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Background: Finding the balance of good postoperative analgesia while facilitiating mobility is important for a safe and satisfactory patient experience during Total Knee Arthroplasty (TKA). This study aimed to compare the efficacy of intrathecal morphine, adductor canal block, and their combination in optimizing pain management and postoperative recovery in TKA patients. This retrospective analysis of prospectively collected data evaluated postoperative pain scores, time to mobilisation, and length of hospital stay. Methods: 1006 consecutive patients undergoing elective TKA across two large tertiary centres were included over six years. They were divided into one of four groups according to the type of analgesia received: Group N patients received no neuraxial morphine or regional block. Group B patients received adductor canal block (ACB) only. Group M patients received intrathecal morphine (ITM) but no regional block. Group BM patients received both ACB and ITM. Results: Patients who received an ACB had faster postoperative mobilization compared to those without (p < 0.001). Patients in Group BM had the lowest pain scores at rest (Visual Analogue Scale (VAS) 2.9) and with movement (VAS 5.3), while Group B patients experienced the highest pain scores at rest (VAS 3.7) and on movement (VAS 6.5) (p = 0.005). Patients who received ITM had the lowest opioid requirements (p < 0.001). There was no significant differences between groups in requirement for rescue pain management strategies (p = 0.06). Conclusions: The combination of ITM and ACB in patients undergoing TKA provides improved postoperative analgesia with lower postoperative opioid requirement and earlier mobilization compared with ACB or ITM alone. [ABSTRACT FROM AUTHOR]

Background: Patients with primary Bone Sarcoma and Giant Cell Tumors in the lower extremities often require major surgery involving tumor prostheses. The postoperative course for this patient group can be complex and influenced by various factors and challenges that demand careful nursing care. This study aims to identify challenges related to the nursing care of individuals with primary bone tumors following surgery for tumor prostheses in the lower extremities. Methods: A retrospective cohort study of 15 patients treated at Rigshospitalet, Copenhagen, Denmark, between November 5. 2016, and April 1. 2020 was conducted by medical record review, focusing on challenges related to postoperative nursing care. All patients with the surgery code "Bone Excision" were identified within the surgery booking system and screened for eligibility. Results: Patients experienced postoperative challenges such as severe pain, prolonged time to mobilization (mean: 4 days), and defecation (mean: 5 days). The mean length of stay at the Rigshospitalet was 13 days. Furthermore, eleven patients (73%) reported disrupted sleep and nausea. Conclusion: Patients undergoing tumor prosthesis surgery in the lower extremities face considerable postoperative challenges that contribute to a prolonged hospital stay. These challenges, including severe pain, delayed mobilization, and gastrointestinal issues, significantly impact recovery. The findings highlight the urgent need for targeted nursing interventions to address these issues effectively. Enhanced pain management protocols, early mobilization strategies, and comprehensive postoperative care plans are essential to improve patient outcomes and reduce the length of hospital stays. Addressing these challenges through dedicated nursing care is crucial for optimizing the recovery process for patients receiving lower extremity tumor prostheses. [ABSTRACT FROM AUTHOR]

These concepts aim to accelerate postoperative recovery, reduce hospital stay duration, and increase patient satisfaction. But how do we achieve good results with these approaches? A central aspect of fast-track concepts is preoperative preparation. This includes comprehensive patient education about the entire treatment process, including realistic expectations for the postoperative phase. Good prehabilitation care, which includes physiotherapy exercises and nutritional counseling, can improve patients' physical condition before surgery and thus speed up postoperative recovery. Intraoperatively, minimally invasive techniques and the use of modern anesthesia methods play a crucial role. These techniques reduce tissue trauma and minimize postoperative pain, leading to faster patient mobilization. The use of tranexamic acid to reduce blood loss and the application of local anesthetics also contribute to improved postoperative outcomes. Postoperatively, multimodal pain management is essential. By combining different analgesics and early mobilization, pain can be effectively controlled, and knee joint functionality can be quickly restored. Close collaboration between surgeons, anesthetists, physiotherapists, and nursing staff is crucial in this regard. Another important factor is structured follow-up care. Regular physiotherapy sessions and continuous monitoring of the healing process help to detect and treat complications early. Involving patients in the rehabilitation process and promoting self-responsibility are also key to long-term success. In conclusion, modern fast-track concepts in knee arthroplasty lead to good results through interdisciplinary collaboration, comprehensive preoperative preparation, minimally invasive surgical techniques, and effective pain management. The continuous development of these concepts and their adaptation to individual patient needs are the keys to successful treatment. [ABSTRACT FROM AUTHOR]

Introduction: Hemostasis following large‐bore femoral vein access remains a challenge. Manual compression has been the standard of care but requires bedside staff, prolonged bed rest, and longer length of stay. The LockeT is an external compression device that attempts to address these issues while achieving venous hemostasis. Objectives: We evaluate postprocedural hemostasis and vascular closure outcomes after using LockeT following cardiac electrophysiologic procedures. Methods: We performed a single‐center, observational study of patients who underwent vascular closure for electrophysiology procedures using LockeT. Postprocedural outcomes were subsequently analyzed. Results: We studied 102 patients (N) for whom LockeT was used to close 182 separate vascular access sites (n). Common procedures were atrial fibrillation ablation (56.9%, N = 58) and left atrial appendage occlusion (28.4%, N = 29). Most often, 8‐Fr [48.3% (n = 126)], 11‐Fr [27.2% (n = 71)], and 8.5‐Fr [16.9% (n = 44)] sheaths were used, with an average procedure time of 82.1 ± 29.4 min. Hemostasis was achieved in 97.8% (n = 187) of all LockeT cases. Time to ambulation and discharge were 3.93 ± 1.10 h and 8.1 ± 4.4 h, respectively. No major complications were noted. Postprocedurally, 52% (N = 53) of patients were discharged on the same day. There were no differences in hemostasis (p =.859) or ambulation times (p =.202) between procedure types. Conclusion: The LockeT can effectively close venous access sites with no major complications. [ABSTRACT FROM AUTHOR]

Background: Early mobilisation is endorsed after abdominal surgery. Healthcare professionals are key figures in mobilisation. However, their experiences of barriers and enablers of mobilisation shortly after abdominal surgery is yet not fully explored. Therefore, the aim was to describe the healthcare professionals' experiences of postoperative mobilisation shortly after abdominal surgery. Methods: This study has a qualitative descriptive design. In November 2017, individual interviews were conducted with a convenience sampling of ten nurses, three nurse assistants and four physiotherapists who participated in an interventional trial mobilising adult patient within two hours after abdominal surgery. Data were analysed with inductive content analysis. Reporting of the study followed the COREQ checklist. Findings: The study findings are presented in two categories: 'a responsibility for the patient' and 'prerequisites and challenges' with five subcategories. The healthcare professionals had initial concerns that mobilisation shortly after surgery would not be safe for the patient and would add extra burden on their workload. However, with time, their perceptions changed to believing that it enhanced the recovery and was feasible to conduct at the postoperative recovery unit. Conclusion: Mobilisation shortly after abdominal surgery at the postoperative recovery unit, was found to be beneficial for the patients without reducing patient safety. However, it is important to assure that sufficient resources and adequate competence are available if such intervention should be implemented in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Many previous studies reported that mobility did not recover to the preoperative level even several months after total knee arthroplasty (TKA). However, recent studies indicate that the time required for recovery may have been shortened. The correct information regarding the mobility improvement is very helpful in assessing a patients' progress in rehabilitation. Therefore, we evaluated the mobility early after TKA. Materials and Methods: One hundred seventy patients participated. We measured gait speed and the Timed Up and Go test (TUG) as mobility at pre-operatively and post-operatively at one, two, and three weeks. Results: Gait speed at 1 and 2 weeks after TKA was significantly lower than the preoperative value, but no significant difference was observed at 3 weeks. TUG at 1 week after surgery was significantly slower than the preoperative value, but no difference at 2 weeks, and faster than the preoperative value at 3 weeks. Approximately half of the patients (gait speed, 50%; TUG, 55%) demonstrated improvements exceeding their preoperative values. Conclusions: Our findings suggest that achieving preoperative mobility within 3 weeks after TKA may serve as a target for assessing early postoperative recovery progress. [ABSTRACT FROM AUTHOR]

Background: The evidence for the benefits of early mobilization in intensive care is growing. Early mobilization differs from most other interventions in intensive care since the patient's participation is requested. What kind of challenges this entails for the intensive care clinicians, and what is crucial in successful early mobilization from their perspective, is sparsely explored and was therefore the purpose of this study. Methods: Semi-structured interviews were held with 17 intensive care clinicians, seven nurses, five assistant nurses and five physiotherapists. The interviews were analyzed with a phenomenographic methodology. Findings: Four descriptive categories emerged: 1) Taking responsibility; 2) Taking the patient's perspective; 3) Time or not time to mobilize; and 4) The "know-how" of early mobilization. Early mobilization was perceived as an important and crucial part of intensive care. It includes positioning and sensory stimulation, which could be used to re-orientate the patient and prevent delirium. The patients' experiences were considered individual with a mix of strong emotions. Despite the stated significance of early mobilization, different conceptions were expressed about the right time, some of them based on concerns for the patient, and some due to safety concerns. In the optimal active mobilization to upright positions there was an emphasis on careful preparation and patient involvement, including negotiation and active participation. Conclusions: The importance of early mobilization is indisputable. Successful early mobilization is achieved by applying a person-centered approach, involving the patient as an active partner. Early mobilization comprises positioning and sensory stimulation and should be included in the daily planning of patient care. [ABSTRACT FROM AUTHOR]

