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While the safety of rapid recovery total joint arthroplasty is well established, less is known about its impact on postoperative care utilization patterns. We wished to examine whether same-day discharge—and its associated presumed reduction in hospital-based postoperative care and education—translates to the need for more postoperative support during the 1-year recovery period. A retrospective review of 1,237 total hip arthroplasty (THA) and 1,710 total knee arthroplasty (TKA) patients who had 0- or 1-day length of stay (LOS) from January 2020 to October 2023 was conducted. The primary outcome was the number of follow-up visits with total joint arthroplasty providers at our institution during the 1-year postoperative period. Secondary outcomes included 30-day emergency department returns, readmissions, 1-year physical therapy utilization, and improvement in Patient-Reported Outcomes Measurement Information System Physical Function scores at 6 to 12 months postoperatively. Bivariate and multivariable analyses were performed to compare outcomes between 0-day and 1-day LOS THA and TKA patients. In both the THA and TKA populations, 0-day LOS patients were younger, had a lower average body mass index, were more likely to be White, men, and had an American Society of Anesthesiologists score < 3 than 1-day LOS patients. After controlling for differences between groups, no significant differences in the number of one-year follow-up visits, physical therapy visits, emergency department returns, or readmissions were seen between 0 and 1-day THA or TKA patients. In TKA patients, 1-day LOS was associated with lower improvements in Patient-Reported Outcomes Measurement Information System Physical Function scores. After risk adjustment, same-day discharge of THA and TKA patients did not result in increased resource utilization during the one-year postoperative period. In the setting of a coordinated joint arthroplasty program with nurse navigator support, same-day discharge can be safely performed without increasing the need for postoperative care in appropriately selected patients undergoing both THA and TKA. [ABSTRACT FROM AUTHOR]

Several studies have suggested that spinal anesthesia gives superior outcomes for primary total joint arthroplasty (TJA). However, there is a lack of available data regarding contemporary general anesthesia (GA) approaches for revision TJA utilized at high-volume joint arthroplasty centers. We retrospectively reviewed a series of 850 consecutive revision TJAs (405 revision total hip arthroplasties and 445 revision total knee arthroplasties) performed over 4 years at a single institution that uses a contemporary GA protocol and reported on the lengths of stay, early recovery rates, perioperative complications, and readmissions. Of the revision arthroplasty patients, 74.4% (632 of 850) were discharged on postoperative day 1 and 68.5% (582 of 850) of subjects were able to participate in physical therapy on the day of surgery. Only 6 patients (0.7%) required an intensive care unit stay postoperatively. The 90-day readmission rate over this time was 11.3% (n = 96), while the reoperation rate was 9.4% (n = 80). While neuraxial anesthesia is commonly preferred when performing revision TJA, we have demonstrated favorable safety and efficiency metrics utilizing GA in conjunction with contemporary enhanced recovery pathways. Our data support the notion that modern GA techniques can be successfully used in revision TJA. [ABSTRACT FROM AUTHOR]

Objective To explore the safety and feasibility of the application of day surgery management model under enhanced recovery after surgery (ERAS) concept in patients undergoing gynecologic laparoscopic surgery. Methods A non-randomized concurrent control trial was conducted on the patients who underwent laparoscopic surgery in our department from January to August 2021. A total of 92 patients admitted on odd date were assigned into Ward B of our department and served as the control group, and another 96 patients hospitalized on even date were subjected into Ward A and served as the observation group. The control group was given the routine treatment schedule, including the relevant examinations after admission and general operation procedure during hospitalization. The observation group was under a day surgery management model based on the concept of ERAS, with aid of a day surgery team and optimized perioperative management measures, including pre-hospital rehabilitation, shortening water fasting before surgery, multi-mode analgesia, preventive antiemesis, intraoperative warmth, prevention of deep vein thrombosis, immediate postoperative eating and activity, and follow-up after discharge. Postoperative subjective comfort, intestinal function recovery, social and economic benefits, postoperative complications and inflammatory indicators were compared between the 2 groups. Results In 0~6, 7~12 and 13~24 h after operation, the scores of thirst, hunger, nausea, pain, abdominal distension and pharyngeal discomfort were significantly lower in the observation group than the control group (P < 0.01). The observation group had obviously shorter length of hospital stay and ealier bowel sound recovery and first anal exhaust than the control group (P < 0.01). No postoperative complication, such as fall, unplanned secondary operation or wound infection was observed in both groups. The postoperative inflammatory indicators, including procalcitonin (PCT), neutrophil percentage (Neu%) and white blood cell count (WBC) were all in the normal ranges in the 2 groups at 24 h and 3 and 7 d after surgery. Statistical differences were found in firstly postoperative mobilization, length of hospital stay, hospitalization cost and patient satisfaction between the 2 groups (P < 0.01). Conclusion ERAS-based day surgery management model has the advantages of shortening hospital stay, reducing medical costs, promoting postoperative rehabilitation, and improving the comfort and satisfaction in patients undergoing gynecologic laparoscopic surgery.

A shift toward same-day discharge (SDD) in primary elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) has created a need to optimize patient selection and improve same-day recovery pathways. The objectives of this study were (1) to identify our institution's most common causes for failed SDD, and (2) to evaluate risk factors associated with failed SDD. A retrospective review of SDD patients undergoing primary TKA or THA from January 2021 to September 2022 was conducted. Reasons for SDD failure were recorded and differences between successful and failed SDD cases were assessed via a multivariate logistic regression. Overall, 85.3% (651 of 753) of patients included were successful SDDs. Failed SDD occurred in 16.8% (74 of 441) of TKA and 11.8% (38 of 322) of THA cases. Primary reasons included failure to clear physical therapy (33.0%, 37 of 112), postoperative hypotension (20.5%, 23 of 112), and urinary retention (16.9%, 19 of 112). Analysis revealed that overall failed SDD cases were more likely to have had prior opioid use and a longer surgical time. Failed TKA SDD cases were more likely to have had a longer surgical time and not have receive a preoperative nerve block, while failed THA SDD cases were more likely to be older. The SDD selection criteria and pathways continue to evolve, with multiple factors contributing to failed SDD. Improving patient selection algorithms and optimizing post-operative pathways can enhance the ability to successfully choose SDD candidates. III. [ABSTRACT FROM AUTHOR]

With the continuous development of new energy generation technology and the increasingly complex power grid environment, the traditional black start scheme cannot meet the requirements of today's power grid in order to ensure the stable operation of the power system can be restored quickly in the face of large power outages, so a more complete black start scheme needs to be developed to cope with the new power system. With the development of energy storage technology, the limitations of the traditional black-start scheme can be solved by new energy farms with energy storage configuration. Therefore, this paper investigates the problems faced by black-start, the key technologies of energy storage assisted new energy black-start, and introduces the research related to new energy black-start technology to provide reference for future research and application of new energy black-start. [ABSTRACT FROM AUTHOR]

