

    Raimondi, Antônio Marcos

    2006-12-01

    Preoperative glucocorticoid administration has been proposed for reducing postoperative morbidity. This is not widely used before esophageal resection because of incomplete knowledge regarding its effectiveness. The aim here was to assess the effects of preoperative glucocorticoid administration in adults undergoing esophageal resection for esophageal carcinoma. Studies were identified by searching the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CancerLit, SCIELO and Cochrane Library, and by manual searching from relevant articles. The last search for clinical trials for this systematic review was performed in December 2005. This review included randomized studies of patients with potentially resectable carcinomas of the esophagus that compared preoperative glucocorticoid administration with placebo. Data were extracted by the reviewer, and the trial quality was assessed using Jadad scoring. Odds ratio with 95% confidence limits and bayesian relative risk were used to assess the significance of the difference between the treatment arms. Four randomized trials involving 169 patients were found. There were no differences in postoperative mortality, anastomotic leakage, hepatic and renal failure between the glucocorticoid and placebo groups. There were fewer postoperative respiratory complications (95% CI = 0.09-0.46), sepsis (95% CI = 0.10-0.81), and total postoperative complications (95% CI = 0.06-0.23) with preoperative glucocorticoid administration. Prophylactic administration of glucocorticoids is associated with decreased postoperative complications.

  20. Correlation between preoperative imaging features and intraoperative blood loss of meningioma: a new scoring system for predicting intraoperative blood loss.

    PubMed

    Lü, J

    2013-06-01

    The aim of this paper was to analyze the correlation between preoperative imaging features and intraoperative blood loss and transfusion of meningioma in order to explore the possibility of reasonable blood preparation based on the preoperative images. The data of 93 adults with meningioma having undergone microsurgical operations was retrospectively analyzed. The intraoperative blood loss of meningioma was evaluated with "estimated blood loss (EBL)". The preoperative imaging features including volume, origin, peritumoral edema, invasive behavior, calcification, dural tail sign, adjacent bone involvement, blood vessel or venous sinus involvement were reviewed. Logistic regression analysis was used to determine the correlations between the imaging factors and the EBL or blood requirement. Origin, volume, and blood vessel or venous sinus involvement of meningioma affected its EBL statistically. Calcification, invasive behaviors, dural tail sign, peritumoral edema and adjacent bone involvement did not influence EBL statistically. Origin and volume were independent risk factors for the high intraoperative blood loss. Origin, volume and blood vessel or venous sinus involvement were independent risk factors for the intraoperative red blood cell transfusion requirement. A scoring method was proposed to predict the intraoperative blood loss and transfusion of meningioma based on preoperative images. It is feasible to predict the intraoperative blood loss and transfusion of meningioma surgery according to the preoperative images.

  1. Initial Cholecystectomy with Cholangiography Decreases Length of Stay Compared to Preoperative MRCP or ERCP in the Management of Choledocholithiasis.

    PubMed

    Lin, Christine; Collins, Jay N; Britt, Rebecca C; Britt, Lunzy D

    2015-07-01

    There are several treatments available for choledocholithiasis, but the optimal treatment is highly debated. Some advocate preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) with cholangiography (IOC). Others advocate initial LC + IOC followed by common bile duct exploration or ERCP. The purpose of this study was to determine whether initial LC + IOC had a shorter length of stay (LOS) compared with preoperative magnetic resonance cholangiopancreatography (MRCP) or ERCP. Patients who underwent cholecystectomy between 2012 and 2013 at two institutions were reviewed. Patients were selected if they had suspected choledocholithiasis, indicated by dilated CBD and/or elevated bilirubin, or confirmed choledocholithiasis. They were excluded if they had pancreatitis or cholangitis. There were 126 patients with suspected choledocholithiasis in this study. Of these, 97 patients underwent initial LC ± IOC with an average LOS of 3.9 days. IOC was negative in 47.4 per cent patients, and they had a shorter LOS compared with positive IOC patients (2.93 vs 4.82, P < 0.001). Laparoscopic common bile duct exploration was successful in 64.7 per cent and had a shorter LOS compared with postoperative ERCP patients (P = 0.01). Preoperative MRCP was performed in 21 patients with an average LOS of 6.48 days. Preoperative ERCP was performed in eight patients with an average LOS of seven days. Initial LC+IOC is associated with a shorter LOS compared to preoperative MRCP or ERCP. It is recommended as the optimal treatment choice for suspected choledocholithiasis.

  2. The value of immediate preoperative vascular examination in an at-risk patient for total knee arthroplasty.

    PubMed

    Garabekyan, Tigran; Oliashirazi, Ali; Winters, Kristie

    2011-01-03

    Arterial complications associated with total knee arthroplasty (TKA), although infrequent, may be associated with the following sequelae: infection, limb loss, and rarely, death. When revascularization is undertaken in the postoperative setting, additional complications may be encountered including postischemic reperfusion injury necessitating prophylactic fasciotomies. The end result is a prolonged postoperative course leading to worse functional outcome. A preoperative history and physical examination performed by the orthopedic surgeon can determine if the patient is at increased risk for vascular complications and whether the at-risk limb can withstand the stress of the operation. Consideration should be given to obtaining ankle-brachial indexes in this patient population, noting that arterial calcification may elevate the value. This article presents a case of an immediate preoperative vascular examination, performed at the time of surgical site marking, in an at-risk patient prior to TKA. We detail the clinical course of a patient with peripheral vascular disease and indwelling superficial femoral artery stent, who developed stent thrombosis in the 2-week period between his last clinic visit and date of surgery, with no change in symptoms. This restenosis was detected on routine preoperative physical examination and resulted in cancellation of the TKA in the preoperative area, allowing the patient to undergo emergent revascularization. We emphasize the importance of an immediate preoperative vascular examination in the setting of TKA and provide a comprehensive review of the literature with guidelines on the perioperative management of antiplatelet agents and appropriate use of the tourniquet. Copyright 2011, SLACK Incorporated.

  3. Preoperative management of anticoagulation and antiplatelet agents.

    PubMed

    Gleason, Lauren Jan; Friedman, Susan M

    2014-05-01

    This article describes current literature and treatment plans for managing anticoagulation and antiplatelet agents in patients presenting with hip fractures. Indications for anticoagulation and antiplatelet agents are discussed, and management techniques for when patients present with hip fractures are reviewed.

  4. Reviews

    NASA Astrophysics Data System (ADS)

    2001-07-01

    A-LEVEL RESOURCES REVIEWS SPECIAL AS and A2 books and resources: deciding what to buy? SUMMARY Exam boards, specifications and support materials OCR (Oxford Cambridge and RSA Examinations) CORRECTION BOOK REVIEW Good Practice in Science Teaching WEB WATCH Astronomy and cosmology DVD REVIEW The Video Encyclopedia of Physics Demonstrations SOFTWARE REVIEW Graph Paper Printer

  5. Reviews

    NASA Astrophysics Data System (ADS)

    2003-07-01

    CD REVIEWS (346) Spectrum 7 Physics - Waves SOFTWARE REVIEW (347) Sound Packages BOOK REVIEW (350) Measured Tones, 2nd edition WEB WATCH (351) What’s the frequency, Kenneth? BOOK REVIEW (354) We know what you did last summer ... now do something better this summer

  6. Reviews

    NASA Astrophysics Data System (ADS)

    2001-03-01

    CD-ROM REVIEWS SPECIAL: Multimedia CD-ROMs WEB WATCH: Medical imaging BOOK REVIEW: Understanding Science Lessons CD-ROM REVIEWS SPECIAL Multimedia CD-ROMs: what do they offer to enhance physics teaching? PEAR: Physics Exercises for Assessment and Revision GCSE Physics 1998 33 72 Contact: Europress WEB WATCH Medical imaging BOOK REVIEW Understanding Science Lessons

  7. Reviews

    NASA Astrophysics Data System (ADS)

    2004-03-01

    WEB WATCH (204) Try unearthing some interesting information about archaeology BOOK REVIEWS (206) Teaching and assessing practical skills Book Review: Learn to drive with Sir Isaac Newton DVD REVIEW (207) Bring some sunshine into the classroom EQUIPMENT REVIEWS (208) Robust air puck takes a kicking Flowlog offers sensing options plus multimode datalogging Mastering Chladni figures takes practice but it offers surprises

  8. Pre-operative visits by ITU nurses: recommendations for practice.

    PubMed

    Cheetham, D

    1993-12-01

    Pre-operative visiting by theatre nurses is now policy in many hospitals, following an explosion of research studies outlining the benefits to the patient. However, the author could find very little available literature on pre-operative visiting by intensive therapy unit (ITU) nurses, to patients electively admitted to ITU following surgery. The purpose of this project is to explore the need for patient information, outline the aims of an ITU nurse's pre-operative visit, and discuss the timing of the proposed visit, the information to give the patient, the inclusion of the patient's family and the provision of printed literature. Finally, recommendations are made for implementing a pre-operative visiting service by ITU nurses.

