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- Brattwall, Metha, 1952, et al.
(författare)
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What can a mobile App add to improve quality of care, with focus on ambulatory surgery?
- 2018
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Ingår i: European Journal for Person Centered Healthcare. - : University of Buckingham Press. - 2052-5656 .- 2052-5648. ; 6:1, s. 20-24
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, aims and objectives: Many surgical procedures are nowadays performed as ambulatory or short stay procedures, reducing hospital length of stay. Patient safety and quality of care remain imperative especially when adopting enhanced recovery pathways. Patients should be adequately informed and prepared prior to admission. Recovery is to a major extent dependent after discharge on self-care and thus techniques to follow the post-operative course after leaving hospital are warranted. Telemedicine has grown tremendously over recent years and the incorporation of mobile telephone app technology for the pre- and post-operative coaching of the ambulatory surgical patient may represent an effective means of assisting patients. The present paper presents a feasibility study of a mobile telephone app providing pre-operative information and following the post-operative recovery following day surgery. Method: Patients scheduled for elective day surgery were asked to participate, testing the app and to assess its usefulness on visual analogue scales. Results: Sixty-nine patients aged 18 to 73 years tested the app. Patients aged 30 to 50 where the most frequent users and patients < 30 less frequent. The app was in general assessed as useful and most users expressed an interest in the option of having an app as a source of information before undergoing a scheduled procedure. General pre-operative information was assessed as the most important. A willingness to submit follow-up information decreased rapidly, only 26 and 16 responded at day 10 and 30, respectively. Conclusion: A mobile telephone app is a feasible and appreciated tool for pre-operative information and coaching as part of person-centered healthcare, but its use for follow-up after discharge is challenging and requires further investigation.
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- Sellbrant, Irene, et al.
(författare)
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The choice between surgical scrubbing and sterile covering before or after induction of anaesthesia: A prospective study
- 2017
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Ingår i: F1000Research. - : F1000 Research Ltd. - 2046-1402. ; :6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Day surgery is increasing, and safe and effective logistics are sought. One part of the in-theatre logistics commonly discussed is whether surgical scrub and sterile covering should be done before or after induction of anaesthesia. The aim of the present study was to compare the impact of surgical scrub and sterile covering before vs. after the induction of anaesthesia in male patients scheduled for open hernia repair. Methods: This is a prospective randomised study. Sixty ASA 1-3 patients scheduled for open hernia repair were randomised to surgical scrub and sterile covering before or after induction of anaesthesia; group “awake” and “anaesthetised”. Need for vasoactive medication during anaesthesia was primary study objective. Duration of anaesthesia and surgery, theatre time, recovery room stay and time to discharge, patients and theatre nurses experiences and willingness to have the same logistics on further potential surgeries, by a questionnaire provided before discharge was also assessed. Results: The duration of anaesthesia was shorter and doses of propofol and remifentanil were reduced by 10 and 13%, respectively, in the awake group. We found still no difference in the need for vasoactive medication during anaesthesia Time in recovery area was significantly reduced in the awake group 39 (SD 15) vs. 48 SD 16) (p<0.05), but time to discharge was not different. There was further no difference in the patients’ assessment of quality of care, and only one patient in the awake group would prefer to be anaesthetised on a future procedure. All nurses found pre-anaesthesia scrubbing acceptable as routine. Conclusion: Surgical scrub and sterile covering before the induction of anaesthesia can be done safely and without jeopardising patients’ quality of care and possibly improve perioperative logistics. Further studies are warranted assessing impact of awake scrubbing and sterile covering on quality and efficacy of perioperative care.
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- Brattwall, Metha, 1952, et al.
(författare)
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Brief review: Theory and practice of minimal fresh gas flow anesthesia.
