Postoperative intestinal obstruction is a perchance deathly complication that occurs after many abdominal surgeries and operations. An intestinal obstruction is where the bowels “fall asleep” after injury and neglect to “awaken” for rather some clip following surgery. Postoperative intestinal obstruction can impact patient nutrition. comfort and particularly length of stay. which consequences in a major cost to insurance companies and infirmaries. Harmonizing to Chan and Law ( 2007 ) . the economic load ensuing from postoperative intestinal obstruction is $ 7. 5 billion per twelvemonth in the United States entirely non including the disbursal of lost work. Clearly. the issue of postoperative intestinal obstruction continuance is one that deserves attending and necessitates a solution. Right now. physicians are forced to offer motility agents. tests with early eating. and hopeful reassurance that intestine map will return shortly.
Each of these methods have their ain set of complications and hazards. such as sickness and emesis. and are non proven to be significantly effectual at cut downing postoperative ileus continuance. Recent clinical tests show that masticating gum postoperatively may keep promise in cut downing postoperative intestinal obstruction and thereby diminish length of stay. Therefore. the intent of this paper is to utilize the Stetler Model of Research Utilization to analyze the research sing the usage of gum masticating to cut down the continuance of postoperative intestinal obstruction in abdominal surgery patients. Validation
The articles used to pull decisions from included two primary articles and two systematic reappraisals. Before comparing the findings. it is of import to analyze each person survey and analyze the specific parts of all surveies in inquiry. In the survey by Matros. et Al. ( 2006 ) . the writers tested a directional hypothesis and were seeking to develop a prognostic degree of cognition. This experiment examined to see if gum mastication was more effectual at diminishing recovery clip from a postoperative intestinal obstruction as compared against the standard pattern and a placebo. The writers stratified. randomized and blinded all of the participants in order to take any prejudice. They used computing machine package in order to split the participants into groups. The writers identified what was already known about this topic from the survey by Asao. Kuwano. Nakamura. Morinaga. & A ; Hirayama. ( 2002 ) . but besides identified a few failings in that survey that necessitated another test to find if important grounds supported gum mastication and its negative consequence on continuance of intestinal obstruction. The failings identified in the experiment by Asao. et. Al. ( 2002 ) were that the survey lacked a placebo or blinding procedure.
The placebo in this experiment was an force per unit area point watchband. The research workers measured the times to passage of first fart postoperatively. first transition of stool postoperatively. and length of clip boulder clay dispatch postoperatively following unfastened colectomy patients. and compared the medians from the different studied groups. The nurses’ certification of the different events was the method of aggregation of informations. The writers used ANOVA and Kruskal-Wallis trials in order to contrast the uninterrupted variables. and a Chi-square trial was used to compare categorical informations. Statistical significance was measured by utilizing a two sided P value of. 025. At this degree. there was non statistically important findings to back up the hypothesis that gum mastication is more effectual at cut downing postoperative ileus clip as compared to standard pattern or a placebo. The writers did indicate out the fact that in their test. patients with unfastened colectomies were selected to be studied. an in the Asao. et. Al. ( 2002 ) survey. they examined laparoscopic colectomy patients. which could be one ground for conflicting findings between the two surveies. This is a strongly made article that evokes level one information. that is about incontrovertible.
Quah. Samad. Neathey. Hay. and Maw ( 2006 ) . besides designed a survey to verify if chewing gum could cut down the clip of postoperative intestinal obstruction. The writers utilized a randomized control test. in which 19 patients standard standard postoperative attention and another 19 received the criterion attention and used masticating gum. The patients were selected harmonizing to the type of surgery. unfastened colectomy for left-sided colon and rectal malignant neoplastic disease. patients that required “postoperative airing or planned intensive attention therapy due to co-morbid conditions were excluded from the survey. ” the eligible topics were indiscriminately selected to either the control or intervention group. and peri-operative intervention was standardized ( Quah et al. 2006. p. 65 ) . Outcome steps were clip to first fart and fecal matters. and length of infirmary stay. and a blinded “independent specializer colorectal nurse practitioner” evaluated the advancement ( Quah et al. 2006. p. 65 ) . Researchers utilized the Mann-Whitney U-test and the X2 trial to analyse the information entered into statistical package. and measured statistical significance utilizing a reversible P value of 0. 05.
The two groups were homogenous “in footings of age. gender co-morbid disease. history of old abdominal surgery. site of tumour and tumour stage” ( Quah et al. 2006. p. 65 ) . The research workers findings were non important plenty to back up the intercession ; the average clip to first fart was 2. 7 yearss for the control group and 2. 4 yearss for the experimental group a p value of 0. 56. the average clip to first fecal matters was 3. 9 yearss for the control group and 3. 2 for the experimental group a p value of 0. 38. and length of infirmary stay was 11. 2 yearss for the control group and 9. 4 yearss for the experimental group a p value of 0. 75. Patients in the experimental group had tolerated the gum masticating good. describing that it “helped to maintain their mouth moist and gave them a sense of good being” ( Quah et al. 2006. p. 67 ) . This survey has many strengths. including being a randomized control test. holding a clearly defined inclusion and exclusion standards. and blinding of the clinician following the advancement of the patients. The failings in this survey consist of a little sample size. and the increased possibility of a type II mistake. The systematic reappraisal by Vasquez. Hernandez. & A ; Garcia-Sabrido ( 2009 ) . consisted of six randomised clinical tests. Along with this systematic reappraisal a meta-analysis was done among the assorted surveies.
After all six articles were reviewed it was found that masticating gum is a inexpensive. physiological. and unafraid intercession that is found to significantly better an intestinal obstruction after a elected colorectal surgery ( Vasquez. Hernandez. Garcia-Sabrido. 2009 ) . The gum mastication was found to excite the appetency and increase the esthesis of wellbeing during the post-operative period. Three variables were studied including clip to flatus. length of infirmary stay and the transition of fecal matters ; each of these variables were used along with standard intervention and so compared to standard intervention entirely. Of the six tests four of them showed a important decrease in the clip to first fart. while merely two of the tests showed significance in decrease in clip to passage of first fecal matters and in the length of infirmary stay. The meta-analysis concluded that the clip to first fart was significantly reduced with gum mastication by 14 hours with a p value of p=0. 001 ; all six tests were heterogenous to this result with a p value of p=0. 01. For the clip to first transition of fecal matters the clip was decreased by 20 five hours and the P value was p=0. 01 ; four of the six tests were used in this analysis and they were heterogenous with a p value of p=0. 05.