Some nutritional factors have been suggested to improve postoperative outcomes in rotator cuff (RC) repair, but dietary effects on the recovery speed after the surgery remain undefined. To investigate the potential roles of dietary habits in this context, we analyzed the 12-month follow-up data of 55 patients with RC repair and found that these patients could be categorized into a rapid recovery group (n = 35) and slow recovery group (n = 20) according to their postoperative recovery patterns. Group-based logistic analysis revealed that habitual intakes of meat (OR = 1.84, 95%CI, 1.22–2.76, p = 0.003), fruits (OR = 2.33, 95%CI, 1.26–5.67, p = 0.01), and wheat-flour foods (OR = 1.62, 95%CI, 1.2–2.25, p = 0.002) were significantly associated with rapid recovery. Moreover, among all intakes of wheat-flour foods, intakes of steamed and boiled flour products were also associated with rapid recovery. Further mediation analysis showed that eosinophilic granulocytes (EOs) significantly mediated the association between rapid RC recovery and the habitual intakes of meat (mediation proportion = 17.5%, P-mediation < 0.0001), fruits (17.9%, p < 0.0001), and wheat-flour foods (11.4%, p < 0.0001). Thus, our study suggests that certain dietary habits play beneficial roles in the context of postoperative recovery for RC repair. [ABSTRACT FROM AUTHOR]

The mainstream application of the anammox process is often hindered by its long recovery phase and instability under disturbance. In this study, a lab-scale anammox sequencing biofilm batch reactor (SBBR) was rapidly recovered within 85 days by gradually increasing the influent nitrogen concentration, and the total inorganic nitrogen (TIN) removal efficiency achieved 83.44 ± 0.03%. During the recovery process, the nitrogen removal rate (NRR) increased from 0.05 to 0.34 kg/(m3·d), with the nitrogen loading rate (NLR) changing from 0.08 to 0.40 kg/(m3·d) in the anammox system. The activities of hydrazine oxidase (HZO) in the biofilm also increased from 0.17 to 10.80 μmol Cyt-c/(g VSS·s). Also, the dominant anammox genera in the biofilm were Candidatus Kuenenia and Candidatus Brocadia. The results of this study suggested that an SBBR–anammox system filled with a microbial carrier could facilitate the enrichment of anammox bacteria and contribute to performance recovery. [ABSTRACT FROM AUTHOR]

Background: Immersive virtual reality (IVR) is utilized as an adjunct to anesthesia to distract patients from their intraoperative environment, thereby potentially reducing sedative and narcotic medication usage. This study evaluated intraoperative and acute postoperative results of patients undergoing primary total hip (THA) and total knee arthroplasty (TKA) with and without IVR. Methods: Utilizing IVR as an adjunct to spinal anesthesia, 18 primary THAs (n = 8) and TKAs (n = 10) were performed. These cases were 1:2 matched based on procedure type, age, sex, and body mass index to those performed without IVR. Intraoperative and postanesthesia care unit sedative/narcotic usage, vital signs, and pain scores were compared. Acute perioperative outcomes, including 24-hour oral morphine equivalent (OME), first ambulation distance, length of stay, and 30-day complications, were also analyzed. Pearson Chi-square and Wilcoxon-Mann-Whitney tests evaluated categorical and continuous variables, respectively. Results: When compared to non-IVR primary THAs and TKAs, those performed with IVR utilized significantly less intraoperative sedation (48 mg vs 708 mg of propofol; P < .001) and trended toward less narcotic usage (13 mcg vs 39 mcg of fentanyl; P = .07). In the postanesthesia care unit, IVR and non-IVR patients showed no significant differences (P > .3) in vital signs, pain scores, or OME received. Additionally, similar (P > .3) postoperative outcomes were noted in both cohorts’ 24-hour OME use, distance at first ambulation, length of stay, and 30-day complications. Conclusions: The use of spinal anesthesia with the IVR adjunct to perform primary THAs and TKAs appears to be well-tolerated and associated with less intraoperative sedative medication usage than spinal anesthesia alone.

To assess whether a preoperative bilateral thoracic paravertebral block (TPVB) would improve postoperative analgesia in infants and small children undergoing open cardiac surgery in the protocol of an ultra-fast track cardiac anesthesia (UFTCA). A single-center, prospective, randomized, controlled study. At a tertiary children's medical center. A total of 180 children undergoing cardiac surgery, aged 1 month to 3 years. Patients are allocated randomly to TPVB and parent- and/or nurse-controlled intravenous analgesia (PNCA) group (Group T) or PNCA group (Group P). The primary outcome is the postoperative pain scores. The secondary outcome are intraoperative consumption of sufentanil, time to extubation, using of neostigmine, cumulative total and invalid PCA attempts in 24 and 48 hours after surgery, hospitalization characteristics, perioperative blood glucose, postoperative arterial oxygen partial pressure, arterial carbon dioxide partial pressure (PaCO 2) and brain natriuretic peptide (BNP). The postoperative pain scores within 24 hours, intraoperative consumption of sufentanil, total, and invalid PCA attempts in 24 and 48 hours, perioperative blood glucose and BNP on the seventh day in Group T were all significantly lower than those in Group P (p < 0. 001). The time to extubation, the use of neostigmine, and PaCO 2 on the sixth hour, postoperatively, were significantly smaller in Group T than those in Group P (p < 0. 05). There were no significant differences in the hospitalizations between the 2 groups. A combination of bilateral single dose TPVB and PNCA pain management is superior to a PNCA pain management alone in infants and small children undergoing open cardiac surgery and contributes to a rapid recovery with preferable perioperative outcomes in the protocol of UFTCA. [ABSTRACT FROM AUTHOR]

Abstract Purpose This study aimed to compare the value of a modified chest tube drainage strategy to a traditional drainage strategy in single‐port thoracoscopic pulmonary wedge resection. Methods From January 2019 to July 2021, we collected clinical data on 405 patients who underwent single‐port thoracoscopic pulmonary wedge resection in the No.1 Department of Thoracic Surgery at Fujian Medical University Union Hospital, with 121 (29.9%) cases in the modified drainage strategy group and 284 (70.1%) cases in the traditional drainage strategy group. The propensity score matching method (Match Ratio = 1:1) was used to reduce differences in clinical characteristics between the two groups. Results Following 1:1 propensity score matching, 120 matched pairs (240 patients) were included in the study. There was no significant difference in general clinical characteristics between the two groups. There was no statistical difference in intraoperative factors except for operative times (71.42 ± 22.98 min vs. 86.80 ± 36.75 min, p

As an excellent room temperature sensing material, polyaniline (PANI) needs to be further investigated in the field of high sensitivity and sustainable gas sensors due to its long recovery time and difficulty to complete recovery. The ZnO/PANI film with p–n heterogeneous energy levels have successfully prepared by spraying ZnO nanorod synthesized by hydrothermal method on the PANI film rapidly synthesized at the gas—liquid interface. The presence of p–n heterogeneous energy levels enables the ZnO/PANI film to detect 0.1–100 ppm (1 ppm = 10−6) NH3 at room temperature with the response value to 100 ppm NH3 doubled (12.96) and the recovery time shortened to 1/5 (31.2 s). The ability of high response and fast recovery makes the ZnO/PANI film to be able to detect NH3 at room temperature continuously. It provides a new idea for PANI to prepare sustainable room temperature sensor and promotes the development of room temperature sensor in public safety. [ABSTRACT FROM AUTHOR]

