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PubMed1991

Laparoscopic appendectomy incidental to gynecologic procedures.

1. The advantages of laparoscopic appendectomy over the traditional "open" method include decreased chance of wound infection, early ambulation and resumption of normal daily activities, decreased postoperative pain, improved diagnostic accuracy, better visualization of intra-abdominal anatomy, improved cosmetic results, and avoidance of "open" appendectomy if pathology is found during routine gynecologic laparoscopic surgery. 2. Single-puncture laparoscopy has several advantages over the multiple-puncture approach, including simplicity, expediency, lower cost, avoidance of potential complications associated with multiple punctures, improved cosmetic results, and flexibility to be converted into multiple-puncture laparoscopy or laparotomy when indicated. 3. Laparoscopy is expected to eventually replace laparotomy as the primary approach for most cases of diseases of the appendix. It is not suitable in cases of dense adhesions with distorted anatomy, malignancy, or severe pelvic peritonitis.

Appendectomy↗

PubMed1995

Cryosurgical ablation of the prostate.

A new surgical procedure, cryosurgical ablation of the prostate, offers patients with organ-confined prostate cancer another treatment option. The advantages of this cryosurgical technique are complete ablation of prostatic cancers without radical prostatectomy procedures, less blood loss, decreased hospital stays, reduced health care costs, and minimal associated morbidity. Some possible complications of cryosurgical ablation of the prostate procedures include incontinence, impotence, rectal freezing from inadequate monitoring of the freezing process, urethrocutaneous and urethrorectal fistula formations, and urethral tissue sloughing. The intraoperative nurse's prime responsibility is to monitor the subfreezing temperatures of the cryoprobes. Postoperatively, patients have only a few perineal incisions covered with sterile dressings and a suprapubic catheter. Most patients have minimal discomfort that is managed easily with opiate analgesics.

Cryosurgery↗

PubMed1990

[A study on the effect of waiting time for operations in the operating room on preoperative patients].

This study was attempted to provide us with basic information on how to improve understanding with patients for operation, and to offer them better nursing and treatment. This kind of study will help scientific application to nursing practice and operating room. The data was collected by interviewing 29 patients who underwent the elective surgery under the general anesthesia at Y hospital in Seoul. The interview ran from October 15 to December 15, 1989. The research instrument was a anxiety measurement device (SAAI) originally developed by Spielberger, et al and modified by Jung-Tack Kim. 1. Hypothesis Testing Hypothesis one was that there would be a difference in state anxiety level according to a time difference in waiting for operation. This hypothesis was rejected (state anxiety level one hour before operation P greater than .05, r = .747, State anxiety level half an hour before operation P greater than .05, r = .1550, state anxiety level just before operation, P greater than .05, r = .1099). However, state anxiety level appeared to be associated with a longer waiting period, like one day before operation (P less than .05, r = .4628). Hypothesis two was that there would be a difference according to state anxiety level of patients for operation. This was rejected. (Change of blood pressure in systolic P greater than .05, r = -.1082. Change of blood pressure in diastolic P greater than .05, r = -.088, Change of pulse rate, P less than .05, r = 1.909) 2. Examining trait anxiety and state anxiety levels, the average level of trait anxiety was 42.034, and the average level of state anxiety one day before operation was 43,000. The average level of state anxiety was averaged 42.356 in a waiting room for operation. 3. Examining the state anxiety level by time period, the level one hour before was 42.379, the level half an hour before 42.276, and the level just before operation 42.414. The low level of state anxiety was due to the fact that premedication was not eliminated. 4. Age and time period like one day before operation was related to state anxiety level (F = 5.271, P less than .001) and blood pressure in waiting room for operation. That is, state anxiety level and blood pressure of patients one day before operation appeared high. Sex was related to changes of blood pressure; the blood pressure of male patients appeared higher than that of female patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Anxiety↗

PubMedDate not supplied

When the OR nurse is discouraged.

1. Though not often associated with OR staff, discouragement (defined as a lack of confidence) is occasionally experienced by OR nurses. 2. Factors that contribute to feelings of discouragement include environmental stressors, personality characteristics, and physical and emotional status. 3. Methods to decrease feelings of discouragement include identifying sources of discouragement, communicating concerns through appropriate channels, sharing feelings with trusted others, increasing knowledge in areas of ignorance, and focusing on positive aspects of the job.

