EP.FRI.132 Current practice in the investigation and management of post-operative ileus

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Camilla English ◽  
Adam Jakes ◽  
Sarah Wheatstone
Keyword(s):  
Ct Scan ◽  
Gastrointestinal Motility ◽  
Serum Potassium ◽  
Current Practice ◽  
Serum Magnesium ◽  
Initial Assessment ◽  
Evidence Based ◽  
Clinical Coding ◽  
Clinical Notes ◽  
Clinical Variation

Abstract Post-operative ileus is non-obstructive impairment of gastrointestinal motility after surgery. Treatment involves nil-by-mouth, correction of electrolytes and stopping aggravating medications. There is no national/trust guideline for investigation and management of post-operative ileus.  Aim To assess current practice in investigation and management of post-operative ileus.  Method All patients with a diagnosis of post-operative ileus on surgical wards at a London hospital between November - December 2020 were identified using clinical coding. Their clinical notes were reviewed and common themes explored.   Results 16 patients were diagnosed with post-operative ileus. 12 (75%) patients were male, with a median age of 60 (IQR: 28). 10 (63%) were open procedures, majority being colorectal (10; 63%), cardiothoracic (3; 19%), urological (2; 13%), vascular (1; 6%) operations. Average time between operation and diagnosis was 5.2 (range: 2-14) days. Only 2 (12.5%) patients had documented auscultation of bowel sounds at initial assessment. 8 (50%) patients had imaging to confirm diagnosis (AXR; 5, CT scan; 4). Majority (15; 94%) of patients had serum magnesium and potassium checked at diagnosis. Patients with serum potassium <4.0mmol/L (5) and magnesium <0.7mmol/L (2) had intravenous supplementation. 14 (88%) were administered Hartmann’s solution. 10 (63%) patients were made nil-by-mouth and 15 (94%) had a Ryles tube inserted. 2 (12.5%) patients were prescribed a prokinetic, and only 2 had either opioids or laxatives stopped. No patients were offered gum.  Conclusion There is apparent clinical variation in investigation and management of post-operative ileus. We plan to develop an evidence-based trust guideline to reduce unwarranted clinical variation. 

scholarly journals 928 Current Practice in The Investigation and Management of Post-Operative Ileus

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
C English ◽  
A Jakes ◽  
S Wheatstone
Keyword(s):  
Ct Scan ◽  
Gastrointestinal Motility ◽  
Serum Potassium ◽  
Current Practice ◽  
Serum Magnesium ◽  
Initial Assessment ◽  
Evidence Based ◽  
Bowel Sounds ◽  
Clinical Notes ◽  
Clinical Variation

Abstract Introduction Post-operative ileus is non-obstructive impairment of gastrointestinal motility after surgery. Treatment involves nil-by-mouth, correction of electrolytes and stopping aggravating medications. There is no current national/trust guideline for investigation and management of post-operative ileus. Aim To assess current practice in investigation and management of post-operative ileus on surgical wards at St Thomas’s Hospital. Method All patients with a diagnosis of post-operative ileus on surgical wards between November - December 2020 were identified. Their clinical notes were reviewed, and common themes explored. Results 16 patients were diagnosed with post-operative ileus. 12 (75%) patients were male, with a median age of 60 (IQR: 28). 10 (63%) were open procedures, majority being colorectal (10; 63%), cardiothoracic (3; 19%), urological (2; 13%), vascular (1; 6%) operations. Average time between operation and diagnosis was 5.2 (range: 2-14) days. Bowel sounds were auscultated in only 2 (12.5%) patients at initial assessment. 8 (50%) patients had imaging to confirm diagnosis (AXR; 5, CT scan; 4). Majority (15; 94%) of patients had serum magnesium and potassium checked at diagnosis. All patients with serum potassium <4.0mmol/L (5) and magnesium <0.7mmol/L (2) had intravenous supplementation. 14 (88%) were administered Hartmann’s solution. 10 (63%) patients were made nil-by-mouth and 15 (94%) had a Ryles tube inserted. 2 (12.5%) patients were prescribed a prokinetic, and only 2 had either opioids or laxatives stopped. No patients were offered gum. Conclusions There is apparent clinical variation in investigation and management of post-operative ileus. We plan to develop an evidence-based trust guideline to reduce unwarranted clinical variation.

scholarly journals Surveillance AFter Extremity Tumor surgerY (SAFETY): A Protocol for an International Randomized Controlled Trial

2018 ◽  
Author(s):  
Patricia Schneider ◽  
Michelle Ghert
Keyword(s):  
Ct Scan ◽  
Chest Radiograph ◽  
Controlled Trial ◽  
Disease Recurrence ◽  
Evidence Based ◽  
Treatment Groups ◽  
Randomized Controlled ◽  
Extremity Sarcoma ◽  
Chest Ct Scan