Objective To investigate the safety of the ultra-early (0~6 h) activity program for patients after minimally invasive radical treatment of cervical cancer. Methods A non-randomized concurrent controlled trial was conducted on 118 patients undergoing minimally invasive radical surgery for cervical cancer in our department from June to December 2019. According to patient's wish, they were divided into the ultra-early (0~6 h) postoperative activity group (n=58) and the conventional activity group (n=60). The patients in both groups received the perioperative program of rapid gynecological rehabilitation. After the operation, the conventional activity group adopted the conventional nursing plan, and the ultra-early activity group adopted the ultra-early postoperative activity plan according to the characteristics of patients with one-to-one guidance and assistance by professional health education nurses. If a patient suffered from conscious weakness, palpitation, dizziness, pale or cold sweats, oxygen saturation < 94%, or heart rate reaching the target heart rate of Karvonen formula, the activity program would be stopped immediately when any of them presented. Results The time to get out of bed for the first time and the activity scores were better in the ultra-early activity group than the conventional activity group (P=0.011). There were no statistically significant differences in SpO2, pulse, pain scores, and incidence of complications between the 2 groups before and after activities. The ultra-early activity group had obviously better average activity in 3 d post-operatively during hospitalization (P=0.000), shorter times to first postoperative exhaust (P=0.020) and to first oral feeding (P=0.010), and shorter length of hospital stay (P=0.010) when compared with the conventional activity group. Conclusion All patients in the ultra-early activity group are able to get out of bed within 24 h post-operatively, and attain better activity level in 3 d after operation than those of the conventional activity group. Ultra-early postoperative activity program can effectively improve the early out-of-bed activity rate after cervical cancer surgery and have no effect on the occurrence of postoperative complications.

Introduction: To retrospectively investigate the early postoperative range of motion (ROM) (days 4, 7, 10) after total knee arthroplasty (TKA) and to test for associations (a) with long-term outcome in terms of ROM and (b) with a disease-specific knee score. Materials and methods: A retrospective analysis was performed in patients with previous primary TKA. Data taken from the medical records were ROM from preoperative and postoperative days 4, 7 and 10 and 1 year. As patient-reported outcome the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC Score) was taken from preoperative and one year after TKA. Results: 316 patients (330 knees) were available. Only negligible correlations were determined between ROM at twelve months postoperative and ROM in the early postoperative days (days 4, 7, 10). Similarly, only negligible correlations were determined between ROM in the early postoperative days (days 4, 7, 10) and the 1-year WOMAC. Conclusion: From the main findings it would seem that steepness of ROM ascent in the early postoperative days is of minor importance for (a) long-term ROM and (b) long-term knee score outcome after TKA. [ABSTRACT FROM AUTHOR]

A comprehensive simulation model is established to predict the trajectory of a high-altitude zero-pressure balloon flight system with no parachute that is required to carry the load floating at the designated altitude for several hours or less. A series of mathematical models, including thermal dynamic, atmospheric, earth, wind, geometry, and exhaust models, are developed to predict the trajectory of the balloon flight system. Based on these models, the uncertainties of the launch parameters and the corresponding flight performance are simulated. Combined with the control strategy, the entire flight trajectory is simulated and discussed in detail, including the ascending, floating, and descending phases. The results show that the vertical velocity takes on a W shape during the ascent process. Furthermore, the balloon begins to gradually descend with weakening solar radiation after noon. Moreover, the landing vertical speed of the balloon flight system can approach zero with the control strategy applied, whereas the lateral drift range is more limited relative to the uncontrolled flight mode. The results and conclusions presented herein contribute to the design and operation of a zero-pressure balloon flight system within limited airspace to improve the rapid recovery ability of the flight system. [ABSTRACT FROM AUTHOR]

Background: The purpose of this survey study was to assess the current analgesia and anesthesia practices used by total joint arthroplasty surgeon members of the American Association of Hip and Knee Surgeons (AAHKS) as well as identify changes in practice made by AAHKS members over time., Methods: A survey of 37 questions was created and approved by the AAHKS Research Committee. The survey was distributed to all 3,243 practicing adult reconstruction surgeon members of AAHKS in May 2023. Results were compared to a nearly identical survey sent out to all board-certified adult reconstruction surgeon members of AAHKS 5 years previously in November 2018., Results: There were 527 responses (16%) to the survey. Since 2018, the mean number of opioid pills prescribed after total joint arthroplasty has declined significantly from 49 to 32 pills after total knee arthroplasty (TKA) and from 44 to 18 pills after total hip arthroplasty (THA). The use of multimodal analgesics in addition to opioids has also increased over the past 5 years from 74 to 93%. The most common medications utilized include nonsteroidal anti-inflammatories (98%), acetaminophen (80%), and gabapentinoids (32%). A majority of surgeons (78%) still use a spinal for TKA and THA. However, there has been an increase in the number of surgeons using peripheral nerve blocks for TKA from 69% in 2018 to 84% in 2023. The routine use of periarticular injection or local infiltration anesthesia in THA and TKA has also increased over the past 5 years from 80 to 86%., Conclusions: Since 2018, there has been increased adoption of multimodal analgesia and anesthesia, and improved consensus regarding the optimal regimen among surveyed arthroplasty surgeon members of AAHKS. The number of opioid pills prescribed after THA and TKA has declined significantly over the past 5 years., (Copyright © 2024 Elsevier Inc. All rights reserved.)

IntroductionThe most frequent complications after abdominal surgery include a decrease or loss of appetite, abdominal distension, abdominal pain caused by reduced gastrointestinal motility, anal arrest with intestinal distension and defecation, and nausea and vomiting due to anesthetic and opioid analgesic administration. These complications severely affect postoperative recovery, prolong hospital stay, and increase the financial burden. The objective of this study is to investigate the efficacy and safety of three acupoint stimulation modalities (electroacupuncture [EA], transcutaneous electrical acupoint stimulation [TEAS], and transcutaneous acupoint electrical stimulation combined with EA [TEAS+EA]), and two EA instrument waveforms (continuous wave and dilatational wave) for rapid recovery after abdominal surgery.Methods and analysisA total of 560 patients will be recruited and randomly allocated to receive one of the following seven interventions: continuous wave EA, continuous wave TEAS, continuous wave TEAS + EA, dilatational wave EA, dilatational wave TEAS, dilatational wave TEAS + EA, and a control. For this study, continuous waves at 2 Hz, and dilatational waves at 2/50 Hz would be selected. The points to be stimulated by EA are the bilateral Neiguan (PC6), Hegu (LI6), Zusanli (ST36), Shangjuxu (ST37), and Xiajuxu (ST39), and TEAS would stimulate the bilateral Liangmen (ST21) and Daheng (SP15). The control group will neither receive EA nor TEAS. All patients will undergo an enhanced recovery plan after surgery and be provided with standardized perioperative management. Treatment will start on the first postoperative day and be administered once daily in the morning until the patient regains spontaneous bowel movements and can tolerate oral intake of solid food. The primary outcome is a composite of time to first defecation and time to tolerance of a solid diet. Secondary outcomes include time to first exhaustion; time of first defecation; time of tolerance of a solid diet; time to the first ambulation; length of hospital stay from surgery to discharge; visual analog scale score for postoperative daily pain, nausea, and vomiting; incidence of postoperative complications; and treatment acceptability.DiscussionThis study will compare the efficacy and safety of three acupoint stimulation methods and two EA instrument waveforms for rapid recovery after abdominal surgery.Trial RegistrationChinese Clinical Trial Registry (http://www.chictr.org.cn), ChiCTR2100043883.

