Sedoanalgesia Administration with Propofol and Ketamine for Minor Urologic Interventions

Aim: In this study we aimed to administer sedoanalgesia with propofol and ketamine combination in patients undergoing planned minor urologic interventions with limited anesthesia. By combining these two medications, lower doses may be used, and we aimed to provide sufficient sedation, analgesia and amnesia without disrupting hemodynamic and respiratory stability and to increase patient and surgeon satisfaction. Material-Method: The study included 53 patients with planned minor urologic interventions aged from 19 to 85 years and physical situation ASA I-III. After six hours starvation, patients were taken to the surgery. Patients were monitored for electrocardiography (ECG), oxygen saturation (SPO2 ) and non-invasive blood pressure. For use if necessary a nasal O2 cannula was inserted. A vein in the back of the left hand was opened and 5 ml/min isotonic sodium chloride infusion was begun. Patient heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP) and oxygen saturation (SpO2 ) values were measured and a 5 point sedation scale (Table 1) was used to measure sedation scores. Basal values were recorded (0 min). Later patients were randomly divided into two groups with Group I administered intraurethral lidocaine gel for local anesthesia by the surgeon, while Group II were administered intravenous 0.015 mg/kg midazolam, 0.5 mg/kg 1% ketamine and 0.5 mg/kg 1% propofol by the authors for sedoanalgesia. At five minute intervals the HR, SAP, DAP, MAP, SpO2 values and sedation scores were measured and recorded. Results: Statistical evaluation found a statistically significant increase in SAP, DAP and MAP values measured at the 5th minute in Group I patients compared to preoperative values. In Group I patients, when the heart rate measured in the 1st and 5th minutes are compared with preoperative values there was a statistically significant increase identified. In Group II patients, there was a statistically significant fall in SpO2 values in the 1st and 5th minutes compared with preoperative values. When patient and surgeon satisfaction are compared with Group I, Group II was found to be statistically significantly higher. Though the blood pressure and heart rate increases in Group I patients were statistically significant, they were not at levels that required clinical intervention and/or treatment. Similarly the SpO2 decrease observed in Group II patients did not fall below 90% in any patient in spite of being statistically significant and rose again without clinical intervention and/or treatment. Conclusion: In this study we showed that sedoanalgesia administration with propofol and ketamine may be an alternative method for patients undergoing minor urology interventions that does not disrupt hemodynamic and respiratory stability, does not delay patient discharge, has low side effect incidence and has high patient and surgeon satisfaction

Data Collection in Care Homes for Older Adults: A National Survey in England

\ua9 2023 The Author(s). Context: In many countries, there is a specification for information that should be collected by care homes. So-called ‘minimum data-sets’ (MDS) are often lengthy, and report on resident health and wellbeing, staff, and facilities. In the UK, the absence of any easily accessible data on the care home population was highlighted at the start of the COVID-19 pandemic. Care homes faced multiple requests for data from external agencies who had little knowledge of what care homes were already collecting. Objective: This study aimed to identify the range (and method) of data collected by care home organisations, in a country without a mandated MDS. Methods: Online survey of care homes (with/without nursing) in England. Care homes recruited via research and care home networks, social media. Questions covered data content, storage, and views on data sharing, analysed with descriptive statistics. Findings: 273 responses were received, representing over 5,000 care homes. Care homes reported extensive data on the health, care and support needs of individual residents, their preferences, and activities. Clinical measures and tools adopted from health were commonly used, but few collected information on quality-of-life. Care homes reported uses of these data that included monitoring care quality, medication use, staff training needs, budgeting, and marketing. Concerns over privacy and data protection regulations are potential barriers to data sharing. Implications: These findings challenge the notion that incentives or mandates are required to stimulate data collection in care homes. Care home organisations are collecting an extensive range of resident-level information for their own uses. Countries considering introducing social care records or an MDS could start by working with care home organisations to review existing data collection and evaluate the implications of collecting and sharing data. A critical approach to the appropriateness of health-related tools in this setting is overdue

Data collection in care homes for older adults: A national survey in England

Context: In many countries, there is a specification for information that should be collected by care homes. So-called 'minimum data-sets' (MDS) are often lengthy, and report on resident health and wellbeing, staff and facilities. In the UK, the absence of any easily accessible data on the care home population was highlighted at the start of the COVID-19 pandemic. Care homes faced multiple requests for data from external agencies who had little knowledge of what care homes were already collecting. Objective: This study aimed to identify the range (and method) of data collected by care home organisations, in a country without a mandated MDS. Methods: Online survey of care homes (with/without nursing) in England. Care homes recruited via research and care home networks, social media. Questions covered data content, storage and views on data sharing, analysed with descriptive statistics. Findings: 273 responses were received, representing over 5000 care homes. Care homes reported extensive data on the health, care and support needs of individual residents, their preferences and activities. Clinical measures and tools adopted from health were commonly used, but few collected information on quality-of-life. Care homes reported uses of these data that included monitoring care quality, medication use, staff training needs, budgeting and marketing. Concerns over privacy and data protection regulations are potential barriers to data sharing. Implications These findings challenge the notion that incentives or mandates are required to stimulate data collection in care homes. Care home organisations are collecting an extensive range of resident level information for their own uses. Countries considering introducing social care records or an MDS could start by working with care home organisations to review existing data collection and evaluate the implications of collecting and sharing data. A critical approach to the appropriateness of health-related tools in this setting is overdue