  9. Appraisal of guidelines for pre-operative body wash.

    PubMed

    Edström, Elisabet; Westerberg, Lisa; Henricson, Maria

    The pre-operative body wash is a strategy for reducing post-operative infection. However, there is a lack of knowledge about its importance. The purpose of the present study was to evaluate the quality of guidelines for the pre-operative body wash using the AGREE instrument--35 guidelines containing instructions for the pre-operative body wash or preparation were included. The AGREE instrument was employed to establish a quality assessment framework that facilitated a comparison of the guidelines. The results were based on the six domains of the AGREE instrument, all of which were found to have low adherence. Descriptive statistics were used to present the assessment score. The AGREE instrument is useful for evaluating the quality of clinical guidelines. The development of evidence-based guidelines must include clinical activities. Further research is required to clarify the pre-operative body wash process and how it should be performed to reduce post-operative infection.

  10. Benefits of preoperative education for adult elective surgery patients.

    PubMed

    Kruzik, Nancy

    2009-09-01

    Patient education is a major concern for perioperative nurses in an ambulatory surgery setting. It has proven difficult to develop formal preoperative teaching programs in this environment, but research has shown that preoperative education can improve patient outcomes and satisfaction with the surgical experience. Typical patient education consists of pamphlets that are given to the patient before surgery and verbal instructions from the physicians and nurses on the day of surgery. Ideally, preoperative patient education should begin in the surgeon's office, continue through preadmission testing, and be completed at admission. Having a well-designed preoperative education program enables perioperative nurses in ambulatory surgery centers to provide a thoughtful approach to perioperative teaching in a limited time. AORN J 90 (September 2009) 381-387. (c) AORN, Inc, 2009.

  11. Association of Preoperative Anemia With Postoperative Mortality in Neonates.

    PubMed

    Goobie, Susan M; Faraoni, David; Zurakowski, David; DiNardo, James A

    2016-09-01

    Neonates undergoing noncardiac surgery are at risk for adverse outcomes. Preoperative anemia is a strong independent risk factor for postoperative mortality in adults. To our knowledge, this association has not been investigated in the neonatal population. To assess the association between preoperative anemia and postoperative mortality in neonates undergoing noncardiac surgery in a large sample of US hospitals. Using data from the 2012 and 2013 pediatric databases of the American College of Surgeons National Surgical Quality Improvement Program, we conducted a retrospective study of neonates undergoing noncardiac surgery. Analysis of the data took place between June 2015 and December 2015. All neonates (0-30 days old) with a recorded preoperative hematocrit value were included. Anemia defined as hematocrit level of less than 40%. Receiver operating characteristics analysis was used to assess the association between preoperative hematocrit and mortality, and the Youden J Index was used to determine the specific hematocrit cutoff point to define anemia in the neonatal population. Demographic and postoperative outcomes variables were compared between anemic and nonanemic neonates. Univariate and multivariable logistic regression analyses were used to determine factors associated with postoperative neonatal mortality. An external validation was performed using the 2014 American College of Surgeons National Surgical Quality Improvement Program database. Neonates accounted for 2764 children (6%) in the 2012-2013 American College of Surgeons National Surgical Quality Improvement Program databases. Neonates inlcuded in the study were predominately male (64.5%), white (66.3%), and term (69.9% greater than 36 weeks' gestation) and weighed more than 2 kg (85.0%). Postoperative in-hospital mortality was 3.4% in neonates and 0.6% in all age groups (0-18 years). A preoperative hematocrit level of less than 40% was the optimal cutoff (Youden) to predict in-hospital mortality

  12. Preoperative Assessment of Adult Patients for Intracranial Surgery

    PubMed Central

    Sivanaser, Vanitha; Manninen, Pirjo

    2010-01-01

    The preoperative assessment of the patient for neurosurgical and endovascular procedures involves the understanding of the neurological disease and its systemic presentation, and the requirements of the procedure. There is a wide spectrum of different neurosurgical disorders and procedures. This article provides an overview of the preoperative evaluation of these patients with respect to general principles of neuroanesthesia, and considerations for specific intracranial and vascular neurosurgical and interventional neuroradiological procedures. PMID:20700431

  13. Preoperative anemia impacts early postoperative recovery following autologous breast reconstruction.

    PubMed

    Nelson, Jonas A; Fischer, John P; Chung, Cyndi U; Fosnot, Joshua; Selber, Jesse C; Serletti, Joseph M; Wu, Liza C

    2014-06-01

    Preoperative anemia impacts a significant portion of breast reconstruction patients, though this does not appear to affect surgical outcomes. The impact of anemia on postoperative physical and mental health, however, is unknown. This study aimed to prospectively evaluate the role of preoperative anemia in recovery after autologous reconstruction. From 2005 to 2010, we prospectively assessed autologous breast reconstruction patients with satisfaction surveys, strength and functional tests, and the short form 36 (SF36). Data was collected preoperatively and at early (<90d), intermediate (90-365d), and late (>365d) follow-up. We stratified patients by presence or lack of preoperative anemia (hemoglobin<12 g/dL). Of 399 patients undergoing reconstruction, 179 enrolled in the study. Anemic patients (n = 31, 17%) had higher rates of preoperative chemotherapy (p = 0.02) and lower rates of radiation (p = 0.001). Preoperatively, anemic patients reported worse physical (p < 0.001), mental (p = 0.003) and overall health (p = 0.0003). These scores worsened postoperatively for anemic and nonanemic patients, though anemic patients had lower average scores in all SF36 categories. This was significant only for early follow-up physical health (p = 0.02). Change in SF36 scores and objective physical exam assessments did not differ between the two cohorts. Though preoperative anemia may not impact surgical outcomes, it adversely impacts the recovery of breast reconstruction patients. Subjective physical health differences were significant in early follow-up, though this did not translate to differences in mental health or satisfaction. We advocate for preoperative optimization of hemoglobin to enhance the early recovery potential of breast reconstruction patients. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  14. Pre-operative intraocular pressure does not influence outcome of trabeculectomy surgery: a retrospective cohort study.

    PubMed

    Nesaratnam, Nisha; Sarkies, Nicholas; Martin, Keith R; Shahid, Humma

    2015-03-05

    To investigate whether pre-operative intraocular pressure (IOP) predicts outcome of trabeculectomy surgery in patients with primary open angle glaucoma over a 3-year period of follow-up. Retrospective cohort study, of a total of 61 patients (80 procedures) who had undergone trabeculectomy surgery after failed medical management at a single centre between 2000 and 2011. Patients were identified through surgical logbooks. A subsequent case note-review identified 61 patients (80 procedures) with primary open angle glaucoma (POAG). The primary outcome was success of trabeculectomy surgery, with failure defined as intraocular pressure (IOP) > 21 mmHg, ≤ 5 mmHg or not reduced by 20% at two consecutive follow-up visits 3-months post-operatively. Qualified success was defined as surgical success with the use of supplemental medical therapy. Secondary outcomes included visual acuity, Humphrey visual field MD, surgical complications and post-operative interventions. At 3 years, the odds ratio of failure was 0.93 per mmHg pre-operative IOP (95% C.I. 0.83-1.03, p = 0.15 Wald Χ (2) test), and the odds ratio of failure or qualified success was 0.96 (95% C.I. 0.89-1.04, p = 0.35). The incidence of surgical complications showed an odds ratio of 1.02 per mmHg pre-operative IOP (95% C.I. 0.95-1.10, p = 0.55 Wald Χ (2) test). The incidence of post-operative interventions showed an odds ratio of 1.01 per mmHg pre-operative IOP (95% C.I. 0.94-1.09, p = 0.80 Wald Χ (2) test). Pre-operative IOP does not predict success of trabeculectomy surgery in POAG patients during the first 3 years of follow-up. The incidence of surgical complications and post-operative interventions shows no association with pre-operative IOP.

  15. Evaluating the effects of preoperative fasting and fluid limitation.

    PubMed

    Tosun, Betül; Yava, Ayla; Açıkel, Cengizhan

    2015-04-01

    The aim of the study was to evaluate the effects of preoperative fasting and fluid limitation in patients undergoing laparoscopic cholecystectomy. Although traditional long-term fasting is not recommended in current preoperative guidelines, this is still a common intervention. Visual analogue scale was used to assess hunger, thirst, sleepiness, exhaustion, nausea and pain; State and Trait Anxiety Inventory was used to assess the preoperative anxiety of 99 patients undergoing elective laparoscopic cholecystectomy. Mean time of preoperative fasting and fluid limitation were, respectively, 14.70 ± 3.14 and 11.25 ± 3.74 h. Preoperatively, 58.60% of the patients experienced moderate anxiety. Patients fasting 12 h or longer had higher hunger, thirst, nausea and pain scores. The mean trait anxiety score of patients fasting 12 h or longer was statistically significantly higher. Receiving nothing by mouth after midnight preoperatively is a persisted intervention and results in discomfort of patients. Clinical protocols should be revised and nurses should be trained in current fasting protocols. © 2014 Wiley Publishing Asia Pty Ltd.