- 2012
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Ingår i: Canadian journal of anaesthesia. - : Springer Science and Business Media LLC. - 1496-8975 .- 0832-610X. ; 59:8, s. 785-797
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this brief review is to provide an update on the theory regarding minimal fresh gas flow techniques for inhaled general anesthesia. The article also includes an update and discussion of the practical aspects associated with minimal-flow anesthesia, including the advantages, potential limitations, and safety considerations of this important anesthetic technique. PRINCIPAL FINDINGS: Reducing the fresh gas flow to<1 L·min(-1) during maintenance of anesthesia is associated with several benefits. Enhanced preservation of temperature and humidity, cost savings through more efficient utilization of inhaled anesthetics, and environmental considerations are three key reasons to implement minimal-flow and closed-circuit anesthesia, although potential risks are hypoxic gas mixtures and inadequate depth of anesthesia. The basic elements of the related pharmacology need to be considered, especially pharmacokinetics of the inhaled anesthetics. The third-generation inhaled anesthetics, sevoflurane and desflurane, have low blood and low tissue solubility, which facilitates rapid equilibration between the alveolar and effect site (brain) concentrations and makes them ideally suited for low-flow techniques. The use of modern anesthetic machines designed for minimal-flow techniques, leak-free circle systems, highly efficient CO(2) absorbers, and the common practice of utilizing on-line real-time multi-gas monitor, including essential alarm systems, allow for safe and cost-effective minimal-flow techniques during maintenance of anesthesia. The introduction of new anesthetic machines with built-in closed-loop algorithms for the automatic control of inspired oxygen and end-tidal anesthetic concentration will further enhance the feasibility of minimal-flow techniques. CONCLUSIONS: With our modern anesthesia machines, reducing the fresh gas flow of oxygen to 0.3-0.5 L·min(-1) and using third-generation inhaled anesthetics provide a reassuringly safe anesthetic technique. This environmentally friendly practice can easily be implemented for elective anesthesia; furthermore, it will facilitate cost savings and improve temperature homeostasis.
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| 8. |
- Brattwall, Metha, 1952, et al.
(författare)
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Dagkirurgin i Sverige sker strukturerat och med enhetliga rutiner
- 2012
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Ingår i: Läkartidningen. - 0023-7205. ; 109:41, s. 1824-1827
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Tidskriftsartikel (refereegranskat)abstract
- Day surgery, come and leave hospital the day of surgery, is today well established practice in Sweden. A web-based questionnaire sent to all day surgical units in Sweden early 2011 asking about current routines and praxis for 2010 showed a remarkably coherent praxis. The routines used were seemingly well in line with evidence based medicine. There were no set age or body weight limits for being acceptable for day surgery, patients were however assessed on an individual base preoperatively by an anaesthetist. Multimodal pain management started prior to surgery is standard of care. Most units are also providing patients prescription and or take home packages with analgesics at discharge after surgery, also strong opioids are not uncommonly send home when needed in limited amounts. Escort to assist when leaving hospital after surgery is commonly requested but not an absolute demand. Follow-up after discharge is not done on a regular base. Also interaction and information with primary care is only done infrequently. Pain, PONV and social circumstances are the most common causes for hospital unplanned admission.
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| 9. |
- Brattwall, Metha, 1952
(författare)
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Day surgery; routines, pain and recovery.
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Day surgery in Sweden is increasing both in numbers and in types of procedures. Also older and sicker patients are often included in day case surgery programs, which puts an extra demand on good practice. Methods: Study I: Questionnaires regarding routines used in 2005 were sent to all day surgery clinics in Sweden. Studies II, III, IV: These studies (in 355 patients) were designed as prospective, multi centre, self-assessed follow-up studies, where questionnaires were answered by t... merhe patients preoperatively and up to 6 months after surgery. Three typical day surgery procedures were chosen; inguinal hernia repair, arthroscopic procedures, cosmetic breast augmentation. A preoperative health profile was the starting point. An extended 8-item EQ-5d questionnaire was used. The questions focused on quality of life and on pain. Study V: This interventional pain study after hallux valgus surgery was designed as a prospective, randomized double blind study in 100 patients. Results: In study I was shown that a high degree of standardization is present among Swedish day surgery units with pain being the most common postoperative problem. Study II showed that tobacco use by smoking or snuffing decreased postoperative nausea but had no effect on postoperative pain. In study III, unplanned hospital contacts were recorded for 70/355 patients while 3 patients were readmitted. Postoperative pain was reported in 40%, 28% and 20% of included patients after 1, 2 and 4 weeks respectively. Presence of pain preoperatively was identified as the main predictor for postoperative pain. In study IV, longitudinally changes in 8-item health profile was shown to be different between procedures during 6 months follow-up. In study V we showed that in treating postoperative pain, etoricoxib was more effective with fewer side effects than tramadol. Conclusions: Day surgery as presently performed is safe and without major morbidity. The preoperative health profile is important for the recovery course. Pain is the main reported postoperative problem followed by mobility problems. Recovery is divergent for different surgery and calls for different follow-up times. In treatment of pain after foot surgery, the NSAID etoricoxib is shown to be more efficient than tramadol without deleterious effects on healing. Key words: day surgery, postoperative pain, analgesics, tramadol, etoricoxib, postoperative nausea and vomiting (PONV), nicotine, snuff, recovery, EQ-5d, health profile, self-assessed questionnaire, follow-up.
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