Objective Based on the concept of ERAS and the rehabilitation needs of patients after laparoscopic hepatocellular carcinoma resection, to construct a rehabilitation log after laparoscopic hepatocellular carcinoma resection and study its application effect. Methods A total of 120 patients undergoing laparoscopic hepatocellular carcinoma resection from January to December 2021 were selected and randomly divided into control group and experimental group according to perioperative management methods （79 cases in ERAS group and 41 cases in non-ERAS group）. The control group adopted holistic nursing and routine perioperative health guidance, while the experimental group adopted the mode of medical, nursing and patient co-management, and applied the recovery log. The recovery and satisfaction of the two groups were compared. Results There was no significant difference in the number of complications between the experimental group and the control group （P > 0.05）, and other indicators of the experimental group were significantly better than the control group （P < 0.05）. Results: There was no statistically significant difference between the two groups in bleeding after ambulation, but other indexes were significantly better than the control group （P < 0.01）. Conclusion The construction and application of rehabilitation log can help patients master postoperative rehabilitation knowledge after laparoscopic hepatectomy, improve the initiative of patients, promote the active participation of family members, and accelerate the recovery of patients. [ABSTRACT FROM AUTHOR]

Background: Rapid neurological recovery from subacute to chronic ischemic stroke in subset of patients following carotid revascularization was observed. Objective: Retrospective analysis of data of the patients who had shown rapid recovery from subacute to chronic ischemic stroke following revascularization by Carotid stenting. Materials and Methods: We retrospectively analyzed pooled data from our carotid stenting patients done during January 2009 to January 2020.The inclusion criterion of the study was patients with rapid recovery within 24 h following revascularization by carotid stenting. There were total of 12 such patients. There were 8 males and 4 females. Apart from NIHSS, stroke severity was measured on MRI by ASPECTS score and cognitive function by MMSE. Each of these patients has undergone Carotid Stenting with distal protection for high-grade stenosis. Results: All of these 12 patients had Prestenting ASPECTS score ranging 8-10. Prestenting NIHSS score was ranging from 6-12 with an average of 8. Postprocedure NIHSS score was decreased to a range of 0-4 with average of 3.Prestenting MMSE was ranging 14-20 with an average of 18 score which turned into Post-stenting MMSE scale ranging 24-28 with an average of 26.Each of these patients shows decrease in NIHSS score by at least 50% in 24h to be called rapid recovery or Lazarus phenomenon. Additionally, they show significant improvement in cognitive function on MMSE scale. Conclusion: Rapid recovery from subacute to chronic ischemic stroke following revascularization by Carotid Stenting is potentially feasible in subset of patient who has mild to moderate deficit but high ASPECTS score. [ABSTRACT FROM AUTHOR]

Objective: To explore the effect of nurse-led nursing mode in laparoscopic hepatectomy. Methods: A total of 120 patients who underwent laparoscopic hepatectomy from January to December 2021 were selected as the research objects, and were divided into observation group and control group with 60 patients in each group by random number table method. The observation group received nurse-led nursing mode, and the control group received conventional holistic nursing mode. Preoperative and postoperative liver function indexes, postoperative complications (bleeding, biliary leakage, ascites, abdominal distension), postoperative ambulation time, feeding time, anal exhaust and defecation time, abdominal drainage tube removal time, length of hospital stay, postoperative pain score, self-care ability score, and hospitalization satisfaction were compared between the two groups. Results: There was no significant difference in preoperative liver function between the observation group and the control group (P > 0.05). The other indicators were better than the control group, with statistical significance (P < 0.05). Conclusion: The application of nurse-led nursing mode in the perioperative period of laparoscopic hepatectomy can accelerate patients' recovery, reduce complications, shorten hospital stay, improve self-care ability, improve treatment effect and hospitalization satisfaction, and has clinical application value. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the value of a modified chest tube drainage strategy to a traditional drainage strategy in single‐port thoracoscopic pulmonary wedge resection. Methods: From January 2019 to July 2021, we collected clinical data on 405 patients who underwent single‐port thoracoscopic pulmonary wedge resection in the No.1 Department of Thoracic Surgery at Fujian Medical University Union Hospital, with 121 (29.9%) cases in the modified drainage strategy group and 284 (70.1%) cases in the traditional drainage strategy group. The propensity score matching method (Match Ratio = 1:1) was used to reduce differences in clinical characteristics between the two groups. Results: Following 1:1 propensity score matching, 120 matched pairs (240 patients) were included in the study. There was no significant difference in general clinical characteristics between the two groups. There was no statistical difference in intraoperative factors except for operative times (71.42 ± 22.98 min vs. 86.80 ± 36.75 min, p < 0.001). In terms of postoperative factors, there were significant differences in postoperative chest tube duration (0.00 ± 0.00 h vs. 32.68 ± 18.51 h, p < 0.001), total drainage volume (143.03 ± 118.33 ml vs. 187.73 ± 140.82 ml, p = 0.008), postoperative hospital stay (2.61 ± 0.70 days vs. 3.27 ± 1.88 days, p < 0.001), number of additional pain relief (0.14 ± 0.40 vs. 0.42 ± 0.74, p < 0.001), facial pain score (2.7 ± 1.8 vs. 3.6 ± 2.7, p = 0.005) and adverse events (p = 0.046). Furthermore, there was a statistical difference between the two groups regarding CTCAE grade‐1 complication, but no statistical difference in CTCAE grade‐2 complication. Conclusions: A modified drainage strategy in single‐port thoracoscopic pulmonary wedge resection is safe and feasible, allowing for less postoperative rehabilitation time, pain relief, reduced postoperative pleural effusion, and reduced clinical workload. [ABSTRACT FROM AUTHOR]

Nanomaterials have been considered as promising materials to construct highly sensitive and miniaturized gas sensors due to their high ratio of surface to volume, but almost all of the reported nanomaterials based resistive gas sensors are difficult to use in the practical system mainly owing to the long recovery time and non-equilibrium state at room temperature. Here, we demonstrate a gate assistant technology to realize the rapid recovery to an equilibrium state in semiconducting carbon nanotube (CNT) thin-film gas sensors and promote the CNT-based gas sensors to reach the practical application level. Specifically, we construct highly uniform gas sensors based on semiconducting solution-derived CNT film and accelerate the gas molecules desorption by applying a voltage on the back gate (substrate), which is named gate-assistant recovery technology. By combining the gate-assistant recovery technology and a modified concentration calculation method, highly reproducible detection systems have been realized by using a custom-built printed circuit board (PCB) based data acquisition circuits to execute a real-time rapid detection of H2 in the air at room temperature, and especially exhibits a record response time of 9 s and recovery time of 50 s under a resolution of 10 ppm, which outperformed previous low dimensional nanomaterials based portable H2 detection systems. The gate-assistant rapid recovery and related concentration calculation technologies are helpful to promote the nanomaterials-based gas sensors to practical application for highly sensitive online gas detection. [ABSTRACT FROM AUTHOR]

