Articles: cations.
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The current paradigm of watchful waiting (WW) in people 65 years or older with an asymptomatic paraesophageal hernia (PEH) is based on a now 20-year-old Markov analysis. Recently, we have shown that elective laparoscopic hernia repair (ELHR) provides an increase in life-years (L-Ys) compared with WW in most healthy patients aged 40 to 90 years. However, elderly patients often have comorbid conditions and may have complications from their PEH such as Cameron lesions. The aim of this study was to determine the optimal strategy, ELHR or WW, in these patients. ⋯ Using a Markov model with updated values for key variables associated with management options for patients with a PEH, we showed that life expectancy was improved with ELHR in most men and women aged 40 to 90 years, particularly in the presence of symptoms and/or Cameron lesions. Comorbid conditions increase the risk for surgery, but ELHR remained the preferred strategy in the majority of symptomatic patients. This model can be used to provide individualized management guidance for patients with a PEH.
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Hospital-acquired urinary tract infections (UTIs) have a detrimental effect on patients, families, and hospital resources. The Sydney Children's Hospital Network (SCHN) participates in the NSQIP-Pediatric (NSQIP-P) to monitor postoperative complications. NSQIP-P data revealed that the median UTI rate at SCHN was 1.75% in 2019, 3.5 times higher than the NSQIP-P target rate of 0.5%. Over three quarters of the NSQIP-P identified patients with UTI also had a urinary catheterization performed intraoperatively. A quality improvement project was conducted between mid-2018 and 2021 to minimize catheter-associated UTIs (CAUTIs) at SCHN. ⋯ A multifactorial approach in quality improvement has been shown to be an effective strategy to reduce UTI rates at SCHN, and patient outcomes were improved within a 3-year timeframe. Although this project has reduced UTI rates at SCHN, there remain opportunities for further improvement.
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Despite the increasing emphasis on rehabilitation training after orthopedic surgery, little is known about the pain caused by the procedure itself. Clinical practice is driven by beliefs in pain management. ⋯ Our study emphasized that medical workers should be aware of the importance of pain management at the same time while treating the disability. The study provides insight into pain management experiences within different educational backgrounds. The findings enable professionals to recognize the importance of pain management and its influencing factors to provide feasible and effective pain management strategies.
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Critical care medicine · Jun 2024
Observational StudyBarriers and Facilitators to End-of-Life Care Delivery in ICUs: A Qualitative Study.
To understand frontline ICU clinician's perceptions of end-of-life care delivery in the ICU. ⋯ Standardized work system communication tasks may improve end-of life discussion processes between clinicians and families.
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Although many integrative therapies exist, studies increasingly demonstrate yoga can help change the negative neuroplastic effects experienced by people living with chronic pain. Despite encouraging findings, a gap exists in accessible yoga programs designed to meet the individual needs of those experiencing limitations from chronic pain. This study evaluated a yoga program designed for people living with chronic pain delivered in a health care setting. Although yoga began as a spiritual practice thousands of years ago, it is now widely practiced for its physical and mental well-being aspects achieved through movement and breathing techniques. ⋯ Evidence supporting the use of yoga in the treatment of chronic pain is growing, yet it remains an underutilized approach in a comprehensive treatment plan. Yoga can not only improve self-agency, but also reduces social isolation. Pain management nurses can play an important role in promoting the application of yoga for chronic pain and advocating for yoga programs that are focused on accessibility for people living with pain.