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Sample records for surgery a safety study

  1. Patient safety issues in office-based surgery and anaesthesia in Switzerland: a qualitative study.

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    McLennan, Stuart; Schwappach, David; Harder, Yves; Staender, Sven; Elger, Bernice

    2017-08-01

    To identify the spectrum of patient safety issues in office-based surgery and anaesthesia in Switzerland. Purposive sample of 23 experts in surgery and anaesthesia and quality and regulation in Switzerland. Data were collected via individual qualitative interviews using a researcher-developed semi-structured interview guide between March 2016 and September 2016. Interviews were transcribed and analysed using conventional content analysis. Issues were categorised under the headings "structure", "process", and "outcome". Experts identified two key overarching patient safety and regulatory issues in relation to office-based surgery and anaesthesia in Switzerland. First, experts repeatedly raised the current lack of data and transparency of the setting. It is unknown how many surgeons are operating in offices, how many and what types of operations are being done, and what the outcomes are. Secondly, experts also noted the limited oversight and regulation of the setting. While some standards exists, most experts felt that more minimal safety standards are needed regarding the requirements that must be met to do office-based surgery and what can and cannot be done in the office-based setting are needed, but they advocated a self-regulatory approach. There is a lack of empirical data regarding the quantity and quality office-based surgery and anaesthesia in Switzerland. Further research is needed to address these research gaps and inform health policy in relation to patient safety in office-based surgery and anaesthesia in Switzerland. Copyright © 2017. Published by Elsevier GmbH.

  2. Oncologic Safety of Robot Thyroid Surgery for Papillary Thyroid Carcinoma: A Comparative Study of Robot versus Open Thyroid Surgery Using Inverse Probability of Treatment Weighting.

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    Sung, Tae-Yon; Yoon, Jong Ho; Han, Minkyu; Lee, Yi Ho; Lee, Yu-Mi; Song, Dong Eun; Chung, Ki-Wook; Kim, Won Bae; Shong, Young Kee; Hong, Suck Joon

    2016-01-01

    The aim of this study was to evaluate the oncologic safety of robot thyroid surgery compared to open thyroid surgery for papillary thyroid carcinoma (PTC). We enrolled 722 patients with PTC who underwent a total thyroidectomy with central compartment node dissection (CCND) from January 2009 to December 2010. These patients were classified into open thyroid surgery (n = 610) or robot thyroid surgery (n = 112) groups. We verified the impact of robot thyroid surgery on clinical recurrence and ablation/control-stimulated thyroglobulin (sTg) levels predictive of non-recurrence using weighted logistic regression models with inverse probability of treatment weighting (IPTW). Age, sex, thyroid weight, extent of CCND, and TNM were significantly different between the two groups (p robot groups (1.5% vs. 2.7%; p = 0.608). The proportion of patients with ablation sTg 0.05). Logistic regression with IPTW using the propensity scores estimated by adjusting all of the parameters demonstrated that robot thyroid surgery did not influence the clinical recurrence (OR; 0.784, 95% CI; 0.150-3.403, p = 0.750), ablation sTg (OR; 0.950, 95% CI; 0.361-2.399, p = 0.914), and control sTg levels (OR; 0.498, 95% CI; 0.190-1.189, p = 0.130). Robot thyroid surgery is comparable to open thyroid surgery with regard to oncologic safety in PTC patients.

  3. Efficacy and safety of a diode laser in second-stage implant surgery: a comparative study.

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    El-Kholey, K E

    2014-05-01

    For more than a decade, peri-implant tissues have been treated with soft tissue lasers to create a bloodless flap for implant placement and to uncover implants with minimal bleeding, trauma, and anaesthesia. This study was designed to assess if dental implant uncovering is possible with a diode laser without anaesthesia, and to compare its performance with traditional cold scalpel surgery. Thirty patients with a total of 45 completely osseointegrated implants participated in this study. Patients were divided into two groups. For the study group, second-stage implant surgery was done with a 970nm diode laser. For the control group, the implants were exposed with a surgical blade. Certain parameters were used for evaluation of the two techniques. The use of the diode laser obviated the need for local anaesthesia; there was a significant difference between the two groups regarding the need for anaesthesia (Pdiode laser can be used effectively for second-stage implant surgery, providing both the dentist and the patient with additional advantages over the conventional methods used for implant exposure.

  4. Utility of melatonin to treat surgical stress after major vascular surgery - a safety study

    DEFF Research Database (Denmark)

    Kücükakin, Bülent; Lykkesfeldt, Jens; Nielsen, Hans Jørgen

    2008-01-01

    Surgery for abdominal aortic aneurysm is associated with elevated oxidative stress. As an antioxidant in animal and human studies, melatonin has the potential of ameliorating some of this oxidative stress, but melatonin has never been administered to adults during surgery for the purpose of reduc......Surgery for abdominal aortic aneurysm is associated with elevated oxidative stress. As an antioxidant in animal and human studies, melatonin has the potential of ameliorating some of this oxidative stress, but melatonin has never been administered to adults during surgery for the purpose...... in the intraoperative phase was safe and without complications. Melatonin may decrease oxidative damage resulting from surgery, but randomized clinical trials are required before definitive conclusions can be drawn regarding the clinical benefit of melatonin in surgical situations....

  5. Utility of melatonin to treat surgical stress after major vascular surgery--a safety study

    DEFF Research Database (Denmark)

    Kücükakin, Bülent; Lykkesfeldt, Jens; Nielsen, Hans Jørgen

    2008-01-01

    registered. Blood samples were collected preoperatively and at 5 min, 6 hr and 24 hr after clamp removal or after re-circulation of the first leg and the samples were analyzed for malondialdehyde (MDA), ascorbic acid (AA), dehydroascorbic acid (DHA), and interleukin-6 (IL-6). Troponin I (TpI) and C...... with melatonin intravenously up to 60 mg in the intraoperative phase was safe and without complications. Melatonin may decrease oxidative damage resulting from surgery, but randomized clinical trials are required before definitive conclusions can be drawn regarding the clinical benefit of melatonin in surgical...

  6. Long-term safety and efficacy of Gamma Knife surgery in classical trigeminal neuralgia: a 497-patient historical cohort study.

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    Régis, Jean; Tuleasca, Constantin; Resseguier, Noémie; Carron, Romain; Donnet, Anne; Gaudart, Jean; Levivier, Marc

    2016-04-01

    Gamma Knife surgery (GKS) is one of the surgical alternatives for the treatment of drug-resistant trigeminal neuralgia (TN). This study aims to evaluate the safety and efficacy of GKS in a large population of patients with TN with very long-term clinical follow-up. Between July 1992 and November 2010, 737 patients presenting with TN were treated using GKS. Data were collected prospectively and were further retrospectively evaluated at Timone University Hospital. The frequency and severity of pain, as well as trigeminal nerve function, were evaluated before GKS and regularly thereafter. Radiosurgery using the Gamma Knife (model B, C, 4C, or Perfexion) was performed with the help of both MR and CT targeting. A single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 7.6 mm (range 4-14 mm) anterior to the emergence of the nerve (retrogasserian target). A median maximum dose of 85 Gy (range 70-90 Gy) was prescribed. The safety and efficacy are reported for 497 patients with medically refractory classical TN who were never previously treated by GKS and had a follow-up of at least 1 year. The median age in this series was 68.3 years (range 28.1-93.2 years). The median follow-up period was 43.8 months (range 12-174.4 months). Overall, 456 patients (91.75%) were initially pain free in a median time of 10 days (range 1-180 days). Their actuarial probabilities of remaining pain free without medication at 3, 5, 7, and 10 years were 71.8%, 64.9%, 59.7%, and 45.3%, respectively. One hundred fifty-seven patients (34.4%) who were initially pain free experienced at least 1 recurrence, with a median delay of onset of 24 months (range 0.6-150.1 months). However, the actuarial rate of maintaining pain relief without further surgery was 67.8% at 10 years. The hypesthesia actuarial rate at 5 years was 20.4% and at 7 years reached 21.1%, but remained stable until 14 years with a median delay of onset of 12 months (range 1-65 months

  7. Ambulatory spine surgery: a survey study.

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    Baird, Evan O; Brietzke, Sasha C; Weinberg, Alan D; McAnany, Steven J; Qureshi, Sheeraz A; Cho, Samuel K; Hecht, Andrew C

    2014-08-01

    Study Design Cross-sectional study. Objective To assess the current practices of spine surgeons performing ambulatory surgery in the United States. Methods An electronic survey was distributed to members of the International Society for the Advancement of Spine Surgery. Data were initially examined in a univariate manner; variables with a p value ambulatory spine surgery, and 49.1% were investors in an ambulatory surgery center. Surgeon investors in ambulatory surgery centers were more likely to perform procedures of increased complexity than noninvestors, though limited data precluded a statistical correlation. Surgeons in private practice were more likely to perform ambulatory surgery (94.3%; p = 0.0176), and nonacademic surgeons were both more likely to invest in ambulatory surgery centers (p = 0.0024) and perform surgery at least part of the time in a surgery center (p = 0.0039). Conclusions Though the numbers were too few to calculate statistical significance, there was a trend toward the performance of high-risk procedures on an ambulatory basis being undertaken by those with investment status in an ambulatory center. It is possible that this plays a role in the decision to perform these procedures in this setting versus that of a hospital, where a patient may have better access to care should a complication arise requiring emergent assessment and treatment by a physician. This decision should divest itself of financial incentives and focus entirely on patient safety.

  8. Oncologic safety of breast conserving surgery after tumour downsizing by neoadjuvant therapy: a retrospective single centre cohort study.

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    Fitzal, F; Riedl, O; Mittlböck, M; Dubsky, P; Bartsch, R; Steger, G; Jakesz, R; Gnant, M

    2011-05-01

    The objective of this study is to analyse local recurrence rates in patients receiving neoadjuvant chemotherapy (nCT) comparing mastecomized (MX) patients with those undergoing breast conserving therapy (BCT). Patients undergoing breast cancer surgery after nCT (3xCMF or 3-6xED) between 1995 and 2007 at our department were retrospectively analysed. The median follow up was 60 months for 308 patients. Patients who were downsized from MX to BCT with partial or complete response (n = 104) had a similar local recurrence free survival (LRFS) compared to patients who did not experience successful downsizing (n = 67) and finally undergoing MX (LRFS MX-BCT 81% vs. MX-MX 91%; P = 0.79). Uni- and multivariate analyses demonstrated that BCT itself was not an independent prognostic factor for a worse LRFS (P = 0.07 and 0.14). After no pathologic change or progressive disease the risk of local recurrence was increased in patients undergoing BCT (MX-BCT; n = 6 LRFS 66%) compared with MX (n = 44; LRFS 90%; P = 0.04). Overall survival in general was better for the BCT group (n = 197) compared with MX group (n = 111) regardless of clinical response (92% vs. 72%; P downsizing by nCT in patients primarily scheduled for mastectomy. These patients, however, should not be treated with breast conservation in the absence of any proven response after nCT.

  9. Application of an engineering problem-solving methodology to address persistent problems in patient safety: a case study on retained surgical sponges after surgery.

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    Anderson, Devon E; Watts, Bradley V

    2013-09-01

    Despite innumerable attempts to eliminate the postoperative retention of surgical sponges, the medical error persists in operating rooms worldwide and places significant burden on patient safety, quality of care, financial resources, and hospital/physician reputation. The failure of countless solutions, from new sponge counting methods to radio labeled sponges, to truly eliminate the event in the operating room requires that the emerging field of health-care delivery science find innovative ways to approach the problem. Accordingly, the VA National Center for Patient Safety formed a unique collaboration with a team at the Thayer School of Engineering at Dartmouth College to evaluate the retention of surgical sponges after surgery and find a solution. The team used an engineering problem solving methodology to develop the best solution. To make the operating room a safe environment for patients, the team identified a need to make the sponge itself safe for use as opposed to resolving the relatively innocuous counting methods. In evaluation of this case study, the need for systematic engineering evaluation to resolve problems in health-care delivery becomes clear.

  10. A comparative study of the safety and efficacy effect of 5-fluorouracil or mitomycin C mounted biological delivery membranes in a rabbit model of glaucoma filtration surgery

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    Wu ZH

    2013-03-01

    Full Text Available Zhihong Wu,1 Shuning Li,2 Ningli Wang,2 Wanshun Liu,3 Wen Liu3 1General Hospital of Armed Police Forces, Beijing, People’s Republic of China; 2Beijing Tongren Eye Center, Capital Medical University, Beijing, People’s Republic of China 3Ocean University of China, Qingdao, People’s Republic of China Purpose: To investigate the potential usage of biological delivery membranes containing mitomycin C (MMC or 5-fluorouracil (5-FU in the construction of glaucoma-filtering blebs, and to evaluate their safety and efficacy. Methods: Chitosan was selected as the biological membrane carrier to prepare sustained-released membranes. Twelve micrograms of 5-FU or MMC was covalently conjugated onto the membranes by solvent volatilization. Rabbits underwent glaucoma filtration surgery and were randomly allocated into one of the four treatment regimens: glaucoma filtration operation with no implantation of chitosan membrane group (as control, drug-free chitosan membrane implantation group (blank/placebo group, membrane containing 5-FU treatment group (5-FU group, and membrane containing MMC treatment group (MMC group. Each group consisted of 12 rabbits. Intraocular pressure (IOP was measured and evaluated over a 28-day period follow-up preoperatively, then after surgery on days 1, 3, 5, 7, 14, 21, and 28 by Tono-Pen. The aqueous humor was analyzed in each experimental and control groups at days 4, 6, 8, 10, 12, 14, 16, and 20 after operation. Bleb survival and anterior segment were examined with a slit lamp microscope and photographed simultaneously. Two rabbits from each group were killed on day 28 and eight eye samples obtained for histopathological study. Corneas and lenses were examined by transmission and scanning electron microscopy. Results: Both 5-FU and MMC significantly prolonged bleb survival compared with control groups. The filtering bleb’s survival period was significantly more prolonged in the MMC and 5-FU groups (maintained 14 days than the

  11. Safety and feasibility of the use of a bevacizumab-methylcellulose mixture as an adjunct to glaucoma surgery: a pilot study

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    Jayter Silva Paula

    2015-06-01

    Full Text Available ABSTRACT Bevacizumab, a monoclonal anti-vascular endothelial growth factor antibody, has been suggested as a potential healing therapeutic following glaucoma surgery. Here, we aimed to improve the bioavailability of bevacizumab when used as an adjunct therapy to non-penetrating deep sclerectomy (DS by using a bevacizumab-methylcellulose mixture (BMM. Ten previously non-operated eyes in ten patients diagnosed with primary open angle glaucoma underwent DS with a subconjunctival injection of 0.3 ml of BMM (bevacizumab 3.75 mg incorporated into 4% methylcellulose at the surgical site. Bevacizumab release was evaluated in vitro using size-exclusion high performance liquid chromatography (HPLC. Intraocular pressure (IOP, bleb morphology, corneal endothelial cell count (CECC, and complications were evaluated at 6 months after surgery. Using HPLC, bevacizumab was detected in BMM for up to 72 h. Moreover, all surgical blebs remained expanded with hyaline material during the first week. A significant IOP reduction (mean ± SD= -10.3 ± 5.4 mmHg, P<0.001 and diffuse blebs were observed at the final follow-up period. Although CECC was slightly reduced (-7.4%, no complications were observed. In conclusion, bevacizumab was released from BMM, and the use of this innovative mixture yielded good results following DS with no complications. Further studies are required to determine its efficacy prior to establishing BMM as an adjunct treatment for penetrating and non-penetrating glaucoma surgeries.

  12. A STUDY OF CONVERSIONS OF LAPAROSOCOPIC SURGERIES INTO OPEN SURGERIES: A ANALYTICAL STUDY

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    Venkata Reddy

    2015-12-01

    Full Text Available INTRODUCTION: The aim of present study is to know the Conversions in Laparoscopic surgery to Open surgery in The patients of all the surgical units in the Department of General Surgery, Government General Hospital, Rangaraya Medical College, Kakinada over a period of 2 years from July 2013 to July 2015. The Objectives of present study is to compare the Conversion Rates of Laparoscopic Surgery to Open Surgery and the factors causing Conversion to Open Surgery in our institution. PATIENTS AND METHODS The protocol is approved by institution ethics committee and written informed consent was taken from each patient. Present clinical Study is an Analytical study conducted over period of 2 years from July 2013 to July 2015 in the Department of General Surgery, Government General Hospital, Rangaraya Medical College, Kakinada, Andhra Pradesh. RESULTS Total number of 536 laparoscopic surgeries were attempted in elective operation theatres with 21 cases out of 536 cases were converted from laparoscopy to open surgery. Total conversion rate in present study is 4%. Most of conversions occurred in laparoscopic chelecystectomy 5.73% cases in comparison to laparoscopic appendectomy 2.26% and laparoscopic hernia repair with 0%. CONCLUSIONS Over all conversion rates of laparoscopic procedure into open surgery is low when compared to other international studies. Most common causes of conversion in present study is altered anatomy, adhesions and intra operative bleed. Conversion of laparoscopic surgery into open surgery resulted in decreased morbidity, complications and increase in duration of hospital stay

  13. Safety of lornoxicam in the treatment of postoperative pain: a post-marketing study of analgesic regimens containing lornoxicam compared with standard analgesic treatment in 3752 day-case surgery patients.