To explore the effect of a short-term, hospital-based, multimodal preoperative prehabilitation intervention on perioperative functional ability of patients with gynecological malignant tumors. According to the order in which they underwent surgery, 97 patients were divided into the control group (48 cases) and the intervention group (49 cases). The control group was given routine preoperative guidance, whereas the intervention group was given short-term multimodal prehabilitation guidance on the basis of the control group intervention. The 6-min walk test was performed on the day of admission to the hospital, the day before surgery, and the 30th day after surgery. Compared with the control group, the intervention group had significantly better 6-min walk distance and superior physical and psychological status on the day before surgery and the 30th day after surgery (P < 0.001). For three consecutive days after surgery, the quality of recovery in the intervention group was significantly higher than that in the control group (P < 0.001), and the first ambulation time and exhaust time were achieved earlier in the intervention group than in the control group (P < 0.05). The preoperative intervention group showed improved preoperative exercise ability and reduced anxiety in patients with gynecological cancer. Furthermore, this intervention improved the overall health of patients and accelerated their postoperative recovery. • This study designed a prehabilitation strategy for gynecological tumor patients. • This strategy is a short-term multimodal prehabilitation intervention program. • The strategy improves the overall health of patients and promotes their recovery. • The strategy offers new ideas to improve the health of gynecologic tumor patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The number of joint replacements is expected to dramatically increase, and the optimization of the available resources is fundamental to maintain high clinical standards while providing an efficient treatment to an increasing number of patients. The present study describes the outcomes of the application of a rapid recovery (RR) protocol in a referral center for hip and knee replacement surgery. PATIENTS AND METHODS: The medical records of every patient undergoing primary hip or knee replacement in 2019 were identified and all the relevant data were retrospectively extracted and compared to those of year 2016 (the last year before the onset of the rapid recovery protocol). The following outcomes were considered: 1) length of stay (LOS); 2) total number of TKR and THR; 3) pre- and post-operative subjective questionnaires; 4) NRS for pain at day 1 following surgery; 5) mean hemoglobin value at discharge; 6) number of blood transfusion performed; 7) complications following surgery. RESULTS: The mean LOS was significantly lower for patients managed through the rapid recovery protocol: 5.1 ± 1.4 days vs. 10.4 ± 2.3 days (p < 0.0001). The earlier discharge of patients promoted an overall increase in the total number of joint replacement procedures performed (2,806 in year 2019 vs. 2,236 in year 2016; p < 0.0001). Higher hemoglobin values at discharge were found in the RR group (10.6 ± 1.4 g/dl vs. 9.6 ± 1.2 g/dl, p = 0.049). No difference was observed in terms of clinical scores and overall complication rate. CONCLUSIONS: The application of a multimodal RR protocol for THR and TKR patients was able to reduce the length of stay and optimize the use of blood products, without increasing the risk of complications or jeopardizing the functional recovery. [ABSTRACT FROM AUTHOR]

Background and Aim: Enhanced Recovery After Surgery (ERAS) protocols are a series of perioperative interventions well-established in improving the care and outcomes of patients. With recent emergence of studies on its implementation in cardiac surgery, this paper represents the first systematic review on current evidence of ERAS efficacy in this field. Methods: Two reviewers independently searched through Pubmed, Cochrane, Google Scholar, Web of Science, Embase and Scopus. Comparative studies with controls that described the implementation of ERAS in all types of cardiac operations from 2001 to 2020 were included. Data extracted included patient demographics, components of ERAS protocol described, types of cardiac surgery, and postoperative outcomes. Results: In the final analysis, nine studies were included, of which there were one randomized controlled trial (RCT), one quasi-experiment and seven retrospective/prospective studies. Significant improvement in hospital and ICU length of stay, as well as reduction in postoperative opioid consumption were demonstrated. No increase in postoperative complications were reported. Conclusion: ERAS in cardiac surgery has shown to be potentially safe and effective in improving certain postoperative outcomes. However, the evidence is limited by the lack of high-quality RCTs. We also found the lack of practice of class 1 recommended interventions set forth by the ERAS Cardiac Society. Furthermore, majority of studies only evaluated the immediate postoperative outcomes of patients, and not the long-term outcomes. RCTs that fully implement measures recommended by the ERAS Cardiac Society, with assessments on both immediate and long-term outcomes, are warranted. [ABSTRACT FROM AUTHOR]

Background: We reviewed the results of a primary total knee arthroplasty (TKA) rapid recovery care pathway applied to patients undergoing aseptic revision TKA. We sought to determine (1) the frequency of postoperative day (POD) 1 discharge, (2) the risk of adverse events, and (3) patient characteristics or surgical factors associated with failure to discharge on POD 1. Methods: The source population was revision TKAs performed by a single surgeon at an academic medical center from 2016 to 2019 (n = 94). A primary TKA rapid recovery care pathway was applied to all patients who underwent aseptic revision TKA involving both femoral and tibial components (n = 33). Patients discharged on POD 1 (n = 21) were compared with those discharged on POD 2 or later (n = 12). Results: The study cohort was 70% women, 12% under-represented minorities, and 70% government insured. Patients each had an average of 5 comorbidities. The average length of stay was 1.7 days, with 64% of patients discharged on POD 1. Ninety-seven percent of patients were discharged home. Although 18% of patients presented to the emergency room (ER) after discharge, there was no increased risk of readmission (P = .9336) or return to the ER (P = .9849) with POD 1 discharge. The LOS was unaffected by patient characteristics or complexity of surgical reconstruction. Conclusions: Using a rapid recovery care pathway for aseptic revision TKA is feasible at an academic medical center. All patients may be considered for this pathway. Close postoperative monitoring is essential to minimizing ER visits, which are not uncommon.

Background: A number of papers have been published comparing the safety and efficacy of day case and inpatient anatomic or reverse total shoulder arthroplasty. However, no systematic review of the literature has been published to date. The aim of this review was to determine if day case total shoulder arthroplasty (length of stay <24 h) leads to similar outcomes as standard-stay inpatients (length of stay ≥24 h). Methods: The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviewers were queried for publications utilizing keywords that were pertinent to total shoulder arthroplasty, day case, outpatient and inpatient, clinical or functional outcomes, and complications. In order to determine the quantitative impact of day case total shoulder arthroplasty on readmission and revision rate, a meta-analysis was performed on articles that observed 30- or 90-day readmission or revision. Results: Eight articles were found to be suitable for inclusion in the present study which included 6103 day case total shoulder arthroplasty and 147,463 inpatient total shoulder arthroplasty. Following meta-analysis, there was no significant difference among patients who underwent day case total shoulder arthroplasty compared to inpatient total shoulder arthroplasty regarding revision rates (OR: 1.001; 95% CI: 0.721–1.389; p = 0.995) and 30-day readmission rates (OR: 0.940; 95% CI: 0.723–1.223; p = 0.646). In contrast, patients who underwent day case total shoulder arthroplasty were less likely to have a readmission within 90 days compared to their inpatient counterparts (OR: 0.839; 95% CI: 0.704–0.999; p = 0.049). Two out of eight studies reported comparable baseline clinical characteristics among groups, while five studies reported significant differences and one study did not provide information regarding clinical characteristics, such as medical comorbidities or American Society of Anaesthesiologists'(ASA) score. No significant difference among groups was found in all or almost all studies regarding mortality rates, and rates of cardiac complications, cerebrovascular events, thromboembolic events, pulmonary complications, cardiac complications, and nerve complications. Finally, results were rather conflicting regarding the correlation of day case total shoulder arthroplasty to the rate of surgical site infections. Conclusions: This study showed that day case total shoulder arthroplasty might lead to similar rates of mortality, complications, revisions, and readmissions compared to inpatient total shoulder arthroplasty when used in a selected population of younger, healthier, and more male patients. In contrast, there was no consensus regarding the impact of day case total shoulder arthroplasty on the rate of surgical site infections. Finally, further research of higher quality is required to establish patient demographic criteria, ASA score, or comorbidity index cut off that might be used to define day case-treated patients who seem to have equivalent outcomes compared to inpatient-treated patients. Level of evidence: Systematic review of level III studies (lowest level included). [ABSTRACT FROM AUTHOR]

