Display omitted
To present our program for ambulatory mini percutaneous nephrolithotomy (mini-PCNL) and evaluate its initial results.
We analyzed the implementation of the protocol into the clinical ...practice with the first 30 outpatient mini-PCNL cases performed in our center between April 2021 and September 2022. Demographic characteristics, perioperative variables, complications and need for unplanned health care, stone-free rate (SFR), stone type and patient satisfaction with the major ambulatory surgery (MAS) process were collected.
A total of 30 patients with a mean age of 60.2 ± 11.6 years who met the inclusion criteria underwent surgery. The mean stone size was 15 mm range: 5−20. No intraoperative complications were recorded. All patients except one were discharged the same day of surgery as planned. In the month following discharge, the rate of complications, emergency department (ED) revisits or hospital readmissions rates were 0%. Stone-free-rate (SFR) at 3 months was 83%. Overall satisfaction with the whole perioperative process was assessed with the EVAN-G questionnaire, obtaining 124.3 points out of a maximum of 150, which is equivalent to a 78.6% level of satisfaction.
Ambulatory mini-PCNL can be implemented as a treatment option in centers with experience in endourology, an established MAS Unit, and strictly selected patients. Our initial results show an adequate safety profile and high overall satisfaction perceived by patients undergoing the ambulatory approach.
Presentar nuestro protocolo de nefrolitotomía percutánea (NLP) ambulatoria y evaluar los resultados iniciales del programa.
Se analiza la implantación clínica del protocolo con los 30 primeros casos de mini NLP ambulatoria realizados en nuestro centro entre abril de 2021 y septiembre de 2022. Se recogen datos demográficos, variables perioperatorias, complicaciones y necesidad de atención médica no planificada, stone-free rate (SFR), tipología litiásica y parámetros de satisfacción con el proceso de cirugía mayor ambulatoria (CMA).
Con una edad media de 60,2 ± 11,6 años se intervinieron un total de 30 pacientes que cumplían los criterios de inclusión. El tamaño medio de la litiasis fue de 15 mm rango: 5–20. No se registró ninguna complicación intraoperatoria. Todos los pacientes excepto uno fueron dados de alta el mismo día de la intervención según lo planificado. El mes posterior al alta, la tasa de complicaciones, reconsulta a urgencias o reingreso hospitalario ha sido del 0%. La SFR a los 3 meses ha sido del 83%. La satisfacción global de todo el proceso perioperatorio, valorada a través del cuestionario EVAN-G, fue de 124,3 puntos sobre un máximo de 150, equivalente a un 78,6% de grado de satisfacción.
La mini NLP en régimen ambulatorio puede instaurarse como una opción de asistencia en centros con experiencia en endourología, una unidad establecida de CMA y mediante una selección estricta de los pacientes. Nuestros resultados iniciales muestran un perfil de seguridad adecuado y un grado de satisfacción global elevado de los pacientes intervenidos en esta modalidad.
To report our initial experience with robotic radical prostatectomy as an outpatient procedure.
Retrospective analysis of patients who underwent RRP as MAS (Major Ambulatory Surgery) at our center ...between March 2021 and May 2022. We collected baseline patient characteristics, intraoperative outcomes and postoperative data (need for unplanned medical care and complications at one month after surgery). Oncologic characteristics at disease diagnosis (PSA, staging, ISUP, MRI) and postoperative pathologic outcomes were collected.
We identified a total of 35 patients with an average age of 60,8 ± 6,88 years and a BMI of 27 ± 2,9 Kg/m2. All patients had a low anesthetic risk and 25.71% had undergone previous abdominal surgery. The surgical time was 151,66 ± 42,15 min and the average blood loss was 301,2 ± 184,38 mL. Two patients (5.7%) were admitted for one night and 7 patients (20%) consulted the emergency department in the following month, of which 3 (8.57%) were readmitted. We recorded one intraoperative complication, seven mild postoperative complications (Clavien I-II) and one severe complication (Clavien IIIb). The severe complication occurred on the eighth postoperative day and was not related to the procedure being ambulatory.
The absence of serious complications in the immediate postoperative period supports RRP in MAS as a safe technique for selected patients.
Reportar nuestra experiencia inicial de prostatectomía radical robótica en régimen ambulatorio.
Análisis retrospectivo de los pacientes intervenidos de PRR en CMA en nuestro centro entre marzo de 2021 y mayo de 2022. Recopilamos las características basales de los pacientes, resultados intraoperatorios y datos del postoperatorio (necesidad de asistencia médica no planificada y complicaciones al mes de la cirugía). Se recogieron las características oncológicas al diagnóstico de la enfermedad (PSA, estadificación, ISUP, RMN) y el resultado anatomopatológico tras la intervención.