Adaptation, Psychological↗

PubMed1999

Redesigning medication distribution systems in the OR.

Detroit Riverview Hospital's surgery suite recently converted to an automated medication distribution system. Focusing on control, access, documentation, and charging, the redesign has benefited pharmacists, nurse anesthetists, and OR nurses. Automation reduced nursing labor associated with ordering and restocking medications, counting narcotics, and investigating discrepancies. Storage and dispensing options, including innovative anesthesia trays, facilitate caregiver productivity, quality initiatives, and clinical pathways. System documentation pinpoints questionable events and patterns to ensure that all medications dispensed were administered to patients. Charges are captured and posted automatically. Overall, automated medication distribution has helped the OR improve clinical care quality and patient service.

Automation↗

PubMed1989

Delegating intraoperative activities. A pilot study.

The purpose of phase one of this descriptive study was to obtain information about the research process. We identified problems associated with the pilot and examined the feasibility of completing phase two of the study at the national level. The pilot provided insight into the weaknesses and strengths of the tool design. It also identified interesting trends and data regarding delivery of intraoperative nursing care. The pilot study supported the ultimate goals of the research project, and we plan to continue with phase two of the study. Further research is needed to substantiate the findings and solidify the implications for perioperative nursing.

Clinical Competence↗

PubMedDate not supplied

Policies and practices for maternal support options during childbirth and breastfeeding initiation after cesarean in southeastern hospitals.

OBJECTIVE: To describe policies, practices, and associated rationales of hospital obstetric units regarding mothers' support person options during childbirth and to explore practices concerning support of breastfeeding initiation after cesarean delivery. DESIGN: Descriptive telephone survey. SETTING: Hospitals in the southeastern region of the United States. PARTICIPANTS: Convenience sample of 154 obstetric nurse manager and nurse representatives employed by the participating hospitals. MAIN OUTCOME MEASURES: Types of policies regarding mothers' support person options during childbirth and immediate postpartum stage, initiation of breastfeeding after cesarean birth, and attitudes about policies. RESULTS: All hospitals allowed two or more support persons during vaginal births, 89% permitted only one support person during nonemergent cesareans, and 58.0% of the nurse representatives believed that mothers should be allowed a second support person. Less than one third (31.2%) of the hospitals considered a mother's request to breastfeed in the operating room, and most (78.6%) allowed mothers to breastfeed in the recovery room. CONCLUSIONS: Overall, maternal support policies, practices, and nurse representatives' attitudes were mother and family friendly, particularly related to vaginal births. Though breastfeeding initiation after cesarean birth was encouraging, support person options during nonemergent cesarean births and related rationales warrant further examination.

Adult↗

PubMed1983

[Exposure to anesthetic gases: risk and prevention].

Several studies published during the last fifteen years seem to demonstrate that major risks, i.e. congenital malformations in the offspring and increased rate of spontaneous abortions, are associated with occupational exposure to anesthetic gases (halothane and nitrous oxide) in operating rooms. In view of the severity of the potential risk, we have: 1) analyzed risk factors in the light of epidermiologic and experimental studies; 2) determined the threshold levels of air pollution for these risk factors; 3) analyzed the situation in the Grenoble Hospital and the means of dealing with it.

Abnormalities, Drug-Induced↗

PubMed2000

Safety and advantages of laparoscopic vs. open colectomy in the elderly: matched-control study.