Introduction: total knee arthroplasty is considered an important intervention to reduce pain when we find ourselves in a situation of knee osteoarthritis. Patients after knee replacement surgery have severe pain and loss of function after the intervention. Physiotherapy has a main function to avoid this. The aim of this review was to find out the moment in which Physiotherapy must be applied so that the treatment is more effective in patients operated on for total knee replacement. Material and method: a systematic review was carried out following the PRISMA standards of the studies published from January 1, 2016 to January 1, 2021 in 5 databases: Pubmed, Embase, Science Direct, Cochrane Plus and PEDro. The methodological quality of the studies that were include in the review was assessed using the PEDro scale. Results: seven randomized control trials met the selection criteria and were included in the review. All subjects included in the samples of the articles analyzed underwent total knee replacement surgery. In all the studies, Physical therapy is a before and after in the improvement of function and symptoms after the operation, but in most studies there were no significant differences between the different treatments applied. Conclusions: there is no difference in terms of symptoms and recovery time between applying Physiotherapy techniques on the same day of surgery or applying them one day after surgery. [ABSTRACT FROM AUTHOR]

A comprehensive simulation model is established to predict the trajectory of a high-altitude zero-pressure balloon flight system with no parachute that is required to carry the load floating at the designated altitude for several hours or less. A series of mathematical models, including thermal dynamic, atmospheric, earth, wind, geometry, and exhaust models, are developed to predict the trajectory of the balloon flight system. Based on these models, the uncertainties of the launch parameters and the corresponding flight performance are simulated. Combined with the control strategy, the entire flight trajectory is simulated and discussed in detail, including the ascending, floating, and descending phases. The results show that the vertical velocity takes on a W shape during the ascent process. Furthermore, the balloon begins to gradually descend with weakening solar radiation after noon. Moreover, the landing vertical speed of the balloon flight system can approach zero with the control strategy applied, whereas the lateral drift range is more limited relative to the uncontrolled flight mode. The results and conclusions presented herein contribute to the design and operation of a zero-pressure balloon flight system within limited airspace to improve the rapid recovery ability of the flight system.

As perioperative protocols have improved, there has been a reduction in the rates of key complications after hip and knee arthroplasty. Likewise, as we have been able to make patients more comfortable postoperatively, hospital length of stay has decreased and in some centers, hip and knee arthroplasty is now routinely performed as an outpatient. While the number of surgeons offering this option and patients choosing to have procedures performed as an outpatient grows, many questions revolve around this movement. This article will review the data supporting outpatient arthroplasty, the business and legal aspects involved, if surgeons can align with their hospital to offer these services, and how tightly knit and highly organized teams are key to the success of safely offering hip and knee arthroplasty on an outpatient basis. [ABSTRACT FROM AUTHOR]

Summary: Background: A significant percentage of patients have an unfavorable outcome following primary total knee arthroplasty (TKA). This study aimed to evaluate whether specific knowledge about the implant and resilience can influence the functional outcome following TKA. Methods: A consecutive series of 163 patients following primary TKA at a mean age of 70 years (SD 9.1 years) were included at a regional rehabilitation center between December 2015 and December 2016. Specific patient knowledge (scale 0–7), Connor Davidson Resilience Scale (CD-RISC), Western Ontario and McMaster Universities (WOMAC) score, University of California and Los Angeles (UCLA) score and constitutional parameters were assessed on admission. Pearson's correlation analysis and stepwise linear regression analysis were performed to investigate associations between knowledge, resilience and functional scores. Results: The mean overall knowledge score was 3.5 out of 7 and the mean resilience score was 72.9 out of 100. Mean WOMAC and UCLA scores on admission were 23.8 and 5.5, respectively. Stepwise linear regression analysis identified knowledge and age as significant predictors of WOMAC scores (R2 = 14.3%, p = 0.003). Knowledge and resilience were identified as significant predictors of UCLA scores (R2 = 13.8%, p = 0.013). Conclusion: This study highlights the importance of patient-related factors as part of an integral patient care concept in TKA. Although the identified predictors still need to be refined, it could be demonstrated how better patient knowledge might ultimately lead to better functional outcome following TKA. Routinely assessing patients' resilience might be a useful tool to identify patients at risk for low activity levels. Level of evidence: III. Patient-reported outcome study. [ABSTRACT FROM AUTHOR]

The low-temperature NO 2 gas sensors with ultra-high response are more helpful for their real-time and accurate monitoring in complex environment, however, the relevant reports are very less. Herein, we firstly prepared graphitic carbon nitride (g-C 3 N 4) by pyrolysis of inexpensive melamine, which was used as template and directly soaked into SnCl 4 ethanol/water solution. Afterwards, the immersed precursors were calcined to generate different SnO 2 -based materials. Among, the morphology of g-C 3 N 4 /SnO 2 -5 calcined at 500 °C is lamella structure composed of trace g-C 3 N 4 and small-size SnO 2 nanoparticles, which possesses narrow mesopores, large specific surface area, rich oxygen vacancy defects, as well as high concentration of surface O 2 - (ad) species. Under the synergy of multiple favorable factors, g-C 3 N 4 /SnO 2 -5 sensor exhibits ultra-high response (S = 12171) for 10 ppm NO 2 gas at 92 °C, which is 1.93 times than that of SnO 2 -6 sensor. It is also the highest response value among reported g-C 3 N 4 /metal oxide composites. In addition, this sensor has fast recovery time (5 s), low detection limit, good moisture resistance and stability. Thus, the simple g-C 3 N 4 template method provides a new strategy for the fabrication of gas sensors with highly efficient sensing ability. [Display omitted] • The trace g-C 3 N 4 /SnO 2 lamella was simply prepared by the pyrolysis of immersed lamellar g-C 3 N 4 template. • The g-C 3 N 4 /SnO 2 -5 sensor achieved ultra-high response and fast recovery of NO 2 gas at low temperature. • The excellent performance stems from the synergism of lamella structure, trace g-C 3 N 4 doping and rich oxygen vacancies. • The simple g-C 3 N 4 template method provides a new horizon for synthesizing other metal oxides with ultra-high response. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the clinical effects of multi-drug combination application of preemptive analgesia in promoting rapid postoperative recovery of patients undergoing lower limb daytime operation in orthopedics. METHODS: Totally 150 patients undergoing lower limb daytime operation in orthopedics of Affiliated Hospital of Xiangnan University from Aug. 2018 to Jun. 2020 were extracted to be divided into the control group and the observation group via the random number table, with 75 cases in each group. All patients were treated with intraspinal anesthesia and postoperative intravenous self-controlled analgesia. On this basis, the observation group received multidrug combination application of preemptive analgesia. Postoperative analgesia, sedation, vital indicators, incidence of postoperative nausea and vomiting (PONV), dosage of analgesics and postoperative length of stay were observed in both groups. RESULTS: The visual analogue scale (VAS) score of the observation group was lower than that of the control group at 2, 6, 12 and 24 h after operation, the Ramsay score at 2 and 6 h after operation was higher than that of the control group, with statistically significant difference ( P < 0. 05). There was no significant difference between two groups in the Ramsay score at 12 and 24 h after operation ( P > 0. 05 ). There was no significant difference in systolic blood pressure ( SBP ), diastolic blood pressure ( DBP ), heart rate ( HR) and pulse oxygen saturation( SpO2 ) between two groups at 2, 6, 12 and 24 h after operation (P>0. 05). The incidence of PONV in the observation group was 5. 33% (4 / 75), significantly lower than 22. 67% (17 / 75) in the control group, and the difference was statistically significant (P<0. 05). The dosage of analgesics tramadol at 24 h after operation in the observation group was less than that in the control group, the postoperative length of stay was shorter than that of the control group, with statistically significant difference (P<0. 05). CONCLUSIONS: Multi-Drug combination application of preemptive analgesia for patients undergoing lower limb daytime operation in orthopaedics can achieve good analgesic and sedative effects, reduce the incidence of PONV, decrease the dosage of analgesics and effectively promote the recovery process of patients after operation. [ABSTRACT FROM AUTHOR]