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    Rawal, Narinder; Krøner, Karsten; Simin-Geertsen, Marija; Hejl, Charlotte; Likar, Rudolf

    2010-01-01

    Post-marketing surveillance studies can provide supplemental data on the safety of medications in the general population. This study aimed to evaluate the safety of analgesic regimens including the NSAID lornoxicam in the short-term treatment of postoperative pain in a clinically relevant population. Randomized, open-label, multicentre, multinational, observational cohort study of 4 days' duration. In-hospital postoperative setting, with discharge to home treatment within 24 hours of surgery. Adults aged > or =18 years expected to be in need of analgesic treatment after day-case surgery. Analgesic regimens containing lornoxicam were compared with a standard analgesic treatment, which was defined as the treatment that the patient would normally receive at the centre. Following day-case surgery, patients were provided with appropriate analgesic medication, and adverse events (AEs; defined as all recorded events with symptoms) were recorded by the investigator during the in-hospital stay and by the patient for the next 3 days using entries recorded morning and evening in a patient diary. Statistical analyses tested for between-treatment differences in AEs, adverse drug reactions (ADRs; defined as events probably, possibly or unlikely to be related to treatment) and gastrointestinal AEs (GI-AEs). A total of 4152 patients were randomized to treatment. Since 400 patients did not take any analgesic, the safety population consisted of 1838 patients for lornoxicam and 1914 patients for standard analgesic treatment. Demographic and disease characteristics were similar between the two treatment groups, as were the type of surgery and the anaesthesia used in surgery. In the safety population, 16.9% of patients received no analgesic in hospital, and when analgesics were provided they were often administered in combination. Similarly, approximately 17% of patients did not take any analgesics at home. AEs were reported in 27.1% and 29.4% of patients in the lornoxicam and standard

  14. Reconstructive pelvic surgery and plastic surgery: safety and efficacy of combined surgery.

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    Craig, Jocelyn B; Noblett, Karen L; Conner, Caroline A; Budd, Michael; Lane, Felicia L

    2008-12-01

    The purpose of this study was to address the safety of combining aesthetic and pelvic floor reconstructive procedures. Fifty-four subjects were included in a case-control study; 18 patients undergoing combined pelvic and plastic reconstructive surgery, age and procedure matched to 18 pelvic surgery and 18 plastic surgery only controls. Chi-square, t test, and Kruskal-Wallis analysis were used to compare the estimated blood loss (EBL), body mass index (BMI), hospital days, operative times, and complications between the groups. No differences were seen with regards to age, BMI, or EBL. There was, however, a significant increase in minor complications and hospital stay after combined procedures relative to the pelvic surgery control group but not the aesthetic control group. Operative times were only greater during combined procedures relative to isolated pelvic floor procedures. Combining pelvic and aesthetic procedures may increase complications, operative times, and length of hospital stay when compared to pelvic reconstructive surgery alone.

  15. Bias towards publishing positive results in orthopedic and general surgery: a patient safety issue?

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    Ziran Bruce H

    2007-11-01

    Full Text Available Abstract Background Research articles reporting positive findings in the fields of orthopedic and general surgery appear to be represented at a considerably higher prevalence in the peer-reviewed literature, compared to published studies on negative or neutral data. This "publication bias" may alter the balance of the available evidence-based literature and may affect patient safety in surgery by depriving important information from unpublished negative studies. Methods A comprehensive review of all published articles in a defined 7-year period was performed in 12 representative journals in the fields of orthopedic and general surgery. Every article published in all volumes of these journals between January 2000 and December 2006 was reviewed and rated by three investigators. Rating of articles was performed according to a uniform, standardized algorithm. All original articles were stratified into "positive", "negative" or "neutral", depending on the reported results. All non-original papers were excluded from analysis. Results A total of 30,197 publications were reviewed over a 7-year time-period. After excluding all non-original articles, a total of 16,397 original papers were included in the final analysis. Of these, 12,251 (74% articles were found to report positive findings, 2,709 (17% reported negative results, and 1,437 (9% were neutral. A similar publication pattern was found among all years and all journals analyzed. Altogether, 91% of all original papers reported significant data (positive or negative, whereas only 9% were neutral studies that did not report any significant findings. Conclusion There is a disproportionately high number of articles reporting positive results published in the surgical literature. A bias towards publishing positive data will systematically overestimate the clinical relevance of treatment effects by disregarding important information derived from unpublished negative studies. This "publication bias

  16. Safety and efficacy of transdermal buprenorphine versus oral tramadol for the treatment of post-operative pain following surgery for fracture neck of femur: A prospective, randomised clinical study.

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    Desai, Sameer N; Badiger, Santhoshi V; Tokur, Shreesha B; Naik, Prashanth A

    2017-03-01

    Transdermal buprenorphine, which is used in chronic pain management, has rarely been studied for use in acute pain management. The aim of this study was to compare the safety and efficacy of transdermal buprenorphine patch to oral tramadol for post-operative analgesia, following proximal femur surgeries. Fifty adult patients undergoing surgery for hip fracture under spinal anaesthesia were included in this study. One group (Group TDB) received transdermal buprenorphine 10 mcg/h patch applied a day before the surgery and other group received oral tramadol 50 mg three times a day for analgesia (Group OT). They were allowed to take diclofenac and paracetamol tablets for rescue analgesia. Pain scores at rest, on movement, rescue analgesic requirement and side effects were compared between the groups over 7 days. Chi-square and independent sample t-test were used for categorical and continuous variables, respectively. Resting pain scores and pain on movement were significantly lower in TDB Group on all 7 days starting from 24 h post-operatively. Rescue analgesic requirement was significantly lower in TDB Group compared to OT Group. All the patients needed rescue analgesic in OT Group whereas 68% of the patients needed the same in TDB Group. Incidence of vomiting was less and satisfaction scores were much higher in TDB Group as compared to OT Group (79% vs. 66%, P tramadol.

  17. Regional anesthesia for pediatric knee surgery: a review of the indications, procedures, outcomes, safety, and challenges

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    Muhly WT

    2015-11-01

    Full Text Available Wallis T Muhly, Harshad G Gurnaney, Arjunan GaneshDepartment of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, PA, USAAbstract: The indications for surgery on the knee in children and adolescents share some similarity to adult practice in that there are an increasing number of sports-related injuries requiring surgical repair. In addition, there are some unique age-related conditions or congenital abnormalities that may present as indications for orthopedic intervention at the level of the knee. The efficacy and safety of peripheral nerve blocks (PNBs for postoperative analgesia following orthopedic surgery has been well established in adults. Recent studies have also demonstrated earlier functional recovery after surgery in patients who received PNBs. In children, PNB is gaining popularity, and increasing data are emerging to demonstrate the feasibility, efficacy, and safety in this population. In this paper, we will review some of the most common indications for surgery involving the knee in children and the anatomy of knee, associated dermatomal and osteotomal innervation, and the PNBs most commonly used to produce analgesia at the level of the knee. We will review the evidence in support of regional anesthesia in children in terms of both the quality conferred to the immediate postoperative care and the role of continuous PNBs in maintaining effective analgesia following discharge. Also we will discuss some of the subtle challenges in utilizing regional anesthesia in the pediatric patient including the use of general anesthesia when performing regional anesthesia and the issue of monitoring for compartment syndrome. Finally, we will offer some thoughts about areas of practice that are in need of further investigation.Keywords: pediatric surgery, regional anesthesia, analgesia, knee surgery

  18. LAPAROSCOPIC GYNAEC SURGERIESA RETROSPECTIVE STUDY

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    Hiremath

    2013-10-01

    Full Text Available ABSTRACT : BACKGROUND: There has been a rapid worldwide adoption of laparoscopic procedures across many surgical specialt ies, most notably in Gynaecology. Unfortunately, the increased adoption of laparoscopic surgery has also been accompanied by a corresponding rise in the rates and types of complications reported. AIMS : To audit the different types of laparoscopic surgerie s and their complications and comparison with other routes of surgery. METHODS & MATERIALS : We have retrospectively analysed 285 laparoscopic surgeries and 306 other routes of surgery which were done at our institute from July 2011 to April 2013.We admit t he patients 1 - 2 days prior to surgery and a complete medical work - up of the patient is done for elective laparoscopic surgery .We defer laparoscopy for malignant conditions, uterine size more than 20 weeks, cervix flushed to the vagina or with history of m ore than 2 pelvic surgeries. Sub - fertile women, after an initial workup, are subjected to diagnostic laparoscopy with chromopertubation. For laparoscopic cystectomies, patients with ultrasono graphy findings suggestive of benign tumours are selected. RESULT S : We have performed 285 laparoscopic procedures over this time period till date. Majority of these cases are Laparoscopic Assisted Vaginal Hysterectomies (LAVH [111 – 38.9%], followed by laparoscopic surgeries for various benign ovarian conditions ( BOC [62 – 21%] and Diagnostic Laparoscopies ( DL with or without laparoscopic ovarian drilling ( LOD [59 cases – 20.7%]. Out of 111 LAVH, 3 patients had bladder injury [2.7%] ; Out of 285 cases that underwent laparoscopic procedures, 5 [1.75%] required conversi on to laparotomy. Overall operative complications including major and minor, are significantly higher in the abdominal surgery group as compared to the laparoscopic group ( p value= 0.001 CONCLUSION : Laparoscopy is a safe route for conventional surgery, with lesser intraoperative, immediate post

  19. Telemedicine and Plastic Surgery: A Pilot Study

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    Denis Souto Valente

    2015-01-01

    Full Text Available Background. Telemedicine can be defined as the use of electronic media for transmission of information and medical data from one site to another. The objective of this study is to demonstrate an experience of telemedicine in plastic surgery. Methods. 32 plastic surgeons received a link with password for real-time streaming of a surgery. At the end of the procedure, the surgeons attending the procedure by the Internet answered five questions. The results were analyzed with descriptive statistics. Results. 27 plastic surgeons attended the online procedure in real-time. 96.3% considered the access to the website as good or excellent and 3.7% considered it bad. 14.8% reported that the transmission was bad and 85.2% considered the quality of transmission as good or excellent. 96.3% classified the live broadcasting as a good or excellent learning experience and 3.7% considered it a bad experience. 92.6% reported feeling able to perform this surgery after watching the demo and 7.4% did not feel able. 100% of participants said they would like to participate in other surgical demonstrations over the Internet. Conclusion. We conclude that the use of telemedicine can provide more access to education and medical research, for plastic surgeons looking for medical education from distant regions.

  20. [WHO Surgical Safety Checklist and guideline for safe surgery 2009].

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    Nishiwaki, Kimitoshi; Ichikawa, Takao

    2014-03-01

    The World Health Organization (WHO) launched the Safe Surgery Saves Lives campaign in 2007 to improve safety of surgical care in the world. As a part of the campaign, the first edition of the Surgical Safety Checklist was created through an international consultative process in 2008 and the second edition was published in the WHO Guidelines for Safe Surgery 2009. The guidelines consist of ten essential objectives for safe surgery, and nine of the ten objectives are facilitated by introducing the surgical checklist in the operating room, which is designed to improve teamwork of the operating room member and to give them chances to use the safety processes consistently. It consists of nineteen check points scheduled to be used in three phases: before anesthesia induction, before any skin incision, and at the end of surgery. In this article we gave an outline of WHO Surgical Safety Checklist and WHO Guidelines for Safe Surgery 2009, and reviewed the evidence of the guidelines and checklist. Finally we presented the evidence indicating the efficacy of the WHO Surgical Safety Checklist, which included the pilot study attached in the guidelines showing that its use markedly decreased complications in patients undergoing noncardiac surgery in eight diverse international hospitals.

  1. Safety and efficacy of transdermal buprenorphine versus oral tramadol for the treatment of post-operative pain following surgery for fracture neck of femur: A prospective, randomised clinical study

    Directory of Open Access Journals (Sweden)

    Sameer N Desai

    2017-01-01

    Full Text Available Background: Transdermal buprenorphine, which is used in chronic pain management, has rarely been studied for use in acute pain management. The aim of this study was to compare the safety and efficacy of transdermal buprenorphine patch to oral tramadol for post-operative analgesia, following proximal femur surgeries. Methodology: Fifty adult patients undergoing surgery for hip fracture under spinal anaesthesia were included in this study. One group (Group TDB received transdermal buprenorphine 10 mcg/h patch applied a day before the surgery and other group received oral tramadol 50 mg three times a day for analgesia (Group OT. They were allowed to take diclofenac and paracetamol tablets for rescue analgesia. Pain scores at rest, on movement, rescue analgesic requirement and side effects were compared between the groups over 7 days. Chi-square and independent sample t-test were used for categorical and continuous variables, respectively. Results: Resting pain scores and pain on movement were significantly lower in TDB Group on all 7 days starting from 24 h post-operatively. Rescue analgesic requirement was significantly lower in TDB Group compared to OT Group. All the patients needed rescue analgesic in OT Group whereas 68% of the patients needed the same in TDB Group. Incidence of vomiting was less and satisfaction scores were much higher in TDB Group as compared to OT Group (79% vs. 66%, P < 0.001. Conclusion: Transdermal buprenorphine can be safely used for post-operative analgesia and is more efficacious in reducing post-operative pain after 24 hours, with fewer side effects when compared to oral tramadol.

  2. The Impact of Patient Safety Training on Oral and Maxillofacial Surgery Residents' Attitudes and Knowledge: A Mixed Method Case Study

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    Buhrow, Suzanne

    2013-01-01

    It is estimated that in the United States, more than 40,000 patients are injured each day because of preventable medical errors. Patient safety experts and graduate medical education accreditation leaders recognize that medical education reform must include the integration of safety training focused on error causation, system engineering, and…

  3. A strategic approach to quality improvement and patient safety education and resident integration in a general surgery residency.

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    O'Heron, Colette T; Jarman, Benjamin T

    2014-01-01

    To outline a structured approach for general surgery resident integration into institutional quality improvement and patient safety education and development. A strategic plan to address Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review assessments for resident integration into Quality Improvement and Patient Safety initiatives is described. Gundersen Lutheran Medical Foundation is an independent academic medical center graduating three categorical residents per year within an integrated multi-specialty health system serving 19 counties over 3 states. The quality improvement and patient safety education program includes a formal lecture series, online didactic sessions, mandatory quality improvement or patient safety projects, institutional committee membership, an opportunity to serve as a designated American College of Surgeons National Surgical Quality Improvement Project and Quality in Training representative, mandatory morbidity and mortality conference attendance and clinical electives in rural surgery and international settings. Structured education regarding and participation in quality improvement and patient safety programs are able to be accomplished during general surgery residency. The long-term outcomes and benefits of these strategies are unknown at this time and will be difficult to measure with objective data. © 2013 Published by Association of Program Directors in Surgery on behalf of Association of Program Directors in Surgery.

  4. Criticality safety basics, a study guide

    Energy Technology Data Exchange (ETDEWEB)

    V. L. Putman

    1999-09-01

    This document is a self-study and classroom guide, for criticality safety of activities with fissile materials outside nuclear reactors. This guide provides a basic overview of criticality safety and criticality accident prevention methods divided into three parts: theory, application, and history. Except for topic emphasis, theory and history information is general, while application information is specific to the Idaho National Engineering and Environmental Laboratory (INEEL). Information presented here should be useful to personnel who must know criticality safety basics to perform their assignments safely or to design critically safe equipment or operations. However, the guide's primary target audience is fissile material handler candidates.

  5. A comparative study of short- and medium-term outcomes comparing emergent surgery and stenting as a bridge to surgery in patients with acute malignant colonic obstruction.

    LENUS (Irish Health Repository)

    Kavanagh, Dara O

    2013-04-01

    The use of self-expanding metal stents as a bridge to surgery in the setting of malignant colorectal obstruction has been advocated as an acceptable alternative to emergency surgery. However, concerns about the safety of stenting have been raised following recent randomized studies.

  6. Introducing standardized “readbacks” to improve patient safety in surgery: a prospective survey in 92 providers at a public safety-net hospital

    Directory of Open Access Journals (Sweden)

    Prabhakar Hari

    2012-06-01

    Full Text Available Abstract Background Communication breakdowns represent the main root cause of preventable complications which lead to harm to surgical patients. Standardized readbacks have been successfully implemented as a main pillar of professional aviation safety for decades, to ensure a safe closed-loop communication between air traffic control and individual pilots. The present study was designed to determine the perception of staff in perioperative services regarding the role of standardized readbacks for improving patient safety in surgery at a single public safety-net hospital and level 1 trauma center. Methods A 12-item questionnaire was sent to 180 providers in perioperative services at Denver Health Medical Center. The survey was designed to determine the individual participants’ perception of (1 appropriateness of current readback processes; (2 willingness to attend a future training module on this topic; (3 specific scenarios in which readbacks may be effective; and (4 perceived major barriers to the implementation of standardized readbacks. Survey results were compared between departments (surgery versus anesthesia and between specific staff roles (attending or midlevel provider, resident physician, nursing staff, using non-parametric tests. Results The response rate to the survey was 50.1 % (n = 92. Respondents overwhelmingly recognized the role of readbacks in reducing communication errors and improving patient safety. There was a strong agreement among respondents to support participation in a readbacks training program. There was no difference in the responses between the surgery and anesthesia departments. There was a statistically significant difference in the healthcare providers willingness to attend a short training module on readbacks (p  The main challenge for respondents, which emanated from their responses, appeared to relate to determining the ideal scenarios in which readbacks may be most appropriately used. Overall

  7. Clinical safety and outcomes of laparoscopic surgery versus open surgery for palliative resection of primary tumors in patients with stage IV colorectal cancer: a meta-analysis.

    Science.gov (United States)

    Zhou, Min-Wei; Gu, Xiao-Dong; Xiang, Jian-Bin; Chen, Zong-You

    2016-05-01

    This study was performed to compare the clinical safety and outcomes of laparoscopic versus open surgery for primary tumors in patients with stage IV colorectal cancer. Pertinent studies were selected from the MEDLINE, EMBASE, and Cochrane Library databases; references from published articles; and reviews. Both prospective and retrospective studies were included for the meta-analysis. Clinical outcomes included safety, complications, mortality, and survival. Six trials involving 1802 patients were included. The operative time was longer for laparoscopic than for open surgery (mean difference (MD) = 44.20, 95 % confidence interval (CI) 17.31-71.09, Z = 3.22, P = 0.001). Laparoscopic surgery was also associated with fewer postoperative complications (odds ratio 0.53, 95 % CI 0.37-0.78, Z = 3.29, P = 0.001) and less operative blood loss (MD = -65.40, 95 % CI -102.37 to -28.42, Z = 3.47, P = 0.0005). Median survival ranged from 11.4 to 30.1 months. The total hospital stay was 1.68 days shorter for laparoscopic than for open surgery (95 % CI -1.83 to -1.53, Z = 21.64, P < 0.00001). Laparoscopic surgery for palliative resection of stage IV colorectal cancer is associated with better perioperative outcomes than open surgery.

