Managing appendicitis in the elderly patient.
Aged; Preoperative Care; Postoperative Care; Middle Age; Intraoperative Care; Perioperative Nursing; Appendicitis – Surgery – In Old Age
Horattas M C; Haught R
AORN Journal
1992
1992-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/S0001-2092(07)68659-1" target="_blank" rel="noreferrer noopener">10.1016/S0001-2092(07)68659-1</a>
Evaluation of infections in the lung transplant patient.
Postoperative Care; Communicable Diseases; Molecular Diagnostic Techniques; Mycobacterium Infections; Pneumonia – Etiology; Aspergillosis – Complications; Cross Infection – Risk Factors; Cytomegalovirus Infections – Diagnosis; Infection – Diagnosis; Infection – Mortality; Infection – Risk Factors; Lung Transplantation – Methods; Patient Assessment – Methods; Pseudomonas Infections – Complications; Staphylococcal Infections – Complications
PURPOSE OF REVIEW: Infections in lung transplant recipients (LTRs) are a serious complication that is associated with high mortality. Early and accurate diagnosis is critical in the management of these infections in order to achieve improved outcomes. This review focuses on studies published in the last 2 years related to the evaluation and management of infections following lung transplantation. RECENT FINDINGS: Valganciclovir is well tolerated and effective for long-term cytomegalovirus prophylaxis. Recently published guidelines recommend that foscarnet be added to ganciclovir for patients with life-threatening or sight-threatening disease while waiting for genotypic assay results because of ganciclovir-resistant strains. Mycobacterium abscessus has emerged as a significant pathogen in LTRs and should be eradicated in potential recipients before transplantation is performed. Preoperative Aspergillus colonization appears to not increase the risk of death after transplant. Azithromycin is protective against the development of bronchiolitis obliterans syndrome (BOS) and reduces mortality in LTRs. Eradication of Staphylococcus aureus in patients colonized prior to surgery can decrease postoperative surgical site infections from it by 80%. RNA interference therapy improves the symptoms of BOS in LTRs but does not have a direct antiviral effect. SUMMARY: Although life-saving for most recipients, lung transplantation can be complicated by serious postoperative infections. Additional prospective studies are needed to better elucidate the role of molecular testing in the diagnosis of infections, to determine whether eradication of S. aureus colonization improves outcomes in LTRs, and to further evaluate the role of RNA interference therapy for infections in LTRs.
Watkins Richard R; Lemonovich Tracy L
Current Opinion in Infectious Diseases
2012
2012-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/qco.0b013e32834c54bc" target="_blank" rel="noreferrer noopener">10.1097/qco.0b013e32834c54bc</a>
Clinical impact of temporary therapy interruptions on anticoagulation control in patients treated with warfarin.
Female; Male; Aged; Prospective Studies; International Normalized Ratio; Drug Administration Schedule; Preoperative Care; Postoperative Care; Human; Middle Age; Retrospective Design; Dose-Response Relationship; Drug; Treatment Outcomes; Drug Monitoring; Anticoagulants – Therapeutic Use; Anticoagulants – Administration and Dosage; Atrial Fibrillation – Drug Therapy; Blood Coagulation Disorders – Drug Therapy; Coronary Thrombosis – Drug Therapy; Euthanasia; Passive; Venous Thromboembolism – Drug Therapy; Warfarin – Administration and Dosage; Warfarin – Therapeutic Use
This retrospective cohort study was completed to describe the impact of short-term therapy interruptions on anticoagulation control in patients receiving warfarin. Patients seen in a pharmacist-managed anticoagulation clinic were included if they were on a stable warfarin dose and then underwent a planned interruption in therapy. Patients were excluded if phytonadione was administered before the interruption or if medications known to interact with warfarin were altered during the interruption. Data were analyzed for 2 groups: (1) patients with a single interruption in therapy (group 1) and (2) patients with a single interruption in therapy plus patients with an extended interruption in therapy (group 2). The primary endpoint was the change in weekly maintenance warfarin dose from preinterruption to postinterruption. Evaluation of 199 patients resulted in 31 interruptions in group 1 and 34 interruptions in group 2. A change in dose was required in 58% of patients in group 1 and 56% of patients in group 2. The mean absolute change in dose was 2.03 ± 2.79 mg (P \textless 0.003) in group 1 and 1.96 ± 2.72 mg (P \textless 0.002) in group 2. For the majority of patients, the dose change represented \textless10% of their preinterruption weekly dose. Of patients requiring a dose change, 50% required an increase in dose. In conclusion, close follow-up is warranted after a warfarin therapy interruption as dose adjustments will likely be needed to regain anticoagulation control and the direction of this dose change cannot be predicted.
Boros Melanie L; Rybarczyk Amy M; Gallegos Patrick J; Zimmerman Jacob P
American Journal of Therapeutics
2013
2013-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/MJT.0b013e31824ea644" target="_blank" rel="noreferrer noopener">10.1097/MJT.0b013e31824ea644</a>
Arthroscopic anterior cruciate ligament reconstruction.
Humans; Arthroscopy/*methods; Knee Joint/*surgery; Postoperative Care; Ligaments; Articular/*surgery
Our understanding of the structure and function of the anterior cruciate ligament has progressed rapidly over the past decade. Arthroscope-assisted anterior cruciate ligament replacement is a new procedure that allows isometric placement of the anterior cruciate ligament graft. Postoperative rehabilitation is enhanced by preservation of the extensor mechanism.
Wilcox P G; Jackson D W
Clinics in sports medicine
1987
1987-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Maximizing patient satisfaction and functional results after total knee arthroplasty.
*Arthroplasty; *Outcome Assessment (Health Care); *Patient Satisfaction; Humans; Knee Prosthesis; Knee/rehabilitation; Minimally Invasive Surgical Procedures; Pain; Patient Education as Topic; Physical Therapy Modalities; Postoperative Care; Postoperative/prevention & control; Preoperative Care; Prosthesis Design; Replacement
The purpose of this article is to review the issues regarding preoperative patient expectations for total knee arthroplasty and whether or not these are fulfilled after surgery. The demographics of the typical total knee arthroplasty patient are changing, and the expectations regarding the outcome of the surgery have been changing as well. Patients are younger, heavier, more active, and often come to the surgeon's office with information provided via the Internet that may be inaccurate and/or misleading. Many expect and assume that the operation will return the knee to "normal." Traditional outcomes measures used by orthopedic surgeons to determine the quality of the results achieved are inadequate and do not take into account the higher expectations of current patients. Various strategies have been developed to improve satisfaction after the surgery. These include preoperative patient education, less invasive surgical approaches, advances in prosthetic design, multimodal pain management, and aggressive postoperative rehabilitation. Using these strategies will make preoperative expectations more realistic and improve postoperative satisfaction.
Greene Kenneth; Harwin Steven F
The journal of knee surgery
2011
2011-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1055/s-0031-1275389" target="_blank" rel="noreferrer noopener">10.1055/s-0031-1275389</a>