  16. Preoperative Planning in Orthopaedic Surgery. Current Practice and Evolving Applications.

    PubMed

    Atesok, Kivanc; Galos, David; Jazrawi, Laith M; Egol, Kenneth A

    2015-12-01

    Preoperative planning is an essential prerequisite for the success of orthopaedic procedures. Traditionally, the exercise has involved the written down, step by step "blueprint" of the surgical procedure. Preoperative planning of the technical aspects of the orthopaedic procedure has been performed on hardcopy radiographs using various methods such as copying the radiographic image on tracing papers to practice the planned interventions. This method has become less practical due to variability in radiographic magnification and increasing implementation of digital imaging systems. Advances in technology along with recognition of the importance of surgical safety protocols resulted in widespread changes in orthopaedic preoperative planning approaches. Nowadays, perioperative "briefings" have gained particular importance and novel planning methods have started to integrate into orthopaedic practice. These methods include using software that enables surgeons to perform preoperative planning on digital radiographs and to construct 3D digital models or prototypes of various orthopaedic pathologies from a patient's CT scans to practice preoperatively. Evidence-to-date suggests that preoperative planning and briefings are effective means of favorably influencing the outcomes of orthopaedic procedures.

  17. Preoperative transcutaneous electrical nerve stimulation for localizing superficial nerve paths.

    PubMed

    Natori, Yuhei; Yoshizawa, Hidekazu; Mizuno, Hiroshi; Hayashi, Ayato

    2015-12-01

    During surgery, peripheral nerves are often seen to follow unpredictable paths because of previous surgeries and/or compression caused by a tumor. Iatrogenic nerve injury is a serious complication that must be avoided, and preoperative evaluation of nerve paths is important for preventing it. In this study, transcutaneous electrical nerve stimulation (TENS) was used for an in-depth analysis of peripheral nerve paths. This study included 27 patients who underwent the TENS procedure to evaluate the peripheral nerve path (17 males and 10 females; mean age: 59.9 years, range: 18-83 years) of each patient preoperatively. An electrode pen coupled to an electrical nerve stimulator was used for superficial nerve mapping. The TENS procedure was performed on patients' major peripheral nerves that passed close to the surgical field of tumor resection or trauma surgery, and intraoperative damage to those nerves was apprehensive. The paths of the target nerve were detected in most patients preoperatively. The nerve paths of 26 patients were precisely under the markings drawn preoperatively. The nerve path of one patient substantially differed from the preoperative markings with numbness at the surgical region. During surgery, the nerve paths could be accurately mapped preoperatively using the TENS procedure as confirmed by direct visualization of the nerve. This stimulation device is easy to use and offers highly accurate mapping of nerves for surgical planning without major complications. The authors conclude that TENS is a useful tool for noninvasive nerve localization and makes tumor resection a safe and smooth procedure.

  18. The preoperative cardiology consultation: goal settings and great expectations.

    PubMed

    Aslanger, Emre; Altun, Ibrahim; Guz, Goksel; Kiraslan, Omer; Polat, Nihat; Golcuk, Ebru; Oflaz, Huseyin

    2011-08-01

    Despite the availability of guidelines for preoperative cardiology consultations, their efficacy in real clinical practice remains unknown. Furthermore, there are concerns that overused cardiology consultations can lead to unnecessary investigations, prolonged hospital stays, and even cancellation of necessary surgery. In this retrospective study, we investigated: (i) the potential impact of the American Heart Association/American College of Cardiology algorithm and (ii) the potential of this algorithm for preventing unnecessary evaluation. We examined the cardiology consultation requests for 712 patients scheduled for elective surgery. Our analysis included: (i) patient characteristics, (ii) abnormalities revealed by the consultant, (iii) impact of these abnormalities on clinical decision making and therapy modification. The most common reason for consultation was 'pre-operative evaluation' (80.9%). Although our cardiologists revealed an abnormality in 67.8% and recommended further work up in 58.7% of our patients, they contributed to the clinical course in only 36.9%. Moreover, when the algorithm was applied to 'routine pre-operative evaluation' requests lacking a specific question, only 7.6% of these consultation requests required further investigation. Preoperative cardiology consultation seems to be overused. Although the fear of missing important issues leads surgeons to use a decreased threshold for pre-operative consultation requests, such a non-specific manner of pre-operative consultation request causes unnecessary investigations and decreased cost-effectiveness. Furthermore, the detection of any clinical abnormality by cardiologists surprisingly adds little to clinical decision making.

  19. Cardiovascular surgery in Jehovah's Witness patients: The role of preoperative optimization.

    PubMed

    Tanaka, Akiko; Ota, Takeyoshi; Uriel, Nir; Asfaw, Zewditu; Onsager, David; Lonchyna, Vassyl A; Jeevanandam, Valluvan

    2015-10-01

    We aimed to identify factors associated with adverse outcomes in Jehovah's Witness patients undergoing complex cardiovascular surgery and to validate our preoperative optimization protocol. We retrospectively reviewed 144 Jehovah's Witnesses who underwent cardiovascular surgery between 1999 and 2014. We excluded 7 salvage cases. The operative procedures included 56 coronary artery bypass graft surgeries, 43 valve procedures, 13 ventricular assist device implantations, 11 heart transplantations, 9 aortic surgeries, and 5 congenital defect repairs. Our preoperative optimization protocol for Jehovah's Witnesses includes discontinuing antiplatelets and adding iron/vitamin or erythropoietin to achieve a target hemoglobin greater than 12 g/dL. We evaluated the risk factors for postoperative mortality and composite outcomes (mortality, myocardial infarction, stroke, acute kidney injury, heart failure, sternal wound infection), and compared the outcomes of optimized patients with a preoperative hemoglobin level greater than 12 g/dL (n = 93) versus unoptimized patients with a preoperative hemoglobin level less than 12 g/dL (n = 44). Preoperative and intraoperative demographics in the optimized and unoptimized groups were similar except for preoperative hemoglobin levels, renal dysfunction (optimized = 25/93 [26.9%], unoptimized = 26/44 [59.1%], P < .001), and emergency/urgent cases (optimized = 20/93 [21.5%], unoptimized = 17/44 [38.6%], P = .035). The mean preoperative, intraoperative nadir, and discharge hemoglobin levels of the entire cohort were 12.7 ± 1.7 g/dL, 9.5 ± 2.6 g/dL, and 9.7 ± 1.8 g/dL, respectively. Hospital mortality was 9 of 137 patients (6.6%) (optimized = 2/93 [2.2%], unoptimized = 7/44 [15.9%], P = .002), and composite outcomes were observed in 44 of 137 patients (32.1%) (optimized = 21/93 [22.6%], unoptimized = 22/44 [50.0%], P = .001). The Youden index identified a cutoff value of the preoperative hemoglobin of 11.7 g/dL for mortality (area under

  20. Pre-operative biliary drainage for obstructive jaundice

    PubMed Central

    Fang, Yuan; Gurusamy, Kurinchi Selvan; Wang, Qin; Davidson, Brian R; Lin, He; Xie, Xiaodong; Wang, Chaohua

    2014-01-01

    Background Patients with obstructive jaundice have various pathophysiological changes that affect the liver, kidney, heart, and the immune system. There is considerable controversy as to whether temporary relief of biliary obstruction prior to major definitive surgery (pre-operative biliary drainage) is of any benefit to the patient. Objectives To assess the benefits and harms of pre-operative biliary drainage versus no pre-operative biliary drainage (direct surgery) in patients with obstructive jaundice (irrespective of a benign or malignant cause). Search methods We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Clinical Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until February 2012. Selection criteria We included all randomised clinical trials comparing biliary drainage followed by surgery versus direct surgery, performed for obstructive jaundice, irrespective of the sample size, language, and publication status. Data collection and analysis Two authors independently assessed trials for inclusion and extracted data. We calculated the risk ratio (RR), rate ratio (RaR), or mean difference (MD) with 95% confidence intervals (CI) based on the available patient analyses. We assessed the risk of bias (systematic overestimation of benefit or systematic underestimation of harm) with components of the Cochrane risk of bias tool. We assessed the risk of play of chance (random errors) with trial sequential analysis. Main results We included six trials with 520 patients comparing pre-operative biliary drainage (265 patients) versus no pre-operative biliary drainage (255 patients). Four trials used percutaneous transhepatic biliary drainage and two trials used endoscopic sphincterotomy and stenting as the method of pre-operative biliary drainage. The risk of bias was high in all trials. The proportion of patients with malignant obstruction varied between 60

  1. Incidence of cranial nerve palsy after preoperative embolization of glomus jugulare tumors using Onyx.

    PubMed

    Gaynor, Brandon G; Elhammady, Mohamed Samy; Jethanamest, Daniel; Angeli, Simon I; Aziz-Sultan, Mohammad A

    2014-02-01

    The resection of glomus jugulare tumors can be challenging because of their inherent vascularity. Preoperative embolization has been advocated as a means of reducing operative times, blood loss, and surgical complications. However, the incidence of cranial neuropathy associated with the embolization of these tumors has not been established. The authors of this study describe their experience with cranial neuropathy following transarterial embolization of glomus jugulare tumors using ethylene vinyl alcohol (Onyx, eV3 Inc.). The authors retrospectively reviewed all cases of glomus jugulare tumors that had been treated with preoperative embolization using Onyx at their institution in the period from 2006 to 2012. Patient demographics, clinical presentation, grade and amount of Onyx used, degree of angiographic devascularization, and procedural complications were recorded. Over a 6-year period, 11 patients with glomus jugulare tumors underwent preoperative embolization with Onyx. All embolization procedures were completed in one session. The overall mean percent of tumor devascularization was 90.7%. No evidence of nontarget embolization was seen on postembolization angiograms. There were 2 cases (18%) of permanent cranial neuropathy attributed to the embolization procedures (facial nerve paralysis and lower cranial nerve dysfunction). Embolizing glomus jugulare tumors with Onyx can produce a dramatic reduction in tumor vascularity. However, the intimate anatomical relationship and overlapping blood supply between these tumors and cranial nerves may contribute to a high incidence of cranial neuropathy following Onyx embolization.