  8. COX-2 selective inhibitors: a literature review of analgesic efficacy and safety in oral-maxillofacial surgery.

    Science.gov (United States)

    Cicconetti, Andrea; Bartoli, Adriano; Ripari, Francesca; Ripari, Andrea

    2004-02-01

    Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed analgesic agents in surgical outpatients. Major limitations of NSAIDs are their gastrointestinal (GI) adverse events (perforation, ulceration, and bleeding), impairment of hemostatic function, and renal failure (with long-term therapy). A new class of NSAIDs, the COX-2 selective inhibitors (CSIs or Coxibs), have been developed with the aim of reducing the GI adverse events of traditional NSAIDs while maintaining their effective anti-inflammatory and analgesic properties. This is a narrative review of the literature aimed to discuss analgesic efficacy, clinical safety and cost-benefit ratio of CSIs in the treatment of post-oral surgery pain. Relevant drug and clinical studies of analgesic efficacy and safety of CSIs in the management of postoperative dental pain were identified through searches of MEDLINE/PubMed, in peer-reviewed journals of medicine and dentistry. The Food and Drug Administration Web site was searched for data of tolerability. Hand-searching included several dental journals and bibliographies of relevant studies. The last electronic search was conducted in April 2003. Data from well-designed, randomized, controlled trials of CSIs on the management of post-oral surgery pain indicate that these drugs are as well-effective analgesic agents as traditional NSAIDs and offer clinical advantages in terms of GI safety and unimpaired platelet function. CSIs do not offer advantages of renal safety over traditional NSAIDs. Although CSIs display analgesic efficacy similar to that of traditional NSAIDs in the treatment of acute, post-oral surgery pain, there is reasonable evidence that these new drugs are preferable in patients who are at an increased risk of developing serious upper-GI complications, in patients who take aspirin for cardiovascular comorbid conditions, and in those allergic to aspirin. Furthermore, CSIs may be given more safely than NSAIDs in perioperative settings

  9. Analgesic efficacy and safety of intravenous paracetamol (acetaminophen) administered as a 2g starting dose following third molar surgery

    DEFF Research Database (Denmark)

    Juhl, Gitte Irene; Nørholt, Sven E.; Tønnesen, Else Kirstine

    2006-01-01

    BACKGROUND: The recommended dose for intravenous (IV) paracetamol injection in adults is 1g, however pharmacokinetic and pharmacodynamic findings suggest that a better analgesia could be obtained with a 2g starting dose. METHODS: A single-centre, randomised, double-blind, placebo-controlled, 3......-parallel group study was performed to demonstrate the analgesic efficacy and safety of IV paracetamol 2g. Following third molar surgery, patients reporting moderate to severe pain received a single 15-min infusion of either IV paracetamol 2g, IV paracetamol 1g or placebo. Efficacy and safety were evaluated...... over 8h. Laboratory tests were performed before and 48h after drug administration. RESULTS: Two hundred and ninety seven patients (132=IV paracetamol 2g; 132=IV paracetamol 1g; 33=placebo) were randomised and completed the study. The summed pain relief over 6h (TOTPAR6) was significantly superior...

  10. Study Abroad Programs: Making Safety a Priority

    Science.gov (United States)

    Buddan, Michael Craig; Budden, Connie B.; Juban, Rusty; Baraya, Aristides

    2014-01-01

    Increasingly, students are participating in study abroad programs. Such programs provide participants a variety of learning experiences. Developing cross-cultural appreciation, communication skills, maturity and a less ethno-centric mindset are among the impacts study abroad programs offer. However, care must be taken to assure student safety and…

  11. Patient safety in dermatologic surgery: Part I. Safety related to surgical procedures.

    Science.gov (United States)

    Hansen, Timothy J; Lolis, Margarita; Goldberg, David J; MacFarlane, Deborah F

    2015-07-01

    Surgical procedures involve unique elements related to patient safety. One must be aware of potential complications and safety issues within the practice of dermatologic surgery. Developing a high level of competence in skin surgery will address some safety issues, while implementing protocols and redundancies provides systems-based correction for other safety issues. We provide an in-depth review of patient safety in dermatologic surgery. In particular, we highlight the most common safety issues and methods for reducing error. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  12. A prospective clinical study of polycarboxylate cement in periapical surgery

    National Research Council Canada - National Science Library

    Peñarrocha-Diago, M-A; Ortega-Sánchez, B; García-Mira, B; Maestre-Ferrín, L; Peñarrocha-Oltra, D; Gay-Escoda, C

    .... A prospective clinical study was made of 25 patients subjected to periapical surgery with ultrasound and magnifying loupes, in which polycarboxylate cement was used as retrograde filling material...

  13. Railway safety climate: a study on organizational development.

    Science.gov (United States)

    Cheng, Yung-Hsiang

    2017-09-07

    The safety climate of an organization is considered a leading indicator of potential risk for railway organizations. This study adopts the perceptual measurement-individual attribute approach to investigate the safety climate of a railway organization. The railway safety climate attributes are evaluated from the perspective of railway system staff. We identify four safety climate dimensions from exploratory factor analysis, namely safety communication, safety training, safety management and subjectively evaluated safety performance. Analytical results indicate that the safety climate differs at vertical and horizontal organizational levels. This study contributes to the literature by providing empirical evidence of the multilevel safety climate in a railway organization, presents possible causes of the differences under various cultural contexts and differentiates between safety climate scales for diverse workgroups within the railway organization. This information can be used to improve the safety sustainability of railway organizations and to conduct safety supervisions for the government.

  14. Safety and efficacy of recombinant activated factor VII: a randomized placebo-controlled trial in the setting of bleeding after cardiac surgery

    DEFF Research Database (Denmark)

    Gill, Ravi; Herbertson, Mike; Vuylsteke, Alain

    2009-01-01

    BACKGROUND: Blood loss is a common complication of cardiac surgery. Evidence suggests that recombinant activated factor VII (rFVIIa) can decrease intractable bleeding in patients after cardiac surgery. Our objective was to investigate the safety and possible benefits of rFVIIa in patients who bleed...... after cardiac surgery. METHODS AND RESULTS: In this phase II dose-escalation study, patients who had undergone cardiac surgery and were bleeding were randomized to receive placebo (n=68), 40 microg/kg rFVIIa (n=35), or 80 microg/kg rFVIIa (n=69). The primary end points were the number of patients...... for treating bleeding after cardiac surgery, but caution should be applied and further clinical trials are required because there is an increase in the number of critical serious adverse events, including stroke, in those patients randomized to receive rFVIIa....

  15. Is gynaecological laparoscopic surgery safe for elderly women? A comparison study.

    Science.gov (United States)

    Cengiz, H; Dagdeviren, H; Kanawati, A; Kaya, C; Ekin, M

    2014-10-01

    The aim of this study was to evaluate the efficacy and safety of gynaecological laparoscopic surgery in an elderly group, by comparing the operative outcomes of the elderly group with those of the younger group. We analysed retrospective data of 121 women who underwent laparoscopic surgery for benign gynaecological disease. Women aged > 60 years were compared with women aged between 30 and 50 years who had the same operation. We evaluated body mass index, comorbidities, number of previous abdominal surgeries, operating time, haemoglobin change, postoperative complications, hospital stay and return of bowel activity. There were no significant differences between the elderly and a matched younger group in number of previous abdominal surgeries, operating time, ASA score distribution, changes in haemoglobin level, hospital stay and postoperative complications (p > 0.05). Laparoscopic surgery can be safely performed in elderly patients with benign gynaecological disease, and surgeons should not hesitate to perform laparoscopic surgery in elderly patients.

  16. Feasibility, efficacy, and safety of a simple insulin infusion protocol in a large volume cardiac surgery unit in India

    Directory of Open Access Journals (Sweden)

    Beena Bansal

    2015-01-01

    Full Text Available Aim: Inpatient hyperglycemia management is essential, but difficult to achieve especially in a large volume cardiac surgery setup, thus necessitating use of nurse-led insulin protocols. A rapid flux of nurses dealing with a huge workload has been a cause for traditionally not using nurse-led protocols in most Indian institutes. The challenges we faced were to have a simple protocol for the nurses to accept it without compromising on glycemic control. Therefore, this observational study was planned to measure the efficacy and safety of the insulin infusion protocol in cardiac surgery patients. Materials and Methods: Insulin protocol was implemented, using seven fixed columns of infusion with the nurse making decisions to initiate and titrate doses based on simple rules. Blood glucose (BG data captured from blood gas analyzers (glucometrics in the intervention group (i.e., after protocol implementation were compared to control group (i.e., before the protocol implementation. Results: The mean BG for the first 48 h was lower in the intervention group as compared to control group, without an increase in the episodes of hypoglycemia. The nurses found the protocol easy to understand, less time-consuming and there was no protocol deviation over 8 months after implementation. Conclusion: A small change in the process, allowing nurses to titrate insulin doses based on some rules and having seven fixed columns of insulin infusion rates, improved glycemic control and efficiency.

  17. Feasibility, efficacy, and safety of a simple insulin infusion protocol in a large volume cardiac surgery unit in India.

    Science.gov (United States)

    Bansal, Beena; Mithal, Ambrish; Carvalho, Pravin; Mehta, Yatin; Trehan, Naresh

    2015-01-01

    Inpatient hyperglycemia management is essential, but difficult to achieve especially in a large volume cardiac surgery setup, thus necessitating use of nurse-led insulin protocols. A rapid flux of nurses dealing with a huge workload has been a cause for traditionally not using nurse-led protocols in most Indian institutes. The challenges we faced were to have a simple protocol for the nurses to accept it without compromising on glycemic control. Therefore, this observational study was planned to measure the efficacy and safety of the insulin infusion protocol in cardiac surgery patients. Insulin protocol was implemented, using seven fixed columns of infusion with the nurse making decisions to initiate and titrate doses based on simple rules. Blood glucose (BG) data captured from blood gas analyzers (glucometrics) in the intervention group (i.e., after protocol implementation) were compared to control group (i.e., before the protocol implementation). The mean BG for the first 48 h was lower in the intervention group as compared to control group, without an increase in the episodes of hypoglycemia. The nurses found the protocol easy to understand, less time-consuming and there was no protocol deviation over 8 months after implementation. A small change in the process, allowing nurses to titrate insulin doses based on some rules and having seven fixed columns of insulin infusion rates, improved glycemic control and efficiency.

  18. Safety and Efficacy of Rocuronium With Sugammadex Reversal Versus Succinylcholine in Outpatient Surgery-A Multicenter, Randomized, Safety Assessor-Blinded Trial.

    Science.gov (United States)

    Soto, Roy; Jahr, Jonathan S; Pavlin, Janet; Sabo, Daniel; Philip, Beverly K; Egan, Talmage D; Rowe, Everton; de Bie, Joris; Woo, Tiffany

    Complex surgical procedures are increasingly performed in an outpatient setting, with emphasis on rapid recovery and case turnover. In this study, the combination of rocuronium for neuromuscular blockade (NMB) reversed by single-dose sugammadex was compared with succinylcholine followed by spontaneous recovery in outpatient surgery. This multicenter, randomized, safety assessor-blinded study enrolled adults undergoing a short elective outpatient surgical procedure requiring NMB and tracheal intubation. Patients were randomized to NMB with either rocuronium 0.6 mg/kg for tracheal intubation with incremental doses of rocuronium 0.15 mg/kg and subsequent reversal with sugammadex 4.0 mg/kg at 1-2 posttetanic counts or succinylcholine 1.0 mg/kg for intubation with spontaneous recovery. The primary efficacy end point was the time from sugammadex administration to recovery of the train-of-four ratio to 0.9; for succinylcholine, time from administration to recovery of the first twitch (T1) to 90% was assessed. From 167 patients enrolled, 150 received treatment. The all-subjects-treated population comprised 70 patients in the rocuronium-sugammadex group and 80 in the succinylcholine group. Geometric mean (95% confidence interval) time from the start of sugammadex administration to recovery of the train-of-four ratio to 0.9 was 1.8 (1.6-2.0) minutes. Geometric mean (95% confidence interval) time from succinylcholine administration to recovery of T1 to 90% was 10.8 (10.1-11.5) minutes. Health outcome variables were similar between the groups. Adverse events were reported in 87.1% and 93.8% of patients for rocuronium-sugammadex and succinylcholine, respectively. In conclusion, rocuronium for intubation followed by sugammadex for reversal of NMB offers a viable treatment option in outpatient surgery without prolonging recovery duration or jeopardizing safety.

  19. A randomized study of combining maze surgery for atrial fibrillation with mitral valve surgery

    NARCIS (Netherlands)

    Jessurun, ER; Van Hemel, NM; Defauw, JJ; De La Riviere, AB; Stofmeel, MAM; Kingma, JH; Ernst, JMPG

    Aim Mitral valve surgery seldom suppresses atrial fibrillation (AF), present prior to surgery. Maze III surgery eliminates AF in >80% of cases, the reason why combining this procedure with mitral valve surgery in patients with AF seems worthwhile. We prospectively studied the outcome of combining

  20. A randomized study of combining maze surgery for atrial fibrillation with mitral valve surgery

    NARCIS (Netherlands)

    Jessurun, ER; Van Hemel, NM; Defauw, JJ; De La Riviere, AB; Stofmeel, MAM; Kingma, JH; Ernst, JMPG

    2003-01-01

    Aim Mitral valve surgery seldom suppresses atrial fibrillation (AF), present prior to surgery. Maze III surgery eliminates AF in >80% of cases, the reason why combining this procedure with mitral valve surgery in patients with AF seems worthwhile. We prospectively studied the outcome of combining th

  1. Socioeconomic outcome of epilepsy surgery: A controlled national study

    DEFF Research Database (Denmark)

    Jennum, Poul; Sabers, Anne; Christensen, Jakob

    2016-01-01

    PURPOSE: Epilepsy surgery has been a standard treatment for refractory epilepsies that cannot be controlled by standard medical treatment. We aimed to evaluate the health and social consequences of resective surgery relative to controls from a study of national data. METHODS: Using the Danish...... National Patient Registry we identified all subjects with an epilepsy diagnosis between 1996 and 2009 and compared them with a group of patients with an epilepsy diagnosis who had had neither epilepsy surgery nor a vagus stimulation diagnosis by the index date, and who were matched by gender, index year...... for epilepsy diagnosis, and index year for epilepsy surgery. We considered all the health and social information available in the Danish health, medication and social registers. The duration of follow-up was three years. RESULTS: 254 epilepsy patients and 989 controls were analyzed. Surgery patients were more...

  2. Fracture risk following bariatric surgery: a population-based study.

    Science.gov (United States)

    Nakamura, K M; Haglind, E G C; Clowes, J A; Achenbach, S J; Atkinson, E J; Melton, L J; Kennel, K A

    2014-01-01

    The effects of bariatric surgery on skeletal health are poorly understood. We found that bariatric surgery patients are more prone to fracture when compared to the general population. While further studies of fracture risk in this population are needed, bone health should be discussed in bariatric surgery clinics. Bariatric surgery is an increasingly common treatment for medically complicated obesity. Adverse skeletal changes after bariatric surgery have been reported, but their clinical importance remains unknown. We hypothesized that bariatric surgery patients are at increased risk of fracture. We conducted a historical cohort study of fracture incidence among 258 Olmsted County, Minnesota, residents who underwent a first bariatric surgery in 1985-2004. Relative fracture risk was expressed as standardized incidence ratios (SIRs), while potential risk factors were evaluated by hazard ratios (HR) obtained from a time-to-fracture regression model. The mean (±SD) body mass index at bariatric surgery was 49.0 ± 8.4 kg/m(2), with an average age of 44 ± 10 years and 82% (212) females. Gastric bypass surgery was performed in 94% of cases. Median follow-up was 7.7 years (range, 6 days to 25 years), during which 79 subjects experienced 132 fractures. Relative risk for any fracture was increased 2.3-fold (95% confidence interval (CI), 1.8-2.8) and was elevated for a first fracture at the hip, spine, wrist, or humerus (SIR, 1.9; 95% CI, 1.1-2.9), as well as for a first fracture at any other site (SIR, 2.5; 95% CI, 2.0-3.2). Better preoperative activity status was associated with a lower age-adjusted risk (HR, 0.4; 95% CI, 0.2-0.8) while prior fracture history was not associated with postoperative fracture risk. Bariatric surgery, which is accompanied by substantial biochemical, hormonal, and mechanical changes, is associated with an increased risk of fracture.

  3. Safety and Effectiveness of Total Thyroidectomy and Its Comparison with Subtotal Thyroidectomy and Other Thyroid Surgeries: A Systematic Review

    Science.gov (United States)

    Padur, Ashwini Aithal; Kumar, Naveen; Guru, Anitha; Badagabettu, Satheesha Nayak; Shanthakumar, Swamy Ravindra; Virupakshamurthy, Murlimanju Bukkambudhi; Patil, Jyothsna

    2016-01-01

    Diseases associated with the thyroid gland are one of the most frequently seen endocrine disorders across the globe. Total thyroidectomy is currently the preferred treatment for many thyroid diseases. Controversies exist among surgeons regarding safety of total thyroidectomy due to the risk associated with it like postoperative hypoparathyroidism or recurrent laryngeal nerve damage. Since, in the recent years, the incidence of thyroidectomy is in increasing trend in south Indian population, this review aims to study the available data regarding the appropriateness and safety of total thyroidectomy and compares it with subtotal thyroidectomy and other thyroid surgeries. This is a retrospective comprehensive review of various articles and publications regarding total and partial thyroidectomy performed across the world. Many retrospective studies and few prospective studies suggest that the incidence of transient hypocalcemia is higher after total thyroidectomy than after subtotal thyroidectomy, but the incidence of other complications including recurrent laryngeal nerve palsy and postoperative hematoma is not significantly different between the two procedures. Hence in our review we found that total thyroidectomy is safe and cost effective with low complication rates and provides little significant advantage of being safer procedure compared to subtotal thyroidectomy. PMID:27006857

  4. Measuring Safety Culture on Ships Using Safety Climate: A Study among Indian Officers

    Directory of Open Access Journals (Sweden)

    Yogendra Bhattacharya

    2015-12-01

    Full Text Available Workplace safety continues to be an area of concern in the maritime industry due to the international nature of the operations. The effectiveness of extensive legislation to manage shipboard safety remains in doubt. The focus must therefore shift towards the human element - seafarers and their perceptions of safety. The study aims to understand the alignment that exists between safety culture and safety climate on board ships as perceived by seafarers. The underlying factors of safety climate were identified using factor analysis which isolated seven factors - Support on Safety, Organizational Support, Resource Availability, Work Environment, Job Demands, ‘Just’ Culture, and Safety Compliance. The perception of safety level of seafarers was found to be low indicating the existence of misalignments between safety culture values and the actual safety climate. The study also reveals that the safety perceptions of officers employed directly by ship owners and those by managers do not differ significantly, nor do they differ between senior and junior officers. A shift in perspective towards how seafarers themselves feel towards safety might provide more effective solutions – instead of relying on regulations - and indeed aid in reducing incidents on board. This paper details practical suggestions on how to identify the factors that contribute towards a better safety climate on board ships.

