Implementation of an enhanced recovery program after bariatric surgery: Clinical and cost-effectiveness analysis

Enhanced recovery after surgery (ERAS) programs are perioperative evidence-based interventions that have the purpose of making the perioperative pathway more efficient in safeguarding patient safety and quality of care. Recently, several ERAS components have been introduced in the setting of bariatric surgery (Enhanced Recovery After Bariatric Surgery, ERABS). The aim of the present study was to evaluate clinical efficiency and cost-effectiveness of the implementation of an ERABS program. It was a retrospective case-control study comparing a group of adult obese (body mass index >40) patients treated according to the ERABS protocol (2014-2015) with a historical control group that received standard care (2013-2014) in the General and Emergency Surgery Department, Arcispedale S. Maria Nuova Hospital, Reggio Emilia, Italy. Data on the occurrence of complications, mortality, re-admissions and re-operations were extracted retrospectively from medical case notes and emergency patient admission lists. Length of hospital stay was significantly different between the two cohort patients. In the control group, the mean length of stay was 12.6±10.9 days, whereas in the ERABS cohort it was 7.1±2.9 days (p=0.02). During hospital stay, seven patients in the control group developed surgical complications, including one patient with major complications, whereas in the ERABS group three patients developed minor complications. Economic analysis revealed a different cost distribution between the two groups. On the whole, there were significant savings for almost all the variables taken into consideration, mainly driven by exclusion of using intensive care unit, which is by far more expensive than the average cost of post-anesthesia care unit. Our study confirmed the implementation of an ERABS protocol to have shortened hospital stay and was cost-saving while safeguarding patient safety

Nursing sensitive outcomes and staffing: A review on healthcare associated infection

Nursing sensitive outcomes and staffing: a review on healthcare associated infection. Introduction. Healthcare associated infections (HAI) continue to be an unresolved problem in hospital settings. Aim. To assess the relationship between nurse staffing and healthcare associated infections in different settings. Methods. From April to May 2015 a review of literature was conducted consulting PubMed, CINAHL and Cochrane Library. Results. An increased amount of Registered Nurse Hours Per Patient Day (RNHPPD) and nurse-to-patient ratio was associated to a decreased occurrence of HAI. In particular an increase of RNHPPD was associated to a reduction of postoperative (OR 0.83, IC95% 0.0.70-0.99), and ventilator-associated pneumonia (OR 0.21, IC95% 0.08-0.53). Even the number of urinary tract infections (-34%) and sepsis (OR 0.54, IC95%: 0.31-0.92) decreased significantly. The most significant results associated to an increase of HPPD were obtained in intensive care units. Conclusions. The review showed the correlations between nurse staffing and the most frequent HAIs. Nursing managers should be aware of the adequate nurse-to-patient ratios and skill-mix in order to inform decision making and improve the quality and safety of patients care

Does the transversus abdominis plan block play a role on length of stay? Results of a retrospective observational study on 208 patients after laparoscopic cholecystectomy

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Safety and efficacy of Staged Extubation Set in patients with difficult airway: a prospective multicenter study

BACKGROUND: A safe extubation is the extension of any airway management strategy. Despite different guidelines, a number of extubation accidents still occurs. Re-intubation failure could be fatal, thus a strategy and safe and efficient devices for this purpose are essential. METHODS: Multicentric prospective observational study on adult patients with endotracheal intubation and known difficult airway. A Staged Extubation Set® (SES) was used for extubation. Demographics, ASA, El Ganzouri, type of surgery, re-intubation success/failure and complications were recorded. The aim of the study was the assessment of the rate of re intubation failure, complications during failures, patients' comfort and evidence of airway injury. RESULTS: Overall, 114 subsequent difficult airway patients were enrolled. Fifteen patients (13%) required re-intubation: ten of 15 (66%) were successfully re-intubated, with a first-pass success rate of 100%. In five patients (33%), re-intubation over SES was unsuccessful, with re-intubation difficulty rate three (easy), three (quite easy) and nine (very difficult) and five cases of desaturation. Complications included one case of esophageal intubation, one case of lip trauma, and two cases of airway edema. Of 114 patients, eight (7%) perceived the procedure as intolerable. CONCLUSIONS: The results from this study show a relatively satisfactory success rate with a relatively high number of re-intubations failure and a low incidence of complications when using a SES in a cohort of difficult airway patients, all failures due to guidewire dislodgement during or after extubation. Further research is needed to improve success rate; at the same time the need for an extubation protocol is strongly advocated

The Place of the History of Chemistry in the Teaching and Learning of Chemistry

To those of us who are sold on history it may seem non-controversial to suggest that the learning and teaching of chemistry should give cognisance to the historical development of the subject. However, this suggestion is proving controversial amongst some in the chemistry profession. For example, in the October 2010 edition of Chemistry in Australia Rami Ibo takes issue with the emphasis on the history of science in the HSC chemistry curriculum (Year 12) in New South Wales. He studied chemistry, physics and biology for his HSC in NSW and concluded that, because the primary focus of these three sciences was History of Science, “There was hardly any content that challenged our minds, and calculations barely involved plugging in numbers into an equation…..We were required to recall Antoine Lavoisier’s experiments that led to the theories of acids and bases… while my friends in Lebanon were studying ideal gas laws, chemical kinetics, acids and bases, organic chemistry, soaps and detergents, medicinal chemistry and new materials” (Ibo 2010). What does the literature have to say in response to such arguments? Does the presence of the history of chemistry in a curriculum necessarily reduce important content and problem solving skills? A study of the literature suggests at least three reasons for persisting with aspects of the history of chemistry in the learning and teaching of chemistry. 1. The fact that student conceptions sometimes recapitulate early ideas found in the history of chemistry is seen as offering teachers a means of a deeper understanding of student ideas with the potential for more positive learning outcomes. 2. Conceptual clarity is more easily achieved within an historical context. Often conceptual usefulness is pursued at the expense of conceptual depth (de Berg 2008a). 3. The history of chemistry directly gives us some idea of the epistemological status of chemistry within science and knowledge in general and therefore gives a student access to aspects of the Nature of Science. This review chapter also examines different ways the history of chemistry has been incorporated into chemistry curricula and looks at the purported advantages, disadvantages, and limitations of such attempts. Some directions for future research in this area are included in the chapter