Spelling suggestions: "subject:"emergency surgery"" "subject:"mergency surgery""
1 |
Capacity Allocation for Emergency Surgical Scheduling with Multiple Priority LevelsAubin, Anisa 25 September 2012 (has links)
Emergency surgeries are serviced by three main forms of capacity: dedicated operating room time reserved for emergency surgeries, alternative (on call) capacity, and lastly, canceling of elective surgeries. The objective of this research is to model capacity implications of meeting wait time targets for multiple priority levels in the context of emergency surgeries. Initial attempts to solve the capacity evaluation problem were made using a non-linear optimisation model, however, this model was intractable. A simulation model was then used to examine the trade-off between additional dedicated operating room capacity (and consequent idle capacity) versus increased re-scheduling of elective surgeries while keeping reserved time for emergency surgeries low. Considered performance measures include utilization of operating room time, elective re-scheduling, and wait times by priority class. Finally, the instantaneous utilization of different types of downstream beds is determined to aid in capacity planning. The greatest number of patients seen within their respective wait time targets is achieved by a combination of additional on call capacity and a variation of the rule allowing low priority patients to utilize on call capacity. This also maintains lower cancelations of elective surgeries than the current situation. Although simulation does not provide an optimum solution it enables a comparison of different scenarios. This simulation model can determine appropriate capacity levels for servicing emergency patients of different priorities with different wait time targets.
|
2 |
Capacity Allocation for Emergency Surgical Scheduling with Multiple Priority LevelsAubin, Anisa 25 September 2012 (has links)
Emergency surgeries are serviced by three main forms of capacity: dedicated operating room time reserved for emergency surgeries, alternative (on call) capacity, and lastly, canceling of elective surgeries. The objective of this research is to model capacity implications of meeting wait time targets for multiple priority levels in the context of emergency surgeries. Initial attempts to solve the capacity evaluation problem were made using a non-linear optimisation model, however, this model was intractable. A simulation model was then used to examine the trade-off between additional dedicated operating room capacity (and consequent idle capacity) versus increased re-scheduling of elective surgeries while keeping reserved time for emergency surgeries low. Considered performance measures include utilization of operating room time, elective re-scheduling, and wait times by priority class. Finally, the instantaneous utilization of different types of downstream beds is determined to aid in capacity planning. The greatest number of patients seen within their respective wait time targets is achieved by a combination of additional on call capacity and a variation of the rule allowing low priority patients to utilize on call capacity. This also maintains lower cancelations of elective surgeries than the current situation. Although simulation does not provide an optimum solution it enables a comparison of different scenarios. This simulation model can determine appropriate capacity levels for servicing emergency patients of different priorities with different wait time targets.
|
3 |
Capacity Allocation for Emergency Surgical Scheduling with Multiple Priority LevelsAubin, Anisa January 2012 (has links)
Emergency surgeries are serviced by three main forms of capacity: dedicated operating room time reserved for emergency surgeries, alternative (on call) capacity, and lastly, canceling of elective surgeries. The objective of this research is to model capacity implications of meeting wait time targets for multiple priority levels in the context of emergency surgeries. Initial attempts to solve the capacity evaluation problem were made using a non-linear optimisation model, however, this model was intractable. A simulation model was then used to examine the trade-off between additional dedicated operating room capacity (and consequent idle capacity) versus increased re-scheduling of elective surgeries while keeping reserved time for emergency surgeries low. Considered performance measures include utilization of operating room time, elective re-scheduling, and wait times by priority class. Finally, the instantaneous utilization of different types of downstream beds is determined to aid in capacity planning. The greatest number of patients seen within their respective wait time targets is achieved by a combination of additional on call capacity and a variation of the rule allowing low priority patients to utilize on call capacity. This also maintains lower cancelations of elective surgeries than the current situation. Although simulation does not provide an optimum solution it enables a comparison of different scenarios. This simulation model can determine appropriate capacity levels for servicing emergency patients of different priorities with different wait time targets.
|
4 |
Worse than Death? The Older Patient and Long-Term Outcomes after Emergency General SurgeryHo, Vanessa P. 26 May 2023 (has links)
No description available.