  5. Perioperative Nurses' Work Experience With Robotic Surgery: A Focus Group Study.

    Science.gov (United States)

    Kang, Min Jung; De Gagne, Jennie C; Kang, Hee Sun

    2016-04-01

    The aim of this study was to explore the work experience of perioperative nurses involved in robotic surgery. A qualitative descriptive study was conducted. Participants were 15 nurses who had been on a robotic surgery team at one of five major university hospitals in Seoul, South Korea. Participants were one male and 14 female nurses (mean age, 31.33 [SD, 4.19] years; range, 25-41 years). Their experience as robotic surgery nurses ranged from 8 months to 6 years. Nurses' experiences with robotic surgery were categorized within four main themes: (1) constant checking on patients' safety and the robot's functions; (2) unexpected robotic machine errors or malfunctions; (3) feelings of burden in a robotic surgical team; and (4) need and desire for more information and education. This study showed that there are common concerns about patient safety and the possibility of emergencies related to robot system failure among nurses. Offering more support for nurses involved in robotic surgery should be a priority to empower them to play an extended role in robotic surgery.

  6. Increasing safety of a robotic system for inner ear surgery using probabilistic error modeling near vital anatomy

    Science.gov (United States)

    Dillon, Neal P.; Siebold, Michael A.; Mitchell, Jason E.; Blachon, Gregoire S.; Balachandran, Ramya; Fitzpatrick, J. Michael; Webster, Robert J.

    2016-03-01

    Safe and effective planning for robotic surgery that involves cutting or ablation of tissue must consider all potential sources of error when determining how close the tool may come to vital anatomy. A pre-operative plan that does not adequately consider potential deviations from ideal system behavior may lead to patient injury. Conversely, a plan that is overly conservative may result in ineffective or incomplete performance of the task. Thus, enforcing simple, uniform-thickness safety margins around vital anatomy is insufficient in the presence of spatially varying, anisotropic error. Prior work has used registration error to determine a variable-thickness safety margin around vital structures that must be approached during mastoidectomy but ultimately preserved. In this paper, these methods are extended to incorporate image distortion and physical robot errors, including kinematic errors and deflections of the robot. These additional sources of error are discussed and stochastic models for a bone-attached robot for otologic surgery are developed. An algorithm for generating appropriate safety margins based on a desired probability of preserving the underlying anatomical structure is presented. Simulations are performed on a CT scan of a cadaver head and safety margins are calculated around several critical structures for planning of a robotic mastoidectomy.

  7. Anesthesia for Ambulatory Pediatric Surgery in Sub-Saharan Africa: A Pilot Study in Burkina Faso.

    Science.gov (United States)

    Kabré, Yvette B; Traoré, Idriss S S; Kaboré, Flavien A R; Ki, Bertille; Traoré, Alain I; Ouédraogo, Isso; Bandré, Emile; Wandaogo, Albert; Ouédraogo, Nazinigouba

    2017-02-01

    Long surgical wait times and limited hospital capacity are common obstacles to surgical care in many countries in Sub-Saharan Africa (SSA). Introducing ambulatory surgery might contribute to a solution to these problems. The purpose of this study was to evaluate the safety and feasibility of introducing ambulatory surgery into a pediatric hospital in SSA. This is a cross-sectional descriptive study that took place over 6 months. It includes all patients assigned to undergo ambulatory surgery in the Pediatric University Hospital in Ouagadougou, Burkina Faso. Eligibility criteria for the ambulatory surgery program included >1 year of age, American Society of Anesthesiologists (ASA) 1 status, surgery with a low risk of bleeding, lasting surgery, of whom 515 were elective cases; 115 of these met the criteria for ambulatory surgery; 103 patients, with an average age of 59.74 ± 41.57 months, actually underwent surgery. The principal indications for surgery were inguinal (62) and umbilical (47) hernias. All patients had general anesthesia with halothane. Sixty-five percent also received regional or local anesthesia consisting of caudal block in 79.23% or nerve block in 20.77%. The average duration of surgery was 33 ± 17.47 minutes. No intraoperative complications were noted. All the patients received acetaminophen and a nonsteroidal anti-inflammatory drug in the recovery room. Twelve (11.7%) patients had complications in recovery, principally nausea and vomiting. Eight (7.8%) patients were admitted to the hospital. No serious complications were associated with ambulatory surgery. Its introduction could possibly be a solution to improving pediatric surgical access in low-income countries.

  8. Adolescent girls' views on cosmetic surgery: A focus group study.

    Science.gov (United States)

    Ashikali, Eleni-Marina; Dittmar, Helga; Ayers, Susan

    2016-01-01

    This study examined adolescent girls' views of cosmetic surgery. Seven focus groups were run with girls aged 15-18 years (N = 27). Participants read case studies of women having cosmetic surgery, followed by discussion and exploration of their views. Thematic analysis identified four themes: (1) dissatisfaction with appearance, (2) acceptability of cosmetic surgery, (3) feelings about undergoing cosmetic surgery and (4) cosmetic surgery in the media. Results suggest the acceptability of cosmetic surgery varies according to the reasons for having it and that the media play an important role by normalising surgery and under-representing the risks associated with it.

  9. SURGICAL SITE INFECTION IN ABDOMINAL SURGERIES: A CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Amit

    2014-09-01

    Full Text Available Purpose: A prospective study of incisional surgical site infection in abdominal surgeries was conducted to find out incidence, common predisposing factors and microbiological profile. METHODS: 375 patients who underwent abdominal surgeries were studied in a span of 1 year. They were divided into two groups – group 1 – 316 cases who did not develop Surgical Site Infection (SSI, the 2nd group – 59 cases that developed SSI. These patients were studied by interviewing and examination according to a set proforma. The results were statistically analyzed by comparing averages using Chi square chart for finding significance of difference where applicable. RESULT: The overall SSI incidence was 15.7 % (59/375. In elective surgeries, the SSI rate was 5.7% and in emergency surgeries, it was 28.6%. It was found that SSI increased with increasing age linearly. Other significant factors involved were increasing class of wound (dirty > clean wound class, increased preoperative stay, presence of remote site infection, increased duration of surgery and use of drains. E. coli was found to be the most common organism causing SSI in abdominal operations. CONCLUSION: SSI can be reduced by decreasing the preoperative hospital stay, appropriate antibiotic administration policies, preoperative control of remote site infections, adequate preoperative patient preparation, reducing the duration of surgery to minimum, judicious use of drains and intraoperative maintenance of asepsis and following operation theatre discipline properly.

  10. A nationwide study on anastomotic leakage after colonic cancer surgery

    DEFF Research Database (Denmark)

    Krarup, Peter-Martin; Jorgensen, L N; Andreasen, A H

    2012-01-01

    Aim: Anastomotic leakage (AL) is a major challenge in colorectal cancer surgery due to increased morbidity and mortality. Possible risk factors should be investigated differentially, distinguishing between rectal and colonic surgery in large-scale studies to avoid selection bias and confounding....... Method: The incidence and risk factors associated with AL were analysed in an unselected nation-wide prospective cohort of patient subjected to curative colonic cancer surgery with primary anastomosis and entered into The Danish Colorectal Cancer Group database between May 2001 and December 2008. Results......: AL occurred in 593 (6.4%) of 9333 patients. Laparoscopic surgery (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.05-1.70; P = 0.03); left hemicolectomy (OR, 2.02; 95% CI, 1.50-2.72) or sigmoid colectomy (OR, 1.69; 95% CI, 1.32-2.17; P = 0.01); intraoperative blood loss (OR, 1.04; 95% CI, 1...

  11. Outpatient- and inpatient-based buckling surgery: a comparative study

    Directory of Open Access Journals (Sweden)

    Lee JC

    2014-04-01

    Full Text Available Jin Cheol Lee,* Yu Cheol Kim*Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea *Both authors contributed equally to this workPurpose: To evaluate the clinical outcomes of ambulatory buckling surgery, comparing outpatient- with inpatient-based surgery.Methods: The authors performed a retrospective study of 80 consecutive cases of rhegmato genous retinal detachment from January 2009 to December 2011 treated by scleral buckling surgery. Two groups of patients were defined according to inpatient (group 1 or outpatient (group 2 surgery, and a comparison of several parameters between these two groups was performed.Results: Of the 80 subjects in this study, the average age of group 1 (50 patients was 49.7 years, and that of group 2 (30 patients was 47.5 years. There were no statistically significant differences in the average logarithm of the minimum angle of resolution-visual acuity, the condition of the lens, or the presence of retinal lattice degeneration prior to the surgery between the groups. There were no statistically significant differences in the patterns of tear or retinal detachment or in surgical procedure between the groups. Comparing the best-corrected visual acuity after 6 months with that prior to the surgery, the changes in group 1 and group 2 were 0.26 and 0.31, respectively. The functional success rates of group 1 and group 2 after 6 months were 90% and 93%, respectively, and the anatomical success rates of group 1 and group 2 after 6 months were 94% and 96%, respectively, but these were also statistically insignificant.Conclusion: Hospitalization is not essential for buckling surgery in uncomplicated rhegmatogenous retinal detachment surgery.Keywords: ambulatory, scleral buckling, rhegmatogenous retinal detachment

  12. Randomised, double-blind, parallel group, placebo-controlled study to evaluate the analgesic efficacy and safety of VVZ-149 injections for postoperative pain following laparoscopic colorectal surgery

    Science.gov (United States)

    Nedeljkovic, Srdjan S; Correll, Darin J; Bao, Xiaodong; Zamor, Natacha; Zeballos, Jose L; Zhang, Yi; Young, Mark J; Ledley, Johanna; Sorace, Jessica; Eng, Kristen; Hamsher, Carlyle P; Maniam, Rajivan; Chin, Jonathan W; Tsui, Becky; Cho, Sunyoung; Lee, Doo H

    2017-01-01

    Introduction In spite of advances in understanding and technology, postoperative pain remains poorly treated for a significant number of patients. In colorectal surgery, the need for developing novel analgesics is especially important. Patients after bowel surgery are assessed for rapid return of bowel function and opioids worsen ileus, nausea and constipation. We describe a prospective, double-blind, parallel group, placebo-controlled randomised controlled trial testing the hypothesis that a novel analgesic drug, VVZ -149, is safe and effective in improving pain compared with providing opioid analgesia alone among adults undergoing laparoscopic colorectal surgery. Methods and analysis Based on sample size calculations for primary outcome, we plan to enrol 120 participants. Adult patients without significant medical comorbidities or ongoing opioid use and who are undergoing laparoscopic colorectal surgery will be enrolled. Participants are randomly assigned to receive either VVZ-149 with intravenous (IV) hydromorphone patient-controlled analgesia (PCA) or the control intervention (IV PCA alone) in the postoperative period. The primary outcome is the Sum of Pain Intensity Difference over 8 hours (SPID-8 postdose). Participants receive VVZ-149 for 8 hours postoperatively to the primary study end point, after which they continue to be assessed for up to 24 hours. We measure opioid consumption, record pain intensity and pain relief, and evaluate the number of rescue doses and requests for opioid. To assess safety, we record sedation, nausea and vomiting, respiratory depression, laboratory tests and ECG readings after study drug administration. We evaluate for possible confounders of analgesic response, such as anxiety, depression and catastrophising behaviours. The study will also collect blood sample data and evaluate for pharmacokinetic and pharmacodynamic relationships. Ethics and dissemination Ethical approval of the study protocol has been obtained from

  13. Opioid pain medication use after dermatologic surgery: a prospective observational study of 212 dermatologic surgery patients.

    Science.gov (United States)

    Harris, KaLynne; Curtis, Julia; Larsen, Brooke; Calder, Scott; Duffy, Keith; Bowen, Glen; Hadley, Michael; Tristani-Firouzi, Payam

    2013-03-01

    To better understand postoperative opioid use after dermatologic surgery. Prospective observational study. Academic dermatology department. The study included 212 adults (1) who were undergoing a single skin excision (including Mohs micrographic surgery), (2) who consented to participate,and (3) who were able to be reached by telephone on postoperative day 3 or 4. Patients who did not meet these criteria and those referred to another physician for further surgical treatment or repair were excluded. The study examined(1) the incidence of opioid prescription after dermatologic surgery, (2) the percentage of prescribed opioid pain medications used in the postoperative period, and (3) patient and surgical characteristics associated with opioid pain medication prescription and use. Opioids were prescribed to 72 of the 212 patients(34%). Twenty-five of the 72 patients (35%) who were prescribed opioids did not use them. Forty-nine of 57 patients (86%) who filled an opioid prescription had leftover pills, and 26 of the 49 patients (53%) planned to keep them. Only maximum pain score was significantly associated with opioid use. Opioids were over prescribed after dermatologic surgery. Patients who had left over opioids did not dispose of them properly, which could lead to potential misuse and abuse.

  14. A prospective clinical study of polycarboxylate cement in periapical surgery

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    Ortega-Sánchez, Bárbara; García-Mira, Berta; Maestre-Ferrín, Laura; Peñarrocha-Oltra, David; Gay-Escoda, Cosme

    2012-01-01

    Objective: To evaluate the clinical efficacy of polycarboxylate cement as retrograde filling material. Design: A prospective clinical study was made of 25 patients subjected to periapical surgery with ultrasound and magnifying loupes, in which polycarboxylate cement was used as retrograde filling material. Measurements were made of the area and diameter of the lesions pre- and postoperatively, and 6 and 12 months after the operation. The apical resection and retrograde filling areas were also measured, and the prognosis following surgery was recorded. Results: A total of 23 patients with 31 apicoectomized teeth were studied (2 patients being lost to follow-up). The mean area of the periapical lesions before surgery was 52.25 mm2, with a mean major diameter of 6.1 mm and a mean lesser diameter of 4.8 mm. The success rate after 12 months was 54.7%, according to the criteria of Von Arx and Kurt. The prognosis was poorer in females, in larger lesions, and in cases with larger retrograde filling areas. Conclusions: Polycarboxylate cement offers good results, with important bone regeneration after periapical surgery. Key words: Periapical surgery, endodontic treatment, polycarboxylate cement. PMID:22143701

  15. Improved Surgery Planning Using 3-D Printing: a Case Study.

    Science.gov (United States)

    Singhal, A J; Shetty, V; Bhagavan, K R; Ragothaman, Ananthan; Shetty, V; Koneru, Ganesh; Agarwala, M

    2016-04-01

    The role of 3-D printing is presented for improved patient-specific surgery planning. Key benefits are time saved and surgery outcome. Two hard-tissue surgery models were 3-D printed, for orthopedic, pelvic surgery, and craniofacial surgery. We discuss software data conversion in computed tomography (CT)/magnetic resonance (MR) medical image for 3-D printing. 3-D printed models save time in surgery planning and help visualize complex pre-operative anatomy. Time saved in surgery planning can be as much as two thirds. In addition to improved surgery accuracy, 3-D printing presents opportunity in materials research. Other hard-tissue and soft-tissue cases in maxillofacial, abdominal, thoracic, cardiac, orthodontics, and neurosurgery are considered. We recommend using 3-D printing as standard protocol for surgery planning and for teaching surgery practices. A quick turnaround time of a 3-D printed surgery model, in improved accuracy in surgery planning, is helpful for the surgery team. It is recommended that these costs be within 20 % of the total surgery budget.

  16. Robotic consolle for ocular surgery: a preliminary study

    Science.gov (United States)

    Rossi, Francesca; Pini, Roberto; Menabuoni, Luca; Lenzetti, Ivo; Russo, Sheila; Menciassi, Arianna; Fortuna, Damiano

    2014-02-01

    Minimally invasive surgery has recently been improved by the use of robot-assisted procedures in several medical fields. Among the ocular surgeries there are a few examples of sophisticated vitreoretinal procedures, while robotic-assisted surgery of the anterior eye segment is still under study. In this paper we propose a new approach to the robotic assisted ocular surgery: a CO2 laser system is equipped with a micromanipulator and scanner, and it is proposed to induce photothermal effects for the removal of neoformations. A sensorized tool is connected to the patient eye and to the robotic arm. This tool is equipped with force and position sensors: by the use of the spatial information from the robotic console and from the patient it is possible to control the position of the target itself and to block it in the correct position for performing surgery. The system is provided by a feedback alarm that remove the block of the patient head in any moment. The optimized robotic consolle can be used in performing scleral cuts and in the treatment of pterigium or neoformations.

  17. A STUDY ON INCISIONAL HERNIA FOLLOWING OBSTETRICS AND GYNAECOLOGICAL SURGERIES

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    Sumathi Ravikumar

    2016-12-01

    Full Text Available BACKGROUND The term ventral hernia encompasses incisional, epigastric, paraumbilical, spigelian and traumatic hernias. This is a hernia that protrudes through defect in an abdominal wound. With evolution of modern surgery and rapid increase in the number of abdominal operations performed, incisional hernias have risen in frequency and this hernia seems to be more common in females following obstetric and gynaecological surgeries. This study undertaken to stress the problem of incisional hernias in females occurring after obstetric and gynaecological surgeries. The aim of the study is to- 1. Study the incidence and prevalence of incisional hernias following obstetrics and gynaecological surgeries in KAPV Government Medical College, Tiruchirappalli. 2. Study aetiological factors for incisional hernia following obstetric and gynaecological surgeries. 3. Analyse preventive measures. 4. Analyse the problems in females, which led to incisional hernia. MATERIALS AND METHODS 178 cases of incisional hernia admitted in KAPV Government Medical College, Tiruchirappalli, during the period of 2 years from June 2014 to May 2016. The cases analysed according to age, previous history, type of incision, suture material used and associated comorbidities. RESULTS Maximum age affected is between 50 to 59 years and with 10 years of surgery. Incidence more following LSCS with midline incision. Incidence more with the usage of absorbable suture material. Postoperative wound infection and anaemia were leading associated factors for incisional hernia. CONCLUSION The incidence of incisional hernia is more common in females especially in obese and multiparous woman. The incidence is more after LSCS and puerperal sterilisation. Onlay reinforced mesh repair using Prolene mesh have given good results. Prolene mesh appears to be best tolerated by body tissues. The use of closed suction drain have significantly reduced the postoperative wound infection.