  2. Preoperative oral health care reduces postoperative inflammation and complications in oral cancer patients

    PubMed Central

    Shigeishi, Hideo; Ohta, Kouji; Fujimoto, Shinichi; Nakagawa, Takayuki; Mizuta, Kuniko; Ono, Shigehiro; Shimasue, Hiroshi; Ninomiya, Yoshiaki; Higashikawa, Koichiro; Tada, Misato; Ishida, Fumi; Okui, Gaku; Okumura, Toshiya; Fukui, Akiko; Kubozono, Kazumi; Yamamoto, Kazuhiro; Ishida, Yoko; Seino, Sayaka; Hashikata, Miho; Sasaki, Kazuki; Naruse, Takako; Rahman, Mohammad Zeshaan; Uetsuki, Ryo; Nimiya, Akiko; Takamoto, Megumi; Dainobu, Kana; Tokikazu, Tomoko; Nishi, Hiromi; Sugiyama, Masaru; Takechi, Masaaki

    2016-01-01

    The records of 70 patients with oral cancer who were treated at a single institution between 2008 and 2014 were reviewed. The body temperature, white blood cell count, and C-reactive protein (CRP) levels were compared between those who had received preoperative oral care (oral care group) and those who had not received any (non-oral care group). When the patients were divided into those who underwent minimally invasive surgery and those who underwent severely invasive surgery, the mean CRP level in the early postoperative period was lower in the oral care group as compared with the non-oral care group in those who underwent minimally invasive surgery as well as those who underwent severely invasive surgery. However, the mean CRP level was most evidently reduced in the severely invasive group on days 1 and 3–5. However, no significant differences were observed with regard to the percentage of postoperative infectious complications (for example, surgical site infection, anastomotic leak and pneumonia) between the oral care (13.6%) and non-oral care (20.8%) groups, though a reduced prevalence of postoperative complications following preoperative oral care was noted. The results of the present study suggest that preoperative oral care can decrease inflammation during the early postoperative stage in patients with oral cancer who undergo severely invasive surgery. PMID:27588111

  3. Preoperative Acute Inflammatory Markers as Predictors for Postoperative Complications in Primary Total Knee Arthroplasty

    PubMed Central

    Godoy, Gustavo; Sumarriva, Gonzalo; Ochsner, J. Lockwood; Chimento, George; Schmucker, Dana; Dasa, Vinod; Meyer, Mark

    2016-01-01

    Background: C-reactive protein (CRP) has been suggested as an independent risk factor for cardiovascular pathology in the nonsurgical setting. While postoperative CRP and erythrocyte sedimentation rate (ESR) have an established role in aiding the diagnosis of periprosthetic joint infections, some authors suggest a link between preoperative CRP and postoperative complications in patients undergoing total joint arthroplasty. Methods: We conducted a retrospective cohort study of 351 patients who underwent unilateral primary total knee arthroplasty by a single surgeon during a 28-month period (January 2013 through April 2015). Patient medical records were reviewed for the following complications occurring within 90 days postoperatively: myocardial infarction, arrhythmia, pulmonary embolism, wound infection, acute renal failure, and reoperation. Results: We found no statistically significant link between postoperative complications and preoperative CRP levels (P=0.5005) or ESR levels (P=0.1610). Conclusion: The results of this study do not support the routine inclusion of CRP and ESR analysis as part of the preoperative evaluation for elective total knee arthroplasty. PMID:27999506

  4. Adult progressive sensorineural hearing loss: is preoperative imaging necessary before cochlear implantation?

    PubMed Central

    Roberts, Deanne M; Bush, Matthew L; Jones, Raleigh O

    2015-01-01

    Objective Pre-operative evaluation of cochlear implant candidate includes routine imaging in order to identify anatomic abnormalities that may preclude or complicate implantation, such as cohlear aplasia, absent/narrowed internal audiotory canals, cochlear ossificans, or significant traumatic fracture. The aim of this study is to determine if preoperative imaging is necessary in select cochlear implant candidates thus defraying cost and ionizing radiation. Study Design Retrospective chart review. Setting Tertiary referral facility. Patients Adult patients with progressive sensorineural hearing loss without evidence of head trauma, meningitis, or congenital hearing loss who underwent cochlear implantation. Interventions Diagnostic and Therapeutic. Main Outcome Measures Pre operative radiologic abnormalities, deviation from standard cochlear implant operation. Results 118 cochlear implants met inclusion criteria. 23.7% of CT scans had a documented abnormality, including chronic otitis media (14.4%), otosclerosis (4.2%) and an enlarged vestibular aqueduct (3.4%). There were 6 eventful surgeries in patients with normal documented CT scan. Events included multiple insertion attempts (3.4%), CSF leak (2.5%) and no apparent round window (2.5%). In every case, a cochlear implant was able to be placed successfully. Conclusion In the appropriately selected patient, pre-operative imaging is not necessary as it does not impact the cochlear implant surgery and will defray cost and ionizing radiation PMID:24448283

  5. Preoperative risk analysis in patients receiving Jarvik-7 artificial heart as a bridge to transplantation.

    PubMed

    Kawaguchi, A T; Cabrol, C; Gandjbackhch, I; Pavie, A; Bors, V; Muneretto, C

    1991-01-01

    To distinguish high-risk patients prior to implantation of a Jarvik-7 artificial heart as a bridge to transplantation, our 37 attempts were reviewed retrospectively. Arbitrary scores of 1 to 4 were given for nine preoperative factors on the basis of results obtained by uni- and multivariate analyses between successful cases and failed attempts; transplant rejection (scored 4: S4) or postoperative heart failure (S3) as the indication, recipient height less than 175 cm (S3), body surface area less than 1.8 m2 (S3), hyperbilirubinemia greater than 24 microM/l (S2), preoperative renal failure requiring dialysis (S2), weight less than 60 kg (S2), and age greater than 40 years (S1). All except one of the 16 patients with successful bridge had a total score of less than 4, with an average score of 1.3 in contrast to 6.6 in the 21 failed cases (p less than 0.001). Among the 17 patients who scored less than 4, 15 received transplants (specificity 90%), while only one qualified for transplantation among 20 patients who scored 4 or more (sensitivity 94%). The two unpredicted failures resulted from mediastinitis and pulmonary infarction, both attributable to postoperative management. Multiple preoperative factors in combination could have successfully predicted the outcome of mechanical support in our experience. These results underscore the importance of patient selection to achieve successful and effective use of the Jarvik-7 as a bridge to heart transplantation.

  6. Outcome of laparoscopic Nissen fundoplication in patients with disordered preoperative peristalsis.

    PubMed Central

    Baigrie, R J; Watson, D I; Myers, J C; Jamieson, G G

    1997-01-01

    BACKGROUND: A 360 degrees or Nissen fundoplication remains controversial in patients with disordered peristalsis, some surgeons preferring a partial wrap to minimise postoperative dysphagia. AIM: To evaluate symptoms and manometric outcome in patients with disordered peristalsis after Nissen fundoplication. PATIENTS: In an initial series of 345 patients studied prospectively, 31 patients who had undergone a Nissen fundoplication had disordered peristalsis. Using preoperative manometry, patients were classified as: equivocal primary peristalsis (eight patients); abnormal primary peristalsis (four patients); abnormal maximal contraction pressure (13 patients); abnormal primary peristalsis and maximal contraction pressure (six patients). METHODS: Postoperatively, patients underwent a barium meal, oesophageal manometry and standardised clinical review by a blinded scientific officer. RESULTS: Twenty eight (90%) patients had satisfaction scores of at least 8 out of a maximum of 10 and all would undergo surgery again. Whereas 15 (48%) patients had dysphagia scores greater than 4/10 preoperatively, only two (6%) had these scores at one year. Improved peristalsis was seen in 78% of postoperative manometric studies, and mean preoperative lower oesophageal sphincter pressure increased from 6.6 (range 0-21) mm Hg to 19 (4-50) mm Hg. CONCLUSIONS: These results are similar to the overall group of 345 patients and suggest that disordered peristalsis, and possibly even absent peristalsis, is not a contraindication to Nissen fundoplication as performed in these patients. PMID:9135529

