BACKGROUND: Cardiovascular disorders continue to be the most prevalent cause of morbidity and mortality in the Philippines and worldwide. Surgical treatments used to manage cardiovascular disorders (unfortunately) have multiple complications. As part of the health care team, nurses need to develop interventions that are safe, scientifically grounded, and cost-effective in order to counteract these complications. One of the nursing interventions that can be implemented is nearly ambulation.

AIM: To search, appraise and synthesize the best evidence surrounding early ambulation among cardiac surgery patients.

METHODS: This study employed an evidence-based review method suggested by Melnyk and Fineout-Overholt (2005). Systematic literature search was done to the following databases: Cochrane, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Joana Briggs Institute (JBI), MEDLINE, National Guideline Clearinghouse (NGC), and Nursing/Academic edition. Post-operative patients who have undergone coronary artery bypass surgery(CABG), percutaneous coronary intervention (PCI), and transfemoral cardiac catheterization (TCC) are included in this study. The final review also included six articles.

RESULTS AND DISCUSSION: Findings show that early ambulation among patients who underwent coronary artery bypass surgery(CABG), percutaneous coronary intervention (PCI), and transfemoral cardiac catheterization (TCC) improves patient care outcomes (i.e., reduce complications such back pain, puncture bleeding,and urinary discomfort, improves general well-being, and decrease health care costs).Parameters for early ambulation (ranges from 3 hours to 24 hours)and late ambulation (ranges from 12 hours to 48 hours) are used in the study reviewed. The non-randomized comparative study found that the complication rate in the early ambulation group is not increased compared to the late ambulation group (test for non-inferiority p=0.002). Randomized controlled trial found out that early ambulation among cardiac surgery patients could reduce back pain (OR=0.19, 95% Cl: 0.08-0.45, p<0.001), decrease urinary discomfort (OR=0.35, 95% Cl:0.14-0.90, p=0.03) for very or unbearable urinary discomfort, and general well-being (p=0.0005 for vitality scale and p=0.014 for the total general well-being). Furthermore, early ambulation group reported decrease in hospitalization costs (less charge $105 or Php 5,040).

CONCLUSION AND RECOMMENDATIONS: This evidence-based practice (EBP) review ascertains that early ambulation among postoperative coronary artery bypass surgery (CABG), percutaneous coronary intervention (PCI), and transfemoral cardiac catheterization (TCC) could improve patient care outcomes such as reduction of complication rate, improvement of general well-being, and decrease of healthcare costs. This study, therefore, recommends the use of early ambulation among CABG,PCI, and TCC postoperative patients to complete the last two phases of evidence-based practice.

OBJECTIVE: To explore the application of the"five-line division method "in selecting the surgical approach for occupying lesions in the saddle area and its adjacent areas. METHODS: Based on the natural anatomic structures, 5 lines (alpha, beta, theta line and lambda, epsilon line) were drawn on the images of the craniocerebral axial plane crossing the middle of the saddle area and the craniocerebral median sagittal plane, thus dividing the saddle area and its adjacent areas into 6 regions in the axial plane (1, 2, 3, 1', 2', and 3' regions) and into 4 regions in the sagittal plane (I, II, III, and IV regions). Based on these divisions, the large space-occupying lesions in the saddle area and adjacent areas were classified and their respective surgical approaches were determined after reviewing the commonly used approaches in the saddle area and clinical experiences. We collected the data of 116 patients undergoing surgeries for space-occupying lesions involving the saddle and the adjacent areas in our hospital between September, 2014 and August, 2017, and analyzed their classifications and the corresponding surgical approaches based on the "five- line division method " to compare the consistency between the hypothetic approaches and the approaches adopted in the actual surgeries. RESULTS: The actual surgical approaches adopted in the 116 cases were all selected under the guidance of experts in our hospital. The hypothetic surgical approaches selected based on the"five- line division method "showed a good consistency with the actually adopted approaches. CONCLUSIONS The"five-line division method "can spatially classify the commonly seen space-occupying lesions involving the saddle area and its adjacent area to provide assistance in the selection of surgical approaches for such lesions.
General Surgery/methods* ; Humans

