SARS-CoV2 has led to a global pandemic affecting almost 3 million people in almost over 3 months. Various clinical presentations have been reported so far and no definite therapy is established. Anticoagulation is recommended by several experts to address the potential prothrombotic complications from COVID-19, but its safety and regimen need further clinical trials and safety and efficacy profile. Here, we present three cases of intracranial hemorrhage in three critically ill patients with COVID-19 and discuss their course in relation to various regimens of anticoagulation used.
Introduction
Enhanced recovery after surgery (ERAS) protocols have been widely studied in elective abdominal surgeries with promising outcomes. However, the use of these protocols in emergency abdominal surgeries has not been widely investigated. This study aimed to evaluate ERAS application outcomes via early oral feeding compared to regular postoperative care in patients undergoing perforated duodenal ulcer repairs in emergency abdominal surgeries.
Materials and methods
We conducted a randomized controlled trial at the Surgical Unit 1 Benazir Bhutto Hospital from August 2018 to December 2019. A total of 42 patients presenting to the emergency department with peritonitis secondary to suspected perforated duodenal ulcer were included in the study. Patients were randomly assigned into two groups. Group A patients followed an ERAS protocol for early oral feeding, and Group B received regular postoperative care (i.e., delayed oral feeding). Our primary outcomes were the length of hospital stay, duodenal repair site leak, the severity of pain (via the visual analog scale), and postoperative ileus duration. Results were analyzed via IBM Statistical Product and Service Solutions (SPSS) Statistics for Windows, Version 20.0 (Armonk, NY: IBM Corp.). and chi-square and independent t-tests were applied.
Results
Patients who received early oral feeding (Group A) showed a shorter length of hospital stay, lower pain scores, and shorter postoperative ileus duration than patients in the traditional postoperative care group. Also, we noted no duodenal repair site leak in the early oral feeding group. The differences between the two groups were statistically significant (P<0.05).
Conclusions
Based on our results, ERAS protocols that promote early oral feeding can be applied in patients undergoing emergency abdominal surgery for perforated duodenal repair. Early oral feeding in emergency surgery patients can reduce the patient burden on hospitals. In addition, early oral feeding can promote better outcomes and reduced economic burden for patients.
Keywords: Perforated duodenal ulcer, ERAS protocol, randomized controlled trial, duodenal repair site leak, length of hospital stay, VAS score, postoperative ileus.
Workplace Bullying (WB) is a general and severe issue on workplace in the current era resulting in adverse concerns for both employees and organizations. The issue of workplace bullying needs to be investigated on workplaces to identify the adverse effect on employees' attitudes and behaviors. The study investigates the direct association between linking between workplace bullying and Job Burnout (JB); and indirect association through the mediation of Psychological Contract Violation (PCV) and Psychological Capital (PC). The data were collected by using purposive sampling technique from 310 nurses though self-administered questionnaires employed in public and private hospitals of Lahore, Pakistan. The Structural Equation Modelling (SEM) analysis was utilized for hypotheses testing. The outcomes demonstrate that workplace bullying is directly positively related to job burnout. In other words, employees who face the workplace bullying or being bullied experience the burnout. The findings also reveal that workplace bullying indirectly influence the JB through intervening role of PC and PCV. In other words, workplace bullying reduces psychological capital which result in job burnout among employees, and result in psychological contract violation which lead toward job burnout among employees. This study provided initial empirical evidence regarding the intervening effect of psychological capital and psychological contract violation between the relationship of workplace bullying and job burnout. The implications, limitations and future directions are also discussed.
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