围手术期医学

脊柱手术患者使用移动数字健康平台的结果:回顾性分析

2022 - 10 - 26 - t09:00:05内

数字卫生解决方案已被证明可以提高患有慢性医疗疾病的个人的预后，但很少有针对外科患者的验证。数字健康平台ManageMySurgery (MMS)已被验证为脊柱外科患者手术过程中的一种可行方法，通过应用内教育和完成患者报告的结果调查。本研究的目的是确定使用MMS的脊柱手术患者与单独使用传统围手术期护理的患者的90天急诊室(ER)就诊率、再入院率和并发症发生率。2017年12月至2021年9月期间，在美国一家学术医院接受脊柱手术的患者被邀请在围术期使用MMS。所有患者都接受了标准的围手术期护理，如果他们登录了应用程序，就被归类为MMS用户。通过电子健康记录审查获取人口统计信息和90天的结果。MMS组和非MMS组之间90天急诊就诊、再入院、轻度并发症和严重并发症的比值比使用逻辑回归模型进行估计。结果:共邀请1015例患者，其中679例使用MMS。MMS用户和非用户具有相似的人口统计特征:平均年龄为57.9 (SD 12.5)岁和61.5 (SD 12.7)岁，54.1%(367/679)和47.3%(159/336)为男性，90.1%(612/679)和88.7%(298/336)分别有商业或医疗保险。颈椎融合(559/ 1015,55.07%)和单路腰椎融合(231/ 1015,22.76%)是所有患者最常见的手术。MMS用户90天再入院率(55/679,8.1%)低于非用户(30/336,8.9%)。 Mild complications (MMS: 56/679, 8.3%; non-MMS: 32/336, 9.5%) and severe complications (MMS: 66/679, 9.7%; non-MMS: 43/336, 12.8%) were also lower in MMS users. MMS users had a lower 90-day ER visit rate (MMS: 62/679, 9.1%; non-MMS: 45/336, 13.4%). After adjustments were made for age and sex, the odds of having 90-day ER visits for MMS users were 32% lower than those for nonusers, but this difference was not statistically significant (odds ratio 0.68, 95% CI 0.45-1.02; P=.06). Conclusions: This is one of the first studies to show differences in acute outcomes for people undergoing spine surgery who use a digital health app. This study found a correlation between MMS use and fewer postsurgical ER visits in a large group of spine surgery patients. A planned randomized controlled trial will provide additional evidence of whether this digital health tool can be used as an intervention to improve patient outcomes.

使用短信平台报告的术后7天疼痛发生率:回顾性观察性研究

2022 - 10 - 25 - t09:30:03内

背景:门诊手术最常见的并发症是术后急性疼痛。目的:本研究的目的是评估术后7天术后疼痛的晚期发生率。我们回顾性分析了2018年1月至2020年2月在鲁昂大学医院接受全麻或局部麻醉手术的患者和接受局部麻醉的患者。收集的数据是在术后1天(次要终点)和7天(主要终点)按数值评分量表(NRS)和gt;3/10定义的中度至重度疼痛报告。这些数据是通过半智能短信短信平台收集的，用于在门诊手术后与患者在家中进行随访。进行单因素和多因素分析以分析疼痛的危险因素。结果:我们分析了6099例患者。术后第一天，5.2%(318/6099)患者出现中度至重度疼痛，全麻或区域麻醉组为5.9%(248/4187)，局麻组为3.7%(70/1912)。术后7 d, 18.6%(1135/6099)患者出现中度至重度疼痛，其中全麻或区域麻醉组21.3%(892/4187)，局麻组12.7%(243/1912)。普外科(优势比[OR] 1.54, 95% CI 1.23-1.92; P<.01) and orthopedic surgery (OR 1.66, 95% CI 1.42-1.94; P<.01) were associated with more late postoperative pain risk. Male gender (OR 0.66, 95% CI 0.57-0.76; P<.01), ophthalmology surgery (OR 0.51, 95% CI 0.42-0.62; P<.01), and gynecologic surgery (OR 0.67, 95% CI 0.50-0.88; P=.01) were associated with less late postoperative pain risk. The rate of emergency consultation or rehospitalization at 7 days after the surgery was 11.1% (679/6099). Late postoperative pain (OR 2.54, 95% CI 1.98-3.32; P<.001), general surgery (OR 2.15, 95% CI 1.65-2.81; P<.001), and urology surgery (OR 1.62, 95% CI 1.06-2.43; P=.02) increased the risk of emergency consultation or rehospitalization. Orthopedic surgery (OR 0.79, 95% CI 0.63-0.99; P=.04) and electroconvulsive therapy (OR 0.43, 95% CI 0.27-0.65; P<.001) were associated with less rates of emergency consultation or rehospitalization. Conclusions: Our study shows that postoperative pain at 7 days after ambulatory surgery was reported in more than 18% of the cases, which was also associated with an increase in the emergency consultation or rehospitalization rates.