  18. Laser safety in otolaryngology--head and neck surgery: anesthetic and educational considerations for laryngeal surgery.

    Science.gov (United States)

    Ossoff, R H

    1989-08-01

    Two investigations concerning anesthetic and educational considerations for laser safety in microlaryngeal carbon dioxide laser surgery have been performed. The first study demonstrated that attendance at a "hands-on" laser surgery course that stressed safety precautions was associated with a reduced rate of laser-related complications in the selected group of otolaryngologists who participated in the course, when compared to another selected group of otolaryngologists who were members of a senior otolaryngology society, and surveyed solely on the basis of their society membership. The second series of studies compared the incendiary characteristics of three endotracheal tubes in various mixtures of oxygen, diluted with either helium or nitrogen. It was determined that the polyvinyl chloride tube should not be used for laser surgery, even when wrapped with reflective, metallic tape. The safest anesthetic gas mixture was found to be 30% oxygen in helium; the addition of 2% halothane did not have an adverse effect, as had been previously reported. Both the Xomed Laser-Shield and Rusch red rubber endotracheal tubes were found to be safe, when used with the laser in the pulsed mode in an atmosphere of 100% oxygen. When the laser was used in the continuous mode, both tubes ignited in an atmosphere of 30% oxygen in helium. These findings challenged the previously reported levels of safety associated with the use of an unwrapped Xomed tube. Based on the results of this investigation, it has been concluded that both the Rusch red rubber tube and the Xomed Laser-Shield tube should be wrapped with reflective, metallic tape, when used for cases of microlaryngeal surgery with the carbon dioxide laser.

  19. NSAID Use after Bariatric Surgery: a Randomized Controlled Intervention Study.

    Science.gov (United States)

    Yska, Jan Peter; Gertsen, Sanneke; Flapper, Gerbrich; Emous, Marloes; Wilffert, Bob; van Roon, Eric N

    2016-12-01

    Use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in bariatric surgery patients. If use of an NSAID is inevitable, a proton pump inhibitor (PPI) should also be used. To determine the effect of an, compared to care-as-usual, additional intervention to reduce NSAID use in patients who underwent bariatric surgery, and to determine the use of PPIs in patients who use NSAIDs after bariatric surgery. A randomized controlled intervention study in patients after bariatric surgery. Patients were randomized to an intervention or a control group. The intervention consisted of sending a letter to patients and their general practitioners on the risks of use of NSAIDs after bariatric surgery and the importance of avoiding NSAID use. The control group received care-as-usual. Dispensing data of NSAIDs and PPIs were collected from patients' pharmacies: from a period of 6 months before and from 3 until 9 months after the intervention. Two hundred forty-eight patients were included (intervention group: 124; control group: 124). The number of users of NSAIDs decreased from 22 to 18 % in the intervention group and increased from 20 to 21 % in the control group (NS). The use of a PPI with an NSAID rose from 52 to 55 % in the intervention group, and from 52 to 69 % in the control group (NS). Informing patients and their general practitioners by letter, in addition to care-as-usual, is not an effective intervention to reduce the use of NSAIDs after bariatric surgery (trial number NTR3665).

  20. Bariatric Surgery in Moderately Obese Patients: A Prospective Study

    Science.gov (United States)

    Cerci, M.; Bellini, M. I.; Russo, F.; Benavoli, D.; Capperucci, M.; Gaspari, A. L.; Gentileschi, P.

    2013-01-01

    Introduction. Moderate obesity (BMI 30–35 kg/m2) affects 25% of the western population. The role of bariatric surgery in this context is currently debated, reserved for patients with comorbidity, as an alternative to conservative medical treatment. We describe our experience in moderately obese patients treated with bariatric surgery. Materials and Methods. Between September 2011 and September 2012, 25 patients with grade I obesity and comorbidities underwent bariatric surgery: preoperative mean BMI 33.2 kg/m2, 10 males, mean age 42 years. In presence of type 2 diabetes mellitus (T2DM) (56%), gastric bypass was performed; in cases with hypertension (64%) and obstructive sleep apnea (OSA) (12%), sleeve gastrectomy was performed. All operations were performed laparoscopically. Results. Mean follow-up was 12.4 months. A postoperative complication occurred: bleeding from the trocar site was resolved with surgery in local anesthesia. Reduction in average BMI was 6 points, with a value of 27.2 kg/m2. Of the 14 patients with T2DM, 12 (86%) discontinued medical therapy because of a normalization of glycemia. Of the 16 patients with arterial hypertension, 14 (87%) showed remission and 2 (13%) improvement. Complete remission was observed in patients with OSAS. Conclusions. The results of our study support the validity of bariatric surgery in patients with BMI 30–35 kg/m2. Our opinion is that, in the future, bariatric surgery could be successful in selected cases of moderately obese patients. PMID:24454338

  1. Bariatric Surgery in Moderately Obese Patients: A Prospective Study

    Directory of Open Access Journals (Sweden)

    M. Cerci

    2013-01-01

    Full Text Available Introduction. Moderate obesity (BMI 30–35 kg/m2 affects 25% of the western population. The role of bariatric surgery in this context is currently debated, reserved for patients with comorbidity, as an alternative to conservative medical treatment. We describe our experience in moderately obese patients treated with bariatric surgery. Materials and Methods. Between September 2011 and September 2012, 25 patients with grade I obesity and comorbidities underwent bariatric surgery: preoperative mean BMI 33.2 kg/m2, 10 males, mean age 42 years. In presence of type 2 diabetes mellitus (T2DM (56%, gastric bypass was performed; in cases with hypertension (64% and obstructive sleep apnea (OSA (12%, sleeve gastrectomy was performed. All operations were performed laparoscopically. Results. Mean follow-up was 12.4 months. A postoperative complication occurred: bleeding from the trocar site was resolved with surgery in local anesthesia. Reduction in average BMI was 6 points, with a value of 27.2 kg/m2. Of the 14 patients with T2DM, 12 (86% discontinued medical therapy because of a normalization of glycemia. Of the 16 patients with arterial hypertension, 14 (87% showed remission and 2 (13% improvement. Complete remission was observed in patients with OSAS. Conclusions. The results of our study support the validity of bariatric surgery in patients with BMI 30–35 kg/m2. Our opinion is that, in the future, bariatric surgery could be successful in selected cases of moderately obese patients.

  2. The safety of field tubal sterilization: a cohort study.

    Science.gov (United States)

    Siswosudarmo, R

    1991-01-01

    A cohort study on female sterilization has been carried out to compare the safety of field-based procedures with hospital-based procedures. A total of 217 women were recruited, consisting of 103 field-based and 114 hospital-based acceptors. Married and healthy women 20-45 years of age, having at least two living children, not obese, no history of major abdominal surgery, no signs of acute pelvic inflammatory disease, and no contraindication to ketamin were included in the study. Women with severe pelvic adhesions encountered during surgery were excluded from the study. The ambulatory procedure was used for all acceptors except those who were sterilized in hospital immediately after delivery. They were asked to come to th Sarjito Hospital (hospital-based) or Puskesmas (primary health care center or field-based), after fasting the night before. Ketamin, 50-100 mg, was used intravenously for general anesthesia. Minilaparotomy followed by the Pomeroy method was used for standard female tubal sterilization. Tetracycline, 3 x 500 mg was given for five days prophylactically. Follow-up was carried out one and six weeks after the day of operation. Data were processed with an IBM-compatible PC, using version 3.0 SPSS program. Students t-test, chi-square test and relative risk (95% confidence limit (CL)) were used for statistical analysis. Both groups were comparable in terms of age, parity, body weight, and body height. The duration of operation in the field was somewhat longer than that in the hospital, i.e. 24.58 vs 21.14 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Recommendations to Improve the Implementation Compliance of Surgical Safety Checklist in Surgery Rooms

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    Juliana Sandrawati

    2014-11-01

    Full Text Available Background: Surgical Safety Checklist has been adopted in surgery room as a tool to improve safe surgery. Its implementation during 2012 was low (33.9% so was the completeness of filling it (57.3%. Objective: To increase the implementation of Surgical Safety Checklist (SSC through analyzing the effect of policy, procedures, patient safety culture, and individual factors on compliance SSC implementation in the surgery room. Methods: Cross-sectional study with descriptive observational approach was done to find influencing factors of health care personnels’ compliance to fill SSC. Sample consisted of all surgery room nurses (45 nurses, 10 surgeons and 4 anesthesists. Data collection was made use of questionnaires, surgical medical records and SSC form. Results:The compliance to fill SSC in April 2013 was still low (55.9%. Written policy on patient safety was absent and awareness of respondents about the procedure was low. Respondents’ assessment showed that patient safety culture in surgery room was good, except management and stress recognition dimensions. Likewise, the respondents’ knowledge about SSC was low (61.0%. Conclusion: The study conclude that influencing factors of compliance implementation SSC is absence of the written policy in patient safety, lack of socialization of Standar Prosedur Operasional to health care personnels, lack of knowledge about SSC, lack awareness about the importance of SSC, shortage of surgery room nurses, and innappropriate perception about filling SSC as workload. Recomendation:The study will be making of written policy in patient safety and SSC, followed by socialization to health care personnels, training about SSC implementation, empowering and advocating surgery room nurses and use of reminders.

  4. A randomized clinical evaluation of the safety of Systane® Lubricant Eye Drops for the relief of dry eye symptoms following LASIK refractive surgery

    Directory of Open Access Journals (Sweden)

    Daniel Durrie

    2008-12-01

    Full Text Available Daniel Durrie, Jason StahlDurrie Vision, Overland Park, Kansas, USAPurpose: To evaluate the safety of Systane® Lubricant Eye Drops in relieving the symptoms of dry eye following laser-assisted in situ keratomileusis (LASIK surgery.Methods: This was a randomized, double-masked, single-center, placebo-controlled, contralateral eye study of 30 patients undergoing LASIK surgery. The mean age of patients was 42.4 ± 10.7 years, and the mean spherical equivalent was −3.29 (range, +1.75 to −7.38. Patients’ right and left eyes were randomized to receive either Systane® or placebo – a preserved, thimerosal-free saline solution – beginning from the day of surgery and ending 30 days following surgery. Outcome measures included tear film break up time (TFBUT, visual acuity, degree of corneal and conjunctival staining, and treatment-related adverse events.Results: Preoperatively, placebo-treated eyes had statistically significantly higher sum corneal staining score than Systane®-treated eyes (p = 0.0464; however, the difference was clinically insignificant (p = 0.27. Two weeks post operatively, the average TFBUT in the Systane®-treated eyes was 1.23 seconds longer than that of the placebo-treated eyes (p = 0.028. All other evaluated variables were comparable between the two treatments. No adverse events were reported in the study.Conclusion: Systane® Lubricant Eye Drops are safe for use following LASIK surgery to relieve the discomfort symptoms of dry eye associated with the procedure.Keywords: Systane®, safety, dry eye, LASIK

  5. Safety Study in Aviation

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    Marek Štumper

    2016-07-01

    Full Text Available The objective of this article is to provide a brief look at safety studies, which are a necessary part of every change of system or a new system in aviation. The main focus is put on the area of air traffic management, because it affects most of the aviation stakeholders. The article begins with a description of safety and safety assessment of changes in systems. Then it discusses analysis of processes, hazard identification and risk assessment. Main part focuses on Safety studies and briefly describes the elements of the study. At the end, possible ways of safety study evaluation are mentioned.

  6. Treatment of FIGO stage IV ovarian carcinoma: results of primary surgery or interval surgery after neoadjuvant chemotherapy: a retrospective study.

    Science.gov (United States)

    Rafii, A; Deval, B; Geay, J-F; Chopin, N; Paoletti, X; Paraiso, D; Pujade-Lauraine, E

    2007-01-01

    The objective of the study is to determine whether surgery influences the outcome of stage IV ovarian cancer. The study design is as follows: From May 1995 to December 2000, 129 patients with FIGO stage IV ovarian cancer, recruited in 42 centers, were prospectively included in GINECO first-line randomized studies of platinum-based regimens with paclitaxel administered simultaneously or sequentially. In all, 109 were eligible for this study. Standard peritoneal cytoreductive surgery was defined as a procedure including at least total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and peritoneal debulking. Surgery was considered optimal if residual lesions were smaller than 1 cm. The Kaplan-Meier method was used to compare survival. Initial abdominopelvic cytoreductive surgery was considered standard in 55 (54%) patients. Abdominopelvic surgery was optimal in 29 patients and nonoptimal in 26. Twenty-two (22%) patients had a simple biopsy, and 25 (24%) patients underwent substandard surgery. Twenty-two of these 47 patients without initial standard surgery underwent a second surgical procedure, and 17 of the 22 patients completed standard surgery. The median overall survival time in the entire population was 24.3 months (95% confidence interval [CI], 19.5-29.1 months). Patients treated without a cytoreductive surgical procedure had significantly worse median survival (15.1 months; 95% CI, 5.4-24.9 months) than patients who had optimal primary surgery (22.9 months; 95% CI, 15.6-30.1 months), nonoptimal primary surgery (27.1 months; 95% CI, 21.2-32.9 months), or neoadjuvant chemotherapy followed by surgery (45.5 months; 95% CI, 23.5-67.5 months) (P= .001). In conclusion, this study shows a significant benefit of debulking surgery in stage IV ovarian cancer patients who responded to neoadjuvant chemotherapy. Neoadjuvant chemotherapy can help to select patients for surgery.

  7. Implementation of the Spanish National Enhanced Recovery Program (ERAS) in Bariatric Surgery: A Pilot Study.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Royo, Pablo; Muñoz, José L; Duran, Manuel; Redondo, Elisabeth; Ramirez, Jose M

    2016-12-01

    The essence of Enhanced Recovery After Surgery (ERAS) programs is the multimodal approach, and many authors have demonstrated safety and feasibility in fast track bariatric surgery. According to this concept, a multidisciplinary ERAS program for bariatric surgery has been developed by the Spanish fast track group (ERAS Spain). The aim of this study was to analyze the initial implementation of this Spanish National ERAS protocol in bariatric surgery. A multicentric prospective pilot study was performed, including 125 consecutive patients undergoing bariatric surgery at 3 Spanish hospitals between January and June 2015, after the Spanish National ERAS protocol in bariatric surgery. Compliance with the protocol, morbidity, mortality, hospital stay, and readmission were evaluated. Bariatric techniques performed included 68 Roux-en-Y gastric bypass (54.4%) and 57 laparoscopic sleeve gastrectomy (45.6%) cases. All surgeries were laparoscopically performed with conversion in only 1 case (0.8%). Median postoperative pain evaluated by visual analogic scale 24 hours after surgery was 2 (range, 0 to 5). Postoperative nausea or vomiting appeared in 7 patients (5.6%). Complications appeared in 6 patients (4.8%). The reoperation rate was 4%. The mortality rate was 0.8%. The median hospital stay was 2 days (range, 2 to 10 d) and readmission rate was 2.4%. The compliance of all the items of the protocol was achieved in 78.4% of the patients. The Spanish National ERAS protocol is a safe issue with a high implementation rate. It can be recommended to establish this protocol to other institutions.

  8. Team training to establish a safety culture in dialysis access surgery.

    Science.gov (United States)

    Davidson, Ingemar; Widmer, Matthias K; Nolen, Billy; Ross, John; Slakey, Douglas P

    2015-01-01

    Operating room (OR) team safety training and learning in the field of dialysis access is well suited for the use of simulators, simulated case learning and root cause analysis of adverse outcomes. The objectives of OR team training are to improve communication and leadership skills, to use checklists and to prevent errors. Other objectives are to promote a change in the attitudes towards vascular access from learning through mistakes in a nonpunitive environment, to positively impact the employee performance and to increase staff retention by making the workplace safer, more efficient and user friendly. © 2015 S. Karger AG, Basel

  9. A multicenter,phase III trial of hemocoagulase Agkistrodon:hemostasis,coagulation,and safety in patients undergoing abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    WEI Jun-min; LI Jie; XU Jing-yong; ZHENG Qing-shan; ZHU Ming-wei; ZHANG Zhong-tao; JIA Zhen-geng; HE Xiao-dong; WAN Yuan-lian; WANG Shan; XIU Dian-rong; TANG Yun

    2010-01-01

    Background Hemocoagulase Agkistrodon for injection is a single component thrombin which has passed phases I and II clinical trials. The purpose of this phase III clinical trial was to evaluate the effect of Hemocoagulase Agkistrodon on hemostasis and coagulation in abdominal skin and subcutaneous incisions and to assess the safety of this agent in surgical patients. Methods This is a phase III, prospective, randomized, double-blind, and controlled multicenter clinical trial including 432 consecutive patients randomized into either a study group (injected with hemocoagulase Agkistrodon at 2 U, n=324) or a control group (injected with hemocoagulase Atrox, n=108). The hemostatic time, hemorrhagic volume, hemorrhagic volume per unit area, blood coagulation, and adverse events were measured and compared between the two groups. Results The mean hemostatic time in the study group was (36.8±18.7) seconds; the hemorrhagic volume was (3.77±3.93) g; and the hemorrhagic volume per unit area was (0.091±0.125) g/cm~2. In the control group, the corresponding values were (38.1±19.7) seconds, (4.00±4.75) g, and (0.095±0.101) g/cm~2, respectively. No significant difference in values existed between the two groups (P >0.05). Blood coagulation results and hepatic and renal function were also similar between the two groups. Adverse events were reported in two cases, but were deemed non-drug-related. Conclusions Hemocoagulase Agkistrodon has good hemostatic and coagulative function and is safe for the use of arresting capillary hemorrhage that occurs while incising the abdomen during surgery.