|
5 |
Patienternas upplevelse av att vara fastande inför akutoperationLarsson, Eugènia Furumula January 2012 (has links)
SAMMANFATTNING Bakgrund: Preoperativ fasta har under många år varit en traditionell metod för att minska risken för aspiration medan patienten är under generell anestesi och för att eliminera risken för postoperativ illamående och kräkningar. Studier visar att trots riktlinjer och rekommendationer gällande preoperativ fasta fastar många patienter i onödan i flera dagar än nödvändigt. Detta kan orsaka skador och obehag hos patienten som till exempel: törst, huvudvärk, illamående, svaghet och trötthet. Syfte: Syfte med denna studie var att undersöka hur patienter upplever fasta mer än 12 timmar innan en akutoperation. Metod: Arbetet hade en kvalitativ ansats där 12 patienter som genomgått akut operation inkluderades. Data samlades in genom en semistrukturerad intervju, med hjälp av öppna frågor enligt en intervjuguide och analyserades med hjälp av manifest innehållsanalys enligt Graneheim och Lundman. Resultat: Analyserna resulterade i fyra kategorier: Preoperativ information, upplevelse av fasta, hantering av preoperativ fasta och upplevelse av preoperativ tid och åtta underkategorier: Bristfällig information, tillräcklig information, bristfällig kunskap trots tidigare vårderfarenhet, fysisk påverkan, psykisk påverkan, strategi, väntetid och fastetid. Slutsats: Deltagarna i studien upplevde brist på information och kunskaper om den preoperativa fastans betydelse. Studien visade att patienterna som väntade på akut operation på akutvårdsavdelning fastade längre än nödvändigt trots riktlinjer och rekommendationer gällande preoperativ fasta från Svensk förening för Anestesi och Intensivvård (SFAI). Patienterna som genomgått apendectomi fastade mellan 13,5-28 timma (M=22,2), medan de som hade genomgått kolecystectomi fastade mellan 12-48 timmar (M=25,6). Detta orsakade fysiskt och psykiskt obehag hos patienterna. / ABSTRACT Background: Preoperative fasting for many years has been a traditional method of reducing the risk of aspiration while the patient is under general anesthesia, and eliminating the risk of postoperative nausea and vomiting. Studies indicate that despite guidelines regarding preoperative fasting, many patients fast longer than necessary. This can cause damage and discomfort for patients including: thirst, headache, nausea, weakness and fatigue. Aim: The aim of the current study was to investigate patients’ experience of fasting more than 12 hours before emergency surgery. Method: The study had a qualitative approach. In total, 12 patients who underwent emergency surgery were included. Data was collected through a semi-structured interview, using open-ended questions following an interview guide. Collected data were analyzed using manifest content analysis according to Graneheim and Lundman. Result: Analyzes resulted in four categories: Preoperative information, experience of fasting, handles preoperative fasting and experiences of the preoperative period and eight subcategories: Lack of information, enough information, lack of knowledge despite previous nursing experience, physical impact, psychological impact, strategy, waiting time and fasting time. Conclusion: Participants in the study experienced lack of information and knowledge of the preoperative fasting importance. This study showed that patients, waiting for emergency surgery in the emergency department fast longer than necessary despite existing guidelines and recommendations of the Swedish Society of Anaesthesia and Intensive care (SFAI) regarding preoperative fasting. Patients who have undergone appendectomy fasted between 13.5 to 28 hours (M = 22.2), whereas those which had undergone cholecystectomy attached between 12-48 hours (M = 25.6). This caused experience of physical and psychological discomfort for the patients.
|
6 |
Características epidemiológicas y clínico quirúrgicas de pacientes con COVID-19 operados de emergencia en un hospital nivel III de Lambayeque, 2020Barrantes Fernandez, Lorena Patricia January 2024 (has links)
Objetivo: Determinar las características epidemiológicas, clínicas y quirúrgicas de pacientes con COVID-19 operados de emergencia en el Hospital Regional Lambayeque durante el año 2020. Materiales y métodos: Estudio descriptivo, transversal, retrospectivo y observacional.
Se recolectaron las historias clínicas físicas de pacientes con COVID-19 que fueron operados de emergencia por el Servicio de Cirugía General durante el año 2020 del Hospital Regional Lambayeque. Los datos obtenidos fueron ingresados desde una ficha de recolección de datos a una hoja de Excel (Microsoft 365 versión 2205) y posteriormente al SPSS (versión 21.0) para su análisis, donde se analizaron las características epidemiológicas clínicas y quirúrgicas con sus respectivas dimensiones como sexo, comorbilidades, riesgo quirúrgico cardiológico, grado de insuficiencia respiratoria, patología quirúrgica, intervención quirúrgica, etc. Resultados: Se incluyeron 88 pacientes, con una mediana de 26,5 años, la mayoría varones (61%). El 25% de los casos presentaron alguna comorbilidad, las principales fueron hipertensión arterial (8%) y obesidad (7%). Los riesgos quirúrgicos cardiológicos más frecuentes fueron RQ I (50%) y RQ II (45,5%). La mayoría de pacientes no presentaron ningún grado de insuficiencia respiratoria (94,3%). La mediana de vacío terapéutico fue de 94,13 horas. El 90,9% no requirió oxigeno
postoperatorio inmediato. La patología quirúrgica más frecuente fue apendicitis (76,1%), así mismo la intervención quirúrgica principal fue la apendicectomía (76,1%). La mediana de tiempo de estancia hospitalaria postquirúrgica fue 3 días. Conclusión: Las características de mayor frecuencia en pacientes operados de emergencia con COVID-19 fueron el sexo masculino, la edad de 16 a 48 años, sin comorbilidades y la operación más realizada fue la apendicectomía. / Objective: To determine the epidemiological, clinical, and surgical characteristics of patients with COVID-19 undergoing emergency surgery at the Lambayeque Regional Hospital in 2020.