  7. Preoperative skin antiseptics for preventing surgical site infections: what to do?

    PubMed

    Poulin, Paule; Chapman, Kelly; McGahan, Lynda; Austen, Lea; Schuler, Trevor

    2014-09-01

    Safe and effective patient preoperative skin antisepsis is recommended to prevent surgical site infections (SSIs), reduce patient morbidity, and reduce systemic costs. However, there is lack of consensus among best practice recommendations regarding the optimal skin antiseptic solution and method of application. In 2010 and 2011 the health technology appraisal committee of the Surgery Operational Clinical Network (SOCN), of Alberta Health Services (AHS), conducted an environmental scan to determine the current preoperative skin antisepsis in Alberta, reviewed key publications and existing guidelines, and requested a systematic review from the Canadian Agency for Drugs and Technologies in Health (CADTH). Using this information, and an established protocol for evidence-informed recommendations, the health technology appraisal committee made recommendations that were, in 2012, reviewed and endorsed by the SOCN executive and the AHS-Infection Prevention and Control (IPC) group. The environmental scan revealed practice variation in the types of antiseptic solutions and application methods being used in the 18 Alberta hospitals surveyed. The systematic review suggested that preoperative antiseptic showering reduces skin flora but the effect on SSI rates was inconclusive. While the review found no conclusive evidence to recommend an optimal antiseptic solution or application method, the results of two large randomized controlled trials suggest that chlorhexidine in 70% alcohol is more effective than povidone iodine in the prevention of SSIs. These results and the recommendations from Safer Healthcare Now!, a program of the Canadian Patient Safety Institute (CPSI), were used to inform the recommendations for AHS. These recommendations included abandoning preoperative showering with antiseptics except for special cases (high-risk surgeries such as sternotomies and implants as recommended by IPC) and standardizing skin antiseptic application methods and solution to

  8. Preoperative Positron Emission Tomography for Node-Positive Head and Neck Cutaneous Squamous Cell Carcinoma.

    PubMed

    Hirshoren, Nir; Olayos, Elizabeth; Herschtal, Alan; Ravi Kumar, Aravind S; Gyorki, David E

    2017-09-01

    Objectives Surgery is the primary treatment modality for node-positive cutaneous squamous cell carcinoma of the head and neck with no distant disease (HNcSCC-M0). The role of preoperative positron emission tomography/computed tomography (PET/CT) scan for these patients is unclear. We compared preoperative PET/CT with final histopathology among patients undergoing lymphadenectomy and/or parotidectomy for HNcSCC-M0. Study Design Case series with chart review. Setting Single Australian center. Subjects and Methods Investigation included disease parameters and preoperative CT and PET/CT findings of 64 patients with node-positive HNcSCC without distant metastatic disease. Fisher's exact test was used to test for a difference in the proportion of patients with chronic lymphocytic leukemia between the false- and true-negative PET/CT subgroups. Results Of 64 patients who underwent PET/CT prior to surgery for node-positive HNcSCC-M0, 56 underwent a neck dissection and 30, a parotidectomy. Of these, 13 neck dissections and 2 parotidectomies were performed in the absence of FDG-avid (18F-fludeoxyglucose) nodes in these nodal fields. The PET/CT positive predictive value of the neck was 91.1%. The negative predictive values in the neck and parotid regions were 60%. Of the false-negative subgroup, 66.7% had chronic lymphocytic leukemia, compared with 11.1% of the true-negative subgroup ( P = .09). Based on PET/CT findings, surgical plans according to preoperative CT were changed for 6.25% of patients. Conclusion Use of PET/CT for surgical candidates with node-positive HNcSCC-M0 has high specificity and positive predictive value with relatively low sensitivity and negative predictive value. A statistical trend toward a higher rate of chronic lymphocytic leukemia among patients with false-negative results is suggested.

  9. Utility of Preoperative Upper Gastrointestinal Series in Laparoscopic Gastrostomy Tube Placement.

    PubMed

    Gonzalez, Katherine W; Dalton, Brian G A; Boda, Sushanth; Aguayo, Pablo; Hendrickson, Richard J; St Peter, Shawn D; Juang, David

    2015-12-01

    An upper gastrointestinal (UGI) series is a standard preoperative test for patients being evaluated for gastrostomy tube placement. We have recently begun to question the value of the radiation-exposing series in patients who tolerate gastric feeds. A retrospective review was conducted in patients who underwent laparoscopic gastrostomy tube placement between 2000 and 2012. Demographics, indication for gastrostomy tube, comorbidities, preoperative imaging, and nutrition were analyzed. Patients with foregut pathology and those who underwent prior gastrointestinal surgery were excluded. Among 695 patients who underwent laparoscopic gastrostomy tube placement, the most common indications were failure to thrive (53%), neurologic disorder (25%), and dysphagia (12%). A UGI series was obtained for 420 patients (60%). Of these, 96 were found to have abnormalities (reflux, aspiration, anatomic). However, only 2 of these patients (0.3%) had a change in management, with 1 patient undergoing the Ladd procedure and 1 having negative diagnostic laparoscopy for suspected malrotation. In the subset analysis of 256 patients tolerating goal gastric feeds, 161 (63%) had a preoperative UGI series with only 2 patients (1.2%) having a resultant change in operative management: 1 undergoing the Ladd procedure and 1 having negative diagnostic laparoscopy. Of the 275 patients who did not have a preoperative UGI series, 1 patient (0.4%) was found to have malrotation postoperatively after two coins became lodged in the duodenum. This patient subsequently underwent an elective Ladd procedure. We found minimal impact of an UGI series during evaluation for gastrostomy alone. These studies may be able to be reserved for those with clear clinical indications.

  10. Value of flexible bronchoscopy for the preoperative assessment of NSCLC diagnosed using percutaneous core needle biopsy.

    PubMed

    Jo, Kyung-Wook; Kim, Hyeong Ryul; Kim, Dong Kwan; Kim, Yong-Hee; Park, Seung-Il; Choi, Se Hoon; Choi, Chang-Min

    2014-10-01

    We aimed to investigate the value of routine flexible bronchoscopy (FB) for the preoperative assessment of early-stage non-small cell lung cancer (NSCLC) diagnosed using percutaneous core needle biopsy (PCNB). We enrolled 688 NSCLC patients who were treated at our hospital between January 2003 and December 2012 and who met the following criteria: (1) early-stage lung cancer (stage I or II); (2) lung cancer had been diagnosed using PCNB; and (3) no evidence of endobronchial disease in the airways other than the primary cancer site on both chest computed tomography (CT) and positron emission tomography-CT (PET-CT). All NSCLC patients were from the same tertiary referral center, where FB is routinely performed preoperatively for this disease, and their medical records were reviewed retrospectively. Of the 688 patients included in the study, 451 (65.6%) were male and the median age was 65 years. Pathology analysis revealed that adenocarcinoma was the most frequently observed cell type (516/688, 75.0%). The distribution of preoperative clinical staging for the 688 patients was (1) IA (54.5%, 375/688); (2) IB (22.1%, 152/688); (3) IIA (18.2%, 125/688); and (4) IIB (5.2%, 36/688). The majority of these patients (95.2%, 655/688) underwent surgical resection. Unsuspected malignant endobronchial lesion on FB was found in only two cases (0.3%), and the surgical strategy had to be modified for both of these patients. Preoperative FB is not beneficial for screening the airways of almost any patient with early-stage NSCLC, provided that neither PET-CT nor CT reveal any evidence of endobronchial malignant involvement other than at the primary cancer site. Georg Thieme Verlag KG Stuttgart · New York.

  11. [Value of core needle biopsy in preoperative diagnostics of soft tissue tumors: possibilities and limitations].

    PubMed

    Agaimy, A

    2014-11-01

    The differential diagnosis of soft tissue swellings encompasses a variety of benign, intermediate, low-grade malignant and high-grade neoplastic lesions in addition to tumor-like reactive processes. As treatment of these heterogeneous conditions varies greatly from conservative observation and simple local excision up to extensive radical surgical resection, treatment decisions are based mainly on a precise preoperative histological diagnosis on limited biopsy material. Even for clinically unequivocal sarcomas, the importance of the preoperative histological diagnosis has been increasingly emphasized as different therapeutic regimens have been established for different sarcoma types and the indications for preoperative treatment is influenced by the tumor grade and by the entity itself. Other factors positively influencing the increasing use of core needle biopsy for preoperative tumor diagnosis in soft tissue pathology are the availability of modern high-resolution imaging modalities as well as the establishment of several new second generation immunohistochemical markers and the discovery of entity-specific translocations detected by fluorescence in situ hybridization (FISH) in several sarcoma subtypes. In this review it will be shown that a targeted approach for processing core needle biopsies oriented towards the characteristic topographical, demographic, cytomorphological and architectural features of soft tissue lesions facilitates a precise diagnosis of soft tissue neoplasms in most cases. However, profound knowledge of the different aspects of soft tissue tumor diagnostics and familiarity with the frequent as well as the less common and rare tumor entities and variants is a prerequisite for appropriate interpretation of core needle biopsy findings and for selecting a limited but well-suited marker panel. The utilization of modern immunohistochemistry and/or FISH methods is highly useful for establishing the diagnosis of rare and unusual neoplasms in core

  12. Preoperative Functional Findings and Surgical Outcomes in Patients with Motor Cortical Arteriovenous Malformation.

    PubMed

    Lin, Fuxin; Wu, Jun; Zhao, Bing; Tong, Xianzeng; Jin, Zhen; Cao, Yong; Wang, Shuo

    2016-01-01

    The relationship between preoperative functional findings, derived from functional magnetic resonance imaging and diffusion tensor imaging, and surgical outcomes in patients with motor cortical arteriovenous malformations (AVMs) has not been determined. The aim of this study was to determine the relationship between preoperative functional findings and surgical outcomes in patients with motor cortical AVM. Fifteen patients with AVM involving the precentral knob and/or paracentral lobule were reviewed. Each motor function involved was examined as an independent object. Preoperative functional findings included cortical reorganization, activation around the nidus, corticospinal tract (CST) reorganization, nidus involving the CST, and the level of the CST involved. The relationship between preoperative functional findings and surgical outcomes was analyzed statistically. A muscle strength of grade 3 or less was defined as a poor outcome after surgery, and a muscle strength of grade 4 or greater was defined as a good outcome. Eighteen objects were created and analyzed. Cortical reorganization (P = 1.000) was not correlated with surgical outcomes. However, nidus involving the CST was significantly associated with poor short-term outcomes (1 week after surgery) (P = 0.028) and permanent deficit in muscle strength (P = 0.042). Most of the objects had good outcomes (16/18, 88.9%) at 6 months after surgery (long-term outcomes). Only 1 patient with CST ruptured at the corona radiata level and 1 patient who had postoperative hemorrhage obtained poor long-term outcomes. Nidus involving the CST and the level of the CST involved, rather than cortical reorganization, may be associated with surgical outcomes in patients with motor cortical AVM. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Outcomes associated with preoperative weight loss after laparoscopic Roux-en-Y gastric bypass.

