Clinical Documents

To edit the draft, click on the text box below.

×

Draft a comprehensive differential diagnosis for acute substernal chest pain in a 45-year-old male with hypertension and hyperlipidemia, diaphoresis, exertional onset, and normal initial ECG/troponin; include life-threatening causes first, key distinguishing features, and immediate diagnostic next steps.

Draft a detailed differential diagnosis for new-onset unilateral throbbing headache with visual aura and brief monocular vision loss in a 32-year-old female on oral contraceptives; include red-flag symptoms, stroke/TIA considerations, and recommended initial workup.

Draft an assessment and plan for stage-2 hypertension (BP 162/98) in an obese 52-year-old with suspected obstructive sleep apnea; include ASCVD risk estimate, lifestyle prescriptions, first-line pharmacotherapy with drug/dose/targets, baseline labs/monitoring, and 4–6 week follow-up.

Draft an assessment and plan for type 2 diabetes follow-up with A1c 9.2% on metformin 1,000 mg BID and eGFR 65; compare adding a GLP-1 receptor agonist vs an SGLT2 inhibitor, address weight loss goals, hypoglycemia education, vaccinations, and micro/macrovascular screening.

Draft a history and physical for a patient presenting with chest pain, including HPI using OLDCARTS, pertinent ROS, PMH/meds/allergies, FH/SH, focused cardiac/pulmonary exam, initial labs and imaging orders, prioritized differential, HEART score risk stratification, and early management.

Draft a history and physical for a new patient with progressive exertional dyspnea, orthopnea, and bilateral leg edema; include differential (heart failure, COPD, PE, anemia, renal disease), targeted exam maneuvers, and first-line diagnostics and management.

Draft a progress note for COPD follow-up two weeks after an acute exacerbation treated with prednisone and antibiotics; include symptom trajectory, CAT score (if available), inhaler technique/adherence, oxygen needs, spirometry plan, smoking cessation counseling, and return precautions.

Draft a progress note for post-operative day 2 after total knee arthroplasty; include pain control strategy, DVT prophylaxis, PT/OT milestones, wound status, bowel/urinary function, labs/vitals review, complications screening, and discharge readiness.

Draft a discharge summary for community-acquired pneumonia admission; include admission/discharge dates, presenting symptoms, radiology/labs, pathogen if identified, inpatient therapies and response, discharge medications with durations, pending tests, follow-up appointments, and return precautions.

Draft a discharge summary for myocardial infarction managed with PCI and drug-eluting stent placement; include cath findings, complications, inpatient course, discharge medications (DAPT, statin, beta-blocker, ACEi/ARB), cardiac rehab referral, and follow-up plan.

Draft discharge instructions for a patient hospitalized with acute decompensated heart failure; include daily weights, sodium and fluid restriction amounts, medication list with dosing, signs of worsening heart failure, follow-up appointments, and lab monitoring plan.

Draft discharge instructions for an asthma exacerbation; include controller and reliever regimen, steroid taper schedule, spacer technique, trigger avoidance, a written asthma action plan, return precautions, and follow-up timing.

Draft a patient handout on managing high blood pressure in plain language; explain what BP numbers mean, key lifestyle steps (DASH diet, sodium limits, alcohol moderation), home BP monitoring instructions, medication adherence tips, and when to call the doctor.

Draft a patient handout for type 2 diabetes education in plain language; cover A1c goals, the plate method, physical activity targets, self-monitoring of blood glucose, hypoglycemia signs and the 15-15 rule, foot care basics, and a vaccination checklist.

Draft a summary of the latest CDC and WHO guidelines for managing community-acquired pneumonia in adults, including empiric antibiotic choices, duration of therapy, and follow-up recommendations.

Draft a plain-language overview of the ADA and AACE guidelines for diabetes management, focusing on A1c goals, weight management, and the use of GLP-1 receptor agonists and SGLT2 inhibitors.

Draft a summary of the 2024 USPSTF breast cancer screening recommendations, including updated screening intervals, risk-based approaches, and the role of MRI for high-risk patients.

Draft a concise summary of NCCN guidelines for melanoma management, including staging, surgical margins, adjuvant therapy, and checkpoint inhibitor recommendations.

Draft treatment alternatives for community-acquired MRSA skin infections in patients allergic to sulfa drugs; include oral and IV options, dosing, and duration.

Draft treatment alternatives for patients with type 2 diabetes who are unable to tolerate GLP-1 receptor agonists due to nausea; include medication substitutions and lifestyle recommendations.

Draft a summary of options for treating refractory depression, comparing ketamine infusions, transcranial magnetic stimulation (TMS), and electroconvulsive therapy (ECT).

Draft treatment options for advanced prostate cancer, including hormonal therapy, radiopharmaceuticals, and novel androgen receptor pathway inhibitors.

Draft a summary of recent research on mRNA vaccine technology beyond COVID-19, including applications in oncology and autoimmune disease prevention.

Draft an easy-to-understand overview of long COVID research, summarizing major symptoms, hypothesized mechanisms, and emerging treatment approaches.

Draft a summary of current research on Alzheimer’s disease biomarkers, including amyloid and tau imaging, and discuss how they influence diagnosis and trial design.

Draft an explanation of the interaction between warfarin and antibiotics such as ciprofloxacin or TMP-SMX, including INR effects and management recommendations.

Draft a summary evaluating drug interactions for patients taking Paxlovid and common cardiovascular drugs; include mechanism and recommended dose adjustments.