Introduction : Hip arthroplasty, including hemiarthroplasty and total hip arthroplasty is a common surgical procedure for patients suffering from hip joint disorders with an aim of complication free early return to activities of daily living. Various minimally invasive surgical approaches have been described to achieve this aim including a relatively new SPAIRE approach. This case series shows our technique of hip arthroplasty using the SPAIRE technique with the help of conventional instruments in an Indian Scenario at a tertiary care center in Eastern India along with our short-term functional outcomes till a follow up period of 6 months. Materials and method : This was the prospective observational study done between May 2022 to Oct 2023 in Tata Main hospital, Jamshedpur. Total 35 patients were operated by this technique. Data including age, gender, time to return orthotic assisted mobility, Harris hip score at 2 months & any complications till the follow up of 6 months were recorded for each patient who underwent Hemiarthroplasty or Total Hip arthroplasty using the SPAIRE technique with conventional instruments for hip arthroplasty (performed by single surgeon – the senior author) in our tertiary care center. Results : 35 patients were operated during this span by using the SPAIRE technique. There were 30 cases of hip hemiarthroplasty and 5 cases of total hip arthroplasty (1 bilateral). 5 patients were lost to follow up during the period of 6 months. Harris hip score was measured for each patient at 2 months and mean Harris hip score was 83.16. Out of 35 patients, 9 patients had excellent outcome, 14 patients had good outcome and 7 patients had fair outcome. No patient had complications such as infection, delayed wound healing, periprosthetic fractures or sciatic nerve injury. One patient reported dislocation at 3 months following a fall. Mean time to return to orthotic assisted ambulation was 1.5 days for all 35 patients. Conclusion : SPAIRE technique is one of the safe surgical approaches for primary hip arthroplasties. This minimally invasive tendon sparing approach which preserves quadricep coxa provides excellent hip stability, early return to preinjury activities. It also reduces postoperative complications such as dislocation. [ABSTRACT FROM AUTHOR]

Background: There is overwhelming evidence of improved patient outcomes as a result of early mobilization in the intensive care unit (ICU). However, several barriers of ICU mobility remain understated with reference to clinical roles. The purpose of this study is to investigate the perceived barriers of early mobility of critically ill patients among ICU healthcare providers. Methods: In this cross‐sectional study, the Mobilization Attitudes and Beliefs Survey (PMABS‐ICU) was administered to ICU healthcare providers using an online survey. The study investigated barriers related to knowledge, attitudes, and behaviors regarding ICU mobility practices. These barriers were compared among different ICU clinical roles. Results: The survey yielded a total number of 214 healthcare providers with 41% female and 59% male. Respiratory therapists reported the highest perceived barriers to ICU mobility (M 39, IQR 36, 43) % compared to physical therapists (who reported the lowest barriers), occupational therapists, nurses, and physicians (p ≤ 0.05). ICU healthcare providers' behavior towards ICU mobility such as perceived benefits and safety is ranked as the primary barrier (M 49, IQR 42, 52) %. Professional experience did not significantly vary among all groups. Conclusion: Our findings highlight that ICU healthcare providers' perceptions, including both potential benefits and safety concerns regarding mobility, are significant barriers to implement mobility practices. ICU mobility barriers should be tackled by providing education and training. A focused effort to include RTs and nurses could advance interdisciplinary ICU mobility practice and reduce associated barriers. [ABSTRACT FROM AUTHOR]

Background: Few studies have evaluated the effects of structured early mobilization (EM) protocols on the level of mobilization in critical care patients. Objective: To evaluate the impact of a structured EM protocol on the level of mobilization, muscle strength, and the level of activities of daily living (LADL) after intensive care unit (ICU) and hospital discharge. Methods: This randomized clinical trial (U1111-1245-4840) included adults patients who were randomized into two groups: intervention (n = 40) and control (n = 45). The intervention group underwent conventional physiotherapy and structured EM protocols, and the control group underwent conventional physiotherapy. The level of mobilization from 0 (no mobilization) to 5 (walking), muscle strength (Medical Research Council scale), LADL (Katz Index), and incidence of complications were evaluated. Results: The level of mobilization from day 1 to day 7 increased in the intervention group compared with the control group (p <.05). Muscle strength did not change during the protocol in the intervention and control groups {day 1 [effect size (r) = 0.15, p =.161], at ICU discharge [r = 0.16, p =.145], and after ICU discharge [r = 0.16, p =.191]}. The LADL did not differ between the intervention and control groups after ICU discharge [4 (1–6) vs. 3 (1–5), p =.702] or 30 days after hospital discharge [6 (5–6) vs. 6 (5–6), p =.945]. The structured EM protocol was safe, and no severe complications were observed during the protocol. Conclusion: A structured EM protocol increased the level of mobilization without improving muscle strength and the LADL compared with conventional physiotherapy. [ABSTRACT FROM AUTHOR]

Background: Rapid return to mobilisation and daily function is essential for recovery after an elective and emergency caesarean section, prevention of short- and long-term complications, and mothers' well-being. High pain levels may delay recovery. Considering the biopsychosocial model, recovery is additionally complex and comprises social and psychological aspects. Objective: This study examined the relationships between preoperative expectations, perioperative subjective experience, postoperative pain levels, and postoperative interruption of functioning and recovery. Methods: Overall, 306 women completed a set of questionnaires on the fourth day after a caesarean section regarding their demographic information, levels of expectation matching the caesarean section and the perioperative subjective experience, and the pain levels and interruption to daily activities 24 hours postpartum. Results: Using a structural equation model, a gap between preoperative expectations and perioperative experience related to a poorer perioperative subjective experience was found. This was associated with higher postoperative pain levels that were directly and indirectly related to the interruption of various functions and activities during the initial 24 hours postpartum. The model explained 58% of the variance in postpartum functioning and had good goodness-of-fit (χ2 = 242.74, df = 112, χ2/df = 2.17, NFI = 0.93, CFI = 0.96, TLI = 0.94, RMSEA = 0.06). Additionally, pain levels were higher and daily activities were more severely impaired for women who had undergone emergency caesarean section compared to those who had undergone elective caesarean section. Conclusion: The need for preoperative preparation and setting expectations, perioperative emotional support, continuous communication with the mother, and an efficient postoperative pain management was highlighted. [ABSTRACT FROM AUTHOR]

Background: Video-assisted thoracoscopic surgery (VATS) is a practical resource in the management of traumatic hemothorax. However, it carries inherent risks and should be mobilized cost-effectively. In this study, we investigated the ideal VATS timing using cost analysis. Methods: 617 cases of unilateral traumatic hemothorax from 2012 to 2022 were identified in our trauma database. We extracted encounter cost, length of stay (LOS), and operative cost information. Using Kruskal-Walli's test, we compared the cost and LOS for patients who underwent VATS or continued nonoperative management in the first 7 days of admission. Additionally, we computed the daily proportion of patients initially managed nonoperatively but ultimately underwent VATS. P -values <.05 were considered significant. Results: The median encounter cost of cases managed operatively before hospital day 4 (HD4) was higher than those managed nonoperatively. This difference was $63k on HD2 (P -value.07) and was statistically significant for HD3 (difference of $65k, P -value.02). The median LOS with operational management on HD2 and 3 was 7 and 6 respectively vs median LOS of 2 and 3 with nonoperative management on those days (P -value <.001,.01 respectively). The proportion of patients who failed nonoperative management did not change from baseline until HD4 (23% (95% CI 19.7, 26.3) vs 33.9% (95% CI 28.3, 39.6), P -value <.001). Discussion: Early mobilization of VATS before hospital day 4 increases the overall hospital cost without offering any length of stay benefit. Continuing nonoperative management longer than 4 days is associated with a high failure rate and a costlier operation. [ABSTRACT FROM AUTHOR]

The authors comment on the randomized controlled trial (RCT) A Very Early Rehabilitation Trial after stroke (AVERT). A total of 2,104 stroke patients was included in the study wherein early mobilization (EM) intervention was carried out within 24 hours after admission. They note the problems existing in clinical studies related to EM, such as screening of included patients, development of intervention methods, and selection of prognostic indicators.

