VC repeated measurements is a poor predictor of the need for further MV in MG patients. This can probably be ascribed to the erratic nature of MG, a disease whose course is largely influenced by many parameters (infection, treatment modifications, initiation of corticosteroid therapy, stress, psychological factors, etc.). Early admissions to the ICU of MG patients with respiratory dysfunction is thus recommended.
Background COVID-19 put a stop to the operative experience of surgical residents, leaving reassignment of the team, to the frontlines. Each program has adapted uniquely; we discuss how our surgical education changed in our hospital. Study Design A retrospective review of changes in general surgery cases, bedside procedures, and utilization of residents before and during the pandemic. Procedures were retrieved from electronic medical records. Operating room (OR) cases 1 month before and 5 weeks after the executive order were collected. Triple lumen catheter (TLC), temporary hemodialysis catheter (HDC), and pneumothorax catheter (PC) insertions by surgical residents were recorded for 5 weeks. Results Before the pandemic, an average of 27.9 cases were done in the OR, with an average of 10.1 general surgery cases. From March 23 to April 30, 2020, the average number of cases decreased to 5.1, and general surgery cases decreased to 2.2. Elective, urgent, and emergent cases represented 83%, 14.6%, and 2.4% prior to the order and 66.7%, 15.1%, and 18.2%, respectively, after the order. Bedside procedures over 5 weeks totaled to 153, 93 TLCs, 39 HDCs, and 21 PCs. Conclusion Repurposing the surgical department for the concerns of the pandemic has involved all surgical staff. We worked with other departments to allocate our team to areas of need and re-evaluated daily. The strengths of our team to deliver care and perform many bedside procedures allowed us to meet the demands posed by this disease while remaining as a cohesive unit.
General surgeons are often asked to evaluate acute abdominal pain which has an expanded differential diagnosis in women of childbearing age. Acute appendicitis accounts for many surgical emergencies as a common cause of nongynecologic pelvic pain. In some rare instances, acute appendicitis has been shown to occur simultaneously with a variety of gynecologic diseases. We report a case of concurrent acute appendicitis and ruptured ovarian endometrioma.
Objective: Hard-to-heal wounds are a common problem, worsened by ageing, and the increased prevalence of diabetes and morbid obesity. The provider–patient relationship has undergone a transformation, from a paternalistic to a mutual participation model, in which ‘the physician tries to enter the patient's world to see the illness through the patient's eyes’. The indepth assessment of the impact of psychosocial, physical issues and provider–patient dynamics is crucial to wound healing and patient wellbeing. It can customise future treatment including physical therapy, psychological and social interventions to improve outcomes. Method: A new health-related quality of life instrument (HRQOL) proposal based on a survey consisting of 20 questions was completed by patients as a pilot project. The psychosocial, physical and provider–patient dynamics were evaluated. A total wound impact score (WIs) was tabulated, ranging from 20–80 points. A wound assessment and plan (PBW–AP) was created. Results: In our sample of 25 patients, 75% experienced a moderate WIs (50–69) and 5% experienced a severe WIs (31–49). Feeling angry about having a wound was reported by 40% of patients. A majority of patients (60%) thought about their wounds >1 hour per day. Importantly, 24% answered that their primary care physicians never mentioned their wounds. Conclusion: It is important for all physicians taking care of patients with hard-to-heal wounds to see ‘the patient behind the wound’. The PBW–AP algorithm is an individualised, multidisciplinary assessment and intervention based on a WIs. It is designed not only to identify but also to tackle psychosocial, physical, and provider–patient issues, to improve overall quality of life, patient satisfaction and clinical outcomes. Based on the results, the PBW–AP algorithm was designed to be used at initial and subsequent visits as a roadmap for problem identification and intervention.
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