  10. Priority setting and cardiac surgery: a qualitative case study.

    Science.gov (United States)

    Walton, Nancy A; Martin, Douglas K; Peter, Elizabeth H; Pringle, Dorothy M; Singer, Peter A

    2007-03-01

    The purpose of this study is to describe priority setting in cardiac surgery and evaluate it using an ethical framework, "accountability for reasonableness". Cardiac surgery is an expensive part of hospital budgets. Priority setting decisions are made daily regarding ever increasing volumes of patients. While much attention has been paid to the management of cardiac surgery waiting lists, little empirical research exists into the way actual decision makers deliberate upon and resolve priority setting decisions on a daily basis. A key goal of priority setting, in cardiac surgical areas as well as others, is fairness. "Accountability for reasonableness" is a leading ethical framework for fair priority setting, and can be used to identify opportunities for improvement (i.e. make it fairer) and highlight good practices. A case study was conducted to examine the process of priority setting processes at three University of Toronto affiliated cardiac surgery centres. Relevant documents were examined, weekly triage rounds were observed for 27 months, and interviews were carried out with 23 key participants including cardiac surgeons, cardiologists, and triage nurses. In data analysis, the conditions of "accountability for reasonableness" (relevance, publicity, appeals and enforcement) were used as an analytic lens. While decisions may appear to be based strictly upon clinical criteria (e.g. coronary anatomy); non-clinical criteria also have an impact upon decision-making (e.g. patients' lifestyle choices, type of surgical practice and departmental constraints on resource use). Participants stated that these factors influence their decision-making and can result in unfair and inconsistent decisions. PUBLICITY: Non-clinical reasons are not publicly accessible, nor are they clearly acknowledged in discussions between cardiac clinicians. APPEALS: There are mechanisms for challenging decisions however without access to the non-clinical reasons, this can be problematic

  11. Efficacy and Safety of Antifibrinolytic Agents in Reducing Perioperative Blood Loss and Transfusion Requirements in Scoliosis Surgery: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Meng Wang

    Full Text Available Routine use of antifibrinolytic agents in spine surgery is still an issue of debate.To gather scientific evidence for the efficacy and safety of antifibrinolytic agents including aprotinin, tranexamic acid (TXA and epsilon aminocaproic acid (EACA, traditionally known as Amicar in reducing perioperative blood loss and transfusion requirements in scoliosis surgery.We conducted a systematic review and meta-analysis for randomized controlled trials (RCTs, retrospective case-control studies, and retrospective cohort studies on the use of antifibrinolytic agents in scoliosis surgery by searching in the MEDLINE and EMBASE databases and the Cochrane Database of Systematic Reviews and Controlled Trials of papers published from January 1980 through July 2014. Safety of the antifibrinolytic agents was evaluated in all included studies, while efficacy was evaluated in RCTs.Eighteen papers with a total of 1,158 patients were eligible for inclusion in this study. Among them, 8 RCTs with 450 patients were included for evaluation of pharmacologic efficacy (1 RCT was excluded because of a lack of standard deviation data. Mean blood loss was reduced in patients with perioperative use of antifibrinolytic agents by 409.25 ml intraoperatively (95% confidence interval [CI], 196.57-621.94 ml, 250.30 ml postoperatively (95% CI, 35.31-465.30, and 601.40 ml overall (95% CI, 306.64-896.16 ml. The mean volume of blood transfusion was reduced by 474.98 ml (95% CI, 195.30-754.67 ml. The transfusion rate was 44.6% (108/242 in the patients with antifibrinolytic agents and 68.3% (142/208 in the patients with placebo. (OR 0.38; 95% CI; 0.25-0.58; P<0.00001, I2 = 9%. All studies were included for evaluation of safety, with a total of 8 adverse events reported overall (4 in the experimental group and 4 in the control group.The systematic review and meta-analysis indicated that aprotinin, TXA, and EACA all significantly reduced perioperative blood loss and transfusion requirements

  12. Safety Culture Enhancement Project. Final Report. A Field Study on Approaches to Enhancement of Safety Culture

    Energy Technology Data Exchange (ETDEWEB)

    Lowe, Andrew; Hayward, Brent (Dedale Asia Pacific, Albert Park VIC 3206 (Australia))

    2006-08-15

    This report documents a study with the objective of enhancing safety culture in the Swedish nuclear power industry. A primary objective of this study was to ensure that the latest thinking on human factors principles was being recognised and applied by nuclear power operators as a means of ensuring optimal safety performance. The initial phase of the project was conducted as a pilot study, involving the senior management group at one Swedish nuclear power-producing site. The pilot study enabled the project methodology to be validated after which it was repeated at other Swedish nuclear power industry sites, providing a broad-ranging analysis of opportunities across the industry to enhance safety culture. The introduction to this report contains an overview of safety culture, explains the background to the project and sets out the project rationale and objectives. The methodology used for understanding and analysing the important safety culture issues at each nuclear power site is then described. This section begins with a summary of the processes used in the information gathering and data analysis stage. The six components of the Management Workshops conducted at each site are then described. These workshops used a series of presentations, interactive events and group exercises to: (a) provide feedback to site managers on the safety culture and safety leadership issues identified at their site, and (b) stimulate further safety thinking and provide 'take-away' information and leadership strategies that could be applied to promote safety culture improvements. Section 3, project Findings, contains the main observations and output from the project. These include: - a brief overview of aspects of the local industry operating context that impinge on safety culture; - a summary of strengths or positive attributes observed within the safety culture of the Swedish nuclear industry; - a set of identified opportunities for further improvement; - the aggregated

  13. Safety of robotic general surgery in elderly patients.

    Science.gov (United States)

    Buchs, Nicolas C; Addeo, Pietro; Bianco, Francesco M; Ayloo, Subhashini; Elli, Enrique F; Giulianotti, Pier C

    2010-08-01

    As the life expectancy of people in Western countries continues to rise, so too does the number of elderly patients. In parallel, robotic surgery continues to gain increasing acceptance, allowing for more complex operations to be performed by minimally invasive approach and extending indications for surgery to this population. The aim of this study is to assess the safety of robotic general surgery in patients 70 years and older. From April 2007 to December 2009, patients 70 years and older, who underwent various robotic procedures at our institution, were stratified into three categories of surgical complexity (low, intermediate, and high). There were 73 patients, including 39 women (53.4%) and 34 men (46.6%). The median age was 75 years (range 70-88 years). There were 7, 24, and 42 patients included, respectively, in the low, intermediate, and high surgical complexity categories. Approximately 50% of patients underwent hepatic and pancreatic resections. There was no statistically significant difference between the three groups in terms of morbidity, mortality, readmission or transfusion. Mean overall operative time was 254 ± 133 min (range 15-560 min). Perioperative mortality and morbidity was 1.4% and 15.1%, respectively. Transfusion rate was 9.6%, and median length of stay was 6 days (range 0-30 days). Robotic surgery can be performed safely in the elderly population with low mortality, acceptable morbidity, and short hospital stay. Age should not be considered as a contraindication to robotic surgery even for advanced procedures.

  14. A prospective clinical study of polycarboxylate cement in periapical surgery

    OpenAIRE

    Peñarrocha Diago, María; Ortega Sánchez, Bárbara; García Mira, Berta; Maestre Ferrín, Laura; Peñarrocha Oltra, David; Gay Escoda,Cosme

    2012-01-01

    Objective: To evaluate the clinical efficacy of polycarboxylate cement as retrograde filling material. Design: A prospective clinical study was made of 25 patients subjected to periapical surgery with ultrasound and magnifying loupes, in which polycarboxylate cement was used as retrograde filling material. Measurements were made of the area and diameter of the lesions pre- and postoperatively, and 6 and 12 months after the operation. The apical resection and retrograde filling areas were also...

  15. Efficacy and Safety of Antifibrinolytic Agents in Reducing Perioperative Blood Loss and Transfusion Requirements in Scoliosis Surgery: A Systematic Review and Meta-Analysis

    OpenAIRE

    Meng Wang; Xin-Feng Zheng; Lei-Sheng Jiang

    2015-01-01

    Background Routine use of antifibrinolytic agents in spine surgery is still an issue of debate. Objective To gather scientific evidence for the efficacy and safety of antifibrinolytic agents including aprotinin, tranexamic acid (TXA) and epsilon aminocaproic acid (EACA, traditionally known as Amicar) in reducing perioperative blood loss and transfusion requirements in scoliosis surgery. Methods We conducted a systematic review and meta-analysis for randomized controlled trials (RCTs), retrosp...

  16. Immediate postoperative complications in transsphenoidal pituitary surgery: A prospective study

    Directory of Open Access Journals (Sweden)

    Tumul Chowdhury

    2014-01-01

    Full Text Available Background: Considering the important role of pituitary gland in regulating various endocrine axes and its unique anatomical location, various postoperative complications can be anticipated resulting from surgery on pituitary tumors. We examined and categorized the immediate postoperative complications according to various tumor pathologies. Materials and Methods: We carried out a prospective study in 152 consecutive patients and noted various postoperative complications during neurosurgical intensive care unit stay (within 48 hrs of hospital stay in patients undergoing transsphenoidal removal of pituitary tumors. Results: In our series, various groups showed different postoperative complications out of which, cerebrospinal fluid leak was the commonest followed by diabetes insipidus, postoperative nausea and vomiting, and hematoma at operation site. Conclusion: Various immediate postoperative complications can be anticipated in transsphenoidal pituitary surgery even though, it is considered to be relatively safe.

  17. Clinical study of a new approach to thoracolumbar surgery

    Institute of Scientific and Technical Information of China (English)

    LIU Gang; ZHAO Jian-ning; Akira Dezawa

    2008-01-01

    Objective: The conventional approaches for treatment of thoracolumbar diseases require extensive surgical exposure, often leading to postoperative pain and morbidity. Thoracoscopic-assisted surgery in these regions usually requires an extended recovery period due to the placement of drainage. We developed an innovative retro-peritoneal-extrapleural approach to thoracolumbar involvement by an extra-diaphragmatic technique using dedicated instruments. Neither incision nor reconstruction of the diaphragm was necessary. Exposure to the lateral part of the thoracolumbar vertebrae could be achieved without crus resection. This study is aimed to evaluate the clinical outcomes of this new surgical procedure. Methods: A total of 9 cases (5 cases of thoracolumbar fracture-dislocation, 1 each of spinal infection, tumor, thoracolumbar scoliosis and ossification of posterior longitudinal ligament) were subjected to the study. The average of the patients was 52.3 years. The results were com pared with the control group consisting of thoracoscopic surgery subgroup (5 patients, mean age 52.1 years) and conventional surgery subgroup (12 patients, mean age 61.3 years). Results: Compared with the control group, the average period of bed confinement and mean intra- and post-operative blood loss decreased significantly. Pulmonary complications were avoided in all cases. The surgical time was shortened, postoperative pain was reduced, and early postoperative ambulation became possible. Conclusion: The diaphragm-preserving retroperito-neal-extrapleural approach that we developed is a valid minimally invasive alternative for the treatment of thora-columbar diseases.

  18. The surgery-first approach in orthognathic surgery: a retrospective study of 50 cases.

    Science.gov (United States)

    Yu, H B; Mao, L X; Wang, X D; Fang, B; Shen, S G

    2015-12-01

    The surgery-first approach (SFA), without presurgical orthodontic treatment, has become favoured in the treatment of dentomaxillofacial deformities. This approach has been applied in our institution since 2012. The purpose of this study was to report our experience with the SFA for skeletal malocclusion. Fifty patients with skeletal malocclusions were enrolled in this study (11 bimaxillary protrusion, 27 skeletal class III malocclusion, and 12 facial asymmetry). After orthognathic-orthodontic consultation, suitability for SFA was determined and a treatment plan drawn up. Patients then underwent orthognathic surgery, which included Le Fort I maxillary osteotomy, bilateral sagittal split ramus osteotomy, subapical osteotomy, and genioplasty. Postoperative orthodontic treatment was started after a healing period of 2 weeks. The mean postoperative orthodontic treatment duration was 14.9 months, which is shorter than that of traditional joint orthognathic-orthodontic treatment. In the bimaxillary protrusion group, this was about 19 months, which was longer than for the other groups. After joint orthognathic-orthodontic treatment, a good facial profile and ideal occlusion were achieved. With the advantages of earlier improvements in patient facial aesthetics and dental function, the reduction in difficulty and treatment duration of orthodontic management, and increasing patient acceptance, SFA is regarded as an ideal and valuable alternative for this potentially complicated procedure.

  19. "Hardware breakage in spine surgery (A retrospective clinical study "

    Directory of Open Access Journals (Sweden)

    "Sadat MM

    2001-11-01

    Full Text Available This was a retrospective review of a consecutive series of patients with spinal disease in year 2000, who underwent posterior fusion and instrumentation with Harrington distraction and Cotrel-Dobousset system to evaluate causes of hardware failure. Many cases of clinical failure has been observed in spinal instrumentation used in spinal disorder like spondylolisthesis, fractures, deformities, … . Thirty six cases that were operated because of spinal disorders like spondylolisthesis, fractures, deformities, …, were included in this study. Seventeen of this cases had breakage of device. Factors like age at surgery, type of instrumentation, angles before and after surgery and …, were compared in two groups of patients. The most common instrument breakage was pedicle screw breakage. Pseudoarthrosis was the main factor that was presented in failure group (P value<0.001. Other important causes were, age of patient at surgery (P value=0.04, pedicle screw placement off center in the sagittal or coronal plane of the pedicle (P value=0.04. Instrumentation loads increased significantly as a direct result of variations in surgical technique that produce pseudoarthrosis, pedicle screw placement off center in the sagittal plane of the pedicle, or using less than 6 mm diameter screw. This factor can be prevented with meticulous surgical technique and using proper devices.

  20. Short- and long-term outcomes of laparoscopic surgery vs open surgery for transverse colon cancer: a retrospective multicenter study

    Directory of Open Access Journals (Sweden)

    Kim JW

    2016-04-01

    Full Text Available Jong Wan Kim,1 Jeong Yeon Kim,1 Byung Mo Kang,2 Bong Hwa Lee,3 Byung Chun Kim,4 Jun Ho Park5 1Department of Surgery, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong Si, 2Department of Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon Si, 3Department of Surgery, Hallym Sacred Heart Hospital, College of Medicine, Hallym University, Anyang Si, 4Department of Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, 5Department of Surgery, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea Purpose: The purpose of the present study was to compare the perioperative and oncologic outcomes between laparoscopic surgery and open surgery for transverse colon cancer.Patients and methods: We conducted a retrospective review of patients who underwent surgery for transverse colon cancer at six Hallym University-affiliated hospitals between January 2005 and June 2015. The perioperative outcomes and oncologic outcomes were compared between laparoscopic and open surgery.Results: Of 226 patients with transverse colon cancer, 103 underwent laparoscopic surgery and 123 underwent open surgery. There were no differences in the patient characteristics between the two groups. Regarding perioperative outcomes, the operation time was significantly longer in the laparoscopic group than in the open group (267.3 vs 172.7 minutes, P<0.001, but the time to soft food intake (6.0 vs 6.6 days, P=0.036 and the postoperative hospital stay (13.7 vs 15.7 days, P=0.018 were shorter in the laparoscopic group. The number of harvested lymph nodes was lower in the laparoscopic group than in the open group (20.3 vs 24.3, P<0.001. The 5-year overall survival (90.8% vs 88.6%, P=0.540 and disease-free survival (86.1% vs 78.9%, P=0.201 rates were similar in both groups.Conclusion: The present study showed that laparoscopic surgery is associated

  1. Transobturator surgery in presence of corona mortis: a study in 13 women.

    Science.gov (United States)

    Castellani, Daniele; Saldutto, Pietro; Galica, Vikiela; Masciovecchio, Stefano; Galatioto, Giuseppe Paradiso; Vicentini, Carlo

    2016-11-18

    Severe and life-threatening bleeding has been reported in the literature after retropubic mid-urethral slings procedure, due to corona mortis damage. The aim of this study is to evaluate safety of transobturator passage of the tape in stress-urinary incontinence (SUI) correction and anchoring the mesh in pelvic-organ prolapse (POP) repair in the presence of corona mortis. Thirteen women with a pre-operatory contrast-enhanced abdominal multidetector computed tomography were prospectively enrolled in the study between January 2009 and December 2014. Eight women underwent a Monarc® and one a Spark® Sling System procedures for SUI correction, and three an Elevate® Anterior and Apical prolapse system and one a Perigee procedure to repair anterior/apical POP. All procedures were performed by a single experienced pelvic surgeon. Surgery was uneventful in all cases. No major bleeding was seen during surgery. No pelvic hematoma was identified 24 hours after the procedure. All women were discharged 1 day after surgery. Transobturator surgery seems to be a safe way in the presence of the corona mortis. However, further studies are needed to confirm these preliminary findings.

  2. Safety Culture Enhancement Project. Final Report. A Field Study on Approaches to Enhancement of Safety Culture

    Energy Technology Data Exchange (ETDEWEB)

    Lowe, Andrew; Hayward, Brent (Dedale Asia Pacific, Albert Park VIC 3206 (Australia))

    2006-08-15

    This report documents a study with the objective of enhancing safety culture in the Swedish nuclear power industry. A primary objective of this study was to ensure that the latest thinking on human factors principles was being recognised and applied by nuclear power operators as a means of ensuring optimal safety performance. The initial phase of the project was conducted as a pilot study, involving the senior management group at one Swedish nuclear power-producing site. The pilot study enabled the project methodology to be validated after which it was repeated at other Swedish nuclear power industry sites, providing a broad-ranging analysis of opportunities across the industry to enhance safety culture. The introduction to this report contains an overview of safety culture, explains the background to the project and sets out the project rationale and objectives. The methodology used for understanding and analysing the important safety culture issues at each nuclear power site is then described. This section begins with a summary of the processes used in the information gathering and data analysis stage. The six components of the Management Workshops conducted at each site are then described. These workshops used a series of presentations, interactive events and group exercises to: (a) provide feedback to site managers on the safety culture and safety leadership issues identified at their site, and (b) stimulate further safety thinking and provide 'take-away' information and leadership strategies that could be applied to promote safety culture improvements. Section 3, project Findings, contains the main observations and output from the project. These include: - a brief overview of aspects of the local industry operating context that impinge on safety culture; - a summary of strengths or positive attributes observed within the safety culture of the Swedish nuclear industry; - a set of identified opportunities for further improvement; - the aggregated

  3. Behavior-based safety on construction sites: a case study.

    Science.gov (United States)

    Choudhry, Rafiq M

    2014-09-01

    This work presents the results of a case study and describes an important area within the field of construction safety management, namely behavior-based safety (BBS). This paper adopts and develops a management approach for safety improvements in construction site environments. A rigorous behavioral safety system and its intervention program was implemented and deployed on target construction sites. After taking a few weeks of safety behavior measurements, the project management team implemented the designed intervention and measurements were taken. Goal-setting sessions were arranged on-site with workers' participation to set realistic and attainable targets of performance. Safety performance measurements continued and the levels of performance and the targets were presented on feedback charts. Supervisors were asked to give workers recognition and praise when they acted safely or improved critical behaviors. Observers were requested to have discussions with workers, visit the site, distribute training materials to workers, and provide feedback to crews and display charts. They were required to talk to operatives in the presence of line managers. It was necessary to develop awareness and understanding of what was being measured. In the process, operatives learned how to act safely when conducting site tasks using the designed checklists. Current weekly scores were discussed in the weekly safety meetings and other operational site meetings with emphasis on how to achieve set targets. The reliability of the safety performance measures taken by the company's observers was monitored. A clear increase in safety performance level was achieved across all categories: personal protective equipment; housekeeping; access to heights; plant and equipment, and scaffolding. The research reveals that scores of safety performance at one project improved from 86% (at the end of 3rd week) to 92.9% during the 9th week. The results of intervention demonstrated large decreases in

  4. Efficacy and safety of uterine manipulators in laparoscopic surgery: a review

    NARCIS (Netherlands)

    Van den Haak, L.; Alleblas, C.; Nieboer, T.E.; Rhemrev, J.P.; Jansen, F.W.