PURPOSE: The aim of this study was to determine rates of complications and extent of benefits for laparoscopic-assisted colectomy compared with open colectomy in patients older than age 75. METHODS: Forty-two patients undergoing laparoscopic-assisted colectomy (1992-1998) were matched to 42 open colectomy patients for gender, age, year of surgery, operating surgeon, and procedure. Health status (American Society of Anesthesiology score), previous abdominal surgery, conversion rate, surgical outcome, and need for assistance at admission and dismissal (independence vs. home with assistance vs. nursing facilities) were reviewed. RESULTS: Mean ages were 81.2 and 80.5 years for laparoscopic-assisted colectomy and open colectomy, respectively (P = not significant). Twenty-one laparoscopic-assisted colectomy and 23 open colectomy patients were females. American Society of Anesthesiology scores were comparable, as were rates of previous abdominal surgery (57 percent for laparoscopic-assisted colectomy vs. 62 percent for open colectomy; P = not significant). Mean operative times were longer for laparoscopic-assisted colectomy (190 minutes for laparoscopic-assisted colectomy vs. 142 minutes for open colectomy; P < 0.001); operating room times progressively decreased from 221 minutes in 1992 to 1995 to 147 in 1998 for laparoscopic right hemicolectomy (P < 0.001). The conversion rate for laparoscopic-assisted colectomy was 14.3 percent. There were no deaths in either group, and laparoscopic-assisted colectomy was associated with fewer morbidities (14.3 percent for laparoscopic-assisted colectomy vs. 33.3 percent for open colectomy; P = 0.04), narcotic usage (2.7 vs. 4.8 days; P < 0.001), time to return to bowel movements (3.9 vs. 5.9 days; P < 0.001), and length of hospital stay (6.5 vs. 10.2 days; P < 0.001). Independent status at admission in 37 laparoscopic-assisted colectomy and 38 open colectomy patients was maintained at discharge by 35 laparoscopic-assisted colectomy vs. 29 open colectomy patients (P = 0.025). CONCLUSIONS: Laparoscopic-assisted colectomy is safe and beneficial, including preservation of postoperative independence, to the elderly when compared with open colectomy.

Aged↗

PubMed1997

Security and legal issues associated with the computerized patient record.

The advances in electronic technology in the form of increased processing power, the ability to computerize many aspects of a patient's record, and the emergence of document imaging systems and telemedicine have enhanced health care professionals ability to more accurately document care. However, with this augmentation comes issues in liability and security of which professionals should be aware. This article discusses some of these issues from the viewpoint of the perioperative nurse.

Computer Security↗

PubMed1994

Impact of postoperative nausea and vomiting in the surgical setting.

Postoperative nausea and vomiting is one of the most common complications of inpatient and day case surgical procedures. In a climate where total cost of an illness is becoming increasingly important, postoperative nausea and vomiting is a major contributor to direct and indirect costs for both the hospital and patient. In patient terms, the impact of increased recovery room stays and extra nursing time required by PONV patients has been estimated to range from 96-576 more surgical procedures which may be performed in an 'average' day case surgery centre. Postoperative nausea and vomiting is perceived by patients to account for equal or more debilitation than surgery itself and may cause them to lose wages due to absence from work. Reducing the incidence of nausea and vomiting and its associated problems may therefore provide opportunities to improve patient care, decrease the size of waiting lists and improve utilisation of scarce healthcare resources.

Activities of Daily Living↗

PubMed1996

A comparison of ranitidine, droperidol or placebo in the prevention of nausea and vomiting after hysterectomy.

PURPOSE: The effect of ranitidine on postoperative nausea and vomiting (PONV) was assessed when compared with droperidol and with placebo. METHODS: Three groups of sixty patients were studied in a double-blind randomized manner. The first group received ranitidine tablets 300 mg on the night before and on the following morning, one hour before induction of anaesthesia. Thirty minutes before surgery ended they were given isotonic saline 0.3 ml iv. The second group had placebo in place of ranitidine while before the operation ended, droperidol 0.75 mg (0.3 ml) was injected. The third group received placebos rather than the study drugs. The immediate two-hour postoperative recovery room period and that on the ward were evaluated until the next morning. PONV information was gathered from complaints by the patients and from direct questioning by the nursing staff. Droperidol 0.75 mg iv served as the "rescue drug." RESULTS: Less PONV occurred in patients who received anti-emetics than those given placebo: recovery room, P = 0.0109; ward, P = 0.007. Droperidol better suppressed PONV in the recovery room (P = 0.005) with no statistical significance seen between ranitidine and placebo. On the ward, both anti-emetics were more effective than placebo (ranitidine, P = 0.01; droperidol, P = 0.003). "Rescue drug" requirements throughout the study periods were not statistically significant. CONCLUSION: Although both anti-emetics were associated with a smaller incidence of PONV than was placebo, droperidol was superior to ranitidine in preventing sickness during the immediate postoperative period. The need for the "rescue drug" was similar in all groups.

Adult↗

PubMed2000

Cost comparison of radical prostatectomy and transperineal brachytherapy for localized prostate cancer.