Title: Surveillance AFter Extremity Tumor surgerY International Randomized Controlled TrialShort Title: SAFETYMethodology: Multi-center, 2 x 2 factorial superiority randomized controlled trial (RCT).Coordinating Center: This study will be centrally coordinated by the Methods Center at the Center for Evidence-Based Orthopaedics (CEO) at McMaster University in Hamilton, Ontario Canada. Clinical Sites: We are expecting ten clinical sites to be involved in the pilot phase. Further sites will be recruited for the definitive phase.Primary Objectives: The overall objective is to determine the effect of surveillance strategy on patient survival after surgery for a soft-tissue sarcoma of the extremity by comparing the effectiveness of: A) a surveillance frequency of every three months vs. every six months; and B) CT scans vs. chest radiographs.Secondary Objectives: We will explore: A) the effects of the post-operative surveillance strategies on patient-important outcomes (patient anxiety, overall satisfaction and quality of life), oncologic outcomes (local recurrence- and metastasis-free survival) and treatment-related complications (chemotherapy- and thoracotomy-related complications); and B) the net costs of post-operative surveillance strategies and of metastasis treatment and treatment-related complications. Treatment Groups: This study will compare two surveillance frequencies (every three months vs. every six months) and two imaging modalities (CT scan vs. chest radiograph) for a total of four treatment groups: 1)Surveillance visit and chest CT scan every three months for two years;2)Surveillance visit and chest CT scan every six months for two years; 3)Surveillance visit and chest radiograph every three months for two years; or4)Surveillance visit and chest radiograph every six months for two years. Study Outcome: The primary outcome is overall survival at five years post-randomization. Follow-Up: Upon completion of the two-year intervention phase, study participants will be followed every six months for another three years. Sample Size: Pilot - 200 participants | Definitive - 830 participantsEstimated Study Duration: Pilot - September 2019 – January 2023 | Definitive - TBDSignificance: Following treatment for a primary extremity sarcoma, patients remain at risk for the development of local and systemic disease recurrence. Metastasis (distant recurrence) to the lung is the most frequent single location of disease recurrence in sarcoma patients, occurring in almost half of all patients. Therefore, careful post-operative surveillance is an integral element of patient care. However, the detection of metastases does not necessarily affect long-term survival and may negatively impact quality of life. Surveillance strategies have not been well researched and have been identified as the top research priority in the extremity sarcoma field. The SAFETY trial will provide the necessary evidence to develop evidence-based surveillance guidelines, and is poised to have a significant impact on the post-operative care and outcomes of extremity soft-tissue sarcoma patients.

scholarly journals Recurrent Generalized Seizures with Postictal Todd’s Paralysis Caused by Medication-Associated Severe Hypomagnesemia: A Case Report

2021 ◽  
pp. 85-90
Author(s):  
Abdalla Khalil ◽  
Jithesh Choyi ◽  
Khalil Hossenbux ◽  
Ahmed Taha
Keyword(s):  
Emergency Department ◽  
Serum Potassium ◽  
Serum Magnesium ◽  
Facial Asymmetry ◽  
Recurrent Seizure ◽  
Electrolyte Disturbances ◽  
Generalized Seizures ◽  
Prolonged Qt Interval ◽  
Ct Brain

Hypomagnesemia is one of the electrolyte disturbances that can cause seizures. It is common in the hospitalized patients and can be induced by long-term usage of many medications. A 68-year-old male known to have hypertension and gastroesophageal reflux presented to the Emergency Department with an unprovoked first seizure at home followed by a temporary right-sided hemiparesis, dysphasia, and facial asymmetry. The hemiparesis, dysphasia, and facial asymmetry resolved within less than an hour after the seizure. His serum potassium was low with prolonged QT interval in the electrocardiogram (serum magnesium was not checked in the Emergency Department). He received intravenous IV potassium chloride infusion, and his serum potassium level was corrected, but he had a recurrent seizure after 10 h. At that time, his serum magnesium was found to be very low, he received IV magnesium sulfate infusion, and his indapamide, omeprazole, and metformin medications were stopped. He had no further seizures, the rest of his blood tests were normal, and his CT brain was unremarkable. He was treated for aspiration pneumonia, and his outpatient MRI brain and EEG came to be normal too.