Background: Early mobilization (EM) is acknowledged for its safety and benefits in the recovery of critically ill patients, yet its implementation in intensive care units (ICU) remains inconsistently aligned with established guidelines. This discrepancy highlights a gap between theoretical endorsement and practical application. While barriers to EM have been extensively studied, the intentions and perceived practices of ICU nurses towards EM, especially in certain geographical regions, have not been adequately understood. Aim: The objective of this study is to assess the perceptions, actual practices and intentions of ICU nurses regarding the implementation of EM for patients in the ICU setting. Study Design: A cross‐sectional, multi‐centre, survey‐based study. Results: The study collected data through an electronic questionnaire from 227 ICU nurses across eight hospitals in Beijing, China, concerning their experiences, practices and intentions related to EM. The survey response rate was 50% (114 of 227), indicating a moderate level of engagement by the target population. Among the surveyed participants, 68.7% (n = 156) reported having experience with EM for critically ill patients. Of these experienced nurses, 49.3% (n = 77) indicated they carried out EM less frequently than once per week, while only 29.5% (n = 46) reported dedicating more than 20 min to EM activities per patient. Only 24.2% (n = 55) of participants confirmed the presence of specific EM guidelines in their workplace. Notably, guideline adherence could be influenced by the patient's condition severity, which may affect how these protocols are applied. Notably, the approach and frequency of EM practices showed significant variation across different ICUs. A substantial majority (75%, n = 170) of participants expressed a strong intention towards implementing EM, correlating significantly with factors such as having a higher education level (bachelor's degree or higher), receiving departmental support, encountering fewer perceived barriers, and belonging to specific departments like respiratory (SICU) and surgery (RICU). The EM guidelines mentioned by participants were primarily focused on specific protocols and guidance, highlighting the emphasis on structured approaches to EM in their clinical settings. Conclusions: Despite the recognized experience with EM among ICU nurses, there is a notable divergence between their practices and the recommendations outlined in EM guidelines. This study underscores the need for the establishment of clear, actionable guidelines, alongside the provision of targeted educational programmes and robust support systems, to foster the consistent and effective implementation of EM in ICU settings. Relevance to Clinical Practice: This study underscores the clinical relevance of EM in ICU settings, advocating for the development of precise EM guidelines to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Pneumonia has a high incidence in traumatic brain injury (TBI) patients and lacks effective treatments. Early mobilization (EM) may be a potentially effective treatment. Aim: To explore the impact of EM on TBI‐related pneumonia in the neurosurgical intensive care unit (NICU). Study Design: This study was a historical control study. 100 TBI patients who received EM intervention were prospectively included as the experimental group (EM cohort), and 250 TBI patients were retrospectively included as the control group. The propensity score matching (PSM) method was employed to balance baseline and minimize potential bias. The relationship between EM and TBI‐related pneumonia was investigated by univariate and multivariate logistic regression, then further determined by subgroup analysis. The influence of other variables was excluded by interaction analyses. Finally, the effect of EM on the prognosis of TBI patients was analysed by comparing the Glasgow Coma Scale (GCS) and the hospital stay. Results: After screening, 86 patients were included in the EM cohort and 199 patients were included in the control cohort. There were obvious differences between the two cohorts at baseline, and these differences were eliminated after PSM, when the incidence of pneumonia was significantly lower in the EM cohort than in the control cohort (35.0% vs. 61.9%, p <.001). Multivariate logistic regression showed that EM was an independent risk factor for TBI‐related pneumonia and was significantly associated with a decreased incidence of pneumonia. This correlation was present in most subgroups and was not affected by other variables (p for interaction >.05). Patients in the EM cohort had shorter length of ICU stay (6 vs. 7 days, p =.017) and higher GCS at discharge (12 vs. 11, p =.010). Conclusion: EM is a safe and effective treatment for TBI patients in NICU, which can reduce the incidence of pneumonia, help to improve prognosis and shorten the length of ICU stay. Relevance to Clinical Practice: Although the utilization rate of EM is low in TBI patients for various reasons, EM is still an effective method to prevent complications. Our study confirms that a scientific and detailed EM strategy can effectively reduce the incidence of pneumonia while ensuring the safety of TBI patients, which is worthy of further research and clinical application. [ABSTRACT FROM AUTHOR]

Background: Recent critical care guidelines recommended the evidence‐based ABCDEF care bundle for intensive care unit (ICU) patients. However, limited information is available on the implementation of the bundle in Turkish ICUs. Aim: To assess the current practices of the ABCDEF care bundle as reported by ICU nurses. Study Design: A cross‐sectional study using a web‐based survey was conducted. Researchers invited nurses with at least 1 year of ICU experience to participate by sending the link to the research questionnaires they created in Google Forms to the one ICU nurse association and one communication group of which they are members. Results: A total of 342 ICU nurses completed the survey. Although 92% of the participants performed pain assessments in their ICUs, 52.7% reported not using protocols. Based on the responses of the nurses, spontaneous awakening and breathing trials are performed in 88.8% and 92.4%, respectively, of ICUs. Fewer than half of the participants reported following a sedation protocol in their ICUs. Only 54.7% of ICU nurses surveyed reported routinely monitoring patients for delirium. It was reported that early mobilization was practised in 68.7% of ICUs, but non‐ventilated patients were mobilized more frequently (70.2%), and 9.7% of ICUs had mobilization teams. Family members were actively involved in 95% of ICUs; however, 9.7% used dedicated staff to support families and 3.5% reported that their unit was open 24 h/day for visits. Conclusions: While the implementation of most pain and sedation evaluations in ICUs were reported by nurses, many of them did not use structured delirium assessments. There is a need to encourage early mobilization programs and family participation. Relevance to Clinical Practice: Health institutions can improve patient care and outcomes by establishing and standardizing a protocol for each component of the ABCDEF care bundle in ICUs. [ABSTRACT FROM AUTHOR]

Objectives: To examine patient, surgical and hospital factors associated with Day‐1 postoperative mobility after hip fracture surgery in older adults. Methods: A cohort study using Australia and New Zealand Hip Fracture Registry was conducted. Participants were aged older than 50 years and underwent hip fracture surgery between 1 January 2020 and 31 December 2020 inclusive. The outcome was standing and step transferring out of bed onto a chair and/or walking Day‐1 after hip fracture surgery. Results: Mean age was 82 years and 68% were women. Of 12,318 patients with hip fracture, 5981 (49%) actually mobilised Day‐1. Odds of actual first‐day mobilisation were lower for individuals usually walking with either stick or crutch (OR = 0.71, 95% CI 0.62–0.82) or two aids or frame (OR = 0.57, 95% CI 0.52–0.64) or wheelchair/bed bound (OR = 0.24, 95% CI 0.17–0.33); who had impaired cognition preadmission (OR = 0.57, 95% CI 0.51–0.64); from aged care facilities (OR = 0.59, 95% CI 0.52–0.67); had an American Society of Anaesthesiologists grade 2 (OR = 0.63, 95% CI 0.41–0.97), 3 (OR = 0.31, 95% CI 0.20–0.47) or 4 or 5 (OR = 0.21, 95% CI 0.14–0.32); surgery delay >48 h (OR = 0.81, 95% CI 0.71–0.91); and restricted/non‐weight‐bearing status immediately postoperatively (OR = 0.53, 95% CI 0.42–0.67). Conclusions: Both non‐modifiable and modifiable patient and surgical factors influence first‐day mobilisation after hip fracture surgery. Reducing time to surgery might assist future quality improvement efforts to increase Day‐1 postoperative mobility. [ABSTRACT FROM AUTHOR]

Background/Aim: Constipation can occur after abdominal procedures. In this study, we investigated whether early mobilization after abdominal surgery is effective for treating constipation. Methods: We conducted a systematic review of studies implementing early and planned mobilization after abdominal surgical procedures. We extracted studies published from 2012-2022 from six electronic databases: PubMed, Google Scholar, Science Direct, Cochrane, TürkMedline, and Ulakbim. The data were collected by two reviewers following a pre-designed subtraction form. We made use of narrative synthesis when presenting our results. Results: We examined 10 articles that satisfied the inclusion criteria; patients underwent a cesarean section in four studies, bariatric surgery (gastric bypass) in one study, liver resection in one study, radical cystectomy in two studies, cholecystectomy in one study, and a kidney transplant in one study. The studies were characterized by differences in the early mobilization programs applied to patients after abdominal surgery. In two of the studies, the patients were mobilized accordingly to daily step goals; in five studies only early stimulation and walking attempts were utilized. In three of the studies, the patients were mobilized within the scope of mobilization programs prepared in detail after surgery, and the targets were determined in terms of distance walked. All of the studies stipulated that physical activity should gradually increase over time. Conclusion: Early and planned mobilization programs applied after surgery had positive effects on first gas/first stool output time, the severity of abdominal distension, the occurrence of nausea/vomiting, and the onset of oral intake. [ABSTRACT FROM AUTHOR]

Background: Adoption of early mobility interventions into intensive care unit (ICU) practice has been slow and varied. Objectives: To examine factors associated with early mobility performance in critically ill adults and evaluate factors' effects on predicting next-day early mobility performance. Methods: A secondary analysis of 66 ICUs' data from patients admitted for at least 24 hours. Mixed-effects logistic regression modeling was done, with area under the receiver operating characteristic curve (AUC) calculated. Results: In 12 489 patients, factors independently associated with higher odds of next-day mobility included significant pain (adjusted odds ratio [AOR], 1.16; 95% CI, 1.09–1.23), documented sedation target (AOR, 1.09; 95% CI, 1.01–1.18), performance of spontaneous awakening trials (AOR, 1.77; 95% CI, 1.59–1.96), spontaneous breathing trials (AOR, 2.35; 95% CI, 2.14–2.58), mobility safety screening (AOR, 2.26; 95% CI, 2.04–2.49), and prior-day physical/occupational therapy (AOR, 1.44; 95% CI, 1.30–1.59). Factors independently associated with lower odds of next-day mobility included deep sedation (AOR, 0.44; 95% CI, 0.39–0.49), delirium (AOR, 0.63; 95% CI, 0.59–0.69), benzodiazepine administration (AOR, 0.85; 95% CI, 0.79–0.92), physical restraints (AOR, 0.74; 95% CI, 0.68–0.80), and mechanical ventilation (AOR, 0.73; 95% CI, 0.68–0.78). Black and Hispanic patients had lower odds of next-day mobility than other patients. Models incorporating patient, practice, and between-unit variations displayed high discriminant accuracy (AUC, 0.853) in predicting next-day early mobility performance. Conclusions: Collectively, several modifiable and nonmodifiable factors provide excellent prediction of next-day early mobility performance. [ABSTRACT FROM AUTHOR]