Background: Several variables are known to correlate with the successful completion of short-stay total hip arthroplasty (THA) protocols. The role of psychological factors remains unclear. We investigated the interaction between patient-reported measures of psychological fitness and successful completion of a short-stay THA protocol.Methods: We performed a prospective cohort study of patients undergoing elective anterior total hip arthroplasty enrolled in a short-stay protocol (success defined as LOS ≤1 midnight versus failed, LOS >1 midnight). Psychological fitness was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) domains for self-efficacy, depression, anxiety, emotional support, and the ability to participate in social roles. PROMIS scores, patient demographics, and surgical factors were assessed for a relationship with failure to complete short-stay protocol.Results: Patients that failed to complete the short-stay protocol had higher mean pre-operative PROMIS depression scores (50.8 vs 47.1, P = .025) and anxiety scores (53.6 vs 49.2, P = .008) and higher postoperative PROMIS depression (48.19 vs 43.49, P = .003) and anxiety scores (51.7 vs 47.1, P = .01). Demographic and surgical variables did not correlate with the successful completion of the short-stay protocol. That seventy-six percent of the patients did not adhere to the short-stay protocol was due to the inability to complete a physical therapy standardized safety assessment.Conclusion: Higher levels of preoperative and postoperative anxiety and depression in otherwise psychologically healthy patients, is associated with an increased risk of failure to complete a short-stay protocol following THA. Targeted interventions are needed to facilitate rapid recovery in patients with psychological barriers to early mobilization. [ABSTRACT FROM AUTHOR]

Background: This study sought to determine the total amount of time committed to planned and unplanned episodes of care related to primary, unilateral total joint arthroplasty (TJA), relative to a growth in outpatient TJA.Methods: All primary, unilateral TJA procedures performed over a 7-year period by a single surgeon at a single institution were retrospectively reviewed. Time dedicated to planned work was calculated over each episode of care, from surgery scheduling to 90 days postoperatively. All telephone inquiries and readmissions involving the surgeon's direct input, over the episode of care, constituted time dedicated to unplanned work.Results: Between 2012 and 2018, as the proportion of outpatient TJAs increased, the average planned episode-of-care time per patient decreased from 412 minutes to 361 minutes. Despite a 108% increase in the total number of outpatient TJAs between 2017 and 2018 (51/432 (11.8%) to 106/555 (19.1%); P = .002), neither the average number of unplanned telephone inquiries (4.6 ± 3.8 vs 4.2 ± 3.7; P = .124), nor the mean time per patient required to respond to calls (23.1 ± 19.4 vs 21.2 ± 18 minutes, P = .135) differed. Between 2017 and 2018, the average total episode-of-care time per patient decreased from 403 minutes (376 planned + 27 unplanned) to 387 minutes (361 planned + 26 unplanned).Conclusion: Despite an increase in outpatient TJA, the average time required for planned and unplanned patient care remained relatively constant. The growth of outpatient TJA nationally should not trigger a change in Centers for Medicare and Medicaid Services benchmarks. [ABSTRACT FROM AUTHOR]

Background: The introduction of bundled funding for total knee arthroplasty (TKA) has motivated hospitals to improve quality of care while minimizing costs. The aim of our quality improvement project is to reduce the acute hospitalization length of stay to less than 2 days and decrease the percentage of TKA patients discharged to inpatient rehabilitation using an enhanced recovery after surgery bundle.Methods: This study used a before-and-after design. The pre-intervention period was January to December 2017 and the post-intervention period was January 2018 to August 2019. A root cause analysis was performed by a multidisciplinary team to identify barriers for rapid recovery and discharge. Four new interventions were chosen as part of an improvement bundle based on existing local practices, literature review, and feasibility analysis: (1) perioperative peripheral nerve block; (2) prophylactic antiemetic medication; (3) avoidance of routine preoperative urinary catheterization; and (4) preoperative patient education.Results: The pre-intervention and post-intervention groups included 232 and 383 patients, respectively. Mean length of stay decreased from 2.82 to 2.13 days (P < .001). The need for inpatient rehabilitation decreased from 20.2% to 10.7% (P = .002). Mean 24-hour oral morphine consumption decreased from 60 to 38 mg (P < .001). The percentage of patients experiencing moderate-to-severe pain and postoperative nausea and vomiting within the first 24 hours decreased by 25% and 15%, respectively (P < .001). Thirty-day emergency department visits following discharge decreased from 12.9% to 7.3% (P = .030).Conclusion: Significant improvements in the recovery of patients after TKA were achieved by performing a root cause analysis and implementing a multidisciplinary, patient-centered enhanced recovery after surgery bundle.Level Of Evidence: Level III. [ABSTRACT FROM AUTHOR]

