Articles: postoperative.
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Paediatric anaesthesia · Nov 2014
Comparative StudyPerception of Pediatric Pain: a comparison of postoperative pain assessments between child, parent, nurse, and independent observer.
Pain is a subjective experience. In children with limited understanding and communication skills, reliable assessment of pain is challenging. Self-reporting of pain is the gold standard of pain measurement. For children who are unable to self-report their pain, assessments made by their parents are often used as a proxy measure. The validity of this approach has not been conclusively determined. ⋯ Children's pain self-reports should be used wherever possible to guide management, but in their absence, parental pain scores can be reliably used as a surrogate measure. Nurses and independent observers produce lower pain scores than parents or children, which may result in inadequate treatment of pain.
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Patients over the age of 65 represent 15% of Canada's population and one-third of patients undergoing surgery. Older surgical patients often have lasting disability following "minor" ambulatory procedures. This study sought to explore the postoperative experience of ambulatory surgery, as described by older surgical patients and their caregivers. ⋯ Patients and caregivers ardently described real challenges during convalescence. Ambulatory care facilities should prepare this specific demographic of patients and caregivers for the post-discharge experience. Paramount for participants was the need for clear communication and a commitment to ongoing support following discharge. The trial on which this analysis was based was registered with Clinical Trials.gov (NCT01382251).
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Anesthesia and analgesia · Nov 2014
Fall-Prevention Strategies and Patient Characteristics That Impact Fall Rates After Total Knee Arthroplasty.
Fall prevention has emerged as a national quality metric, a focus for The Joint Commission, because falls after orthopedic surgery can result in serious injury. In this study, we examined patient characteristics and effects of fall-prevention strategies on the incidence of postoperative falls in patients undergoing total knee arthroplasty. ⋯ Our data demonstrate a reduction in fall incidence coinciding with the implementation of a multi-intervention fall-prevention strategy. Despite prevention efforts, patients of advanced age, elimination-related activities, and patients in the intermediate phase (late postoperative day 1 through day 3) of recovery continue to have a high risk for falling. Therefore, fall-prevention strategies should continue to provide education to all patients (especially elderly patients) and reinforce practices that will monitor patients within their hospital rooms.
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Lung transplantation is a widely accepted therapeutic option for patients with end-stage lung disease. However, despite the significant medical progress achieved since the first human lung transplant was performed in 1963, perioperative and long-term patient outcomes are still jeopardised by a variety of complications. ⋯ However, in the absence of internationally recognised guidelines, the optimal strategies for managing lung transplant recipients remain unclear. This article presents a practical approach to the management of the early post-transplantation period aiming at standardising clinical care and improving patient outcome.
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Letter Case Reports
Severe hypophosphatemia: a rare cause of postoperative muscle weakness.