Introduction: There are two surgical approaches to reconstruct a pressure ulcer (PU): one-stage reconstruction or two-stage reconstruction. One stage reconstruction consists of surgical debridement and flap reconstruction during one operation. Two-stage surgery consist of a surgical debridement and a final reconstruction in two different sessions, with approximately six weeks between both sessions. Objective: The aim of this study was to compare the results of single stage surgery and two-stage surgery on the PU recurrence rate and other important post operative complications. Method: A retrospective, comparative study in Spinal Cord Injured (SCI) individuals with a single- or two stage surgical reconstruction between 2005 and 2016 was designed. A total of 81 records were included for analysis. Results: The primary outcome, the difference in occurrence of a recurrent PU in the reconstructed area (33.3% versus 31.6%), is not statistically significant between one-and two-stages reconstruction. Also, the mean duration to develop a recurrent PU between both surgical reconstructions is not statistically significant. Other surgical complications in the reconstructed area like wound hematoma, hemorrhage, seroma or (partial) flap failure did not differ significantly between both groups, apart and in total. We calculated the additional costs in case of a two-stage approach compared with a single-stage reconstruction at EUR 16,362. Conclusions: There are no statistical significant differences in PU recurrence rate or other post operative complications between SCI patients who have undergone one- or two stage PU reconstructive surgery. The most obvious choice for a one-stage approach in case of PU reconstructive surgery has great positive implications for the patient, family, health care providers and the health care system.
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ObjectiveRepeated practice, or spacing, can improve various types of skill acquisition. Similarly, virtual reality (VR) simulators have demonstrated their effectiveness in fostering surgical skill acquisition and provide a promising, realistic environment for spaced training. To explore how spacing impacts VR simulator-based acquisition of surgical psychomotor skills, we performed a systematic literature review.MethodsWe systematically searched the databases PubMed, PsycINFO, Psychology and Behavioral Sciences Collection, ERIC and CINAHL for studies investigating the influence of spacing on the effectiveness of VR simulator training focused on psychomotor skill acquisition in healthcare professionals. We assessed the quality of all included studies using the Medical Education Research Study Quality Instrument (MERSQI) and the risk of bias using the Cochrane Collaboration’s risk of bias assessment tool. We extracted and aggregated qualitative data regarding spacing interval, psychomotor task performance and several other performance metrics.ResultsThe searches yielded 1662 unique publications. After screening the titles and abstracts, 53 publications were retained for full text screening and 7 met the inclusion criteria. Spaced training resulted in better performance scores and faster skill acquisition when compared to control groups with a single day (massed) training session. Spacing across consecutive days seemed more effective than shorter or longer spacing intervals. However, the included studies were too heterogeneous in terms of spacing interval, obtained performance metrics and psychomotor skills analysed to allow for a meta-analysis to substantiate our outcomes.ConclusionSpacing in VR simulator-based surgical training improved skill acquisition when compared to massed training. The overall number and quality of available studies were only moderate, limiting the validity and generalizability of our findings.
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Background: The increasing numbers of surgeries involving high risk, multi-morbid patients, coupled with inconsistencies in the practice of perioperative surgical wound care, increases patients’ risk of surgical site infection and other wound complications. Objectives: To synthesise and evaluate the recommendations for nursing practice and research from published systematic reviews in the Cochrane Library on nurse-led pre-operative prophylaxis and post-operative surgical wound care interventions used or initiated by nurses. Design: Meta-review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data sources: The Cochrane Library database. Review methods: All Cochrane Systematic Reviews were eligible. Two reviewers independently selected the reviews and extracted data. One reviewer appraised the methodological quality of the included reviews using A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) checklist. A second reviewer independently verified these appraisals. The review protocol was registered with the Prospective Register of Systematic Reviews. Results: Twenty-two Cochrane reviews met the inclusion criteria. Of these, 11 reviews focused on pre-operative interventions to prevent infection, while 12 focused on post-operative interventions (one review assessed both pre-and post-operative interventions). Across all reviews, 14 (63.6%) made at least one recommendation to undertake a specific practice, while two reviews (9.1%) made at least one specific recommendation not to undertake a practice. In relation to recommendations for further research, insufficient sample size was the most predominant methodological issue (12/22) identified across reviews. Conclusions: The limited number of recommendations for pre- and post-operative interventions reflects the paucity of high-quality evidence, suggesting a need for rigorous trials to address these evidence gaps in fundamentals of nursing care.