The Future of Priority-Setting in Global Health

2019 ◽  
pp. 317-326
Author(s):  
Trygve Ottersen ◽  
Joseph Millum ◽  
Jennifer Prah Ruger ◽  
Stéphane Verguet ◽  
Kjell Arne Johansson ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Global Health ◽  
Health Effects ◽  
Priority Setting ◽  
Systematic Approach ◽  
Current Practice ◽  
Evidence Based ◽  
Normative Issues ◽  
Distributional Impact

This book has sought to inform efforts to improve systematic, evidence-based priority-setting by assessing the state-of-the-art of methods for priority-setting, engaging with the fundamental normative issues at stake, and providing specific recommendations for improving current practice. This final chapter, written by the eight editors of this volume, provides seven key recommendations for future priority-setting in global health: (1) A more systematic approach to priority-setting in health is needed; (2) Information on cost-effectiveness is essential; (3) Distributional impact needs to be integrated; (4) Stillbirths need to be integrated; (5) Non-health effects need to be integrated; (6) Process needs to be emphasized alongside substantive criteria; and (7) New methods and tools need to be used and further developed.

Improving Oral Care in Patients Receiving Mechanical Ventilation

2005 ◽  
Vol 14 (5) ◽  
pp. 389-394 ◽  
Author(s):  
Constance J. Cutler ◽  
Nancy Davis
Keyword(s):  
Mechanical Ventilation ◽  
Best Practice ◽  
Current Practice ◽  
Oral Care ◽  
Implementation Strategies ◽  
Baseline Period ◽  
Evidence Based ◽  
Oral Secretions ◽  
Mucosal Tissues ◽  
Care Practices

• Background Comprehensive oral care is an evidence-based prevention strategy to reduce the risk of ventilator-associated pneumonia in patients receiving mechanical ventilation. Until recently, no comprehensive guidelines or standards existed to define necessary tasks, methods, and frequency of oral care to provide patients with optimal results. • Objectives To observe current practice of, define best practice for, and measure compliance with standardized comprehensive oral care. • Methods This observational study was part of a larger research study performed at 5 acute care hospitals. Time blocks of 4 hours were randomized over 8 intensive care units and the 7 days of the week. Baseline data were collected before implementation of multifaceted education on an oral-cleansing protocol; interventional data were collected afterward. • Results Oral care practices were observed for 253 patients. During the baseline period, oral cleansing was primarily via suction swabs. Toothbrushing and moisturizing of the oral tissues were not observed. Only 32% of the patients had suctioning to manage oral secretions. During the interventional period, 33% of patients had their teeth brushed, 65% had swab cleansing, and 63% had a moisturizer applied to the oral mucosal tissues. A total of 61% had management of oral secretions; 38% had oropharyngeal suctioning via a special catheter. • Conclusions Implementation of an evidence-based oral cleansing protocol improved the care of patients receiving mechanical ventilation. Multifaceted education and implementation strategies motivated staff to increase oral care practices.

Ethical Practice of Cognitive Behavior Therapy

2015 ◽  
Author(s):  
Debbie Sookman
Keyword(s):  
Behavior Therapy ◽  
Cognitive Behavior Therapy ◽  
Ethical Issues ◽  
Complex Interventions ◽  
Initial Assessment ◽  
Evidence Based ◽  
Cognitive Behavior ◽  
Ethical Practice ◽  
Psychotherapeutic Treatment ◽  
Specific Symptoms

Contemporary cognitive behavior therapy (CBT) comprises complex interventions that have demonstrated efficacy and/or are currently the evidence-based psychotherapeutic treatment of choice for many psychiatric disorders. This chapter discusses management of ethical issues that may arise during evidence-based CBT: initial assessment, informed consent, exposure-based therapy, out of office sessions, management of boundaries, homework, and risk management. The patient-therapist relationship and conceptualization of resistance during CBT are discussed. A crucial requirement of ethical mental health care is additional dissemination of CBT expertise. In this current era of specialization, interventions that target disorder specific symptoms and related difficulties (American Psychiatric Association,2013) show special promise. It is the ethical responsibility of clinicians regardless of orientation to be guided by current empirical research and their own specific areas of competence when making treatment recommendations. A priority for clinical research is further examination of the specific therapeutic ingredients that impact outcome and optimize recovery.

Choosing an Advanced Therapy in Parkinson’s Disease; is it an Evidence-Based Decision in Current Practice?

2016 ◽  
Vol 6 (3) ◽  
pp. 533-543 ◽  
Author(s):  
Frouke A.P. Nijhuis ◽  
Jolien van Heek ◽  
Bastiaan R. Bloem ◽  
Bart Post ◽  
Marjan J. Faber
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Current Practice ◽  
Evidence Based ◽  
Advanced Therapy

PTSD Treatment of African American Adults in Primary Care: The Gap Between Current Practice and Evidence-Based Treatment Guidelines

2011 ◽  
Vol 103 (7) ◽  
pp. 585-593 ◽  
Author(s):  
Ruth Elaine Graves ◽  
John R. Freedy ◽  
Notalelomwan U. Aigbogun ◽  
William B. Lawson ◽  
Thomas A. Mellman ◽  
...  
Keyword(s):  
Primary Care ◽  
African American ◽  
Current Practice ◽  
Treatment Guidelines ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
Ptsd Treatment ◽  
African American Adults
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