    2015-01-01

    Purpose This review aims to objectively assess the efficacy and safety of uterine manipulators as reported in scientific literature. Furthermore, it evaluates as to which manipulator best suits which surgical procedure. Methods PubMed, Embase, Web of Science, COCHRANE, CINAHL, Academic Search Premi

  5. Efficacy and safety of uterine manipulators in laparoscopic surgery: a review

    NARCIS (Netherlands)

    Haak, L. van den; Alleblas, C.; Nieboer, T.E.; Rhemrev, J.P.; Jansen, F.W.

    2015-01-01

    PURPOSE: This review aims to objectively assess the efficacy and safety of uterine manipulators as reported in scientific literature. Furthermore, it evaluates as to which manipulator best suits which surgical procedure. METHODS: PubMed, Embase, Web of Science, COCHRANE, CINAHL, Academic Search Prem

  6. Efficacy and safety of uterine manipulators in laparoscopic surgery: a review

    NARCIS (Netherlands)

    Haak, L. van den; Alleblas, C.; Nieboer, T.E.; Rhemrev, J.P.; Jansen, F.W.

    2015-01-01

    PURPOSE: This review aims to objectively assess the efficacy and safety of uterine manipulators as reported in scientific literature. Furthermore, it evaluates as to which manipulator best suits which surgical procedure. METHODS: PubMed, Embase, Web of Science, COCHRANE, CINAHL, Academic Search

  7. Efficacy and safety of uterine manipulators in laparoscopic surgery: a review

    NARCIS (Netherlands)

    Van den Haak, L.; Alleblas, C.; Nieboer, T.E.; Rhemrev, J.P.; Jansen, F.W.

    2015-01-01

    Purpose This review aims to objectively assess the efficacy and safety of uterine manipulators as reported in scientific literature. Furthermore, it evaluates as to which manipulator best suits which surgical procedure. Methods PubMed, Embase, Web of Science, COCHRANE, CINAHL, Academic Search

  8. Safety Study in Aviation

    OpenAIRE

    2016-01-01

    The objective of this article is to provide a brief look at safety studies, which are a necessary part of every change of system or a new system in aviation. The main focus is put on the area of air traffic management, because it affects most of the aviation stakeholders. The article begins with a description of safety and safety assessment of changes in systems. Then it discusses analysis of processes, hazard identification and risk assessment. Main part focuses on Safety studies and briefly...

  9. Towards a Czech Road Safety Information System : a feasibility study.

    NARCIS (Netherlands)

    Craen, S. de & Wegman, F.

    2003-01-01

    The Czech Republic aims at improving its road safety and in the last years it achieved significant successes in reducing the number of road traffic casualties. Increasingly, road safety measures have to be taken in an effor to lower the number of accidents. A Road Safety Information System (RSIS), w

  10. Two mechanical methods for thromboembolism prophylaxis after gynaecological pelvic surgery: a prospective, randomised study

    Institute of Scientific and Technical Information of China (English)

    GAO Jie; JIANG Ying; ZHAO Na; ZHANG Zhen-yu; LI Zhan; LIU Chong-dong; ZHAN Yu-xin; QIAO Bao-li; SANG Cui-qin; GUO Shu-li; WANG Shu-zhen

    2012-01-01

    Background Venous thromboembolism is known to be an important social and health care problem because of its high incidence among patients who undergo surgery.Studies on the mechanical prophylaxis of thromboembolism after gynaecological pelvic surgery are few.The aim of our study was to evaluate the effect of mechanical thromboembolism prophylaxis after gynaecological pelvic surgery using a combination of graduated compression stockings (GCS) and intermittent pneumatic compression (IPC) or GCS alone.Methods The study was performed on 108 patients who were randomly assigned to two groups.The first group received GCS before the operation and IPC during the operation (IPC+GCS group).The second group received GCS before the operation (GCS group).To analyze the effect of the preventive measures and the laboratory examination on the incidence of thrombosis and to compare the safety of these measures,the incidence of adverse reactions was assessed.Results The morbidity associated with DVT was 4.8% (5/104) in the IPC+GCS group and 12.5% (14/112) in the GCS group.There were significant statistical differences between the two groups.There were no adverse effects in either group.Conclusions The therapeutic combination of GCS and IPC was more effective than GCS alone for thrombosis prevention in high-risk patients undergoing gynaecological pelvic surgery,and there were no adverse effects in either group.(No.ChiCTR-PRC-10000935).

  11. Health care worker safety in surgery.

    Science.gov (United States)

    King, Cecil A

    2011-11-01

    Nursing is ranked as one of the occupations with the most incidences of workplace-related injury and illness. The six types of injury risk specific to the perioperative environment are biological, ergonomic, chemical, physical, psychosocial, and cultural in nature. Strategies to improve safety include the use of engineering controls to change the work environment, the equipment used, and how the work is done; administrative controls, such as implementing policies and procedures to develop a culture of safety; and behavioral controls that individuals can exercise to reduce the risk of injury. In addition, every perioperative RN is responsible for following safety policies and has the responsibility to identify safety hazards, take appropriate actions, and report the hazards through appropriate channels.

  12. Integrating surgery and radiology in one suite: a multicenter study.

    Science.gov (United States)

    ten Cate, Gerben; Fosse, Erik; Hol, Per Kristian; Samset, Eigil; Bock, Richard W; McKinsey, James F; Pearce, Benjamin J; Lothert, Mark

    2004-09-01

    The study was performed to evaluate the performance of digital fixed-mounted angiographic C-arm systems in the operating room as used by surgeons, cardiologists, and interventional radiologists. An observational study in the operating room was performed, along with a structured questionnaire and semi-structured interviews. Twenty interventions were observed at 5 sites. Workflow was analyzed. Integration of high-end angiographic imaging equipment in the operating room enables image-guided surgery with high-quality images, on-table quality assessment of surgical procedures, and "one-stop shopping" procedures. Integrated suites were run by surgery as well as radiology departments, and are used for a variety of procedures, including vascular, cardiothoracic, open surgical, percutaneous, and combined procedures. Operation of the angiographic system and its user interface design were not considered ideal for operating room use. Limited patient accessibility was observed, sometimes leading to uncomfortable positions for the operating physicians. Certain procedures, such as tibial artery surgery, were difficult to perform, owing to lack of accessories. Patient transfer was considered inadequate. Cleaning of the system was rated as poor. Operating room use puts an even higher demand on reliability of the system. Integration of digital angiographic systems into operating rooms has produced opportunities for new treatments and offers a superior solution for interdisciplinary work among surgeons, cardiologists, and radiologists. However, the context of use differs radically from that in the traditional radiologic examination room; the environment, users, and procedures are all different. Integration of imaging methods into the operating room can be more successful if special operating room conditions are taken into account by medical systems manufacturers.

  13. Ocular safety limits for 1030nm femtosecond laser cataract surgery

    Science.gov (United States)

    Wang, Jenny; Sramek, Christopher; Paulus, Yannis M.; Lavinsky, Daniel; Schuele, Georg; Anderson, Dan; Dewey, David; Palanker, Daniel V.

    2013-03-01

    Application of femtosecond lasers to cataract surgery has added unprecedented precision and reproducibility but ocular safety limits for the procedure are not well-quantified. We present an analysis of safety during laser cataract surgery considering scanned patterns, reduced blood perfusion, and light scattering on residual bubbles formed during laser cutting. Experimental results for continuous-wave 1030 nm irradiation of the retina in rabbits are used to calibrate damage threshold temperatures and perfusion rate for our computational model of ocular heating. Using conservative estimates for each safety factor, we compute the limits of the laser settings for cataract surgery that optimize procedure speed within the limits of retinal safety.

  14. STUDYING OF SAFETY CLIMATE ASSESSMENT: A CASE STUDY AT STEEL INDUSTRY

    Directory of Open Access Journals (Sweden)

    Hassan DARVISH

    2011-01-01

    Full Text Available Evolution of safety climate used as a practical means has determined and assessed potential problems relevant to safety issues in an organization and can be used in individuals’ performance and work efficiency and decreasing rate of incidents ;as well as; guidance to provide safety organization policy and comparison of safety performance in different organizations. The study wants to determine and prepare safety climate profile and application of its results in improving safety situation. In this study, applied tools presented by Loughborough University are used to evaluate safety climate in one of steel industries and data is collected through questionnaire, group discussions or purposeful interviews and observations, and safety climate score was obtained in 17 scopes. Calculating the score of each safety climate domain and preparing the profile indicated there is the average rate (4.89 2 in the safety climate of the industry.

  15. A Safety Study of 100 Cases of Air Pneumoperitoneum Laparoscopic Surgery%空气气腹下腹腔镜手术100例的安全性研究

    Institute of Scientific and Technical Information of China (English)

    彭毅; 莫灿荣; 何立锐; 郑俊城

    2016-01-01

    Objective To investigate the values of air pneumoperitoneum laparoscopic surgery for intra -abdominal diseases . Methods From November 2013 to October 2015, there were a total of 100 cases of abdominal diseases .By using an improved “flush and suction pump” system for pneumoperitoneum , the filtered air sterilization for abdominal distention medium was pumped into the abdomen.The laparoscopic surgery was performed with conventional laparoscopic equipments and instruments .The heart rate, blood pressure (BP), respiration (R), blood oxygen saturation(SpO2), PETCO2, and postoperative complications were analyzed . Results The operations were successfully accomplished in 97 cases.No conversion to open surgery was needed .The operating time was 20-170 min (mean, 40 min).During laparoscopic surgery, no significant changes were found in BP , heart rate, R, SpO2 and PETCO2, and no abnormal cardiac and pulmonary functions or significant decrease of blood oxygen saturation .No air embolism or body blasting occurred.In 3 cases, CO2 pneumoperitoneum was used actively during the operation to perform the irrigation and suction of blood clot , bile, and decompression of biliary tract.Postoperative hospital stay was 1-9 d (mean, 3 d).No incisional infection happened.Clinic follow-up reviews for 3 months showed recovery of normal daily life and working . Conclusions Air pneumoperitoneum laparoscopic surgery is safe and feasible .The portable “flush and suction pump” system has both functions of abdominal insufflation and gas injection, having complementary advantages with CO 2 pneumoperitoneum and gasless apparatus .%目的探讨空气气腹下腹腔镜手术在腹腔内疾病中的临床应用价值。方法2013年11月~2015年10月我们对100例采用改良“冲洗吸引泵”体系作为气腹机,将过滤灭菌的空气作为膨腹介质泵入腹内,气腹压维持在(10±4) mm Hg,使用常规腹腔镜设备和操作器械来完成腹腔镜手术操作,

  16. Core Outcomes for Colorectal Cancer Surgery: A Consensus Study.

    Directory of Open Access Journals (Sweden)

    Angus G K McNair

    2016-08-01

    Full Text Available Colorectal cancer (CRC is a major cause of worldwide morbidity and mortality. Surgical treatment is common, and there is a great need to improve the delivery of such care. The gold standard for evaluating surgery is within well-designed randomized controlled trials (RCTs; however, the impact of RCTs is diminished by a lack of coordinated outcome measurement and reporting. A solution to these issues is to develop an agreed standard "core" set of outcomes to be measured in all trials to facilitate cross-study comparisons, meta-analysis, and minimize outcome reporting bias. This study defines a core outcome set for CRC surgery.The scope of this COS includes clinical effectiveness trials of surgical interventions for colorectal cancer. Excluded were nonsurgical oncological interventions. Potential outcomes of importance to patients and professionals were identified through systematic literature reviews and patient interviews. All outcomes were transcribed verbatim and categorized into domains by two independent researchers. This informed a questionnaire survey that asked stakeholders (patients and professionals from United Kingdom CRC centers to rate the importance of each domain. Respondents were resurveyed following group feedback (Delphi methods. Outcomes rated as less important were discarded after each survey round according to predefined criteria, and remaining outcomes were considered at three consensus meetings; two involving international professionals and a separate one with patients. A modified nominal group technique was used to gain the final consensus. Data sources identified 1,216 outcomes of CRC surgery that informed a 91 domain questionnaire. First round questionnaires were returned from 63 out of 81 (78% centers, including 90 professionals, and 97 out of 267 (35% patients. Second round response rates were high for all stakeholders (>80%. Analysis of responses lead to 45 and 23 outcome domains being retained after the first and

  17. On safety management and nuclear safety - A frame of reference for studies of safety management with examples from non-nuclear contects of relevance for nuclear safety

    Energy Technology Data Exchange (ETDEWEB)

    Svenson, O.; Allwin, P. [Stockholm Univ. (Sweden); Salo, I. [Lund Univ. (Sweden)

    2004-03-01

    The report includes three case studies of safety management. The studies are presented as chapters, but are written in a format that makes them easy to read separately. Two of the studies cover regulators (the Swedish Civil Aviation Safety Authority, Luftfartsinspektionen) and the Norwegian Petroleum Directorate) and one a regulated activity/industry (a car manufacturer, Volvo Car). The introduction outlines a living system framework and relates this to concepts used in organizational management. The report concludes with some findings with potential relevance for safety management in the nuclear power domain. In the next phase of the work, the regulated counterparts of the regulators here will be investigated in addition to a fourth case study of a regulated activity/industry. (au)

  18. Retinal safety of near-infrared lasers in cataract surgery

    Science.gov (United States)

    Wang, Jenny; Sramek, Christopher; Paulus, Yannis M.; Lavinsky, Daniel; Schuele, Georg; Anderson, Dan; Dewey, David; Palanker, Daniel

    2012-09-01

    Femtosecond lasers have added unprecedented precision and reproducibility to cataract surgery. However, retinal safety limits for the near-infrared lasers employed in surgery are not well quantified. We determined retinal injury thresholds for scanning patterns while considering the effects of reduced blood perfusion from rising intraocular pressure and retinal protection from light scattering on bubbles and tissue fragments produced by laser cutting. We measured retinal damage thresholds of a stationary, 1030-nm, continuous-wave laser with 2.6-mm retinal spot size for 10- and 100-s exposures in rabbits to be 1.35 W (1.26 to 1.42) and 0.78 W (0.73 to 0.83), respectively, and 1.08 W (0.96 to 1.11) and 0.36 W (0.33 to 0.41) when retinal perfusion is blocked. These thresholds were input into a computational model of ocular heating to calculate damage threshold temperatures. By requiring the tissue temperature to remain below the damage threshold temperatures determined in stationary beam experiments, one can calculate conservative damage thresholds for cataract surgery patterns. Light scattering on microbubbles and tissue fragments decreased the transmitted power by 88% within a 12 deg angle, adding a significant margin for retinal safety. These results can be used for assessment of the maximum permissible exposure during laser cataract surgery under various assumptions of blood perfusion, treatment duration, and scanning patterns.

  19. Seguridad del paciente en la cirugía refractiva con láser Safety of the patients in the refractive surgery with laser

    Directory of Open Access Journals (Sweden)

    Yureisi Labarrere Cruz

    2012-06-01

    Full Text Available Objetivo: Describir aspectos relacionados con la seguridad del paciente en la cirugía refractiva con láser y enumerar las medidas para disminuir el riesgo de complicaciones. Métodos: Se realizó un estudio descriptivo transversal. El universo de estudio y la muestra se conformó por 11 720 ojos correspondientes a 5 955 pacientes que fueron intervenidos de cirugía refractiva con láser de excímeros entre los años 2005 y 2009 en el salón de cirugía refractiva del Instituto Cubano de Oftalmología "Ramón Pando Ferrer". Los datos se presentaron en tablas y gráficos, procesados en el paquete estadístico Statgraph Plus 50. Resultados: El número de ojos operados tuvo un aumento progresivo y su mayor representación en los años 2008 y 2009 (24,5 % y 25,1 %, respectivamente. Las complicaciones representaron 0,74 % del total de ojos intervenidos y con tendencia a la disminución en el tiempo. Conclusión: Existe un aumento en la demanda de la cirugía refractiva por láser en nuestro medio para la corrección de los defectos refractivos. Es necesario cumplir un conjunto de medidas que disminuyen la presencia de complicaciones, así se brinda mayor seguridad al paciente.Objective: To Identify and to describe aspects of the patient's safety in the refractive surgery with laser, as well as the measures to reduce the risk of complications. Methods: A cross-sectional descriptive study was undertaken. The universe of study was the sample of 11 720 eyes from 5 955 patients who had undergone refractive surgery with excímer laser from 2005 to 2009 in Refractive Surgery service of ¨Ramón Pando Ferrer¨ Cuban Institute of Ophthalmology. Data was processed by Statgraph Plus 50 package and presented in charts and graphics. Results: The number of operated eyes progressively increased and the biggest figure was reached in 2008 and 2009, accounting for 24.5% and 25.1% respectively. The complications occurred in 0.74 % of the total of operated eyes, with a

  20. Efficacy and safety of biodegradable osteofixation devices in oral and maxillofacial surgery : a systematic review

    NARCIS (Netherlands)

    Buijs, G. J.; Stegenga, B.; Bos, R. R. M.