    PubMed

    Blackledge, Camille; Graham, Laura A; Gullick, Allison A; Richman, Joshua; Stahl, Richard; Grams, Jayleen

    2016-11-01

    Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective treatment for achieving and maintaining weight loss and for improving obesity-related comorbidities. As part of the approval process for bariatric surgery, many insurance companies require patients to have documented recent participation in a supervised weight loss program. The goal of this study was to evaluate the relationship of preoperative weight changes with outcomes following LRYGB. A retrospective review was conducted of adult patients undergoing LRYGB between 2008 and 2012 at a single institution. Patients were stratified into quartiles based on % excess weight gain (0-4.99 % and ≥5 % EWG) and % excess weight loss (0-4.99 % and ≥5 % EWL). Generalized linear models were used to examine differences in postoperative weight outcomes at 6, 12, and 24 months. Covariates included in the final adjusted models were determined using backwards stepwise selection. Of the 300 patients included in the study, there were no significant demographic differences among the quartiles. However, there was an increased time to operation for patients who gained or lost ≥5 % excess body weight (p < 0.001). Although there was no statistical significance in postoperative complications, there was a higher rate of complications in patients with ≥5 % EWG compared to those with ≥5 % EWL (12.5 vs. 4.8 %, respectively; p = 0.29). Unadjusted and adjusted generalized linear models showed no statistically significant association between preoperative % excess weight change and weight loss outcomes at 24 months. Patients with the greatest % preoperative excess weight change had the longest intervals from initial visit to operation. No significant differences were seen in perioperative and postoperative outcomes. This study suggests preoperative weight loss requirements may delay the time to operation without improving postoperative outcomes or weight loss.

  14. Preoperative treatment planning with intraoperative optimization can achieve consistent high-quality implants in prostate brachytherapy

    SciTech Connect

    Kudchadker, Rajat J.; Pugh, Thomas J.; Swanson, David A.; Bruno, Teresa L.; Bolukbasi, Yasemin; Frank, Steven J.

    2012-01-01

    Advances in brachytherapy treatment planning systems have allowed the opportunity for brachytherapy to be planned intraoperatively as well as preoperatively. The relative advantages and disadvantages of each approach have been the subject of extensive debate, and some contend that the intraoperative approach is vital to the delivery of optimal therapy. The purpose of this study was to determine whether high-quality permanent prostate implants can be achieved consistently using a preoperative planning approach that allows for, but does not necessitate, intraoperative optimization. To achieve this purpose, we reviewed the records of 100 men with intermediate-risk prostate cancer who had been prospectively treated with brachytherapy monotherapy between 2006 and 2009 at our institution. All patients were treated with iodine-125 stranded seeds; the planned target dose was 145 Gy. Only 8 patients required adjustments to the plan on the basis of intraoperative findings. Consistency and quality were assessed by calculating the correlation coefficient between the planned and implanted amounts of radioactivity and by examining the mean values of the dosimetric parameters obtained on preoperative and 30 days postoperative treatment planning. The amount of radioactivity implanted was essentially identical to that planned (mean planned radioactivity, 41.27 U vs. mean delivered radioactivity, 41.36 U; R{sup 2} = 0.99). The mean planned and day 30 prostate V100 values were 99.9% and 98.6%, respectively. The mean planned and day 30 prostate D90 values were 186.3 and 185.1 Gy, respectively. Consistent, high-quality prostate brachytherapy treatment plans can be achieved using a preoperative planning approach, mostly without the need for intraoperative optimization. Good quality assurance measures during simulation, treatment planning, implantation, and postimplant evaluation are paramount for achieving a high level of quality and consistency.

  15. Improving patient flow in pre-operative assessment

    PubMed Central

    Stark, Cameron; Gent, Anne; Kirkland, Linda

    2015-01-01

    Annual patient attendances at a pre-operative assessment department increased by 24.8% from 5659 in 2009, to 7062 in 2012. The unit was staffed by administrative staff, nurses, and health care assistants (HCA). Medical review was accessed via on call medical staff, or notes were sent to anaesthetists for further review. With rising demand, patient waits increased. The average lead time for a patient (time from entering the department to leaving) was 79 minutes. 9.3% of patients attended within two weeks of their scheduled surgery date. 10% of patients were asked to return on a later day, as there was not sufficient capacity to undertake their assessment. There were nine routes of referral in to the department. Patients moved between different clinic rooms and the waiting area several times. Work patterns were uneven, as many attendances were from out-patient clinics which meant peak attendance times were linked to clinic times. There were substantial differences in the approaches of different nurses, making the HCA role difficult. Patients reported dissatisfaction with waits. Using a Lean quality improvement process with rapid PDSA cycles, the service changed to one in which patients were placed in a room, and remained there for the duration of their assessment. Standard work was developed for HCWs and nurses. Rooms were standardised using 5S processes, and set up improved to reduce time spent looking for supplies. A co-ordinator role was introduced using existing staff to monitor flow and to organise the required medical assessments and ECGs. Timing of booked appointments were altered to take account of clinic times. Routes in to the department were reduced from nine to one. Ten months after the work began, the average lead time had reduced to 59 minutes. The proportion of people attending within two weeks of their surgery decreased from 9.3% to 5.3%. Referrals for an anaesthetic opinion decreased from 30% to 20%, and in the month reviewed no one had to return to

  16. Preoperative duplex ultrasound parameters predicting male fertility after successful varicocelectomy

    PubMed Central

    Alshehri, Fahad M.; Akbar, Mahboob H.; Altwairgi, Adel K.; AlThaqufi, Omar J.

    2015-01-01

    Objectives: To assess duplex ultrasound (DUS) parameters, and predicti the outcome of varicocele ligation in male infertility. Methods: This retrospective and follow up study was conducted at Dr. Sulaiman Al Habib Hospital, AlQassim, Saudi Arabia between January 2011 and December 2012. Eighty-two patients were selected, who presented with clinical/subclinical varicocele and male infertility. All these patients had DUS of the scrotum and underwent for low ligation varicocelectomy. These patients were followed for a period of 12-24 months after surgery for the occurrence of paternity. We reviewed pre-operative scrotal DUS of these 82 patients for the testicular size and volume, pampiniform veins caliber and duration of reflux in the dilated veins at rest, and after valsalva maneuver. These DUS parameters were correlated with the postoperative paternity rate. Results: Postoperative paternity was achieved in 18 patients (31.6%) with normal-sized testes, and in 3 patients (12%) with small size testes. The positive paternity rate was higher (38.5%) in patients with clinically detected varicocele, compared with only 16.7% of patients with subclinical varicocele (detected by ultrasound only). In addition, postoperative paternity was significantly higher in patients with bilateral varicocele (70.6%), with shunt-type varicocele (71.4%), and patients with a permanent grade of venous reflux (62.5%). Conclusion: Selection of patients for the successful paternity after varicocele repair depends mainly on DUS parameters, which includes normal size testicles with shunt type of bilateral varicocele and continuous reflux. PMID:26620986

  17. Making safer preoperative arrangements for patients using vitamin K antagonists

    PubMed Central

    van Fessem, Joris; Willems, Jessica; Kruip, Marieke; Hoeks, Sanne; Jan Stolker, Robert

    2017-01-01

    Use of vitamin K antagonists creates a risk for patient health and safety. The Dutch framework “Nationwide Standard Integrated Care of Anticoagulation” propagates a shared plan and responsibility by surgeon and anesthesiologist together in the preoperative setting. In our institution, this framework had not been implemented. Therefore, a quality-improvement project was started at the Anesthesia Department to improve perioperative safety. After exploration of barriers, multiple interventions were carried out to encourage co-workers at the preoperative screening department to take shared responsibility: distribution of prints, adjustments in electronic patient records, introduction of a protocol and education sessions. Efficacy was measured retrospectively performing a before-after study collecting perioperative data of patients using vitamin K antagonists. The primary outcome measure was the percentage of predefined safe preoperative plans. Secondary outcome measures were (1) incidence of postoperative bleeding and thrombo-embolic events within the first 24 hours after intervention and (2) necessity to preoperative correction of anticoagulation. Before intervention 72 (29%) safe, 93 (38%) partially unsafe and 83 (33%) unsafe arrangements were made. After the intervention these numbers were 105 (80%), 23 (17%) en 4 (3%), respectively: a significant 51% increase in safe preoperative plans (P<0.001). We observed no significant difference (P=0.369) regarding bleeding and thrombo-embolic events: pre-intervention 12 (5%) cases of postoperative bleeding were documented, vs. 6 (5%) post intervention and the number of thrombo-embolic events was 5 (2%) vs. 0. Also, no significant differences concerning preoperative correction of anticoagulation were observed: 11 (4%) vs. 8 (6%) (P=0.489). This quality improvement project demonstrates a major improvement in safer preoperative arrangements in our institution regarding vitamin K antagonists, using the described interventions