Materials and methods: A descriptive, cross-sectional, retrospective, and observational study.
All the physical medical records of COVID-19 patients who underwent emergency surgery by the general surgery service in 2020 at the Lambayeque Regional Hospital were collected. The data obtained were entered from a data collection sheet to an Excel sheet (Microsoft 365 version 2205) and then to the SPSS (version 21.0) for analysis, where the clinical and surgical epidemiological characteristics were analyzed with their respective dimensions such as sex, comorbidities, surgical risk, degree of respiratory failure, surgical pathology, surgical intervention, etc.
Results: It included 88 patients, with a median age of 26.5 years, mostly men (61%). 25% of the cases had some comorbidity but the main ones were arterial hypertension (8%) and obesity (7%). The most frequent cardiac surgical risks were SR I (50%) and SR II (45.5%). Most patients did not present respiratory failure (94.3%). The median time elapsed from the beginning of complaints to admission to the emergency department was 94.13 hours. The 90.9% of patients didn’t require immediate postoperative oxygen. The most frequent surgical pathology was acute appendicitis (76.1%), likewise, the primary surgical intervention was appendectomy (76.1%). The median postoperative hospital stay time was 3 days.
Conclusion: The most common characteristics of patients with COVID-19 operated in the emergency were male sex, ages between 16 and 48 years, without comorbidity, and the most common operation was appendectomy.
|
7 |
Vad kommer hända nu? : individens upplevelse inför akut- och traumakirurgi i samband med vistelse på akutmottagning eller traumaenhet / What will happen now? : the individual experience before emergency- and trauma surgery during a visit at the emergency room or a trauma centerKlöverås, Pernilla, Nilsson, Sanne January 2024 (has links)
Trauma eller livshotande tillstånd medför att en individ blir patient och i förlängningen kan bli aktuell för trauma- och akutkirurgi. Aktuell inriktning av kirurgisk behandling är flytande och kan utföras oavsett kontext samt tid på dygnet. Det initiala omhändertagandet sker på akut- eller traumaenhet. Individens förmåga att ta in och hantera det som sker kräver en känsla av sammanhang. Syftet var att belysa vuxna individers upplevelser av traumaomhändertagande på akutrum och relaterade föreställningar kring att eventuellt behöva genomgå akutkirurgi. Aktuell metod utgör en allmän litteraturöversikt med systematisk metod. Underlaget består av 15 originalartiklar där data har bearbetats med integrativ analys. Resultatet presenteras i tre övergripande teman och berör alla upplevelser inför möjlig eller konstaterad akutkirurgi ur sammanhanget av ett traumaomhändertagande. Upplevelserna förenas med känsla av sammanhang inom individen. Individens sammanhängande upplevelse består i många omvälvande känslor som rädsla, oro och ovisshet inför vad som kommer att ske. Kommunikation och vikten att tillhandahålla adekvat information är av yttersta vikt. Vårdpersonal kan utgöra ett viktigt stöd för individen. Negativa upplevelser existerar och består till en del av brist på information, förståelse, delaktighet samt förmågan för individen att uppleva ett sammanhang under det akuta omhändertagandet. Förbättringspotential finns både avseende bemötande samt vårdpersonalens sätt att hantera patientens upplevelser sprungna ur rädsla och oro inför ett eventuellt akut kirurgiskt ingrepp. Vårdrelationen som etableras förutsätter fullgod kommunikation och ett adekvat personcentrerat förhållningssätt från sjuksköterskans sida. Förhållningssättet sjuksköterskan använder sig av bör även koncentreras till att stärka individen i att uppnå och bevara en hög grad utav känsla av sammanhang. / The occurrence of traumatic or life-threatening conditions means that an individual becomes a patient and, in the long run, may be considered for trauma- and emergency surgery. The current branch of surgical treatment can be carried out regardless of context and at any time of the day. The initial care takes place in an emergency or trauma unit. The individual's ability to comprehend and deal with what is happening requires a sense of coherence. The aim was to shed light on adults' experiences of trauma care in the emergency department’s crash room and related beliefs about possibly having to undergo emergency surgery. The current publication is a general literature review with a systematic method. The basis consists of 15 original articles where the data has been processed with integrative analysis. The results are presented in three overall themes and touch on experiences concerning possible or ascertained emergency surgery in the context of trauma care. The experiences are combined with the sense of coherence within the individual. The individual overall experience contains many upsetting emotions such as fear, worry and uncertainty about what will happen. Communication and the importance of providing adequate information are of utmost importance. Healthcare professionals can provide important support for the individual. Negative experiences exist and consist in part of a lack of information, understanding, participation and the ability for the individual to experience context during the moments of emergency care. Potential for improvement is present both in terms of treatment and the way the healthcare professionals handle the patient's experience stemming from fear and anxiety before a possible emergency surgical intervention. The care relationship that is established presupposes good communication and an adequate person-centred approach on the part of the registered nurse. The approach the registered nurse uses should also concentrate on strengthening the individual in gaining and preserving a high degree of sense of coherence.