心脏手术术后并发症的定义和分类:先导德尔菲研究

2022 - 10 - 12 - t09:30:03内

背景:心脏手术术后并发症很常见，是卫生服务和社会的严重负担。然而，专家们在哪些事件应该被视为“并发症”以及如何评估其严重性方面缺乏共识。本研究旨在咨询领域专家，以试点开发心脏手术后并发症的定义和分类系统，目的是促进心脏手术的标准化临床过程和系统的进展。我们进行了德尔菲(Delphi)研究，这是在复杂问题上达成专家共识的一种行之有效的方法。我们向包括心脏外科医生和麻醉师在内的领域专家发送了2轮调查，以定义和分类心脏手术后的术后并发症。对开放式问题的回答采用专题分析框架进行分析。结果:在研究的第一轮和第二轮中，总共有71和37位专家的意见被纳入分析。心脏麻醉师和心脏危重症护理专家参与了这项研究。心脏外科医生没有参与。专家们一致认为，心脏手术术后并发症的分类是有用的，并就心脏手术术后并发症的通用定义达成了共识。 Consensus was also reached on classification of complications according to the following 4 levels: “Mild,” “Moderate,” “Severe,” and “Death.” Consensus was also reached on definitions for “Mild” and “Severe” categories of complications. Conclusions: Domain experts agreed on the definition and classification of complications in cardiac surgery for “Mild” and “Severe” complications. The standardization of complication identification, recording, and reporting in cardiac surgery should help the development of quality benchmarks, clinical audit, care quality assessment, resource planning, risk management, communication, and research.

两种从自动术中温度数据集中去除伪影的新算法的演示和性能评估:多中心、观察性、回顾性研究

2022 - 10 - 05 - t09:15:03内

通过温度探头自动获取术中患者温度数据可能会产生一些与探头定位相关的伪影，这些伪影可能会影响这些探头在观察研究中的效用。我们试图比较过滤此类伪影的两种从头算法的性能。在这项观察性回顾性研究中，接受全身麻醉进行非心脏手术的成人患者的术中体温数据从多中心围手术期结果组注册中提取。开发了两种算法，然后将其与参考标准-麻醉医师人工伪影检测过程进行比较。算法1(基于斜率的算法)基于相邻3个温度数据点的线性曲线拟合。算法2(基于间隔的算法)评估相邻温度记录之间的时间间隔。计算每种算法伪影检测的灵敏度和特异性值，以及通过每种方法去除伪影后，每个患者的平均温度和曲线下面积(温度低于36°C)。共分析了200个麻醉记录中的27,683个温度读数。麻醉医师的总体认同率为92.1%。两种算法都具有较高的特异性，但灵敏度适中(特异性:算法1为99.02%，算法2为99.54%; sensitivity: 49.13% for algorithm 1 vs 37.72% for algorithm 2; F-score: 0.65 for algorithm 1 vs 0.55 for algorithm 2). The areas under the curve for time × hypothermic temperature and the mean temperatures recorded for each case after artifact removal were similar between the algorithms and the anesthesiologists. Conclusions: The tested algorithms provide an automated way to filter intraoperative temperature artifacts that closely approximates manual sorting by anesthesiologists. Our study provides evidence demonstrating the efficacy of highly generalizable artifact reduction algorithms that can be readily used by observational studies that rely on automated intraoperative data acquisition.