  18. Role of preoperative cycloplegic refraction in LASIK treatment of hyperopia.

    PubMed

    Frings, Andreas; Steinberg, Johannes; Druchkiv, Vasyl; Linke, Stephan J; Katz, Toam

    2016-07-01

    Previous studies have suggested that, to improve refractive predictability in hyperopic LASIK treatments, preoperative cycloplegic or manifest refraction, or a combination of both, could be used in the laser nomogram. We set out to investigate (1) the prevalence of a high difference between manifest and cycloplegic spherical equivalent in hyperopic eyes preoperatively, and (2) the related predictability of postoperative keratometry. Retrospective cross-sectional data analysis of consecutive treated 186 eyes from 186 consecutive hyperopic patients (mean age 42 [±12] years) were analyzed. Excimer ablation for all eyes was performed using a mechanical microkeratome (SBK, Moria, France) and an Allegretto excimer laser platform. Two groups were defined according to the difference between manifest and cycloplegic spherical equivalent which was defined as ≥1.00 diopter (D); the data was analyzed according to refractive outcome in terms of refractive predictability, efficacy, and safety. In 24 eyes (13 %), a preoperative difference of ≥1.00D between manifest spherical equivalent and cycloplegic spherical equivalent (= MCD) occurred. With increasing preoperative MCD, the postoperative achieved spherical equivalent showed hyperopic regression after 3 months. There was no statistically significant effect of age (accommodation) or optical zone size on the achieved spherical equivalent. A difference of ≥1.00D occurs in about 13 % of hyperopia cases. We suggest that hyperopic correction should be based on the manifest spherical equivalent in eyes with preoperative MCD <1.00D. If the preoperative MCD is ≥1.00D, treatment may produce manifest undercorrection, and therefore we advise that the patient should be warrned about lower predictability, and suggest basing conclusions on the arithmetic mean calculated from the preoperative manifest and cycloplegic spheres.

  19. Preoperative Evaluation of Patients with Diabetes Mellitus.

    PubMed

    Miller, Joshua D; Richman, Deborah C

    2016-03-01

    There are more than 29 million people in the United States with diabetes; it is estimated that by 2050, one in 3 individuals will have the disease. At least 50% of patients with diabetes are expected to undergo surgery in their lifetime. Complications from uncontrolled diabetes can impact multiple organ systems and affect perioperative risk. In this review, the authors discuss principles in diabetes management that will assist the perioperative clinician in caring for patients with diabetes.

  20. [Multilocular cystic nephroma. Preoperative diagnosis with CAT].

    PubMed

    González Escalante, A; García Riestra, V; Fernández García, M L; Relea Sarabia, A; Beiras Garcia, M; Varela Salgado, M; Sarandeses Portela, A; Alcázar Otero, J J

    1993-01-01

    We report a case of multilocular cystic nephroma in a 45-year-old female patient who had been referred for urological evaluation on detecting a mass in the left lumbar region. Patient work up included CT evaluation, which proved to be the most useful in making the diagnosis. The literature is reviewed with special reference to the nature of this lesion and the existing controversy on whether it is an embryonary tumor or a congenital malformation.

  1. Utility of preoperative in vitro platelet function tests for predicting bleeding risk in patients undergoing functional endoscopic sinus surgery

    PubMed Central

    Lee, A-Jin; Kim, Sang-Gyung

    2016-01-01

    Background It is necessary to predict the bleeding risk in patients undergoing functional endoscopic sinus surgery (FESS). To evaluate the adequacy of primary hemostasis, preoperative hemostatic screening tests are used. In the present study, we determined whether there is a positive correlation between prolonged closure time (CT) with collagen/epinephrine (CT-epi), prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT) and bleeding during FESS. Patients and methods We reviewed the medical records of 90 patients without bleeding histories who had undergone FESS from March 2013 to June 2014. More than 200 mL of blood loss was defined as moderate bleeding during surgery. With respect to bleeding during surgery, we determined the sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of CT-epi, PT, INR and aPTT. Results Of the 90 patients, 17 (18.9%) patients had preoperative prolonged CT values and three (17.6%) patients had bleeding. In comparison, five (6.8%) of the 73 (81.1%) patients who had undergone FESS with preoperative normal PFA values experienced bleeding (P=0.171). On the other hand, patients with prolonged PT values (2, 2.2%), prolonged INR values (3, 3.3%) or prolonged PTT values (1, 1.1%) had no bleeding episode. Preoperative CT had low sensitivity (44.4%) and PPV (23.5%). Conclusion During preoperative period, the hemostatic screening may not be helpful to detect the bleeding tendency in adult patients undergoing FESS. Routine measurement of CT-epi, PT, INR and aPTT for preoperative screening may not be recommended for FESS patients. PMID:27799837

  2. Effect of acupressure on preoperative anxiety: a clinical trial.

    PubMed

    Valiee, Sina; Bassampour, Shiva Sadat; Nasrabadi, Alireza Nikbakht; Pouresmaeil, Zahra; Mehran, Abbas

    2012-08-01

    Preoperative anxiety, as an emotional reaction, is common among patients undergoing surgery. The purpose of this study was to examine the effect of acupressure on preoperative anxiety before abdominal surgery. The 70 subjects of this clinical trial were randomly assigned into the acupressure group (n=35), which received acupressure at the true points, or the placebo group (n=35), which received acupressure at sham (false) points. Preoperative anxiety and vital signs before and after the intervention were measured in both groups. The findings demonstrated a reduction in the level of preoperative anxiety for both groups (P<.001). Furthermore, they showed a statistically significant difference between the mean of vital signs before and after the intervention in the acupressure group (P<.001) and only statistically significant results for cardiovascular (P=.016) and respiratory rates (P=.007) in the placebo group. Overall, findings revealed that acupressure at true points (third eye and Shen men) can reduce higher preoperative anxiety of patients before abdominal surgery and that it has had a more clinically beneficial effect than sham points.

  3. Validation of a virtual preoperative evaluation clinic: a pilot study.

    PubMed

    Zetterman, Corey V; Sweitzer, Bobbie J; Webb, Brad; Barak-Bernhagen, Mary A; Boedeker, Ben H

    2011-01-01

    Patients scheduled for surgery at the Omaha VA Medical Center were evaluated preoperatively via telemedicine. Following the examination, patients filled out a 15 item, 5 point Likert scale questionnaire regarding their opinion of preoperative evaluation in a VTC format. Evaluations were performed under the direction of nationally recognized guidelines and recommendations of experts in the field of perioperative medicine and were overseen by a staff anesthesiologist from the Omaha VA Medical Center. No significant difficulties were encountered by the patient or the evaluator regarding the quality of the audio/visual capabilities of the VTC link and its ability to facilitate preoperative evaluation. 87.5% of patients felt that virtual evaluation would save them travel time; 87.5% felt virtual evaluation could save them money; 7.3% felt uncomfortable using the VTC link; 12.2% felt the virtual evaluation took longer than expected; 70.7% preferred to be evaluated via VTC link; 21.9% were undecided; 9.7% felt they would rather be evaluated face-to-face with 26.8% undecided; 85.0% felt that teleconsultation was as good as being seen at the Omaha surgical evaluation unit; 7.5% were undecided. Our study has shown that effective preoperative evaluation can be performed using a virtual preoperative evaluation clinic; patients are receptive to the VTC format and, in the majority of cases, prefer it to face-to-face evaluation.

  4. Role of preoperative vascular ultrasonography in hemodialysis vascular access operation.

    PubMed

    Siribumrungwong, Boonying; Tomtitchong, Prakitpunthu; Kanpirom, Kitti

    2010-12-01

    Preoperative vascular mapping increase rate of successful hemodialysis vascular access operation. Several studies recommend using this procedure routinely. But some studies recommend using this procedure in selected patients. So this study aims to determine the impacts of preoperative vascular mapping in unfavorable-examined patients. 55 patients were studied retrospectively from August 2006 to October 2009. Before April 2008, the operative plans were based on physical examination (group 1). After April 2008, the surgeon did preoperative vascular mapping prior to the operation in unfavorable-examined patients (group 2). The results were compared. There were high maturation rates in favorable-examined patients. In unfavorable-examined patients, preoperative vascular mapping can identified nonpalpable favorable vein which successful maturation of 18.75%. Complementary duplex scan decrease rate of unsuccessful operation significantly (p = 0.037) but does not increase maturation rate. Careful physical examination is important part before operation. Preoperative vascular mapping has benefit only in patients with unfavorable-examined patients. It finds some nonpalpable favorable vein and decrease unsuccessful exploration.

