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Use of Nanomaterials in Fortification of Anastomoses on the Gastrointestinal Tract
Rosendorf, Jáchym ; Liška, Václav (advisor) ; Herrmann, Inge K. (referee) ; Wexner, Steven D. (referee)
Background: The main focus of the dissertation is the use of nanofibrous biodegradable materials for the healing support of intestinal anastomoses in colorectal surgery. The altered healing process of intestinal anastomosis leads to several types of local complications. Anastomotic leakage is one of the most feared ones. Severe anastomotic leakage causes peritonitis, sepsis and is a life-threatening condition. Reoperation is necessary in many cases, bringing the need for intensive care, and hospital stays prolongation. Extensive peritoneal adhesions are another source of postoperative complications. These adhesions are a frequent cause of bowel obstruction and abdominal discomfort and are the most common reason for readmission after colorectal procedures. Nanofibrous biodegradable materials showed positive effects on the healing process in various locations. We aimed to develop and perfect a biodegradable patch for both prevention of anastomotic leakage and the formation of extensive peritoneal adhesions. Methods: We conducted 3 subsequential experiments on porcine models. In Experiment A, we managed to develop polycaprolactone and polylactic acid- polycaprolactone copolymer nanofibrous patches and applied them on anastomoses on the small porcine intestine. The animals were observed for 3 weeks....
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Increasing Efficiency of Inpatient Care in the Czech Republic: ERAS Protocol Adherence in Colorectal Surgery
Hrušková, Barbora ; Bryndová, Lucie (advisor) ; Landovská, Petra (referee)
Barbora Hrušková Abstract Standardization of care is necessary to achieve more efficient inpatient care. En- hanced recovery after surgery (ERAS) protocols have proven to accelerate the recov- ery of patients, decrease lengths of stay and reduce complications. However, close adherence to the protocol is necessary to achieve the beneficial outcomes. The pur- pose of this study is to prove that higher adherence to ERAS protocol increases its efficiency by achieving lower expenses and higher productivity due to the decreased patient length of stay. De-identified dataset of patients who underwent colorectal surgery between April 2016 and March 2020 at Motol University Hospital was used for our analysis. Ordinary least squares (OLS) models were created to investigate the effect of adherence to individual items of the protocol as well as the different levels of total adherence on the length of stay. We proved that seven items of ERAS protocol are independent predictors of the length of stay. Moreover, we found an inverse relationship between the ERAS protocol adherence and the length of stay. Finally, after assigning monetary values to our results we could conclude that higher adherence to ERAS protocols provides more efficient inpatient care and contributes to cost savings in the Czech Republic.
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Role of alarmins in perioperative medicine.
Máca, Jan ; Holub, Michal (advisor) ; Závada, Josef (referee) ; Veselý, Jaroslav (referee)
Introduction: Inflammatory response (IR) is a fundamental reaction to the cell and tissue injury. It is aimed at correcting the pathologic condition and maintaining the structural and functional integrity of the organism. The insult with too extensive or prolonged effect can lead to dysregulation of IR to the systemic level. Major abdominal surgery (MAS) can be considered as a potentially significant insult. Alarmins are endogenous, intracellular proteins that are passively or actively released upon the cell injury to extracellular space where they express their bioactive effect. Alarmins has therefore potential reflect the degree of surgical injury. Purpose: The main goal of the study was elucidating the role of selected alarmins in inflammatory response after MAS. The secondary aims were: 1) determining the relationship between alarmins and outcome prediction, 2) to determine relationship of alarmins and place of surgical intervention, 3) to determine correlation between alarmins and some of the surgery characteristics, e.g. length of surgery, blood loss, and intraoperative fluid load, 4) compare injury caused by laparoscopy and open surgery reflected by alarmins, and 5) to confirm previous results by determining the role of alarmins in surgical injury in subgroup of patients undergoing colorectal...
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The Role of Nurses in Colorectal Surgeries
ŠULCOVÁ, Jana
Theoretical basis: The problems in rectal and anal diseases have had rising tendency, especially haemorrhoidal diseases, on which we put emphasis in our bachelor thesis. 37% of adult population suffers from this disease so we may line it up to civilization illnesses. Their treatment involves wide range of medical methods, from the conservative therapy to semi invasive ways of treatment. The semi invasive treatment is well withstood by patients and it can help up to 90% of clients. This bachelor thesis is concerned with specifics of nursing duties in a colorectal surgery. It links with topics like taking faecal specimen, basic methods of endoscopy, communication with patients and giving them information about lifestyle. The theoretical basis describes haemorrhoidal disease and gives brief introduction into causes of its developing, most common symptoms and possible treatments. The aim of the thesis: From the practical point of view we set two tasks. The first one is aimed at specifics of nursing job in a colorectal surgery and the second one tries to monitor how nurses in colorectal surgeries inform patients about healthy lifestyle. We asked two research questions regarding these aims. The first research question is: What are the specifics of the nursing job in the colorectal surgery? The second question concerns how nurses in colorectal surgeries provide information to their patients about healthy lifestyle. Methodology: Regarding the bachelor thesis we decided to choose a form of a qualitative research with using semi structural interviews with practical nurses working in colorectal surgeries. The interviews took place from February 28 2014 to March 15 2014 in five colorectal surgeries in following towns: České Budějovice, Písek, Strakonice, Jindřichův Hradec a Třemošná u Plzně. The focus group was created of 6 nurses working in colorectal surgeries. The interviews were performed and recorded with the consent of all practical nurses involved in the research. All extracted data was arranged and categorised into groups that were consequently analysed. The interviewer´s questions were prepared in advance and some extra questions were asked during the interview. The interview was divided into five areas: Identification questions, role of a nurse, examination methods, recommendation and giving information about lifestyle. Results: The results show the specifics of nursing in colorectal surgeries. We found out that nurses working in colorectal surgeries deal mainly with preparing special medical instruments and devices needed for endoscopic examination. Then they assist doctors during a medical examination and with treatment methods of RBL (Barron´s rubber band ligation) and Hemoron, they manipulate with devices in a surgery, check hygiene measures, do administrative work and keep surgery office running. In other conversation areas practical nurses mostly mentioned sampling of biological materials, mainly blood and faecal specimen taking to be given up to histological examination, preparing patients for an endoscopic exam, communication with patients and attending to the intimacy of patients. Consequently we found out that more than half of the practical nurses pay attention to psychological conditioning of the patient before rectoscopy. The research also revealed some weak spots. More than half of the nurses in the focus group do not inform patients about preparations before anoscope exam. Barely one third of the group said that they inform patients about the natural emptying before the exam. Regarding the issue of giving information about lifestyle, we came to the conclusion that practical nurses, even though they do not have enough time, try to inform patients about physical activities, hygiene care and quality of eating and they do it in sufficient rate. But because of the time constrain they put emphasis only on the essential information.
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