Piloting of a minimum data set for older people living in care homes in England: protocol for a longitudinal, mixed-methods study

INTRODUCTION: Health and care data are routinely collected about care home residents in England, yet there is no way to collate these data to inform benchmarking and improvement. The Developing research resources And minimum data set for Care Homes' Adoption and use study has developed a prototype minimum data set (MDS) for piloting. METHODS AND ANALYSIS: A mixed-methods longitudinal pilot study will be conducted in 60 care homes (approximately 960 residents) in 3 regions of England, using resident data from cloud-based digital care home records at two-time points. These will be linked to resident and care home level data held within routine National Health Service and social care data sets. Two rounds of focus groups with care home staff (n=8-10 per region) and additional interviews with external stakeholders (n=3 per region) will explore implementation and the perceived utility of the MDS. Data will be assessed for completeness and timeliness of completion. Descriptive statistics, including percentage floor and ceiling effects, will establish data quality. For validated scales, construct validity will be assessed by hypothesis testing and exploratory factor analysis will establish structural validity. Internal consistency will be established using Cronbach's alpha. Longitudinal analysis of the pilot data will demonstrate the value of the MDS to each region. Qualitative data will be analysed inductively using thematic analysis to understand the complexities of implementing an MDS in care homes for older people. ETHICS AND DISSEMINATION: The study has received ethical approval from the London Queen's Square Research Ethics Committee (22/LO/0250). Informed consent is required for participation. Findings will be disseminated to: academics working on data use and integration in social care, care sector organisations, policy makers and commissioners. Findings will be published in peer-reviewed journals. Partner NIHR Applied Research Collaborations, the National Care Forum and the British Geriatrics Society will disseminate policy briefs

Comparison of the mobilization and proprioceptive neuromuscular facilitation methods in the treatment of shoulder impingement syndrome

The aim of this study was to compare the effectiveness of the mobilization and proprioceptive neuromuscular facilitation methods in the treatment of shoulder impingement syndrome. Forty patients were included in the study and they were divided into two groups: Group 1 was treated by mobilization and Group 2 by proprioceptive neuromuscular facilitation (PNF). All findings were scored using a visual analogue scale, joint range of motion, and University of California at Los Angeles criteria, before and after treatment. It was observed that mobilization and proprioceptive neuromuscular facilitation methods are both similarly effective, but mobilization was painless and better tolerated than PDF. © 2005 VSP

Correlation of p16 expression with clinicopathologic features in oropharyngeal carcinoma

WOS: 000344386800280

Place of the Post-Anesthesia Care Unit in Patient Care after Anesthesia

Aim: The aim of this study is to emphasize that the post-anesthesia care unit provides good quality service and is an important place for treatment of patients at high risk of postoperative complications. Material And Methods: Patients admitted to the post-anesthesia care unit with ASA II, III, IV, and V risk group during the postoperative period between 1 March 2013 and 30 September 2013 in Ankara Numune Training and Research Hospital were retrospectively evaluated for data relating to age, gender, disease requiring surgery, surgical procedures, and perioperative anesthesia method, admission criteria for postoperative post-anesthesia care unit, duration of stay in post-anesthesia care unit and patient’s follow-up information in the ward. Results: A total of 583 patients who were admitted to the post-anesthesia care unit between 1 March 2013 and 30 September 2013 in Ankara Numune Training and Research Hospital were evaluated, retrospectively. Of patients 74.8% of in risk group ASA III. The average age was 59.36 years. Of patients 51.6% were male and 48.4% were female. In terms of clinic, 38.4% of the patients were operated by general surgery, 30.4% were operated by the department of orthopedics. General anesthesia was administered to 93.7% of the patients. Of patients, 48.7% had respiratory failure and 25.4% had hypotension. For 98.5% of patients post-anesthesia unit stay was one day and 6.5% of the patients were transferred to the intensive care unit. Conclusions: We revealed that the majority of PACU admissions were patients undergoing general surgery procedures and the most frequent cause of admission was respiratory failure. This study shows that PACU has a considerably important place in peroperative patient managemen