Identificamos un total de 35 pacientes con una edad promedio de 60,8 ± 6,88 años y un IMC de 27 ± 2,9 Kg/m2. Todos presentaban un riesgo anestésico bajo y un 25,71% tenía alguna cirugía abdominal previa. El tiempo quirúrgico fue de 151,66 ± 42,15 minutos y el sangrado promedio fue de 301,2 ± 184,38 mililitros. Dos pacientes (5,7%) ingresaron la primera noche de la cirugía y 7 pacientes (20%) consultaron en urgencias en el mes siguiente, de los cuales 3 (8,57%), reingresaron. Registramos una complicación intraoperatoria, siete complicaciones postoperatorias leves (Clavien I-II) y una complicación grave (Clavien IIIb). La complicación grave transcurrió al octavo día postoperatorio y no tuvo relación con la ambulatorización del procedimiento.
La ausencia de complicaciones graves en el postoperatorio inmediato avala la PRR en régimen de CMA como una técnica segura dirigida a pacientes seleccionados.
This manuscript describes the synthesis (based on the intermatrix synthesis (IMS) method), optimization, and application to bacterial disinfection of Ag@Co polymer–metal nanocomposite materials with ...magnetic and bactericidal properties. This material showed ideal bactericide features for being applied to bacterial disinfection of water, particularly (1) an enhanced bactericidal activity (when compared with other nanocomposites only containing Ag or Co nanoparticles), with a cell viability close to 0% for bacterial suspensions with an initial concentration below 105 colony forming units per milliliter (CFU/mL) after a single pass through the material, (2) capacity of killing a wide range of bacterial types (from coliforms to Gram-positive bacteria), and (3) a long performance-time, with an efficiency of 100% (0% viability) up to 1 h of operation and higher than 90% during the first 24 h of continuous operation. The nanocomposite also showed a good performance when applied to water samples from natural sources with more complex matrices with efficiencies always higher than 80%.
INTRODUCTION AND OBJECTIVEPenile prosthesis (PP) surgery is performed in many institutions as an inpatient procedure. We have recently initiated a major ambulatory surgery (MAS) program, thus ...reducing the hospital stay. The objective of this study was to assess the feasibility, complications and satisfaction of the implantation of outpatient surgery PP program in our hospital. MATERIAL AND METHODSRetrospective observational study evaluating the results and satisfaction of PP implanted as an outpatient procedure in Bellvitge University Hospital during 2018. RESULTSDuring 2018 we implanted 49 PP: 27 (55%) inpatient surgeries vs. 22 (45%) outpatient surgeries. Of these 22, 2 (9%) were second implants. All patients underwent both general anesthesia and crural, proximal dorsal nerve and transversus abdominis plane block (TAP). Complication rates between inpatient and outpatient procedures were similar, 2 (7%) and 1 (5%), respectively, without reporting infections or requiring PP removal. Postoperatively, a satisfaction telephone survey was conducted in 19 (86%) patients: 16 (84%) considered the time of hospital stay as appropriate, 15 (79%) would have preferred to be operated again in an outpatient care setting and 15 (79%) would recommend it. The patients' main concerns were related to being at home with no medical assistance at home and about coming back the next day for drainage removal. All patients reported well-controlled pain without requiring opioid intake in any case. CONCLUSIONSIn our series, PP implantation in an ambulatory care setting is feasible and safe. Although there are some aspects that should be improved, the program showed acceptable satisfaction rates and an adequate postoperative pain control, neither raising the administration of opioids, nor increasing complications and re-admission rates.
Penile prosthesis (PP) surgery is performed in many institutions as an inpatient procedure. We have recently initiated a major ambulatory surgery (MAS) program, thus reducing the hospital stay.
The ...objective of this study was to assess the feasibility, complications and satisfaction of the implantation of outpatient surgery PP program in our hospital.
Retrospective observational study evaluating the results and satisfaction of PP implanted as an outpatient procedure in Bellvitge University Hospital during 2018.
During 2018 we implanted 49 PP: 27 (55%) inpatient surgeries vs. 22 (45%) outpatient surgeries. Of these 22, 2 (9%) were second implants. All patients underwent both general anesthesia and crural, proximal dorsal nerve and transversus abdominis plane block (TAP). Complication rates between inpatient and outpatient procedures were similar, 2 (7%) and 1 (5%), respectively, without reporting infections or requiring PP removal.