Femoral catheters are commonly viewed as a barrier to Burn ICU mobility progression due to anatomical location and potential risk of complications. The purpose of this review was to examine outcomes and complication rates following implementation of femoral catheter mobilization guidelines, as well as determine safety and feasibility of mobilization with femoral catheters in place within the burn population. A retrospective review was completed on 17 patients prior to and following the implementation of new femoral catheter mobility guidelines, 34 patients total. Burn therapy notes were reviewed for burn admissions with at least 1 femoral catheter in place, including arterial, central, and dialysis catheters. Demographic data, admission statistics, line placement timelines, and active mobility achieved during therapy sessions were recorded for both the nonmobilization group (NMG) and mobilization group (MG). The 34 patients reviewed had 99 total lines placed (30 NMG, 69 MG). Change in mobility protocols for the MG resulted in more therapy sessions (n = 516 vs 281) and a significant increase in active mobility sessions (n = 83 vs 5, P <.001), including 146 total mobility activities such as transitions to chairs, tilt table, sitting edge of bed, standing, active chair transfers, ambulation, and cycle ergometry. No catheter-associated adverse events occurred during active mobility sessions and no complications were associated with participation in mobility. This review supports that the presence of femoral catheters alone should not limit the progression of mobility interventions with the use of clinical judgment in specialty-trained burn therapists. [ABSTRACT FROM AUTHOR]

Purpose: Despite mobilization is highly recommended in the ERAS® colorectal guideline, studies suggest that more than half of patients don't reach the daily goal of 360 min out of bed. However, data used to quantify mobilization are predominantly based on self-assessments, for which the accuracy is uncertain. This study aims to accurately measure postoperative mobilization in ERAS®-patients by validated motion data from body sensors. Methods: ERAS®-patients with elective bowel resections were eligible. Self-assessments and motion sensors (movisens: ECG-Move 4 and Move 4; Garmin: Vivosmart4) were used to record mobilization parameter from surgery to postoperative day 3 (POD3): Time out of bed, time on feet and step count. Results: 97 patients were screened and 60 included for study participation. Self-assessment showed a median out of bed duration of 215 min/day (POD1: 135 min, POD2: 225 min, POD3: 225 min). The goal of 360 min was achieved by 16.67% at POD1, 21.28% at POD2 and 20.45% at POD3. Median time on feet objectively measured by Move 4 was 109 min/day. During self-assessment, patients significantly underestimated their "time on feet"-duration with 85 min/day (p = 0.008). Median number of steps was 933/day (Move 4). Conclusion: This study confirmed with objectively supported data, that most patients don't reach the daily mobilization goal of 360 min despite being treated by an ERAS®-pathway with ERAS®-nurse. Even considering an empirically approximated underestimation, the ERAS®-target isn't achieved by more than 75% of patients. Therefore, we propose an adjustment of the general ERAS®-goals into more patient-centered, individualized and achievable goals. Registration: This study is part of the MINT-ERAS-project and was registered prospectively in the German Clinical Trials Register on 25.02.2022. Trial registration number is "DRKS00027863". [ABSTRACT FROM AUTHOR]

Background: In recent decades, early rehabilitation after Achilles tendon rupture (ATR) repair has been proposed. The aim of this prospective cohort study was to compare different immobilisation durations in order to determine the optimal duration after open surgery for ATR repair. Methods: This study included 1088 patients (mean age, 34.9 ± 5.9 years) who underwent open surgery for acute ATR repair. The patients were categorised into four groups (A, B, C, and D) according to postoperative immobilisation durations of 0, 2, 4, and 6 weeks, respectively. All patients received the same suture technique and a similar rehabilitation protocol after brace removal,; they were clinically examined at 2, 4, 6, 8, 10, 12, 14, and 16 weeks postoperatively, with a final follow-up at a mean of 19.0 months. The primary outcome was the recovery time for the one-leg heel-rise height (OHRH). Secondary outcomes included the time required to return to light exercise (LE) and the recovery times for the range of motion (ROM). Data regarding the surgical duration, complications, the visual analogue scale (VAS) score for pain, the Achilles tendon Total Rupture Score (ATRS), and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score were also collected. Results: The recovery times for OHRH, LE, and ROM were significantly shorter in groups A and B than in groups C and D (P < 0.001). The VAS scores decreased over time, reaching 0 in all groups by 10 weeks. The mean scores in groups A and B were higher than those in the other groups at 2 and 4 weeks (P < 0.001), whereas the opposite was true at 8 weeks (P < 0.001). ATRS and the AOFAS Ankle-Hindfoot scale score increased across all groups over time, showing significant between-group differences from weeks 6 to 16 (P < 0.001) and weeks 6 to 12 (P < 0.001). The mean scores were better in groups A and B than in groups C and D. Thirty-eight complications (3.5%) were observed, including 20 re-ruptures and 18 superficial infections. All complications were resolved at the last follow-up, with no significant between-group differences. Conclusions: Immobilisation for 2 weeks after open surgery for ATR repair may be the optimal strategy for early rehabilitation with relatively minimal pain and other complications. Trial registration: ClinicalTrials.gov (NCT04663542). [ABSTRACT FROM AUTHOR]

Introduction: Up to one-third of patients with fragility hip fractures are totally dependent in the year following the injury which leads to later morbidity and mortality. Understanding the related factors that affect patients' ambulation helps health care providers prepare for the treatment plans to improve their functional outcomes. This study aimed to evaluate the factors associated with independent walking disability in the early postoperative period after fragility hip fractures. Material and methods: This retrospective cohort study involved 394 patients with fragility hip fractures with either intertrochanteric, subtrochanteric, or femoral neck fractures from January 2018 to June 2023. The related factors including preoperative demographics, perioperative, and postoperative factors, were collected and analyzed. The endpoint was the independent walking disability of patients at 6 weeks after surgery. Results: 110 patients (27.9%) were disabled, whereas 284 patients (72.1%) could walk independently at postoperative 6 weeks. The multivariable risk ratio regression analysis showed that patients with age ≥80 years (RR 1.65; 95% CI 1.21-2.25; P = 0.001), pre-fracture walking with the gait aid (RR 2.03; 95% CI 1.53-2.69; P < 0.001), having ≥2 underlying comorbidities (RR 1.63; 95% CI 1.19-2.23; P = 0.002), preoperative hypoalbuminemia (RR 1.74; 95% CI 1.32-2.29; P < 0.001), and presence of the postoperative medical complication (RR 2.04; 95% CI 1.37-3.02; P < 0.001) were significantly associated with independent walking disability at the early postoperative period of 6 weeks. Conclusions: Post-hip fracture surgery patients with the presence of postoperative medical complication have the highest risk of independent walking disability. Health care providers should concentrate on high-risk patients, correct the modifiable factors, and minimize any postoperative complications to improve functional recovery and decrease morbidity related to non-ambulation after fragility hip fractures. [ABSTRACT FROM AUTHOR]

Simple Summary: Diabetes and cancer are major global health problems that cause significant illness and death. Many cancer patients also have diabetes, which complicates their treatment, especially if surgery is needed. This review highlights the link between diabetes and cancer. It looks into how cancer treatments can worsen blood sugar control, examines the risks that surgery holds for patients with both conditions, and outlines the strategies that can be used to manage diabetes around the time of surgery. More research is needed to provide new strategies that can reduce complications following surgery in patients with diabetes and cancer. Background: Both diabetes and cancer are major global health issues that are among the leading causes of morbidity and mortality. There is a high prevalence of diabetes among cancer patients, many of whom require a surgical procedure. This review focuses on the operative complications in patients with diabetes and cancer, and the perioperative management of diabetes in cancer patients. Methodology: A literature search of articles in English—published between January 2010 and May 2024—was carried out using the databases PubMed, MEDLINE, Google Scholar, and the Cochrane Database of Systematic Reviews. The search primarily focused on the operative complications in patients with diabetes and cancer, and perioperative management strategies. Results: The relationship between cancer and diabetes is complex; cancer patients have a high risk of developing diabetes, while diabetes is a risk factor for certain cancers. In addition, various cancer therapies can induce or worsen diabetes in susceptible patients. Many individuals with cancer and diabetes require surgery, and due to underlying diabetes, they may have elevated risks for operative complications. Optimal perioperative management for these patients includes managing perioperative glycemia and other comorbid illnesses, adjusting diabetic and cancer treatments, optimizing nutrition, minimizing the duration of fasting, supporting early mobilization, and providing patient education to enable self-management. Conclusions: While evidence is limited, optimal perioperative management for patients with both diabetes and cancer is necessary in order to reduce surgical complications. Future studies are needed to develop evidence-informed perioperative strategies and improve outcomes for these patients. [ABSTRACT FROM AUTHOR]

