Day care surgery

Day case surgery is the admission of selected patients to hospital for a planned surgical procedure, returning home on the same day. They represent about 70% of all surgery.

Surgical day cases have been identified as the number one high-impact change to improve productivity; healthcare guidelines advise for a target of “treating day surgery (rather than inpatient surgery) as the norm for elective surgery”.

The advantages of day case surgery are:

• Shorter inpatient stays
• Lower infection rates
• Reduced waiting lists
• Cheaper than surgery requiring an overnight stay

Preparing for Day Case

A patient undergoing a day case procedure should be advised not to eat and drink for the 6 hours prior to the surgery (when involving a general anaesthetic). Many surgeons will allow a patient to drink small volumes of water up to 2 hours before a general anaesthetic and local guidelines should be adhered to.

Medications should be reviewed to ensure that they will not interfere with the planned surgery and guidance is sometimes necessary from the operating surgeon.

In general, most medications may be continued up to the day of the operation, including the day of the procedure. However, special care should be taken over certain classes of medication, such as anti-coagulants (+/- anti-platelets) in operations where bleeding is a risk.

Types of Day Case Surgery

For a surgical procedure to be considered for day case surgery, it must meet the following criteria:

• Minimal blood loss expected
• Short operating time (<1 hour="" li="">
• No expected intra-operative or post-operative complications
• No requirement for specialist aftercare

  Selection of the Patient

  Much of the success of day-case surgery is down to care in patient selection. In the UK, most hospitals follow local guidelines to aid in this – these generally include absolute and relative contraindications based on co-morbidities.
  
  The selection of a patient for day surgery should be based upon social and medical factors:
• Social factors – a patient must understand the planned procedure, consent appropriately, and understand the following post-operative care
  • The patient should also have sufficient provisions to have a responsible adult escort them home and provide support for the first 24 hours of post-operative care.
• Medical factors – a patient’s health must be suitable for a day case procedure, remembering that some stable chronic diseases (e.g. DM or asthma) can often be better managed as a day procedure to minimise any disruption to their daily routine.

Diabetes is REVERSIBLE

If you have a diagnosis of type 2 diabetes or if you have been told you are at high risk or if you have significant abdominal obesity,  
Here are 11 ways to start reversing the effects immediately:

1. Avoid or reduuce ALL refined carbohydrates. That means no / little pasta, rice or bread (even wholegrain bread will spike your insulin)
2. Avoid ALL added sugar. If your body is already in a state where you cannot process carbohydrates and sugars properly, you are going to have to take steps to fully eliminate all sugars, at least in the short term.
3. Avoid ALL sweet drinks. It is best to stick to water, tea, coffee.
4. Do not be scared of good quality, healthy, natural fat – avocados, olives, almonds etc. Don’t worry about this causing you to put on weight. A study published in 2003 showed that people who supplemented their diet with almonds lost more weight than those who supplemented with so-called “healthy, complex carbs”
5. Do not waste your energy counting calories. Concentrate on the quality of the food that you are eating and the calorie control will take care of itself.
6. FEED YOUR GUT BUGS, not just yourself. There are trillions of bugs that live in your gut – their health is critical in determining your health. Many studies show links between the state of your gut bugs (your microbiota) and type 2 diabetes. Start improving the health of your gut immediately by eating five servings of different coloured vegetables each day. The non digestible fibre in vegetables is the preferred food for your gut bacteria and when your gut bugs are happy, you will be happy. The wider the variety of colours, the more phytonutrients you will be getting.
7. Do my 30 minutes  workout once a day. This could be before breakfast, lunch or dinner – whatever works for you.
8. If you like to snack, keep some high fat healthy snacks with you, such as olives, nuts or hummus. When you snack on refined carbohydrates such as biscuits, you go on a blood sugar rollercoaster that results in you feeling hungry shortly after. Fats, on the other hand, will keep you fuller for longer.
9. Include high quality protein and fat with EVERY single meal. This helps to stabilise your blood sugars and promotes satiety and fullness, making it less likely that you will want to reach for dessert after your meal.
10. Eat your meals sitting down at a table. Eating on the sofa while watching TV encourages a mindless form of eating – this can lead you to eat higher quantities than you otherwise would. If you sit at a table and concentrate on what you’re eating, you are more likely to enjoy your food, feel satisfied at the end of your meal and eat less.
11. Consider a form of regular fasting (more to come in a later blog), such as intermittent fasting or time-restricted feeding (TRF). TRF means eating your calories during a specific window of the day, and choosing not to eat food for the rest. It’s a great way to reduce insulin levels in your body and help undo the effects of chronically elevated levels.

Screening Test for Pre-eclampsia in different Trimesters.

Women are generally health-conscious during pregnancy. But no matter how cautious a woman can be, adverse situations may still arise and one of these is the development of pre-eclampsia.       

Pre-eclampsia is a complication of pregnancy marked by high blood pressure and the presence of protein in the urine (proteinuria). The cause of pre-eclampsia remains unknown but studies have shown that it affects blood flow in the placenta, which can lead to pregnancy-induced hypertension and fetal complications such as intrauterine growth restriction and prematurity. Left untreated, it may progress into more severe conditions like eclampsia, wherein the mother develops seizures, and on one extreme, may, unfortunately, lead to death. Various reports show that 5-8 percent of pregnancies are affected by pre-eclampsia worldwide, with 76,000 maternal and 500,000 fetal deaths yearly. In the Philippines, eclampsia was the leading cause of maternal death (19.6 percent) based on local statistics (PSA, 2015).     

Although the blood pressure of pregnant women tends to decrease in the first trimester, early screening to predict pre-eclampsia can be performed at this time. By the second trimester, symptoms of pre-eclampsia may begin to appear. Undiagnosed and untreated, pre-eclampsia may lead to early delivery during the third trimester.

Thus, when it comes to pre-eclampsia, timing is of the essence. The earlier women at high risk for pre-eclampsia are identified, the better the outcome for both Mommy and baby.       

To date, the most sensitive first-trimester test for pre-eclampsia is PLGF 1-2-3. It is the 2nd generation PLGF assay, and when it is used in combination with a comprehensive first-trimester screening program that includes maternal medical history and mean arterial blood pressure, women at high risk for pre-eclampsia can be identified long before symptoms appear. The PLGF 1-2-3 assay can also be used in the second and third trimester of pregnancy for effective reassessment, monitoring, or diagnosis.    

Pre-eclampsia screening for 1st trimester – screening test for pre-eclampsia for patients  in their 1st trimester of pregnancy

          o PLGF 1-2-3 (placental growth factor)  

          o PAPP-A (pregnancy-associated plasma protein A)        

          o Risk assessment for pre-eclampsia     
Pre-eclampsia screening for 2nd and 3rd trimester – screening for risk of pre-eclampsia for patients in their 2nd/3rd trimester of pregnancy  

•   PLGF 1-2-3    
•   Risk assessment for pre-eclampsia

Interpretation of Hepatitis B Serologic Test Results(CDC)

Hepatitis B serologic testing involves measurement of several hepatitis B virus (HBV)-specific antigens and antibodies. Different serologic “markers” or combinations of markers are used to identify different phases of HBV infection and to determine whether a patient has acute or chronic HBV infection, is immune to HBV as a result of prior infection or vaccination, or is susceptible to infection.

Adapted from: A Comprehensive Immunization Strategy to EliminateTransmission of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices.

Part I: Immunization of Infants, Children, and Adolescents. MMWR 2005;54(No. RR-16).