短信服务(扁桃体-短信给我)对儿童扁桃体切除术围手术期结果的影响:具有历史对照组的队列研究

2022 - 09 - 20 - t08:45:02内

背景:扁桃体切除术是北美一种常见的儿童外科手术。照顾者在为孩子的手术做准备和在家协调护理方面面临着复杂的挑战，因此，他们可以从获得教育资源中受益。先前的一项可行性研究Tonsil-Text-To-Me，一个自动短信短信服务，发送15个时间敏感的活动提醒，营养和补水提示的链接，疼痛管理策略，以及监测并发症的指导，显示了有希望的结果，护理人员的满意度和参与度都很高。本研究旨在在现实环境中初步测试扁桃体-文本给我，以确定它是否以及如何可能改善护理人员和患者的围手术期体验和结果。方法:包括接受扁桃体切除术的3 - 14岁儿童的看护者。比较具有相同研究参数(如合格标准和手术团队)的历史对照组和干预组的数据。测量方法包括育儿自我代理测量、一般健康问卷-12、父母术后疼痛测量、客户满意度问卷-8和参与分析，以及止痛剂消耗、疼痛、儿童活动水平和卫生服务使用。数据收集于术前一天、术后3天和术后14天。干预组的参与者从术前2周开始接收短信，直到术后第8天。采用描述性统计和推理统计。 Results: In total, 51 caregivers (n=32, 63% control; n=19, 37% intervention) who were predominately women (49/51, 96%), White (48/51, 94%), and employed (42/51, 82%) participated. Intervention group caregivers had a statistically significant positive difference in Parenting Self-Agency Measure scores (P=.001). The mean postoperative pain scores were higher for the control group (mean 10.0, SD 3.1) than for the intervention group (mean 8.5, SD 3.7), both of which were still above the 6/15 threshold for clinically significant pain; however, the difference was not statistically significant (t₃₉=1.446; P=.16). Other positive but nonsignificant trends for the intervention group compared with the control group were observed for the highest level of pain (t₃₉=0.882; P=.38), emergency department visits (χ²₂=1.3; P=.52; Cramer V=0.19), and other measures. Engagement with resources linked in the texts was moderate, with all but 1 being clicked on for viewing at least once by 79% (15/19) of the participants. Participants rated the intervention as highly satisfactory across all 8 dimensions of the Client Satisfaction Questionnaire (mean 29.4, SD 3.2; out of a possible value of 32.0). Conclusions: This cohort study with a historical control group found that Tonsil-Text-To-Me had a positive impact on caregivers’ perioperative care experience. The small sample size and unclear impacts of COVID-19 on the study design should be considered when interpreting the results. Controlled trials with larger sample sizes for evaluating SMS text messaging interventions aimed to support caregivers of children undergoing tonsillectomy surgery are warranted.

利用术中生理反应的高阶奇异值分解预测术后长期疼痛:前瞻性队列研究

2022 - 09 - 14 - t09:15:02内

背景:术后长期疼痛(POP)和患者对镇痛药物的反应尚未完全了解。尽管最近的研究已经开发了一个基于多种生理参数的全麻患者痛觉水平指数，但尚不清楚这些参数是否与长期POP结果相关。本研究旨在通过多变量时间分析，提取无偏的、可解释的描述，描述患者对手术和术中用药的反应中生理参数的动态变化。我们证明了术中生理反应的主要特征与长期POP之间存在相关性，即使不声明因果关系，也具有预测价值。我们提出了一种复杂的高阶奇异值分解方法，以准确地将患者的生理反应分解为随时间变化的多元结构。我们使用来自混合手术队列的175例患者的术中生命体征，提取患者生理反应的三种相互关联的、低维的、复杂值的描述:反映亚生理参数的多变量因素;时间因素，反映常见的术中时间动态;以及患者因素，描述患者间生理反应的变化。结果:采用复高阶奇异值分解方法，可以明确术中生理反应中包含的动态相关结构。在主要描述符的子空间内，242名患者的复值生理反应的瞬时阶段使我们能够在术后第30天和第90天区分轻度和非轻度(中等-严重)疼痛水平。 Following rotation of physiological responses before projection to align with the common multivariate-temporal dynamic, the method achieved an area under curve for postoperative day 30 and 90 outcomes of 0.81 and 0.89 for thoracic surgery, 0.87 and 0.83 for orthopedic surgery, 0.87 and 0.88 for urological surgery, 0.86 and 1 for colorectal surgery, 1 and 1 for transplant surgery, and 0.83 and 0.92 for pancreatic surgery, respectively. Conclusions: By categorizing patients into different surgical groups, we identified significant surgery-related principal descriptors. Each of them potentially encodes different surgical stimulation. The dynamics of patients’ physiological responses to these surgical events were linked to long-term POP development.