The year 2020 will be recorded in world history as one of the most challenging periods. With the benefit of hindsight from previous crises, humanity will eventually (and this time hopefully) prevail. Covid-19 pandemic which has been around for a full calendar year sets a reminder and a call for us to adapt with a new mindset to embrace the new normal in our life. Not many countries can strike a delicate balance between saving lives and protecting livelihoods during this difficult time. Obviously, most developing countries have been struggling to control this seemingly intractable calamity from the first day of the outbreak. Covid-19 pandemic has sent the world one strong message, it is that we are only as safe as the most vulnerable among us. This indicates the central place of solidarity in our life. While we are predicting the emergency-authorized vaccine as the “game-changer”, estimating the outcome in the following years leads us to numerous possibilities and scenarios. Questions surrounding vaccine distribution, efficacy rate, and unintended consequences will still linger. Narrowing down the probabilities will lead us to two contrasting scenarios either growth will be propelled immediately or growth will not be accelerated due to various factors. Echoing previous editorial notes, the impact of the Covid-19 pandemic on SDGs targets (also to other global and national development plans) can be mixed. The quintessential question is on how we maintain positive outcomes when the pandemic is over and how to get back on the right track. Apparently, many development targets need to be revised and some if not most of them might not be easy to catch up with. This situation arguably sets a backdrop for “the great reset” where all development strategies need to be restarted, policies have to be scrutinized, and targets must be re-calibrated. Undoubtedly, making predictions these days is not an easy job indeed. Too many variables and events need to be taken into account so as to reflect the complex world we live in. Sophisticated statistical methods and state-of-the-art computation technology do not really guarantee accuracy. It only needs a shock which makes our prediction becomes irrelevant. Many these days acknowledge VUCA (volatility, uncertainty, complexity, and ambiguity) as inherent characteristics of modern development. This poses serious challenges for those who work as planners in various contexts. Revising our projection might increase credibility but nobody knows for how long the revised targets will remain in a dynamic setting like nowadays. The year 2020 gives a lesson that we seemingly learn the hard way. One important lesson is on finding the correct perspective in viewing government spending. For many years we have seen the dominant role of government spending in development and it becomes more prominent when the economy stagnates. However, we have also been constantly looking for a better way to increase the quality of spending and more importantly: the way we measure it. Apparently, it seems, current measurement is inextricably linked with rigid public accounting standard which does not allow much flexibility and largely fulfills an administrative purpose. Sadly, it tends to normalize the “gold standard” of government spending: “the more we spend, the better” which unfortunately reveals the downside of such a spending pattern. That explains the acceleration of absorption rate at the end of the fiscal year, anecdotes on a spending frenzy, and whimsical disbursement for the sake of spending. Alternative measurement like efficiency score needs to be introduced immediately as a replacement of current performance indicators which is merely based on the monetary-based absorption rate of the annual budget. A simplistic method of budget absorption rate might still be relevant with tangible projects like infrastructure but it might be barely sensible within the context of intangible activities such as research, studies, advisory, and other knowledge sector-related projects. In order to reduce the Covid-19 contagion, governments opt for mobility restriction which consequently causes almost entirely business activities into the hold. Travelling and MICE industries—which arguably predominates government spending on knowledge-sector as well as one of the most prioritized sectors in the economy—have been hit the hardest during the pandemic. The inefficiency problem has been rising to the surface and this time should attract more attention to policymakers and scholars. This sends an urgent call for those who are competent to develop a correct alternative to measure one’s performance. Indeed, government spending is considered as the prime mover during difficult times and plays a pivotal role to accelerate economic recovery. However, the quality of spending will determine policy effectiveness. Mobility restriction brings a corollary that practices like working from home, digital economy, and assistive technology become a new normal. Numerous companies in developed countries pledged to resume this highly efficient and environment-friendly practice even after the pandemic. Yet, we have to ponder upon this shift into the context of developing countries where the informal economy is still rampant with the labor force population entering its peak. Probably unbeknownst to many, this “inefficiency” and negative externality (air pollution, road congestion, disposed waste) somehow correlates with employment creation and significantly acts as an economic multiplier. Finding the balance between “multiplier” and “efficiency” on government spending is therefore another issue that should be on the problem-solving bucket list. With quality spending, the policy effectiveness will lead to better outcomes which hopefully will bring rapid recovery. Not only have the Covid-19 crisis taken a heavy toll on people’s lives, but it also made a dent in the global economy. Its adverse impact on jobs, livelihoods, poverty, and inequality has been reversing some of the gains that countries had made over the past few decades. To contain the damage, countries the world over have been adopting and adapting various policies to protect their populations and stabilize the economy. Problems and challenges that remain unsolved before the pandemic have been looking for solutions. Therefore, in this issue, we invite authors from diverse academic backgrounds to present their works not exclusively revolving around topics on Covid-19 pandemic but also to other important themes such as poverty (Nuryitmawan), urban planning (Sari et al), public finance (Putri), disaster mitigation (Erlinna), environment (Yazawa and Shimizu), well-being measurement (Suriadi and Kususanto), middle class (Pratomo et al), and tourism (Warganegara). We invite the readership to give us feedback on these articles and we surely welcome submissions on other topics from all fields of science in the upcoming issue.

Background: Advances in perioperative care have enabled early discharge and outpatient primary total joint arthroplasty (TJA). However, the safety of early discharge after revision TJA (rTJA) remains unknown and the COVID-19 pandemic will force decreased hospitalization. This study compared 90-day outcomes in patients undergoing aseptic rTJA discharged the same or next day (early) to those discharged 2 or 3 days postoperatively (later).Methods: In total, 530 aseptic rTJAs performed at a single tertiary care referral center (December 5, 2011 to December 30, 2019) were identified. Early and later discharge patients were matched as closely as possible on procedure type, sex, American Society of Anesthesiologists physical status classification, age, and body mass index. All patients were optimized using modern perioperative protocols. The rate of 90-day emergency department (ED) visits and hospital admissions was compared between groups.Results: In total, 183 early discharge rTJAs (54 hips, 129 knees) in 178 patients were matched to 183 later discharge rTJAs (71 hips, 112 knees) in 165 patients. Sixty-two percent of the sample was female, with an overall average age and body mass index of 63 ± 9.9 (range: 18-92) years and 32 ± 6.9 (range: 18-58) kg/m2. There was no statistical difference in 90-day ED visit rates between early (6/178, 3.4%) and later (11/165, 6.7%) discharge patients (P = .214). Ninety-day hospital admission rates for early (7/178, 3.9%) and later (4/165, 2.4%) discharges did not differ (P = .545).Conclusion: Using modern perioperative protocols with appropriate patient selection, early discharge following aseptic rTJA does not increase 90-day readmissions or ED visits. As hospital inpatient capacity remains limited due to COVID-19, select rTJA patients may safely discharge home the same or next day to preserve hospital beds and resources for more critical illness. [ABSTRACT FROM AUTHOR]

BACKGROUND: Postoperative pain is a common clinical problem in unicompartmental knee arthroplasty, and severe pain can affect postoperative efficacy. Hormone is a common and effective anti-inflammatory drug, and there is some controversy over whether to add hormone to the local injection of cocktail in unicompartmental knee arthroplasty. OBJECTIVE: To evaluate the effectiveness of adding hormones to the cocktail to promote rapid recovery after unicompartmental knee arthroplasty. METHODS: Osteoarthritis patients receiving unilateral unicompartmental knee arthroplasty from October 2017 to March 2019 were randomly divided into a hormone group (local injection of cocktail + 40 mg triamcinolone acetonide) and a control group (local injection of cocktail + equivalent normal saline). Visual analogue scale score, fentanyl consumption, knee function, inflammatory indicators, adverse reactions and complications were observed in both groups after surgery. RESULTS AND CONCLUSION: (1) Finally, 80 patients were included in the study (n=40 in each group). There was comparability between the two groups (P > 0.05). (2) The static and dynamic visual analogue scale scores of patients in the hormone group at 1, 2 and 3 days after surgery were significantly lower than those in the control group (P < 0.05). (3) The dosage of fentanyl in the hormone group was significantly lower than that in the control group at 48 hours after surgery (P < 0.05). (4) At 1, 3, 5 days and 3 months after surgery, the knee flexion range of motion in the hormone group was higher than that of the control group (P < 0.05). (5) Hospital for Special Surgery score of knee in the hormone group was higher than that in the control group at 3 months after surgery (P < 0.05). There was no statistically significant difference in Hospital for Special Surgery scores of the knee between two groups at 6 months after surgery (P > 0.05). (6) C-reactive protein levels at 3 days and interleukin-6 levels at 24 hours after surgery in the hormone group were significantly lower than those in the control group (P < 0.05). (7) The incidence of complications in the hormone group was significantly lower than that in the control group (P < 0.05). (8) Addition of hormones in the cocktail can effectively promote the rapid recovery after unicompartmental knee arthroplasty. [ABSTRACT FROM AUTHOR]