Persistent postsurgical pain: risk factors and prevention

Glucagon-like peptide 1 (GLP-1) is a 30-amino acid peptide hormone produced in the intestinal epithelial endocrine L-cells by differential processing of proglucagon, the gene which is expressed in ...

The Physiology of Glucagon-like Peptide 1

Accurate assessment is required to assess current and changing physical activity levels, and to evaluate the effectiveness of interventions designed to increase activity levels. This study systematically reviewed the literature to determine the extent of agreement between subjectively (self-report e.g. questionnaire, diary) and objectively (directly measured; e.g. accelerometry, doubly labeled water) assessed physical activity in adults. Eight electronic databases were searched to identify observational and experimental studies of adult populations. Searching identified 4,463 potential articles. Initial screening found that 293 examined the relationship between self-reported and directly measured physical activity and met the eligibility criteria. Data abstraction was completed for 187 articles, which described comparable data and/or comparisons, while 76 articles lacked comparable data or comparisons, and a further 30 did not meet the review's eligibility requirements. A risk of bias assessment was conducted for all articles from which data was abstracted. Correlations between self-report and direct measures were generally low-to-moderate and ranged from -0.71 to 0.96. No clear pattern emerged for the mean differences between self-report and direct measures of physical activity. Trends differed by measure of physical activity employed, level of physical activity measured, and the gender of participants. Results of the risk of bias assessment indicated that 38% of the studies had lower quality scores. The findings suggest that the measurement method may have a significant impact on the observed levels of physical activity. Self-report measures of physical activity were both higher and lower than directly measured levels of physical activity, which poses a problem for both reliance on self-report measures and for attempts to correct for self-report – direct measure differences. This review reveals the need for valid, accurate and reliable measures of physical activity in evaluating current and changing physical activity levels, physical activity interventions, and the relationships between physical activity and health outcomes.

/pdf/a-comparison-of-direct-versus-self-report-measures-for-ebc2zoxerg.pdf

A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review

Objective: To evaluate the effect of modifying perioperative care in noncardiac surgical patients on morbidity, mortality, and other outcome measures. Background: New approaches in pain control, introduction of techniques that reduce the perioperative stress response, and the more frequent use of minimal invasive surgical access have been introduced over the past decade. The impact of these interventions, either alone or in combination, on perioperative outcome was evaluated. Methods: We searched Medline for the period of 1980 to the present using the key terms fast track surgery, accelerated care programs, postoperative complications and preoperative patient preparation; and we examined and discussed the articles that were identified to include in this review. This information was supplemented with our own research on the mediators of the stress response in surgical patients, the use of epidural anesthesia in elective operations, and pilot studies of fast track surgical procedures using the multimodality approach. Results: The introduction of newer approaches to perioperative care has reduced both morbidity and mortality in surgical patients. In the future, most elective operations will become day surgical procedures or require only 1 to 2 days of postoperative hospitalization. Reorganization of the perioperative team (anesthesiologists, surgeons, nurses, and physical therapists) will be essential to achieve successful fast track surgical programs. Conclusions: Understanding perioperative pathophysiology and implementation of care regimes to reduce the stress of an operation, will continue to accelerate rehabilitation associated with decreased hospitalization and increased satisfaction and safety after discharge. Developments and improvements of multimodal interventions within the context of "fast track" surgery programs represents the major challenge for the medical professionals working to achieve a "pain and risk free" perioperative course.

Multimodal strategies to improve surgical outcome.

The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm

Background:The optimal surgical strategy for the treatment of chronic pain after inguinal hernia repair is controversial and based on relatively weak evidence. The purpose of this study was to anal...

https://journals.sagepub.com/doi/pdf/10.1177/1457496920954570

A Simplified Clinical Algorithm for Standardized Surgical Treatment of Chronic Pain After Inguinal Hernia Repair: A Quality Assessment Study:

INTRODUCTION Intraoperative fluorescent cholangiography is a novel non-invasive imaging technique to visualise the extrahepatic biliary tract during laparoscopic cholecystectomy. It has been proven feasible, fast and cost effective. Never-theless, there is only sparse data on the capacity of fluorescent cholangiography to visualise the biliary anatomy. METHODS Based on a non-inferiority design, patients with complicated gallstone disease are randomised to either -intraoperative conventional X-ray cholangiography (reference group, n = 60) or intraoperative fluorescent cholangiography (n = 60). The primary outcome is visualisation of the junction between the cystic duct, the common hepatic duct and the common bile duct. CONCLUSION The present study may show that fluorescent cholangiography is as valid for visualisation of important structures of the extrahepatic biliary tract as conventional X-ray cholangiography. This may lead to the introduction of online imaging of the extrahepatic tract during dissection of the gallbladder during cholecystectomy. FUNDING none. TRIAL REGISTRATION This study was registered with clinicaltrials.gov (No. NCT02344654), with the National Committee on Health Research Ethics (Reg. no. H-15000817) and with the Danish Data Protection Agency (Reg no. AHH- 2015-005).

Fluorescence versus X-ray cholangiography during laparoscopic cholecystectomy: protocol for a randomised trial.

Surgical treatment of pilonidal sinus often leads to significant pain, extended period of wound healing and convalescence, and carries a substantial risk of recurrence. Based on extant surgical evidence, the present review suggests a differential step-up surgical strategy to optimise surgical outcome in the treatment of pilonidal sinus.

Treatment of pilonidal sinus

Background:Majority of studies on chronic postoperative inguinal pain has described the occurrence after unilateral inguinal hernia repair. Endo-laparoscopic repair, for example, laparoscopic trans...

https://journals.sagepub.com/doi/pdf/10.1177/1457496919874483

Nationwide Results on Chronic Pain After Bilateral Transabdominal Preperitoneal Inguinal Hernia Repair.

INTRODUCTION Inguinal hernia repair is the most common surgical procedure in paediatric patients. Despite limited evidence, an increasing number of surgeons suggest laparoscopic repair as an alternative to the gold standard of open repair. This review critically analysed post-operative clinical outcome on open versus laparoscopic inguinal hernia repair in paediatric patients. Before initiating the study, recurrence was defined as the primary outcome, and secondary outcomes were early post-operative pain, operation time and surgical site infections. METHODS The PRISMA guidelines were followed. Using strict inclusion and exclusion criteria, the following databases were searched: MEDLINE, Cochrane Library, Web of Science and Embase (May 2019). Retrospective and uncontrolled studies were excluded. RESULTS Five studies were identified, four randomised controlled trials (n = 272) and one controlled prospective study (n = 85) which included a total of 357 patients. Generally, the studies included few patients, were highly heterogenic and were overall of moderate quality. With a follow-up time ranging from three months to 14 years, there was no difference in recurrence rate after unilateral open (0-2%) versus unilateral laparoscopic (0-4%) or bilateral open versus bilateral laparoscopic repair (n = 281; p > 0.05 in all studies). There were no other significant differences in any of the outcomes, including post-operative pain (p > 0.05). CONCLUSIONS There is no solid evidence that clinical outcome is improved after laparoscopic paediatric inguinal hernia repair compared with the gold standard.

Thue Bisgaard

Papers

A Simplified Clinical Algorithm for Standardized Surgical Treatment of Chronic Pain After Inguinal Hernia Repair: A Quality Assessment Study:

Fluorescence versus X-ray cholangiography during laparoscopic cholecystectomy: protocol for a randomised trial.

Treatment of pilonidal sinus

Nationwide Results on Chronic Pain After Bilateral Transabdominal Preperitoneal Inguinal Hernia Repair.

Laparoscopic or open paediatric inguinal hernia repair - a systematic review.