Purpose: To provide pragmatic guidance for acute rehabilitation management and implementation of early mobility for individuals with critical illness due to COVID-19. Methods: Clinical perspective developed through reflective clinical practice and narrative review of best available evidence. Results: Current clinical practice guidelines do not provide guidance for implementation of early mobility interventions for individuals with critical illness due to COVID-19 who require enhanced ventilatory support or support of inhaled pulmonary artery vasodilators. Many individuals who may benefit from implementation of early mobility interventions are excluded by strict interpretation of current guidelines. Conclusions: Risk vs benefit of implementing early mobility interventions in individuals with critical illness due to COVID-19 can be mitigated through coordinated efforts of interdisciplinary teams to promote shared decision-making through therapeutic alliances with patients and their families. Clinicians must clearly define the goals of care, understand the limitations of monitoring equipment in the intensive care unit, prepare to titrate levels of oxygen based on an individual's physiologic response to mobility interventions, and help individuals maintain external goal-directed focus of attention to optimize outcomes of early mobility interventions. IMPLICATIONS FOR REHABILITATION: Current clinical practice guidelines do not provide guidance for implementation of early mobility interventions for individuals with critical illness due to COVID-19 who require enhanced ventilatory support or support of inhaled pulmonary artery vasodilators. Risk vs benefit of implementing early mobility interventions in individuals with critical illness due to COVID-19 can be mitigated through coordinated efforts of interdisciplinary teams to promote shared decision-making through therapeutic alliances with patients and their families. Clinicians must clearly define the goals of care, understand the limitations of monitoring equipment in the intensive care unit, prepare to titrate levels of oxygen based on an individual's physiologic response to mobility interventions, and help individuals maintain external goal-directed focus of attention to optimize outcomes of early mobility interventions. [ABSTRACT FROM AUTHOR]

Background: Enhanced recovery after surgery (ERAS) became a widely adapted and introduced concept of multimodal pain control. However, this idea was not standardized and left room for exploration of a variety of different analgesic modalities. One such modality is the bilateral quadratus lumborum (QL) catheter block that was introduced in 2018 but is not yet been fully studied in the gynecological oncology population. Objective: Authors hypothesized that use of these catheters would help with pain management and decrease opioid consumption in the postoperative period. Methods: A retrospective chart review was conducted from 2018 to 2020 looking at patients with known gynecological malignancy who underwent an exploratory laparotomy. Groups who had the QL block were compared with those without the block. Primary outcome was opioid consumption measured in morphine milligram equivalents (MME). Secondary outcomes looked at opioid consumption analyzed by adjuvants used in the block, length until ambulation, and length of stay in the hospital. Results: Authors found that the results showed no difference on MME used on postoperative day (POD) 1 (p = 0.704), POD2 (p = 0.562), and POD3 (p =0.749, or combined over the 3 days (p = 0.597). Secondary outcomes also showed no difference: length to ambulation (p = 0.704), length of stay (p = 0.912), and QL adjuvant epinephrine (p = 1.0) and dexamethasone (p = 1.0). Results suggest that a variety of confounders may have influenced statistical significance when providers notice a clinical difference in pain control in patients who have a QL block. Conclusions: This study provides the first step in understanding pain control with blocks and paves the way for a future trial. [ABSTRACT FROM AUTHOR]

BACKGROUND: Postoperative delirium in patients receiving head and neck surgery is a pressing concern, affecting morbidity, mortality, and healthcare costs. With an aging population and about 65,000 new head and neck cancer diagnoses per year in the United States, surgery remains a primary treatment modality, regardless of age. OBJECTIVES: This article offers an educational overview of postoperative delirium management in patients receiving head and neck surgery, summarizing incidence, etiology, pathophysiology, diagnostic tests, treatment, complications, and risk factors. METHODS: A narrative literature review of articles published in the past 10 years was conducted to consolidate information on postoperative delirium in patients receiving head and neck surgery. FINDINGS: Postoperative delirium is characterized by acute, fluctuating cognitive dysfunction within 30 days after surgery, with incidence ranging from 11% to 26%. Pathophysiology is multifactorial, and pharmacologic options are limited because of side effects and varying effectiveness. Nonpharmacologic management focuses on addressing underlying causes and early mobilization. Reducing postoperative delirium risk necessitates interprofessional, systemwide collaboration. [ABSTRACT FROM AUTHOR]

Background: To reduce maternal-fetal morbidity and mortality, it is becoming increasingly important for anesthetists to understand and implement enhanced recovery after surgery (ERAS) cesarean delivery guidelines. Our aim was to reveal the knowledge of anesthesia assistants in Turkey about ERAS during cesarean delivery and to increase their awareness of ERAS. Methods: This descriptive study was conducted in the city of Isparta, Turkey in 2023. The survey, which was approved by the ethics committee, was distributed to participants across Turkey via e-mail and online messages. The survey comprises of a total of 42 questions evaluating perioperative ERAS recommendations. Results: Of the 404 participants in our survey, 59.9% were associated with university hospitals and 65.8% had completed three or more years of education. A total of 87.9% of the participants were familiar with ERAS; however, only 42.8% had received ERAS training. Although 93.8% of the participants' institutions performed a cesarean delivery, ERAS recommendations were only implemented at a rate of 48%. This may be due to the absence of an ERAS team, which was identified in our survey at a high rate of 66.6%. Conclusion: Awareness about ERAS was high among the participants, but the implementation rates of some recommendations were low. The reason for this may be the inability to form a multidisciplinary team and inadequate training of participants. For this purpose, we recommend the formation of a multidisciplinary team for ERAS protocol implementation and increased participant training opportunities. [ABSTRACT FROM AUTHOR]

Early mobility of hospitalized patients has been associated with improved postoperative results and psychological outcomes, decreased length of stay, and other benefits. This article discusses Mobility Optimizes Virtually Everything (MOVE), an interactive bingo-like activity for patients, and its impact on patient satisfaction, mobility documentation, and decompensation rates. [ABSTRACT FROM AUTHOR]

Background: During transcatheter aortic valve implantation (TAVI), secondary access is required for angiographic guidance and temporary pacing. The most commonly used secondary access sites are the femoral artery (angiographic guidance) and the femoral vein (temporary pacing). An upper extremity approach using the radial artery and an upper arm vein instead of the lower extremity approach using the femoral artery and femoral vein may reduce clinically relevant secondary access site-related bleeding complications, but robust evidence is lacking. Trial design: The TAVI XS trial is a multicentre, randomised, open-label clinical trial with blinded evaluation of endpoints. A total of 238 patients undergoing transfemoral TAVI will be included. The primary endpoint is the incidence of clinically relevant bleeding (i.e. Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding) of the randomised secondary access site (either diagnostic or pacemaker access, or both) within 30 days after TAVI. Secondary endpoints include time to mobilisation after TAVI, duration of hospitalisation, any BARC type 2, 3 or 5 bleeding, and early safety at 30 days according to Valve Academic Research Consortium‑3 criteria. Conclusion: The TAVI XS trial is the first randomised trial comparing an upper extremity approach to a lower extremity approach with regard to clinically relevant secondary access site-related bleeding complications. The results of this trial will provide important insights into the safety and efficacy of an upper extremity approach in patients undergoing transfemoral TAVI. [ABSTRACT FROM AUTHOR]

Patient refusal of care often puts healthcare professionals in an ethical dilemma. The ethics of refusing nursing care are examined in this editorial, which emphasizes the patient's autonomy and the healthcare professional's duty to provide care. Coercion and information manipulation to override patient's refusal contradict principles of autonomy and justice.... [ABSTRACT FROM AUTHOR]

Aim: To understand the status quo of multiprofessional and multidisciplinary collaboration for early mobilization of mechanically ventilated patients in Chinese ICUs and identify any factors that may influence this practice. Design: A multi‐centre cross‐sectional survey. Methods: From October to November 2022, the convenience sampling method was used to select ICU multiprofessional and multidisciplinary early mobility members (including physicians, nurses and physiotherapists) from 27 tertiary general hospitals in 14 provinces, cities and autonomous regions of China. They were asked to complete an author‐developed questionnaire on the status of collaboration and the Assessment of Inter‐professional Team Collaboration Scale. A multiple linear regression model was used to analyse the factors associated with the level of collaboration. Results: Physicians, nurses and physiotherapists mostly suffered from the lack of normative protocols, unclear division of responsibilities and unclear multiprofessional and multidisciplinary teams when using a collaborative approach to early activities. Multiple linear regression analysis showed that the number of ICU patients managed, the existence of norms and processes, the attitude of colleagues around them, the establishment of a team, communication methods and activity leaders were significant influences on the level of collaboration among members of the multiprofessional and multidisciplinary early activities. Conclusion: The collaboration of multiprofessional and multidisciplinary early activity members for mechanically ventilated patients in the ICU remains unclear, and the collaboration strategy needs to be constructed and improved, taking into account China's human resources and each region's economic development level. Impact: This study investigates the collaboration status of multiprofessional and multidisciplinary activity members from the perspective of teamwork, analyses the reasons affecting the level of collaboration and helps to develop better teamwork strategies to facilitate the implementation of early activities. Patient or Public Contribution: The participants in this study were multiprofessional and multidisciplinary medical staff who performed early activities for ICU patients. [ABSTRACT FROM AUTHOR]