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Since 2015, the research group Lifelong Learning in Music of Hanze University of Applied Sciences Groningen, together with the University Medical Center Groningen (UMCG), has developed and researched the MiMiC practice for patients and nurses on surgical wards. The musicians make tailor-made music in the patients' rooms in collaboration with patients and nurses. They do this on the basis of verbal and non-verbal contact with patients and nurses. Person-centred music-making turns out to be easy to realise in a medical setting and to be meaningful for all involved. People who have just had surgery experience less pain. Nurses feel more deeply involved with their patients. Musicians show sensitivity for the social context in which they carry out their artistic practice.In this project the research group is developing an innovative artistic practice with a focus on elderly patients. Musicians work with patients and the care staff that are taking care of these patients during their stay in hospital. The research should lead to insights in the effects of this practice and to a new training for master students and professional musicians who want wish to specialise themselves in this field. Pilots on six different wards of the UMCG with professional musicians and master students are part of the research which will last two years in its entirety. The project has been granted funding from the 'Banning de Jong Fonds' of the national 'Prins Bernhard Cultuurfonds' and the 'Fonds Sluyterman van Loo'.
In Nederland worden jaarlijks meer dan 2 miljoen operaties uitgevoerd waarbij 75% van de patiënten acute pijn krijgen. Bij één op de tien mensen ontwikkelt de acute pijn zich tot chronische pijn en bij één op de zeven mensen leidt dat tot langdurig opioïdengebruik. Mensen met beperkte gezondheidsvaardigheden hebben hierop een verhoogd risico. Deze problemen leiden niet alleen tot een traag herstel, de ontwikkeling van nieuwe ziekten of vermindering van de levenskwaliteit, maar maatschappelijk gezien neemt het werkvermogen af en de medische zorgconsumptie toe. Het is belangrijk dat zorgprofessionals deze potentiële problemen vroegtijdig herkennen en passende interventies uitvoeren, voor en na een operatie om ernstige gevolgen van pijn en langdurig gebruik van opioïden te verminderen. Een antwoord op deze problemen is de begeleiding van patiënten door zorgprofessionals, die werkzaam zijn in een zogenaamde Transitionele Pijn Service. Zij kunnen de multidisciplinaire pijnzorg coördineren, de patiënt (met beperkte gezondheidsvaardigheden) en naaste coachen en begeleiden in de pijnbehandeling, en opioïde pijnmedicatie tijdig helpen afbouwen, ook in de thuissituatie. Zorgprofessionals voelen zich echter handelingsverlegen ten aanzien van welke interventies en hulpmiddelen ze hierbij in kunnen zetten, en hoe ze daarbij patiënten met beperkte gezondheidsvaardigheden adequaat kunnen ondersteunen. Doel van dit project is om voor en door zorgprofessionals en samen met ervaringsdeskundigen een tool set van preventieve gepersonaliseerde interventies en hulpmiddelen te ontwikkelen om kwetsbare chirurgische patiënten met beperkte gezondheidsvaardigheden te ondersteunen. Hiermee kunnen patiënten vanaf de voorbereiding tot in de thuissituatie begeleiding ontvangen, gestimuleerd worden in zelfmanagement, en zal acute en chronische pijn en langdurig en ongewenst opioïdengebruik verminderen. Deze tool set, die ontwikkeld wordt via ontwerpgericht onderzoek, zal in een pilot getest worden op bruikbaarheid, acceptatie en toepasbaarheid. Tevens ontwikkelen we een onderwijsmodule voor zorgprofessionals in het initiële zorgonderwijs en voor bij-en nascholingstrajecten, zodat zorgprofessionals in het hele land hiermee gaan werken.
The clubfoot deformity is one of the most common congenital orthopaedic “conditions”. Worldwide approximately 100,000 children are born with unilateral or bilateral clubfoot every year. In the Netherlands the incidence is approximately 175 every year. This three dimensional deformity of the foot involves, equinus, varus, adductus, and cavus . Left untreated the clubfoot leads to deformity, functional disability and pain. Physical impairments of children with clubfoot might lead to limitations in activities and therefore impede a child’s participation. In clinical practice, the orthopaedic surgeon and physiotherapists are regularly consulted by (parents of) clubfoot patients for functional problems such as impaired walking and other daily activities. This does not only affect long-term and physical health of a child, it will also affect the development of social relationships and skills as well. Since walking is a main activity in children to be able to participate in daily life, our previous study (financially supported by SIA Raak Publiek) focussed on gait differences between children with clubfoot and controls. However, differences in gait characteristics do not necessarily lead to functional limitations and restricted participation. Therefore, providing insight in participation and a child’s performance in other activities than walking is necessary. Insight in a child’s participation will also indicate the functional outcome of the treatment, which on its turn could provide essential information concerning a possible relapse.. Early identification of a relapse is important since it could prevent the need for major surgical interventions. The occurrence of a relapse clubfoot will probably also lead to functional differences in the foot as well as problems during activity and participation. Therefore, the main focus of this study is the functional outcomes of physical activities and the characterisation of participation of children with clubfeet in daily activities of childhood.