Introduction: Degenerative disorder involving the acromioclavicular joint (ACJ) is quite common especially in the elderly. One of the surgical modalities of treatment of this disorder is the Mumford Procedure. Arthroscopic approach is preferred due to its reduced morbidity and faster post-operative recovery. One method utilizes the anteromedial and Neviaser portals, which allow direct and better visualization of the ACJ from the subacromial space. However, the dangers that may arise from incision and insertion of instruments through these portals are not fully understood. This cadaveric study was carried out to investigate the dangers that can arise from utilization of these portals and which structures are at risk during this procedure. Materials and Methods: Arthroscopic Mumford procedures were performed on 5 cadaver shoulders by a single surgeon utilizing the anteromedial and Neviaser portals. After marking each portals with methylene blue, dissection of nearby structures were carried out immediately after each procedure was completed. Important structures (subclavian artery as well as brachial plexus and its branches) were identified and the nearest measurements were made from each portal edges to these structures. Results: The anteromedial portal was noted to be closest to the suprascapular nerve (SSN) at 2.91 cm, while the Neviaser portal was noted to be closest also to the SSN at 1.60 cm. The suprascapular nerve was the structure most at risk during the Mumford procedure. The anteromedial portal was noted to be the most risky portal to utilize compared to the Neviaser portal. Conclusion: Extra precaution needs to be given to the anteromedial portal while performing an arthroscopic distal clavicle resection in view of the risk of injuring the suprascapular nerve of the affected limb.
urgical Procedures, Operative ; General Surgery

The healthcare environment is continuing to change and so too is education and training of surgeons. We now live in an age of increased specialisation, of technology, of accountability, of greater patient education and expectation and mass media attention. The traditional apprentice method and emphasis too much on examinations will have to be changed to a more structured system of training with training standards, regular assessment and feed back. There are new skills to be learnt for future surgical practice and new ways to learn them to become competent. We need to make changes in the institutions and departments to create a learning environment and an organisational system to implement the training programme. The current shortage of surgical work force in the institutions and lack of sufficient teachers committed to teaching and training are major issues that need to be addressed.
General Surgery ; education ; trends ; Singapore

Decision Making ; General Surgery ; Humans

No abstract available.
Blindness* ; General Surgery* ; Mydriasis* ; Orbit*

Human ; Female ; Child ; General Surgery ; Hearing

OBJECTIVE: To determine the sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of FNAB in detecting parotid malignancies in our institution.
METHODS:
Design: Restrospective Chart Review
Setting: Tertiary Government Hospital
Participants: Postoperative records of seventy six (76) patients with tumors of the parotid gland preoperatively diagnosed by FNAB.
RESULTS: The sensitivity of FNAB was 46%. The specificity and positive predictive value were both 100% and negative predictive value was 90%. Overall accuracy in diagnosing malignant parotid tumor was 91%.
CONCLUSION: FNAB in this institution is a poor predictor of malignancy, having a sensitivity rate of only 46%. While this may serve as a basis for not recommending pre-operative FNAB for patients with parotid tumors in the interim, other factors should also be considered, including concerns with the actual performance and interpretation of FNAB in our institution.

 

Post-traumatic parotid sialocoele is a subcutaneous extravasation of saliva from the parotid gland secondary to traumatic disruption of its duct or parenchyma. Currently, there is no consensus regarding the best therapy for parotid sialocoele, as it is resistant to conservative management. The present paper puts forward a relatively simple, safe and effective technique for the treatment of parotid sialocoele, specifically a peroral drainage technique. The results justify our recommendation to use this approach for the treatment of sialocoele.
Wounds and Injuries ; General Surgery ; Salivary Ducts

Decision Making ; General Surgery ; Humans ; Judgment ; Physicians