Aim: To investigate the potential challenges experienced by cardiac intensive care unit (ICU) nurses in the first out‐of‐bed patient mobilization after open‐heart surgery and propose solutions. Design: A qualitative study design using the descriptive phenomenological approach. Methods: Individual face‐to‐face interviews were conducted via a widely used videoconferencing program between 28 July and 22 October 2022, in the tertiary cardiac ICU of a university hospital. Nurses who had at least 1 year of cardiac ICU experience and actively participating in patient care were included. The COREQ criteria and checklist were followed in this investigation and the data were analysed by using the ATLAS.ti 8.0. Findings: Nurses reported that they experience challenges when mobilizing patients, such as patients' fear, reluctance or resistance; nurses having insufficient experience, strength or lack of team members. Despite these challenges, they highlighted some positive outcomes of mobilization, such as feeling happy, reinforced team communication and nurse–patient relationship. The nurses also suggested some facilitators, such as patient motivation and an explanation of the process. Conclusion: Nurses experience various patient‐related and nurse‐related challenges during the first out‐of‐bed mobilization of the patient after open‐heart surgery. It is recommended that healthcare institutions should implement effective strategies to address the staffing shortages and to support nurse motivation to ensure adequate nursing care. Impact: This study provides valuable insights into the existing literature by examining the potential challenges and strategies of the first out‐of‐bed patient mobilization in the cardiac ICU. It shows that patient education and organizational adaptations are effective ways to overcome the challenges. It also suggests that motivating and informing patients before the mobilization can make the process easier. Moreover, it reveals that successful patient mobilization makes nurses happy, improves team communication and strengthens nurse–patient relationship. Patient and Public Involvement and Engagement: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Purpose: Early ambulation is an important step in accelerating post-joint replacement surgery recovery. However, there is limited research on populations who are unable to walk immediately after the operation. The purpose of this study was to determine the factors influencing postoperative ambulation in total knee arthroplasty (TKA) patients. Methods: Primary TKA patients were included in this retrospective study. All patients were divided into two groups. Patients who began walking within 24 h were categorized as the early ambulation group, while patients who began walking after 24 h were classified as the late ambulation group. Recorded demographic data included age, gender, body mass index (BMI), clinical diagnosis, and comorbidities. Hematological parameters potentially affecting patients' preoperative physical condition were also documented. Additionally, intraoperative metrics such as surgical time, surgical side, tourniquet time, intraoperative blood loss, the placement of drains, and prosthetic model were recorded. Results: A total of 453 patients (79.0% female, 21.0% male) were included in this study. The average age of all patients was 68.5±7.9 years, ranging from 36 to 87 years, with an average BMI of 27.2±9.9 kg/ m 2 . The mean postoperative ambulation time was 1.6 days, with a range of 0–4 days. In univariate group comparisons, an increase in postoperative time to ambulation was significantly associated with a history of heart disease ( P < 0.001 ), stroke history ( P = 0.003 ), and prior surgeries ( P = 0.003 ). Patients who delayed ambulation also exhibited significantly higher coagulation-related parameters including PT ( P < 0.001 ), APTT ( P = 0.002 ), TT ( P = 0.039 ) before surgery compared to those who mobilized early. Furthermore, prolonged surgical time ( P = 0.030 ), increased intraoperative blood loss ( P < 0.001 ), and the placement of intraoperative drains ( P < 0.001 ) also significantly extended the time to postoperative ambulation. However, after multivariate logistic regression analysis, only PT (OR 1.86, 95% CI 1.32 - 2.61, P < 0.001 ), TT (OR 1.30, 95% CI 1.09 - 1.55, P = 0.004 ) intraoperative blood loss (OR 1.01, 95% CI 1.00 - 1.01, P = 0.008 ) and the placement of intraoperative drains (OR 11.39, 95% CI 6.59 - 19.69, P < 0.001 ) were identified as predictive factors for late ambulation in patients after TKA. Conclusion: In this study, preoperative coagulation function, intraoperative blood loss and the placement of intraoperative drains were factors contributing to delay ambulation time. Therefore, it is believed that properly improving preoperative coagulation function, effective intraoperative hemostasis, and reducing the placement of drains have a positive impact on early postoperative ambulation in patients undergoing TKA. [ABSTRACT FROM AUTHOR]

Purpose: The association between preoperative mental health and immediate postoperative ambulation in primary Total Joint Arthroplasty (TJA) has sparsely been studied. Thus, this study's objective was to investigate the association between mental health (measured by the Mental Component Score (MCS) from the Veterans RAND 12 (VR-12)) and peri-operative metrics. Methods: We conducted a retrospective study of patients who underwent primary TJA and completed a VR-12 questionnaire between January 2018 and June 2023 at a single academic hospital. Patients were stratified into terciles based on preoperative MCS. Patient demographics, ambulation within 4 h postop, LOS, and discharge location were compared. The effect of MCS on LOS while controlling discharge location was assessed using negative binomial regression. Results: 1120 patients were included in this analysis (432 THA and 688 TKA). After stratification into terciles (Low: 34.7 ± 6.6, Middle: 49.3 ± 3.7, High:62.1 ± 4.4), comparison of demographics revealed significant differences in age (p = 0.005) and sex distribution (p = 0.04) but no difference in surgery type (p = 0.857). There was no significant difference in ambulation rate between MCS groups (p = 0.789) or in distance covered during first ambulation (p = 0.251). Low MCS patients had a longer LOS (p = 0.000, p = 0.002) and a lower rate of discharged home (p = 0.016). After controlling discharge location, no significant association was found between MCS and LOS (p = 0.288). Conclusion: Patient with low MCS tended to be younger, women, and had poorer preoperative HOOS/KOOS scores. Low MCS was associated with longer LOS and lower rates of discharge home. However, MCS was not associated with early ambulation rate and LOS after controlling discharge location. [ABSTRACT FROM AUTHOR]

Objective: To determine the association between the extent of mobilisation within the first postoperative day and 30-day mortality after hip fracture. Design: Cohort study Setting: Acute orthopaedic hospital ward Participants: Consecutive sample of 701 patients, 65 years of age or older, 80% from own home, 49% with a trochanteric fracture, and 61% with an American Society of Anesthesiology grade > 2. Intervention: n/a Main measures: Cumulated ambulation score (CAS) (0-6 points) on the first postoperative day and 30-day postoperative mortality. A CAS = 0 reflects no functional mobility (bedridden), while a CAS = 6 reflects independent out-of-bed-transfer, chair-stand, and indoor walking status. Results: Overall, 86% of patients were mobilised to standing or seated in chair (CAS ≥ 1) on the first postoperative day. A CAS of 0, 1–3, and 4–6 was observed for 97 (14%), 519 (74%), and 85 (12%) patients, respectively. Overall, 61 (8.7%) patients died within 30 days with the highest mortality (23.7%, n = 23) seen for those not mobilised (CAS = 0). Only one patient (1.2%) with a CAS of 4–6 points died. Cox regression analysis adjusted for age, sex, residential status, pre-fracture CAS, fracture type, and American Society of Anesthesiology grade, showed that a one-unit increase in CAS was associated with a 38% lower risk of 30-day mortality (Hazard Ratio = 0.63, 95%Confidence Interval, 0.50–0.78). Conclusion: Mobility on the first postoperative day was associated with 30-day postoperative mortality, with a lower risk observed for those completing greater mobility. National registries may consider extending collection of mobility on the first postoperative day from a binary indicator to the CAS which captures the extent of mobility achieved. [ABSTRACT FROM AUTHOR]

Among patients having elective abdominal surgery, how much does preoperative physiotherapy education with breathing exercise training reduce the incidence of postoperative pulmonary complications (PPCs), hospital length of stay and 12-month mortality? How stable are the treatment effects across different PPC definitions, including pneumonia? How much do the treatment effects on PPC, hospital length of stay and mortality vary within clinically relevant subgroups? Individual participant-level meta-analysis (n = 800) from two randomised controlled trials analysed with multivariable regression. Adults undergoing major elective abdominal surgery. Experimental participants received a single preoperative session with a physiotherapist within 4 weeks of surgery and educated on PPC prevention with breathing exercises and early mobilisation. They were taught breathing exercises and instructed to start them immediately on waking from surgery. The control group received no preoperative or postoperative physiotherapy, or early ambulation alone. PPC, hospital length of stay and 12-month mortality. Participants who received preoperative physiotherapy had 47% lower odds of developing a PPC (adjusted OR 0.53, 95% CI 0.34 to 0.85). This effect was stable regardless of PPC definition. Effects were greatest in participants who smoked, were aged ≤ 45 years, had abnormal body weight, had multiple comorbidities, or were undergoing bariatric or upper gastrointestinal surgery. Participants having operations ≤ 3 hours in duration were least responsive to preoperative physiotherapy. Participants with multiple comorbidities were more likely to have a shorter hospital stay if provided with preoperative physiotherapy (adjusted MD –3.2 days, 95% CI –6.2 to –0.3). Effects on mortality were uncertain. There is strong evidence to support preoperative physiotherapy in preventing PPCs after elective abdominal surgery. [ABSTRACT FROM AUTHOR]

