SummaryIn current practice, the length of epidural catheter that should be left in the epidural space is not standardised for effective postoperative analgesia. This prospective, randomised, double-blinded study aimed to determine the most appropriate length of epidural catheter that should be inserted into the epidural space for postoperative analgesia. We recruited 102 women and assigned them into three study groups (3, 5 and 7 cm insertion). An epidural catheter was inserted and epidurography was performed. Postoperatively, mean pain scores, motor and sensory levels, and any complications associated with the epidural catheter were recorded. No statistically significant difference for mean postoperative pain score was found at all study timings. Motor and sensory blockade was also statistically insignificant. Unilateral sensory analgesia developed in one patient in the 7 cm group and epidural catheter dislodgement was observed in four patients in the 3 cm group. In order to minimise catheter-related complications for postoperative analgesia, the most appropriate length that an epidural catheter should be left in the epidural space is 5 cm. Continuous epidural analgesia is considered one of the most effective techniques for postoperative analgesia [1]. The position of an epidural catheter and the distribution of local anaesthetic drugs in the epidural space are two of the most important determining factors for successful epidural analgesia. The incidence of failed or inadequate epidural analgesia has been reported as 4.2-6.3% in one study, because of suboptimal placement of the epidural catheter within the epidural space [2]. In our institution, regular audit of the acute pain service also showed that catheterrelated problems are one of the main reasons for failed or incomplete epidural analgesia.In current practice, controversy exists regarding the length of epidural catheter that should be left within the epidural space for successful pain management. Inserting a limited length of the epidural catheter, i.e. 3-4 cm, may result in an increased incidence of migration of the epidural catheter out of the epidural space. However, if a longer length of epidural catheter is left in the epidural space, this may increase the likelihood of a unilateral block or intravenous cannulation [3]. Clinical trials have shown that even if the epidural catheter was left 2-5 cm in the epidural space, this was found to provide satisfactory analgesia. However, one trial has shown that if more than 3 cm of the epidural catheter is left in the epidural space, this increases the risk of transforaminal escape [4].The length of the epidural catheter that should be left in the epidural space has not been standardised. The main aim of this study was to determine the most appropriate length of epidural catheter that should be inserted into the epidural space for postoperative analgesia. The secondary aim was to determine the complications associated with different lengths of epidural catheter.
Background Venous compromise is still the most common cause of free flap failure. The need of a second venous anastomosis to prevent free flap failure is controversial. It is proposed that the use of dual venous anastomoses reduces venous compromise. However, some surgeons suggest that dual venous drainage reduces venous blood flow causing a potential risk of thrombosis. Objective This study aimed to compare the frequency of reexploration secondary to venous thrombosis in free flap surgeries in reconstruction of soft tissue defects with 1-vein versus 2-vein anastomosis. Materials and Methods We performed a retrospective cohort study including 298 flaps. In 180 of these patients, 2-vein anastomosis was done, and in 118, 1-vein anastomosis was done. The study was conducted at Aga Khan University Hospital from January 2017 to December 2018. Results The number of venous anastomosis was not associated with flap survival. The group with dual anastomosis required more frequent reexploration as compared with 1 venous anastomosis group (8% vs 1.7%). Outcome and salvage rate were better in the 2-vein group as compared with the 1-vein group (64% vs 50%). Conclusion There is no difference in flap survival in single or dual venous anastomosis, but we have noticed higher reexploration rates in the 2-vein group. However, outcome is better in the 2-vein group.
Background and Objective: Simulation-based learning has been a part of teaching in healthcare for a long time; however, in recent decades, simulation-based learning has been adopted by a significant number of healthcare institutes at different levels to improve practical skills, confidence, and preparedness to ensure patient safety and its application in real-life situations towards better patient care. The main objective of this paper was to use existing literature to explore aspects of simulation in healthcare teaching. Methods: It is a narrative review on simulation in healthcare that was conducted by using various search engines for English-language articles published between 2010 and August 2020. The main search terms were simulation, healthcare teaching, and simulation in healthcare. All articles found relevant to the title and/or abstract were retrieved. Searches were conducted using the academic databases PubMed, Google Scholar, MEDLINE, CINAHL, and Athabasca University (AU) library site. The studies were reviewed if they were considered relevant to the search by the primary authors. Results: Thirty-nine articles, which met the pre-set criteria, were analyzed and employed as a reference in this paper to support the idea that simulation is an effective way of learning in healthcare. Conclusion: This paper reviewed various aspects of simulation, including its background, philosophies, and highlighted the advantages and disadvantages of incorporating simulation as a pedagogical approach into current educational curriculums for healthcare students. Furthermore, it presents a brief discussion on the current uses of simulation, followed by the educational strategies related to simulation and the importance of debriefing in simulation activities. doi: https://doi.org/10.12669/pjms.39.4.7145 How to cite this: Saleem M, Khan Z. Healthcare Simulation: An effective way of learning in health care. Pak J Med Sci. 2023;39(4):---------. doi: https://doi.org/10.12669/pjms.39.4.7145 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objective: The purpose of the present literature review is to examine the psychosocial issues that emerge in the patients and their spouses upon cancer diagnosis and during its treatment. Furthermore, to search the immigrant specific supportive approaches when providing cancer care. Study Design: Systematic Literature Review. Period: 2008 to 2020. Material & Methods: Thirty-three articles, which met the pre-set criteria, were analyzed, and employed as a reference in this paper. Results: The analysis of the literature reported that depression, anxiety and low quality of life are prevalent among cancer patients and their spouses. The well-established evidence strengthened that culturally competent care, social, as well as linguistic support, are the immigrant tailored strategies that can help satisfy the need of this vulnerable population. Conclusion: The key research findings presented in the paper concludes that immigrants experiencing cancer and their spouses are more prone to acquire psychosocial issues due to their unprecedented circumstances that demand specific immigrants’ tailored approaches.
Background: As the most prevalent form of congenital hand malformation, syndactyly carries significant aesthetic and practical implications. For the vast majority of situations, surgery is the best option. Congenital syndactyly can be repaired with skin grafts and local flaps, however the results are often less functional and cosmetic than anticipated and often leave scars and residual syndactyly. So we set out to find out how children's syndactyly healing went in this study.1 Objective: To analyze the functional outcome of syndactyly repair in children presenting in a tertiary care hospital. Methodology: This Descriptive case series was conducted at Department of Plastic and Reconstructive Surgery, LUMHS Jamshoro / Hyderabad for 6 months. Sample size of 180 cases was recruited through Non-probability consecutive sampling. Then all patients underwent surgery under general anesthesia. In all cases, procedure was performed depends upon the type / extent of syndactyly. Then patients were discharged after recovery and were followed up on 1st, 2nd and 3rd months post operatively for assessment of functional outcome of syndactyly repair i.e. no supination and no pronation was noted. All this information was noted on proforma. Data was entered and analyzed using SPSS 22.0. Results: The mean age of children was 6.30+3.55. There were 66 (37%) females and 114 (63%) male in the sample. There were 128 (71%) cases of simple syndactyly and 52 (29%) cases of complex syndactyly. There were 127 (71%) cases who had no-supination, 162 (90%) cases who had no-pronation. There was significant difference observed between both type of syndactyly (P<0.05) for supination while insignificant for pronation. Conclusion: Thus we have found that syndactyly repair is effective technique through which we can attain success in maximum number of patients which can help in achieving normal angulation of fingers after surgery. Key words: Syndactyly, Pronation, Supination, Angulation, Children
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