OBJECTIVES: To compare perioperative costs associated with radical retropubic prostatectomy (RRP) to transperineal brachytherapy (BXRT) with iodine-125 (125I) seeds in the treatment of localized prostate cancer. METHODS: Actual costs per case for the perioperative period were compiled prospectively for 583 consecutive patients undergoing RRP or BXRT between January 1, 1997 and October 30, 1998 using a hospital-wide cost accounting system. The total cost per case included both technical and professional components. The technical costs included those incurred for anesthesiology, laboratory medicine, medicine, pharmacy, nursing, radiology, 125I seeds, and BXRT technicians. Professional costs included fees from anesthesiology, laboratory, medicine, urology, radiation oncology, and physics. Cases were divided into three groups for analysis: group 1, RRP (n = 404); group 2, BXRT with planning ultrasound performed in the office setting before implantation (n = 107); and group 3, BXRT with planning ultrasound performed in the operating room at the time of implantation (n = 72). Results are reported as relative cost ratios, with RRP assigned a relative cost of 1.0. RESULTS: The total relative perioperative cost for BXRT exceeded that for RRP by 85% to 105%. Technical cost, exclusive of 125I seeds, was substantially lower for BXRT (relative cost 0.36 to 0.42) but was more than offset by the cost of the seeds when comparing total cost with RRP. Performance of the planning ultrasound in the operating room (group 3) increased the total cost by 20%. The categorical technical costs for both BXRT groups were significantly lower for anesthesiology, laboratory medicine, medicine, pharmacy, and nursing but were significantly higher for radiology. The total professional costs were similar for all groups. CONCLUSIONS: Perioperative costs of BXRT with 125I seeds are substantially higher than RRP in the treatment of localized prostate cancer, primarily because of the cost of the seeds.

Brachytherapy↗

PubMed1997

Giant intracranial aneurysm obliteration using deep hypothermic circulatory arrest.

Giant intracranial aneurysms pose significant technical problems for the neurosurgical team. Because of the location and structure of these lesions, the risks associated with traditional surgical techniques are usually unacceptable. Although aneurysm clipping using deep hypothermic circulatory arrest was first described 30 years ago, it was nearly abandoned because of poor outcomes associated with the systemic and cardiac complications of extracorporeal circulation. Advances in cardiopulmonary bypass techniques have inspired renewed interest in the use of this method in surgery for intracranial aneurysm. Deep hypothermic circulatory arrest, using low-flow states, has yielded exceptional patient outcomes. This increasingly popular means of management provides unique challenges to the neurosurgical health care team. Understanding the pre-, intra-, and postoperative care of these patients is imperative for neurosurgical nurses of the twenty-first century.

Heart Arrest, Induced↗

PubMed2001

Latex symptoms and sensitisation in health care workers.

BACKGROUND: Natural rubber latex has become an important occupational health concern, particularly among health care workers, who for protection are required to wear latex gloves when at work. This study evaluated the prevalence of latex-related symptoms and sensitisation among a large group of health care workers in Trieste hospitals. METHODS: We evaluated the prevalence of latex-related symptoms in 1,165 health care workers, by means of a questionnaire, a medical examination, skin prick tests and IgE-specific evaluation. We determined atopy and latex sensitivity by skin prick tests using a battery of common inhalant allergens, a commercial latex extract (Lofarma Allergeni, Milan) and individual skin puncture tests for each of the vegetables immunologically related to latex (potato, tomato, chestnut, banana, kiwi fruit). Associations between potential risk factors for latex allergy were assessed. RESULTS: Glove-related symptoms were noticed on 17.2% of the nurses (200) the majority of symptoms being mild dermatitis with itching and erythema (120 subjects, 11.1%). Symptoms suggestive of IgE-mediated latex allergy were found in 51 subjects: 35 (3%) complained of contact urticaria and 16 (2.2%) complained of asthma and/or rhinitis. The resulting symptoms were significantly related to skin prick tests that were positive to latex (odds ratio (OR) = 11.89; 6.40-22.2), to personal atopy (OR = 2.15; 1.47-3.12), to familiar atopy (OR = 2.12; 1.48-3.03), to skin prick test positivity to related fruit (OR = 2.01; 1.16-3.46) but not to prick test positivity to common inhalant allergens (OR = 1.00; 0.71-1.39). Symptoms increased as a direct function of the time-usage of latex gloves and were more prevalent in operating room staff. CONCLUSION: In this large cross-sectional study, glove-related symptoms and latex skin sensitisation appear to be substantial among health care workers, and are related to common signs of atopy. We stress the need of preventive measures to avoid latex exposure when health care workers are at risk of developing allergy symptoms.