Background: Critical illness requiring invasive mechanical ventilation can precipitate important functional disability, contributing to multidimensional morbidity following admission to an intensive care unit (ICU). Early in-bed cycle ergometry added to usual physiotherapy may mitigate ICU-acquired physical function impairment. Methods: We randomly assigned 360 adult ICU patients undergoing invasive mechanical ventilation to receive 30 minutes of early in-bed Cycling + Usual physiotherapy (n=178) or Usual physiotherapy alone (n=182). The primary outcome was the Physical Function ICU Test-scored (PFIT-s) at 3 days after discharge from the ICU (the score ranges from 0 to 10, with higher scores indicating better function). Results: Cycling began within a median (interquartile range) of 2 (1 to 3) days of starting mechanical ventilation; patients received 3 (2 to 5) cycling sessions for a mean (±standard deviation) of 27.2 ± 6.6 minutes. In both groups, patients started Usual physiotherapy within 2 (2 to 4) days of mechanical ventilation and received 4 (2 to 7) Usual physiotherapy sessions. The duration of Usual physiotherapy was 23.7 ± 15.1 minutes in the Cycling + Usual physiotherapy group and 29.1 ± 13.2 minutes in the Usual physiotherapy group. No serious adverse events occurred in either group. Among survivors, the PFIT-s at 3 days after discharge from the ICU was 7.7 ± 1.7 in the Cycling + Usual physiotherapy group and 7.5 ± 1.7 in the Usual physiotherapy group (absolute difference, 0.23 points; 95% confidence interval, -0.19 to 0.65; P=0.29). Conclusions: Among adults receiving mechanical ventilation in the ICU, adding early in-bed Cycling to usual physiotherapy did not improve physical function at 3 days after discharge from the ICU compared with Usual physiotherapy alone. Cycling did not cause any serious adverse events. (Funded by the Canadian Institutes of Health Research and others; ClinicalTrials.gov numbers, NCT03471247 [full randomized clinical trial] and NCT02377830 [CYCLE Vanguard 46-patient internal pilot].) [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to describe the role of occupational therapy (OT), including types of interventions that can be provided in a pediatric intensive care unit (PICU) setting, and to evaluate the use and safety of OT services in an early mobility program. Methods: A retrospective review via medical records occurred between January 2019 and June 2020. The frequencies and adverse events of OT interventions were compared preimplementation (January–September 2019) and postimplementation (October 2019–June 2020) of an early mobility program. Results: A convenience sample of 56 patients comprised the preimplementation group, and 83 comprised the postimplementation group. Through the BRAVE (Beginning Restorative Activities Very Early) program, occupational therapists increased the percentage of OT interventions performed, including active range of motion (48.21% to 75.90%, p = 0.0008), active bed positioning (41.07% to 46.99%, p = 0.4913), splinting (7.14% to 7.23%, p = 1.00), sensory stimulation (3.57% to 4.82%, p = 1.00), sit to stand (16.07% to 16.87%, p = 0.9014), therapeutic play/activities (50% to 56.63% p = 0.4420), self-care training (5.36% to 15.66%, p = 0.0619), and physical performance tests (33.93% to 39.76%, p = 0.4860). Postimplementation, there were no adverse events. Conclusion: OT is safe to perform with hematology-oncology patients in the PICU and did not increase adverse events. [ABSTRACT FROM AUTHOR]

Background and Objectives: Dexmedetomidine, an alpha-2 agonist, is used as an adjunct to anesthesia in enhanced recovery after surgery (ERAS) programs. One of its advantages is the opioid-sparing effect which can facilitate early extubation and recovery. When the ERAS cardiac society was set in 2017, our facility was already using the ERAS program, in which the "fast-track Anesthesia" was facilitated by the intraoperative infusion of dexmedetomidine. Our objective is to share our experience and investigate the potential impact of intraoperative dexmedetomidine use as a part of the ERAS program on patient outcomes in elective cardiac surgery. Materials and Methods: An observational retrospective cohort study was conducted at a university hospital in Switzerland. The patients who underwent elective cardiac surgery with cardiopulmonary bypass between 1 June 2017 and 31 August 2018 were included in this analysis (n = 327). Regardless of the surgery type, all the patients received a standardized fast-track anesthesia protocol inclusive of dexmedetomidine infusion, reduced opioid dose, and parasternal nerve block. The primary outcome was the postoperative time when the criteria for extubation were met. Three groups were identified: group 0—(extubated in the operating room), group < 6 (extubated in less than 6 h), and group > 6 (extubated in >6 h). The secondary outcomes were adverse events, length of stay in ICU and in hospital, and total hospitalization costs. Results: Dexmedetomidine was well-tolerated, with no significant adverse events reported. Early extubation was performed in 187 patients (57%). Group 3 had a significantly longer length of stay in the ICU (median: 70 h vs. 25 h) and in hospital (17 vs. 12 days), and consequently higher total hospitalization costs (CHF 62,551 vs. 38,433) compared to the net data from the other two groups (p < 0.0001). Conclusions: Our findings suggest that dexmedetomidine can be safely used as part of the opioid-sparing anesthesia protocol in patients undergoing elective cardiac surgery with cardiopulmonary bypass with the potential to facilitate early extubation, shorter ICU and hospital stays, and reduced hospitalization costs. [ABSTRACT FROM AUTHOR]

Cultured epidermal autografts (CEA) have since become more prevalent in the treatment of burn-injured patients with limited available donor sites for adequate wound closure, resulting in decreased mortality rates and an increased number of these patients requiring burn therapy services to achieve optimal functional outcomes at discharge. However, the use and postoperative management of CEA continue to be controversial due large to the physiological fragility and expense of CEA, leading to variable postoperative treatment practices across burn centers. As such, minimal research is available regarding patient outcomes following CEA application, specifically related to burn therapy intervention. Thus, a retrospective chart review was conducted on a series of 10 patients, 18 years of age or older, admitted to a single, American Burn Association verified burn center, between April 2015 and April 2023, who required CEA and received pre- and postoperative treatment by burn therapists in accordance with center-specific burn rehabilitation guidelines. The resulting patient outcomes, in response to early implementation of therapy interventions post-CEA surgery, demonstrated optimal functional status for patients upon discharge and positive long-term implications. [ABSTRACT FROM AUTHOR]

Background: Early mobility (EM) is vital in the intensive care unit (ICU) to counteract immobility-related effects. A multidisciplinary approach is key, as it requires precise initiation knowledge. However, physicians' understanding of EM in adult ICU settings remains unexplored. This study was conducted to investigate the knowledge and clinical competency of physicians working in adult ICUs toward EM. Methods: This cross-sectional study enrolled 236 physicians to assess their knowledge of EM. A rigorously designed survey comprising 30 questions across the demographic, theoretical, and clinical domains was employed. The criteria for knowledge and competency were aligned with the minimum passing score (70%) stipulated for physician licensure by the medical regulatory authority in Saudi Arabia. Results: Nearly 40% of the respondents had more than 5 years of experience. One-third of the respondents received theoretical knowledge about EM as part of their residency training, and only 4% of the respondents attended formal courses to enhance their knowledge. Almost all the respondents (95%) stated their awareness of EM benefits and its indications and contraindications and considered it safe to mobilize patients on mechanical ventilators. However, 62.3% of the respondents did not support EM for critically ill patients on mechanical ventilators until weaning. In contrast, 51.7% of respondents advised EM for agitated patients with RASS > 2. Only 113 (47.9%) physicians were competent in determining the suitability of ICU patients for EM. For critically ill patients who should be mobilized, nearly 60% of physicians refused to initiate EM. Conclusions: This study underscores insufficient practical knowledge of ICU physicians about EM criteria, which leads to suboptimal decisions, particularly in complex ICU cases. These findings emphasize the need for enhanced training and education of physicians working in adult ICU settings to optimize patient care and outcomes in critical care settings. [ABSTRACT FROM AUTHOR]

Background: Basicervical femoral neck fracture is a rare proximal femur fracture with a high implant failure rate. Biomechanical comparisons between cephalomedullary nails (CMNs) and dynamic hip screws (DHSs) under torsion loading are lacking. This study compared the biomechanical performance of three fixations for basicervical femoral neck fractures under torsion load during early ambulation. Methods: The biomechanical study models used three fixations: a DHS, a DHS with an anti-rotation screw, and a short CMN. Finite element analysis was used to simulate hip rotation with muscle forces related to leg swing applied to the femur. The equivalent von Mises stress (EQV) on fixation, fragment displacement, and strain energy density at the proximal cancellous bone were monitored for fixation stability. Results: The EQV of the short CMN construct (304.63 MPa) was comparable to that of the titanium DHS construct (293.39 MPa) and greater than that of the titanium DHS with an anti-rotation screw construct (200.94 MPa). The proximal fragment displacement in the short CMN construct was approximately 0.13 mm, the greatest among the constructs. The risk of screw cutout for the lag screw in short CMNs was 3.1–5.8 times greater than that for DHSs and DHSs with anti-rotation screw constructs. Conclusions: Titanium DHS combined with an anti-rotation screw provided lower fragment displacement, stress, and strain energy density in the femoral head than the other fixations under torsion load. Basicervical femoral neck fracture treated with CMNs may increase the risk of lag screw cutout. [ABSTRACT FROM AUTHOR]