  5. Surgical Risk Preoperative Assessment System (SURPAS): III. Accurate Preoperative Prediction of 8 Adverse Outcomes Using 8 Predictor Variables.

    PubMed

    Meguid, Robert A; Bronsert, Michael R; Juarez-Colunga, Elizabeth; Hammermeister, Karl E; Henderson, William G

    2016-07-01

    To develop accurate preoperative risk prediction models for multiple adverse postoperative outcomes applicable to a broad surgical population using a parsimonious common set of risk variables and outcomes. Currently, preoperative assessment of surgical risk is largely based on subjective clinician experience. We propose a paradigm shift from the current postoperative risk adjustment for cross-hospital comparison to patient-centered quantitative risk assessment during the preoperative evaluation. We identify the most common and important predictor variables of postoperative mortality, overall morbidity, and 6 complication clusters from previously published prediction analyses that used forward selection stepwise logistic regression. We then refit the prediction models using only the 8 most common and important predictor variables, and compare the discrimination and calibration of these models to the original full-variable models using the c-index, Hosmer-Lemeshow analysis, and Brier scores. Accurate risk models for 30-day outcomes of mortality, overall morbidity, and 6 clusters of complications were developed using a set of 8 preoperative risk variables. C-indexes of the 8 variable models are between 97.9% and 99.2% of those of the full models containing up to 28 variables, indicating excellent discrimination using fewer predictor variables. Hosmer-Lemeshow analyses showed observed to expected event rates to be nearly identical between parsimonious models and full models, both showing good calibration. Accurate preoperative risk assessment of postoperative mortality, overall morbidity, and 6 complication clusters in a broad surgical population can be achieved with as few as 8 preoperative predictor variables, improving feasibility of routine preoperative risk assessment for surgical patients.

  6. Preoperative use of pregabalin for acute pain in spine surgery

    PubMed Central

    Jiang, Hai-liang; Huang, Shuang; Song, Jiang; Wang, Xiang; Cao, Zhong-shu

    2017-01-01

    Abstract Background: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of pregabalin for pain management following spine surgery. Methods: In September 2016, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews. RCTs of patients prepared for spine surgery that compared pregabalin with placebo were retrieved. The primary endpoint was the VAS score with rest or mobilization at 12 hours, 24 hours, and 48 hours and cumulative morphine consumption at 24 hours and 48 hours. The secondary outcomes were complications of nausea, sedation, dizziness, headache, and visual disturbances. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary. Results: Ten clinical studies with 535 patients (pregabalin group = 294, control group = 241) were included in the meta-analysis. Pregabalin was associated with reduced pain scores at 12 hours, 24 hours, and 48 hours, corresponding to a reduction of 1.91 points (95% CI, –4.07 to 0.24 point) at 12 hours, 2.66 points (95% CI, –4.51 to –0.81 point) at 24 hours, and 4.33 points (95% confidence interval, –6.38 to –2.99 point) at 48 hours on a 100-point numeric rating scale. There was no significant difference between VAS scores with mobilization at 12 hours, 24 hours, or 48 hours. Similarly, pregabalin was associated with a reduction in cumulative morphine consumption at 24 hours (–7.07, 95% CI –9.84, –4.30) and 48 hours (–6.52, 95% CI –7.78, –5.25, P = 0.000). Furthermore, pregabalin can reduce the occurrence of nausea (RR 0.57, 95% CI 0.41, 0.79, P = 0.001, number needed to treat = 8.4). There were no significant differences in the occurrence of sedation, dizziness, headache, or visual disturbances. Conclusions: Preoperative use of pregabalin was

  7. Measuring preoperative anxiety in patients with breast cancer using the visual analog scale.

    PubMed

    Aviado-Langer, Jennifer

    2014-10-01

    Preoperative anxiety is a prevalent concern with deleterious effects in patient recovery and is not routinely assessed in the preoperative screening process. When it is assessed, it may prompt an increase in the use of anesthetic agents, heightened postoperative pain, and prolonged hospitalization. Preoperative women with breast cancer face anxiety as it relates to anesthesia, surgery, and recovery. The preoperative anxiety visual analog scale may identify and quantify anxiety in this population, provide advocacy and support, and improve the preoperative screening process.

  8. Reviews

    ERIC Educational Resources Information Center

    Schodde, P.; Ed.

    1976-01-01

    Reviews 17 books and curriculum materials of interest to secondary science teachers. Topics include plant science, pollution, fishes, science investigations, general zoology, neurobiology, electronics, and the environment. (MLH)

  9. Reviews

    ERIC Educational Resources Information Center

    Schodde, P.; Ed.

    1976-01-01

    Reviews 17 books and curriculum materials of interest to secondary science teachers. Topics include plant science, pollution, fishes, science investigations, general zoology, neurobiology, electronics, and the environment. (MLH)

  10. Preoperative IABP in high risk patients undergoing CABG.

    PubMed

    Theologou, T; Field, M L

    2011-01-01

    A recent international consensus conference on the reduction in mortality in cardiac anesthesia and intensive care included intraoperative aortic balloon pump among the ancillary (i.e. non-surgical) drugs/techniques/strategies that might influence survival rates in patients undergoing cardiac surgery. The consensus conferences state that "Pre-operative intraoperative aortic balloon pump might reduce 30-day mortality in elective high risk patients undergoing coronary artery bypass surgery unless specifically contraindicated". The authors of this "expert opinion" presents their insights into the use of the preoperative intraoperative aortic balloon pump and conclude that based on available limited randomized controlled trials and clinical experience preoperative intraoperative aortic balloon pump saves lives in unstable patients.

  11. Assessment of obstetric brachial plexus injury with preoperative ultrasound.

    PubMed

    Smith, Edward C; Xixis, Kathryn Idol; Grant, Gerald A; Grant, Stuart A

    2016-06-01

    Tools used in the assessment of obstetric brachial plexus injuries (OBPIs) have traditionally included electrodiagnostic studies, computerized tomography with myelography, and MRI. However, the utility of ultrasound (US) in infants for such assessment has not been extensively examined. This retrospective case series reports the preoperative brachial plexus US findings in 8 patients with OBPI and compares US with intraoperative findings. When available, the preoperative US was compared with the preoperative MRI. US revealed abnormalities in all 8 patients. Although MRI detected abnormalities in the majority of patients, US provided accurate information regarding severity and anatomic location of injury in some patients. US is a relatively inexpensive, noninvasive, painless diagnostic modality that can be used to assess OBPI. This case series suggests that US is a valuable adjunct to current diagnostic modalities. Muscle Nerve 53: 946-950, 2016. © 2015 Wiley Periodicals, Inc.

  12. Preoperational practices for steam generators and secondary-system components

    SciTech Connect

    Not Available

    1991-09-01

    PWR operating experience has shown that proper control of steam generator and secondary plant cleanliness during construction will prevent corrosion of critical components, minimize impurity transport to the steam generators, and minimize startup delays. This volume contains the following guidelines which address preoperational practices: Preoperational Flushing, Cleaning, and Layup of PWR Steam/Feedwater/Condensate Systems, Revision 1; and Guidelines to Minimize Contamination of PWR Steam Generators during Plant Construction, Revision 1. The guidelines provide specific recommendations and associated justifications for maintaining steam generator cleanliness during shipment, storage, and installation; and secondary plant cleanliness during construction. Recommendations for preoperational cleaning and flushing of secondary systems are also provided. 1 ref., 9 figs., 2 tabs.

  13. Development, Functioning, and Effectiveness of a Preoperative Risk Assessment Clinic

    PubMed Central

    Tariq, Hassan; Ahmed, Rafeeq; Kulkarni, Salil; Hanif, Sana; Toolsie, Omesh; Abbas, Hafsa; Chilimuri, Sridhar

    2016-01-01

    Lee first described the concept of preoperative assessment testing (PAT) clinic in 1949. An efficiently run clinic is associated with increased cost-effectiveness by lowering preoperative admission time and thus reducing the length of stay and the associated costs. The setup of the PAT clinic should be based on the needs, culture, and resources of the institution. Various models for the setup of PAT clinic have been described, including the concept of a perioperative surgical home, which is a patient-centered model designed to improve health and the delivery of health care and to reduce the cost of care. Although there are several constraints in the development of PAT clinics, with increasing awareness about the usefulness of pre-operative risk assessments, growing bodies of literature, and evidence-based guidelines, these clinics are becoming a medical necessity for the improvement of perioperative care. PMID:27812286

  14. Development, Functioning, and Effectiveness of a Preoperative Risk Assessment Clinic.

    PubMed

    Tariq, Hassan; Ahmed, Rafeeq; Kulkarni, Salil; Hanif, Sana; Toolsie, Omesh; Abbas, Hafsa; Chilimuri, Sridhar

    2016-01-01

    Lee first described the concept of preoperative assessment testing (PAT) clinic in 1949. An efficiently run clinic is associated with increased cost-effectiveness by lowering preoperative admission time and thus reducing the length of stay and the associated costs. The setup of the PAT clinic should be based on the needs, culture, and resources of the institution. Various models for the setup of PAT clinic have been described, including the concept of a perioperative surgical home, which is a patient-centered model designed to improve health and the delivery of health care and to reduce the cost of care. Although there are several constra