Draft a summary of the common and serious side effects of semaglutide, including GI intolerance, gallbladder disease, and thyroid-related warnings.

Draft an overview of potential side effects associated with long-term corticosteroid use, including osteoporosis, glucose intolerance, and adrenal suppression.

Draft a summary of essential lab tests to order in suspected acute pancreatitis, including amylase, lipase, liver enzymes, and metabolic panels, with interpretation guidance.

Draft laboratory workup recommendations for suspected hypothyroidism, including TSH, free T4, thyroid antibodies, and when to consider secondary causes.

Draft an explanation of which labs should be monitored in patients receiving methotrexate therapy, including CBC, LFTs, renal function, and frequency of monitoring.

why choose us

Edit Geo

×

300×250 Ad Slot

Research Article: Compliance with early postoperative ambulation and Its associated barriers in hepatobiliary surgery patients within an enhanced recovery after surgery framework

Date Published: 2026-06-24

Abstract:
Early postoperative ambulation is a core element of the Enhanced Recovery After Surgery (ERAS) pathway for hepatobiliary surgery, yet real-world compliance has been reported to be variable and the patient-level barriers in this surgical population remain incompletely characterised. We therefore retrospectively reviewed the routinely collected ERAS quality-control archive of our hepatobiliary surgical unit to describe the actual compliance status and to identify factors associated with non-compliance. We retrospectively extracted the records of 320 consecutive adult patients who had undergone elective hepatobiliary surgery between January 2022 and December 2024 and whose perioperative care had followed the institutional ERAS clinical pathway as standard practice. The institutional pathway comprised eight standardised components organised across the preoperative, intraoperative and postoperative phases, including structured patient education, carbohydrate loading, goal-directed fluid therapy, multimodal opioid-sparing analgesia, restrictive abdominal drainage, omission of routine nasogastric tubes, early oral feeding, and the early-ambulation prescription. Compliance with the early ambulation protocol [out-of-bed activity by postoperative day (POD) 1 and ambulation distance ?30?m by POD 2] and patient-reported barriers documented in the routine nursing-assessment questionnaire were retrieved from the electronic medical record. The primary outcome was compliance status, while postoperative length of stay, time to first flatus, pulmonary complications, surgical site infection, symptomatic venous thromboembolism, major postoperative haemorrhage, in-hospital all-cause mortality and 30-day readmission were pre-specified secondary outcomes. Group allocation (compliant vs. non-compliant) reflected real-world clinical and patient/family decisions, not investigator-led randomisation. Univariable comparisons (chi-square, Fisher exact for low-frequency events, or Welch t-test as appropriate) and multivariable logistic regression adjusted for age, sex, BMI and the pre-specified clinical predictors were used to identify factors associated with non-compliance. Two hundred and three of 320 patients (63.4%) were classified as compliant with the early ambulation protocol. Compliance varied markedly by procedure, ranging from 80.0% after laparoscopic hepatectomy to 33.3% after biliary reconstruction. The most frequently documented patient-reported barriers were postoperative pain (46.3%), fatigue/weakness (37.0%), knowledge deficit (35.6%), and the presence of multiple drainage tubes (35.0%). In multivariable analysis, open or major hepatobiliary surgery [adjusted odds ratio (aOR) 3.53, 95% CI 1.92–6.48], having ?3 drainage tubes (aOR 2.52, 1.43–4.42), Clinical Frailty Scale score ?4 (aOR 2.51, 1.45–4.34), age ?65 years (aOR 2.30, 1.26–4.18), and absence of a documented family companion (aOR 1.80, 1.03–3.13) were all independently associated with non-compliance. The model demonstrated acceptable discrimination (Hosmer–Lemeshow ? 2 =?6.41, P =?0.602; area under the ROC curve 0.812, 95% CI 0.765–0.859) without evidence of problematic multicollinearity (all variance inflation factors <1.8). Non-compliance was associated with longer hospital stay (11.9?±?3.2 vs. 7.5?±?2.3 days, P <?0.001) and higher rates of pulmonary complications (23.9% vs. 7.4%, P <?0.001) and 30-day readmission (14.5% vs. 3.4%, P =?0.001). In this retrospective single-centre cohort, just under two-thirds of hepatobiliary surgery patients were compliant with the early ambulation component of the ERAS pathway. Compliance was associated with surgical magnitude, drainage burden, frailty, age, and family companionship, and may be related to the higher rate of postoperative complications observed in non-compliant patients. These findings suggest that targeted, multifactorial barrier-mitigation strategies could improve early-ambulation adherence in hepatobiliary surgery, although the observational design does not permit causal inference.

Introduction:
Early postoperative ambulation is a core element of the Enhanced Recovery After Surgery (ERAS) pathway for hepatobiliary surgery, yet real-world compliance has been reported to be variable and the patient-level barriers in this surgical population remain incompletely characterised. We therefore retrospectively reviewed the routinely collected ERAS quality-control archive of our hepatobiliary surgical unit to describe the actual compliance status and to identify factors associated with non-compliance.

Read more

300×250 Ad Slot

×
Chat & Ask Questions Career Openings Medical Doctors Check on Drug
Interactions Latest Health News
by WebHealthNetwork Get CME Credits Latest Clinical Trials Latest Research Articles Clinical Documents Update Profile

News

Chat

HCP Tools

Careers

Update Profile