In the specialized literature, valvulopathies are defined as functional or organic conditions affecting one or more heart valves, disrupting their ability to open or close properly and affecting the heart's overall function. During surgery, the diseased heart valve is replaced with a prosthesis using extracorporeal circulation. Currently, the most commonly used prostheses are biological and mechanical. Physiotherapy plays a crucial role in the rehabilitation of patients with surgically corrected valvulopathies, primarily due to its beneficial effects on the respiratory and cardiovascular systems, which help ensure functional independence. In the late 1970s, Dr. Nanette Wenger proposed the first cardiac rehabilitation program. This program recommended, for the first time, early mobilization of the patient, aiming to transition the patient from a supine position to sitting and eventually to moving within 14 days. The purpose of this study is to present and implement a cardiac rehabilitation program, as well as to analyse its effects based on the results obtained from monitoring and evaluating selected patients. The conclusions of this study validate the research hypothesis that the application of a cardiac rehabilitation program leads to an increase in effort capacity (and, consequently, the quality of life), in patients with valvulopathies surgically corrected by minimally invasive techniques. [ABSTRACT FROM AUTHOR]

Objective. The aim of this scoping review was to investigate the mobilization dose reporting in the randomized clinical trials (RCTs) of patients receiving mechanical ventilation in the intensive care unit. Methods. In this scoping review, RCTs published from inception to December 2022 were searched in relevant electronic databases. Trials that involved adults receiving mechanical ventilation (>48 hours) and any early mobilization modality were analyzed. Two independent authors screened, selected, and extracted data. The mobilization doses of the intervention groups (IGs) and the comparator groups (CGs) were assessed as the proportion of reported items/total applicable from the main items of the Consensus on Exercise Reporting Template (CERT). Results. Twenty-three RCTs comprising 2707 patients (1358 from IG and 1349 from CG) were included, involving studies on neuromuscular electrical stimulation (n=7), progressive mobility (n=6), leg cycling (n=3), tilt table (n=1), and multicomponent (n=6) mobilization. The pooled reporting of CERT items was 68% (86% for IG and 50% for CG). The most reported CERT items were type of exercise (100%) and weekly frequency (100%) for IG, whereas the least reported were intensity (4%) and individualization (22%) for CG. Regardless of the group, individualization, progression, and intensity of mobilization were the least reported items. Eight IGs (35%) reported all CERT items, whereas no CGs reported all of them. Conclusions. Deficits in mobilization dose reporting of intensive care unit RCTs were identified, especially for exercise intensity in adults receiving mechanical ventilation. One-third of IG reported all exercise dosing items, whereas no CG reported all of them. Future studies should investigate the details of optimal dosage reporting, particularly for CG. Impact. The lack of dose reporting may partially explain the inconsistency in the meta-analysis results of early mobilization trials, thus limiting the interpretation for clinical practice in the intensive care unit. [ABSTRACT FROM AUTHOR]

Objectives: Acute rupture of achilles tendon is a commonly occurring injury affecting mostly the young individuals involved in sports activities. Operative management is most often employed to treat such injuries. This study was aimed to evaluate the functional outcome in patients with acute tendo achilles tear managed by open repair using a suture anchor. Methods: This was a prospective study conducted between September 2018 to August 2020 on patients who underwent suture anchor repair for acute tendo achilles tear. All patients were followed up for at least 9 months. The patients were clinically evaluated and AOFAS score was used to assess their functional outcome. Results: In a total of 38 patients, 28 (73.7%) patients showed Excellent and 7 (18.4%) patients had Good results whereas 1 (2.6%) had Fair and 2 (5.3%) patients demonstrated Poor surgical result at the final follow-up. 89.5% patients did not have any complication. The average AOFAS score was 90.97 ± 10.24. Conclusion: Operative treatment with suture anchor in acute tendo achilles tear has a high success rate, quick recovery after surgery, lower rate of complications, faster return to daily activities, excellent aesthetic and comparable functional results and is also a safe, simple and accepted surgical technique. [ABSTRACT FROM AUTHOR]

Purpose: Coronal shear fractures of the distal humerus involving the capitellum and trochlea are rare injuries. Internal fixation with headless compression screws provides a stable construct facilitating early mobilisation. Our study aimed to identify the key determinants of both radiological and functional outcomes of patients with distal humerus coronal shear fractures treated with internal fixation. Methods: A retrospective analysis of 61 patients with distal humerus coronal shear fractures who were treated surgically was done. Demographics, fracture morphology, time to surgery, operative details such as surgical approach and implant used, quality of reduction, time to union, and associated complications from hospital records. Radiological outcomes were assessed using plain radiographs, and the functional outcomes were by Oxford Elbow Score (OES) and Mayo Elbow Performance Index (MEPI). Results: Patients with anatomical reduction of the fracture had better functional outcomes and range of motion. The presence of posterior comminution of capitellum resulted in poorer outcomes (p = 0.03). Delayed presentation did not alter the outcome when the anatomical reduction was achieved. Myositis ossificans was noted in nine patients and non-union in five patients. Two patients developed avascular necrosis of the capitellum and arthritis of the elbow joint. Conclusion: Anatomical reduction and posterior comminution are the two key determinants of the functional outcome in these coronal shear fractures of the distal humerus. Early mobilisation following a stable fixation is crucial in achieving a good outcome. [ABSTRACT FROM AUTHOR]

Aim: Early mobilization of patients with a major lower extremity amputation (LEA) is often a challenge because of lack of compliance. Therefore, we investigated factors limiting independent mobility and physiotherapy on the first day with physiotherapy (PTDay1) and the following 2 days after LEA. Methods: A total of 60 consecutive patients, mean age 73.7 years (SD 12.1 years), undergoing LEA were included over a period of 7 months. The Basic Amputee Mobility Score was used to assess basic mobility. Predefined limitations for not achieving independent mobility or not completing physiotherapy were residual limb pain, pain elsewhere, fear of being mobilized, fatigue, nausea/vomiting, acute cognitive dysfunction or "other" factors reported on PTDay1 and the following 2 days after LEA. Results: Fatigue and fear of being mobilized were the most frequent limitations for not achieving independent mobility on PTDay1 and the following 2 days after LEA. Patients (n = 55) who were not independent in the Basic Amputee Mobility Score activity transferring from bed to chair on PTDay1 were limited by fatigue (44%) and fear of being mobilized (33%). A total of 21 patients did not complete planned physiotherapy on PTDay1, and were limited by fatigue (38%), residual limb pain (24%) and "other" factors (24%). Conclusion: Fatigue and fear of being mobilized were the most frequent factors that limited independent mobility early after LEA. Fatigue, residual limb pain and "other" factors limited completion of physiotherapy. Geriatr Gerontol Int 2024; 24: 470–476. [ABSTRACT FROM AUTHOR]

Esophageal carcinoma is one of the most common digestive tract malignancies and poses a serious health threat to patients. This study discussed the influence of stepwise nutrition management and comprehensive nursing on esophageal carcinoma patients, which can shed light on the future clinical treatment of esophageal carcinoma. A total of 107 esophageal carcinoma patients admitted to our hospital between July 2022 and June 2023 were divided into a control group (n = 54) that received conventional care and an experimental group (n = 53) that received stepwise nutrition management along with comprehensive care. The postoperative rehabilitation time and clinical efficacy of the two groups were statistically analyzed, and differences in nutritional status and physical fitness before and after care were determined. The results showed that the experimental group had a faster first postoperative anal exhaust, bowel movement, ambulation, and anastomotic healing time than the control group (P < 0.05). No marked intergroup difference was identified in the overall response rate (P > 0.05). In addition, better nutritional status and physical fitness were observed in the experimental group than in the control group (P < 0.05). The experimental group exhibited a lower incidence of adverse reactions (P < 0.05) than the control group. These findings demonstrated the vital role of stepwise nutrition management in combination with comprehensive nursing for esophageal carcinoma patients. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your knowledge of blunt mechanism chest wall injury • To understand the acute care priorities for patients with blunt mechanism chest wall injury following initial assessment • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). Blunt mechanism chest wall injury (CWI) is commonly seen in the emergency department (ED), since it is present in around 15% of trauma patients. The thoracic cage protects the heart, lungs and trachea, thereby supporting respiration and circulation, so injury to the thorax can induce potentially life-threatening complications. Systematic care pathways have been shown to improve outcomes for patients presenting with blunt mechanism CWI, but care is not consistent across the UK. Emergency nurses have a crucial role in assessing and treating patients who present to the ED with blunt mechanism CWI. This article discusses the initial assessment and acute care priorities for this patient group. It also presents a prognostic model for predicting the probability of in-hospital complications following blunt mechanism CWI. [ABSTRACT FROM AUTHOR]