|
8 |
Évaluation économique d'antidotes pour le renversement des nouveaux anticoagulants oraux en contexte de chirurgie d'urgence et de saignement majeur non contrôléCharron, Jean-Nicolas 01 1900 (has links)
No description available.
|
9 |
Colorectal Cancer : Audit and Health Economy in Colorectal Cancer Surgery in a Defined Swedish PopulationJestin, Pia January 2005 (has links)
<p>Colorectal cancer is one of the most common malignancies in Sweden, with more than 5000 new cases annually. Median age at time of diagnosis is approximately 75 years. Owing to the ageing population, the incidence of colorectal cancer is increasing. The improvement in surgical technique and the introduction of adjuvant radio- and chemotherapy increased the 5-year survival rate from approximately 30-40% in the early 1960s to almost 60% in the late 1990s. The cost of public health care has risen considerably, and case-costing systems are increasingly demanded. Linked to clinical guidelines and quality registers, such control systems form a proper basis for quality assurance projects and improvement. The aim of this thesis is to describe the efficiency and cost effectiveness of colorectal cancer treatment in a defined Swedish population. Emergency surgery for colon cancer, constituting 25% of the cases, increased both mortality and cost. Among emergency cases there was not only an increase in postoperative mortality but also a stage specific decrease in long-term survival rate. Correct staging is decisive for further treatment of patients after colon cancer surgery and influences long-term survival. The number of lymph nodes examined varied between different pathology departments and could be used as a quality measurement. The proportion of tumour stage III increased the more nodes examined. A prognostic estimation of stage III cases that is less sensitive to the number of nodes examined is proposed. A case-control study aimed at identifying risk factors for anastomotic leakage after rectal cancer surgery confirmed previously known risk factors but failed to identify further steps during the perioperative course that were amenable to improvement. This research has confirmed that population-based quality and case-costing registers, linked to clinical guidelines, constitute a proper source for projects of quality improvement and decisions about distribution of resources in health care.</p>
|
10 |
Colorectal Cancer : Audit and Health Economy in Colorectal Cancer Surgery in a Defined Swedish PopulationJestin, Pia January 2005 (has links)
Colorectal cancer is one of the most common malignancies in Sweden, with more than 5000 new cases annually. Median age at time of diagnosis is approximately 75 years. Owing to the ageing population, the incidence of colorectal cancer is increasing. The improvement in surgical technique and the introduction of adjuvant radio- and chemotherapy increased the 5-year survival rate from approximately 30-40% in the early 1960s to almost 60% in the late 1990s. The cost of public health care has risen considerably, and case-costing systems are increasingly demanded. Linked to clinical guidelines and quality registers, such control systems form a proper basis for quality assurance projects and improvement. The aim of this thesis is to describe the efficiency and cost effectiveness of colorectal cancer treatment in a defined Swedish population. Emergency surgery for colon cancer, constituting 25% of the cases, increased both mortality and cost. Among emergency cases there was not only an increase in postoperative mortality but also a stage specific decrease in long-term survival rate. Correct staging is decisive for further treatment of patients after colon cancer surgery and influences long-term survival. The number of lymph nodes examined varied between different pathology departments and could be used as a quality measurement. The proportion of tumour stage III increased the more nodes examined. A prognostic estimation of stage III cases that is less sensitive to the number of nodes examined is proposed. A case-control study aimed at identifying risk factors for anastomotic leakage after rectal cancer surgery confirmed previously known risk factors but failed to identify further steps during the perioperative course that were amenable to improvement. This research has confirmed that population-based quality and case-costing registers, linked to clinical guidelines, constitute a proper source for projects of quality improvement and decisions about distribution of resources in health care.
|
Page generated in 0.0762 seconds