Adult↗

PubMed2005

Effectiveness of a simple heated water-filled mattress for the prevention and treatment of neonatal hypothermia in the labour room.

INTRODUCTION: This study aimed to determine the proportions of normothermic infants who remained normothermic, and hypothermic infants who became normothermic following the use of a heated water-filled mattress (HWM) in the labour room. METHODS: A prospective observational study carried out in the labour room over a 2.5 month period on 228 well term infants delivered by lower segment caesarean section (LSCS) in the operating theatre (environmental temperature 18 degrees Celsius). Upon arrival in the labour room, the infants were placed on a HWM in a nursing cot. The axillary temperature was measured using a mercury thermometer for three minutes. Each infant was then wrapped with a large piece of linen, and covered with a blanket. Just before transfer to postnatal wards, the axillary temperature was re-measured. RESULTS: 52.2 percent (119/228) of infants were hypothermic (temperature less than 36.5 degrees Celsius) upon arrival in the labour room. Before leaving the labour room, the median increase in axillary temperature of the initially hypothermic infants was significantly higher (0.2 degrees Celsius, interquartile range 0.5) than those initially normothermic infants (0.0 degrees Celsius, interquartile range 0.3) (p-value is less than 0.00001). Among the initially hypothermic infants, 40.3 percent (48/119) became normothermic before transfer to postnatal wards. The significant independent risk factors associated with persistent hypothermia were lower birthweight (p-value equals 0.02), lower gestational age (p-value equals 0.02) and shorter duration on the warming mattress (p-value equals 0.08). Among 109 initially normothermic infants, 17.4 percent became mildly hypothermic (mean axillary temperature 36.2 degrees Celsius, standard deviation 0.2) before leaving the labour room. CONCLUSION: The HWM is a reasonably effective simple device for the prevention and treatment of hypothermia in the labour room.

Beds↗

PubMed2006

After-hours discharges from intensive care are associated with increased mortality.

OBJECTIVE: To investigate the change in pattern of discharge of patients from an intensive care unit (ICU) to hospital wards and to determine the impact of discharge time on subsequent hospital mortality. DESIGN AND PARTICIPANTS: A retrospective cohort study of 10 903 patients discharged alive from a single ICU between 1 January 1992 and 31 December 2002. MAIN OUTCOME MEASURE: In-hospital mortality. RESULTS: Of the 10 903 patients discharged alive from the ICU, 486 (4.5%) died in hospital wards. When discharge times were categorised according to nursing shift (morning, 07:00-14:59; afternoon, 15:00-21:59; and night, 22:00-06:59), patients were more likely to be discharged on an afternoon shift (odds ratio, 3.63; 95% CI, 3.05-4.30) or night shift (4.52; 95% CI, 3.15-6.64) in 2000-2002 compared with 1992-1994. In a multiple logistic model, hospital mortality after discharge from the ICU was increased by higher APACHE II score (1.14; 95% CI, 1.12-1.16); admission to ICU from the operating room (1.47; 95% CI, 1.11-1.95) and from the general ward (1.75; 95% CI, 1.37-2.23); and discharge during the afternoon (1.36; 95% CI, 1.08-1.70) and night shifts (1.63; 95% CI, 1.03-2.57). CONCLUSION: Over an 11-year period, more patients are being discharged from the ICU in the afternoon and night suggesting increasing pressure on ICU beds. Patients discharged on these shifts have an increased risk of death.

Adolescent↗

PubMed1997

Use of scrubs and related apparel in health care facilities.

There is no scientific evidence that the use of scrubs or other related apparel contributes to either the cause or the prevention of infections associated with health care facilities. However, because this type of apparel is now used so commonly as a replacement for the more traditional type of uniform, its original function as an ensemble worn by surgical personnel no longer prevails. The variety of these applications actually raises a new series of issues and challenges that would be best resolved by a multidisciplinary health care group with representatives from administration, nursing, medicine, materials management, human resources, infection control, and other affected departments. The purpose of this report is to facilitate this process.

Cross Infection↗