在已使用医院电子病历系统的情况下，实施重症监护信息系统减少医疗差错:回顾性分析

2022 - 08 - 31 - t09:45:02内

背景:尽管重症监护病房(ICUs)的临床信息系统(如重症监护信息系统(ICISs))的各种优势已被报道，但它们在预防医疗事故方面的作用尚不清楚。目的:本研究旨在探讨在已使用医院电子病历系统的情况下，ICU实施ICIS前后错误发生率和类型的变化。方法:将ICIS应用于某高校医院综合ICU。经过3个月的逐步实施，从2019年4月起，所有患者都使用了ICIS。我们使用事件报告系统的数据，对ICIS实施前后6个月ICU的错误进行回顾性分析，确定错误的数量、发生率、类型和患者预后水平。结果:2018年4月至2018年9月ICU收治755例患者，2019年4月至2019年9月ICU收治719例患者。2018年研究期间的错误数量为153个，2019年研究期间为71个。2018年和2019年的错误发生率分别为54.1 (95% CI 45.9-63.4)和27.3 (95% CI 21.3-34.4)事件/ 1000个患者日(P<.001)。在这两个时期，错误类型的构成没有显著变化(P=.16)，最常见的错误类型是用药错误。结论:ICIS的实施与ICU中错误的数量和发生率降低了50%有关。 Although the most common type of error was medication error in both study periods, ICIS implementation significantly reduced the number and incidence rate of medication errors. Clinical Trial: University Hospital Medical Information Network Clinical Trials Registry UMIN000041471; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047345

住院登记进入电子患者门户网站的骨科手术后随访改善结果:聚类随机对照试验

2022 - 08 - 11 - t09:00:04内

背景:电子患者门户(EPP)的使用与较低的缺勤率和增加的患者满意度相关。然而，这些交流平台的注册情况存在差异。目的:我们假设，与通常在出院总结中提供信息的做法相比，指导住院患者进入EPP将提高骨科手术患者的临床随访和EPP使用率。方法:我们对229例因骨科疾病住院的成年患者进行了随机对照试验，这些患者需要3个月的随访。患者按周分组随机分为对照组或干预组。对照组在出院文件中获得如何注册和使用EPP的信息，而干预组则积极注册并教授如何使用EPP。出院后3个月，随访观察患者是否参加随访预约或使用EPP。结果:229例患者中，83% (n=190)进行了3个月的随访(对照组:93/116,80.2%;干预率:97/113,85.8%;<我> P < / i > = 0。25) The likelihood of EPP use was significantly higher in the intervention group (control: 19/116, 16.4%; intervention: 70/113, 62%; odds ratio [OR] 8.3, 95% CI 4.5-15.5; P<.001). Patients in the intervention group who used the EPP were more likely to present for postsurgical follow-up (OR 3.59, 95% CI 1.28-10.06; P=.02). Conclusions: The inpatient enrollment of patients who underwent orthopedic surgery into an EPP increased EPP use but did not independently result in enhanced follow-up. Patients who were enrolled as inpatients and subsequently used the portal had the highest likelihood of 3-month follow-up. Clinical Trial: ClinicalTrials.gov NCT03431259; https://clinicaltrials.gov/ct2/show/NCT03431259

2021年全国麻醉协会在四大社交网络上的全球存在:观察性案例研究

2022 - 07 - 20 - t09:45:02内

尽管医疗协会在社交网络(SNs)上的存在对于传播专业信息可能是有趣的，但没有研究调查它们在社交网络上的存在。这个观点的目的是描述国家麻醉协会在社交网络上的全球存在和活动。该观察性研究评估了世界麻醉师协会联合会会员协会在社交网站Twitter、Facebook、Instagram和YouTube上的活跃存在度(在收集日期前一年≥1个帖子)。我们在世界麻醉师协会联合会网站上收集了关于每个麻醉学会的数据。在136个社团中，66个(48.5%)社团至少活跃在一个SN上。使用最多的SN是Facebook (n=60, 44.1%)，其次是Twitter (n=37, 27.2%)， YouTube (n=26, 19.1%)和Instagram (n=16, 11.8%)。关注者最多的社交网络是Facebook 52个(78.8%)，Twitter 12个(18.2%)。Twitter上的粉丝数为361 (IQR 75-1806)， Facebook上的粉丝数为2494 (IQR 1049-5369)， Instagram上的粉丝数为1400 (IQR 303-3058)， YouTube上的粉丝数为214 (IQR 33-955)。推特上的帖子数量和追随者数量之间存在很强的相关性(r=0.95, 95% CI 0.91-0.97;<我> P < / i > & lt;措施)、Instagram (r <我> < / i > = 0.83, 95% CI 0.58 - -0.94; P<.001), and YouTube (r=0.69, 95% CI 0.42-0.85; P<.001). According to the density of anesthetists in the country, there was no difference between societies with and without active SN accounts. Conclusions: Less than half of national anesthesia societies have at least one active account on SNs. Twitter and Facebook are the most used SNs.

更正:术中自动短消息服务更新:质量改善举措，以减轻护理人员的担忧

2022 - 07 - 15 - t15:00:02内