Postoperatively, a satisfaction telephone survey was conducted in 19 (86%) patients: 16 (84%) considered the time of hospital stay as appropriate, 15 (79%) would have preferred to be operated again in an outpatient care setting and 15 (79%) would recommend it. The patients’ main concerns were related to being at home with no medical assistance at home and about coming back the next day for drainage removal. All patients reported well-controlled pain without requiring opioid intake in any case.
In our series, PP implantation in an ambulatory care setting is feasible and safe. Although there are some aspects that should be improved, the program showed acceptable satisfaction rates and an adequate postoperative pain control, neither raising the administration of opioids, nor increasing complications and re-admission rates.
El implante de prótesis de pene (PP) es llevado a cabo en muchos centros como régimen de hospitalización. Recientemente en nuestro centro hemos iniciado su realización como cirugía mayor ambulatoria (CMA), reduciendo la estancia hospitalaria.
El objetivo de este estudio ha sido evaluar la viabilidad, complicaciones y satisfacción de las PP implantadas en CMA en nuestro centro.
Estudio observacional retrospectivo de los resultados y satisfacción de las PP realizadas en CMA en el Hospital Universitario de Bellvitge durante 2018.
En 2018 se realizaron 49 PP: 27 (55,1%) hospitalizadas y 22 (44,9%) ambulatorias. De estas 22, 2 (9,1%) fueron segundos implantes. Los pacientes recibieron anestesia general y bloqueo locorregional crural, dorsal del pene y del plano transverso del abdomen (TAP). Las tasas de complicaciones entre hospitalizados y CMA fueron similares, 2 (7%) y 1 (5%) respectivamente, sin reportar ningún caso de infección ni requerir la retirada del implante.
Postoperatoriamente se realizó una encuesta telefónica contactando a 19 (86%) pacientes: 16 (84%) consideraron adecuado el tiempo de estancia, 15 (79%) volverían a intervenirse en CMA y 15 (79%) lo recomendarían, siendo el motivo de reticencia la preocupación por la falta de asistencia médica en el domicilio y evitar volver a las 24h para retirar el drenaje. Todos tuvieron buen control del dolor sin requerir mórficos en el postoperatorio.
En nuestra serie, el implante de PP en CMA ha resultado ser viable y seguro. A pesar de que existen puntos de mejoría, se mantiene una correcta satisfacción del paciente y buen control del dolor, sin implicar un aumento de las complicaciones ni readmisiones.
Although some articles have analysed the definitions of health and health promotion from the perspective of health-care users and health care professionals, no published studies include the ...simultaneous participation of health-care users, primary health care professionals and key community informants. Understanding the perception of health and health promotion amongst these different stakeholders is crucial for the design and implementation of successful, equitable and sustainable measures that improve the health and wellbeing of populations. Furthermore, the identification of different health assets and deficits by the different informants will generate new evidence to promote healthy behaviours, improve community health and wellbeing and reduce preventable inequalities. The objective of this study is to explore the concept of health and health promotion and to compare health assets and deficits as identified by health-care users, key community informants and primary health care workers with the ultimate purpose to collect the necessary data for the design and implementation of a successful health promotion intervention.
A descriptive-interpretive qualitative research was conducted with 276 participants from 14 primary care centres of 7 Spanish regions. Theoretical sampling was used for selection. We organized 11 discussion groups and 2 triangular groups with health-care users; 30 semi-structured interviews with key community informants; and 14 discussion groups with primary health care workers. A thematic content analysis was carried out.
Health-care users and key community informants agree that health is a complex, broad, multifactorial concept that encompasses several interrelated dimensions (physical, psychological-emotional, social, occupational, intellectual, spiritual and environmental). The three participants' profiles consider health promotion indispensable despite defining it as complex and vague. In fact, most health-care users admit to having implemented some change to promote their health. The most powerful motivators to change lifestyles are having a disease, fear of becoming ill and taking care of oneself to maintain health. Health-care users believe that the main difficulties are associated with the physical, social, working and family environment, as well as lack of determination and motivation. They also highlight the need for more information. In relation to the assets and deficits of the neighbourhood, each group identifies those closer to their role.
Generally, participants showed a holistic and positive concept of health and a more traditional, individual approach to health promotion. We consider therefore crucial to depart from the model of health services that focuses on the individual and the disease toward a socio-ecological health model that substantially increases the participation of health-care users and emphasizes health promotion, wellbeing and community participation.
PDF