    2006-01-01

    The use of osteofixation devices should be evidence-based if uncomplicated bone healing is to be achieved. Numerous studies describe and claim the advantages of biodegradable over titanium devices as a bone fixation method. Here, we systematically review the available literature to determine the cli

  1. Mortality after surgery in Europe: a 7 day cohort study

    NARCIS (Netherlands)

    Pearse, R.M.; Moreno, R.P.; Bauer, P.; Pelosi, P.; Metnitz, P.; Spies, C.; Vallet, B.; Vincent, J.L.; Hoeft, A.; Rhodes, A.; Pickkers, P.; Bouw, M.P.

    2012-01-01

    BACKGROUND: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an intern

  2. Pyoderma gangrenosum mimicking mediastinitis after cardiac surgery: a case study.

    Science.gov (United States)

    Hysi, I; Vincentelli, A

    2016-06-01

    Pyoderma gangrenosum is a dermatosis which associates both, necrosis and polynuclear infiltration of the skin. While the aetiology is not well understood, the disease is thought to be due to immune system dysfunction and it can occur after minor trauma or surgery. Although it has seldom been reported after cardiac surgery in the literature, it is not exceptional. Here we report a case of pyoderma gangrenosum after coronary artery bypass grafting in a 76-year-old patient with chronic idiopathic myelofibrosis. Diagnosis was clinically made and the patient was treated with systemic steroids. The lesions showed a remarkable improvement with this therapy. In the field of cardiac surgery, physicians of the surgical team and nurses should think about this diagnosis in all rapidly expanding postoperative lesions without improvement after debridement or antibiotics. The authors have no conflicts of interest to declare.

  3. Intracranial hemorrhage requiring surgery in neurosurgical patients given ketorolac: a case-control study within a cohort (2001-2010).

    Science.gov (United States)

    Magni, Giuseppina; La Rosa, Italia; Melillo, Guido; Abeni, Damiano; Hernandez, Helssy; Rosa, Giovanni

    2013-02-01

    Ketorolac tromethamine (ketorolac) is a nonsedating drug with potent analgesic and moderate anti-inflammatory activity, which does not increase the sedation level. The safety of ketorolac with respect to risk of bleeding has been demonstrated in large numbers of patients undergoing general surgery, yet comparable safety data for neurosurgical patients are lacking. We studied the risk of symptomatic bleeding requiring surgery in patients undergoing elective neurosurgical procedures who received ketorolac as analgesic therapy. We established a cohort of patients who had elective intracranial procedures from January 2001 to August 2010 (excluding patients with urgent surgery, coagulopathy, history of anticoagulant or nonsteroidal, anti-inflammatory drug therapy) and verified the occurrence of postcraniotomy intracranial hemorrhage (ICH; detected by computed tomography and requiring surgery) in patients who received or did not receive ketorolac. Then, to control for potential confounders, we conducted a "nested" case-control study within the cohort: cases were defined as patients with ICH; controls were patients without ICH matched in a 2:1 ratio. The cohort included 4086 craniotomy patients (mean age, 52.4±14.3 years, 2124 male, 52%). Of the 1571 patients who received ketorolac (mean dosage, 50±15 mg/d), 8 (0.5%) suffered ICH; of the 2515 patients who did not receive ketorolac, 35 (1.3%) had ICH (relative risk, 0.37; 95% confidence interval, 0.17-0.79; P=0.007). In the nested case-control study, the adjusted odds ratio for ketorolac administration between the 2 groups was 1.09 (95% confidence interval, 0.35-3.44; P=0.88). Although the adjusted estimate for risk of symptomatic bleeding requiring surgery and ketorolac use is very close to the null effect, it may be not reproducible, and the width of the confidence interval is not conclusive evidence of the safety of ketorolac after elective neurosurgical procedures.

  4. Increasing nurse staffing levels in Belgian cardiac surgery centres: a cost-effective patient safety intervention?

    Science.gov (United States)

    Van den Heede, Koen; Simoens, Steven; Diya, Luwis; Lesaffre, Emmanuel; Vleugels, Arthur; Sermeus, Walter

    2010-06-01

    This paper is a report of a cost-effectiveness analysis from a hospital perspective of increased nurse staffing levels (to the level of the 75th percentile) in Belgian general cardiac postoperative nursing units. A previous study indicated that increasing nurse staffing levels in Belgian general cardiac postoperative nursing units was associated with lower mortality rates. Research is needed to compare the costs of increased nurse staffing levels with benefits of reducing mortality rates. Two types of average national costs were compared. A first calculation included the simulation of an increase in the number of nursing hours per patient day to the 75th percentile for nursing units staffed below that level. For the second calculation (the comparator) we used a 'do nothing' alternative. The most recent available data sources were used for the analysis. Results were expressed in the form of the additional costs per avoided death and the additional costs per life-year gained. The analysis used 2007 costing data. The costs of increasing nurse staffing levels to the 75th percentile in Belgian general cardiac postoperative nursing units amounted to euro1,211,022. Such nurse staffing levels would avoid an estimated number of 45.9 (95% confidence interval: 22.0-69.4) patient deaths per year and generate 458.86 (95% confidence interval: 219.93-693.79) life-years gained annually. This corresponds with incremental cost-effectiveness ratios of euro26,372 per avoided death and euro2639 per life-year gained. Increasing nurse staffing levels appears to be a cost-effective intervention as compared with other cardiovascular interventions.

  5. Safety of amisulpride (Solian): a review of 11 clinical studies.

    Science.gov (United States)

    Coulouvrat, C; Dondey-Nouvel, L

    1999-07-01

    We assessed the overall safety profile of amisulpride based on the results from 11 clinical studies performed in patients suffering from schizophrenia with predominance of positive or negative symptoms. A total of 1933 patients were randomly assigned to treatment with amisulpride (n = 1247) or haloperidol (n = 309), risperidone (n = 113), flupentixol (n = 62) and placebo (n = 202). Safety data collection was performed using open reporting, UKU scales or specific extrapyramidal side-effect scales; electrocardiogram recording and vital signs examination; laboratory data collection. Amisulpride demonstrated a satisfactory global safety profile in the range of doses usually prescribed. The number of patients having at least one extrapyramidal side-effect was higher in haloperidol patients compared with both amisulpride and risperidone patients (50% versus 30% in the two latter groups). For endocrine events, a similar rate was observed between amisulpride and risperidone groups (4% versus 6%, respectively) versus 1% in the haloperidol group. Electrocardiogram results were satisfactory, confirmed by the absence of cardiovascular events. The overall laboratory safety profile of amisulpride did not show clinically relevant abnormalities in liver function tests nor haematological abnormalities. Our extensive clinical data confirm the satisfactory safety profile of amisulpride which is superior to standard reference compounds.

  6. Epilepsy Surgery Series: A Study of 502 Consecutive Patients from a Developing Country

    Directory of Open Access Journals (Sweden)

    Abdulaziz Alsemari

    2014-01-01

    Full Text Available Purpose. To review the postoperative seizure outcomes of patients that underwent surgery for epilepsy at King Faisal Specialist Hospital & Research Centre (KFSHRC. Methods. A descriptive retrospective study for 502 patients operated on for medically intractable epilepsy between 1998 and 2012. The surgical outcome was measured using the ILAE criteria. Results. The epilepsy surgery outcome for temporal lobe epilepsy surgery (ILAE classes 1, 2, and 3 at 12, 36, and 60 months is 79.6%, 74.2%, and 67%, respectively. The favorable 12- and 36-month outcomes for frontal lobe epilepsy surgery are 62% and 52%, respectively. For both parietal and occipital epilepsy lobe surgeries the 12- and 36-month outcomes are 67%. For multilobar epilepsy surgery, the 12- and 36-month outcomes are 65% and 50%, respectively. The 12- and 36-month outcomes for functional hemispherectomy epilepsy surgery are 64.2% and 63%, respectively. According to histopathology diagnosis, mesiotemporal sclerosis (MTS and benign CNS tumors had the best favorable outcome after surgery at 1 year (77.27% and 84.3%, resp., and 3 years (76% and 75%, resp.,. The least favorable seizure-free outcome after 3 years occurred in cases with dual pathology (66.6%. Thirty-four epilepsy patients with normal magnetic resonance imaging (MRI brain scans were surgically treated. The first- and third-year epilepsy surgery outcome of 17 temporal lobe surgeries were (53% and (47% seizure-free, respectively. The first- and third-year epilepsy surgery outcomes of 15 extratemporal epilepsy surgeries were (47% and (33% seizure-free. Conclusion. The best outcomes are achieved with temporal epilepsy surgery, mesial temporal sclerosis, and benign CNS tumor. The worst outcomes are from multilobar surgery, dual pathology, and normal MRI.

  7. Risk factors for incidental durotomy during lumbar surgery: a retrospective study by multivariate analysis.

    Science.gov (United States)

    Chen, Zhixiang; Shao, Peng; Sun, Qizhao; Zhao, Dong

    2015-03-01

    The purpose of the present study was to use a prospectively collected data to evaluate the rate of incidental durotomy (ID) during lumbar surgery and determine the associated risk factors by using univariate and multivariate analysis. We retrospectively reviewed 2184 patients who underwent lumbar surgery from January 1, 2009 to December 31, 2011 at a single hospital. Patients with ID (n=97) were compared with the patients without ID (n=2019). The influences of several potential risk factors that might affect the occurrence of ID were assessed using univariate and multivariate analyses. The overall incidence of ID was 4.62%. Univariate analysis demonstrated that older age, diabetes, lumbar central stenosis, posterior approach, revision surgery, prior lumber surgery and minimal invasive surgery are risk factors for ID during lumbar surgery. However, multivariate analysis identified older age, prior lumber surgery, revision surgery, and minimally invasive surgery as independent risk factors. Older age, prior lumber surgery, revision surgery, and minimal invasive surgery were independent risk factors for ID during lumbar surgery. These findings may guide clinicians making future surgical decisions regarding ID and aid in the patient counseling process to alleviate risks and complications. Copyright © 2015 Elsevier B.V. All rights reserved.

  8. NSAID Use after Bariatric Surgery : a Randomized Controlled Intervention Study

    NARCIS (Netherlands)

    Yska, Jan Peter; Gertsen, Sanneke; Flapper, Gerbrich; Emous, Marloes; Wilffert, Bob; van Roon, Eric N.

    2016-01-01

    Background Use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in bariatric surgery patients. If use of an NSAID is inevitable, a proton pump inhibitor (PPI) should also be used. Aim To determine the effect of an, compared to care-as-usual, additional intervention to reduce NSAID

  9. NSAID Use after Bariatric Surgery : a Randomized Controlled Intervention Study

    NARCIS (Netherlands)

    Yska, Jan Peter; Gertsen, Sanneke; Flapper, Gerbrich; Emous, Marloes; Wilffert, Bob; van Roon, Eric N.

    2016-01-01

    Background Use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in bariatric surgery patients. If use of an NSAID is inevitable, a proton pump inhibitor (PPI) should also be used. Aim To determine the effect of an, compared to care-as-usual, additional intervention to reduce NSAID

  10. A study on drug safety monitoring program in India

    Directory of Open Access Journals (Sweden)

    A Ahmad

    2014-01-01

    Full Text Available Pharmacovigilance is useful in assuring the safety of medicines and protecting the consumers from their harmful effects. A number of single drugs as well as fixed dose combinations have been banned from manufacturing, marketing and distribution in India. An important issue about the availability of banned drugs over the counter in India is that sufficient adverse drug reactions data about these drugs have not been reported. The most common categories of drugs withdrawn in the last decade were nonsteroidal antiinflammatory drugs (28%, antidiabetics (14.28%, antiobesity (14.28%, antihistamines (14.28%, gastroprokinetic drugs (7.14%, breast cancer and infertility drugs (7.14%, irritable bowel syndrome and constipation drugs (7.14% and antibiotics (7.14%. Drug withdrawals from market were made mainly due to safety issues involving cardiovascular events (57.14% and liver damage (14.28%. Majority of drugs have been banned since 3-5 years in other countries but are still available for sale in India. The present study compares the drug safety monitoring systems in the developed countries such as the USA and UK and provides implications for developing a system that can ensure the safety and efficacy of drugs in India. Absence of a gold standard for a drug safety surveillance system, variations in culture and clinical practice across countries makes it difficult for India to completely adopt another country′s practices. There should be a multidisciplinary approach towards drug safety that should be implemented throughout the entire duration spanning from drug discovery to usage by consumers.

  11. A Study on the Enterprises' Safety Management System

    Institute of Scientific and Technical Information of China (English)

    王春芳; Zhulingyun

    2010-01-01

    1. The causes of safety issues in production In general, there are many reasons caused safety risks in production, some are material factors and the others are human's factors. 1) The safety awareness level is low Many local government officers put economic development on first priority,ignoring the importance of safety in production. Especially in recent years,many efforts are made to increase investment;a number of preferential policies being made, which lead to the establishment of many industrial parks.

  12. Children Coping with Surgery through Drawings: A Case Study from a Parenting Class

    Science.gov (United States)

    Broecher, Joachim

    2012-01-01

    This case study illustrates how parents can help their children cope with the fear and pain of surgery by engaging them in expressive drawing. As part of a parenting class that utilized art therapy techniques, a father shared his 6-year-old son's spontaneous drawings that had been created directly before and after surgery. Through guidance by the…

  13. Children Coping with Surgery through Drawings: A Case Study from a Parenting Class

    Science.gov (United States)

    Broecher, Joachim

    2012-01-01

    This case study illustrates how parents can help their children cope with the fear and pain of surgery by engaging them in expressive drawing. As part of a parenting class that utilized art therapy techniques, a father shared his 6-year-old son's spontaneous drawings that had been created directly before and after surgery. Through guidance by the…

  14. Neuronavigation in a developing country: A pilot study of efficacy and limitations in intracranial surgery

    Directory of Open Access Journals (Sweden)

    Dwarakanath S

    2007-01-01

    Full Text Available Context: Neuronavigation provides a patient-specific, three-dimensional (3-D anatomy for preoperative planning and intraoperative navigation. However, the initial and maintenance costs are quite prohibitive, especially in the Indian scenario. Aims : To study the efficacy and limitations of neuronavigation, especially in the Indian scenario. Settings and Design: A prospective nonrandomized study. Materials and Methods : A total of 121 patients underwent intracranial surgery from 2002-2006, in which neuronavigation was used. In this, the initial part, we studied the efficacy and limitations of neuronavigation in the initial 37 patients. The efficacy of the image guidance was graded according to a point′s scale in which points were awarded ranging from 0 to 3. Cranial image guided score (IGS was calculated by the summation of grading during designing the flap/burr hole, delineation of the intraoperative anatomy, navigation and access to the lesion and resection / biopsy of the lesion or completion of the procedure. The scoring ranged from 0-12 and the utility of IGS in cranial neurosurgical procedures was calculated based on the total points for each surgery. Results and Conclusion : Cranial image guidance was useful in a variety of operative steps. Intraoperative approach and navigation was relatively easier with an increase in perception of safety. Limitations of IGS include learning curve, cost and the phenomenon of brain shift. Drawbacks of the study included that this was a subjective rather than a truly objective study and the relatively lesser number of patients. We hope to conduct a larger study with randomization but the question of ethical approval would be a primary concern.

  15. Children's vomiting following posterior fossa surgery: A retrospective study

    Directory of Open Access Journals (Sweden)

    Dundon Belinda

    2009-07-01

    Full Text Available Abstract Background Nausea and vomiting is a problem for children after neurosurgery and those requiring posterior fossa procedures appear to have a high incidence. This clinical observation has not been quantified nor have risk factors unique to this group of children been elucidated. Methods A six year retrospective chart audit at two Canadian children's hospitals was conducted. The incidence of nausea and vomiting was extracted. Hierarchical multivariable logistic regression was used to quantify risk and protective factors at 120 hours after surgery and early vs. late vomiting. Results The incidence of vomiting over a ten day postoperative period was 76.7%. Documented vomiting ranged from single events to greater than 20 over the same period. In the final multivariable model: adolescents (age 12 to Conclusion The incidence of vomiting in children after posterior fossa surgery is sufficient to consider all children requiring these procedures to be at high risk for POV. Nausea requires better assessment and documentation.

  16. The efficacy and safety of enoxaparin versus unfractionated heparin for prevention of deep vein thrombosis in elective cancer surgery. A double blind randomized multicentre trail with venographic assesment

    DEFF Research Database (Denmark)

    Bergkvist, A; Eldor, A; Thorlacius-Ussing, O.

    1997-01-01

    BACKGROUND: Surgery for malignant disease carries a high risk of deep vein thrombosis. The aim of this study was to evaluate the prophylactic effect of a low molecular weight heparin, enoxaparin, 40 mg once daily, beginning 2 h before surgery, compared with that of unfractionated low-dose heparin...

  17. Periapical endodontic surgery: a 3-year follow-up study.

    Science.gov (United States)

    Maddalone, M; Gagliani, M

    2003-03-01

    To monitor the outcome of periradicular surgery in a group of teeth treated with microsurgical technology and ultrasonic root-end preparation. One hundred and twenty-eight teeth with failed conventional root canal treatment were included. The surgical procedure was completed using ultrasonic retrotips and a zinc oxide-EBA (Super Seal, Ogna Pharmaceuticals. Milan, Italy)-reinforced material was used to seal the root end cavities. Lesions were examined radiologically at 1. 3. 6. 12, 24 and 36-month intervals. Radiographs were independently analysed according to a previously published classification. Eight teeth were extracted due to fracture or perforations undetected radiologically: these cases were excluded from the study. Of the 120 teeth examined. the overall success rate was 92.5%; 94 healed with complete bone filling of the surgical cavity, 17 were considered to have healed by apical scar formation, four demonstrated uncertain healing and five were considered failures. Eighty of 120 teeth examined had successfully healed from a radiological point of view within 12 months. No differences in outcome occurred between anterior, premolar and molar teeth. Although all failures occurred in teeth with posts, no statistically significant difference was noted (Mann-Whitney U-test, P = 0.37). Modern surgical endodontic procedures associated and ERA (Super Seal, Ogna Pharmaceuticals, Milan, Italy) root end fillings were successful over 3 years in 92.5% of cases.

  18. Sacrococcygeal pilonidal disease: sinotomy versus excisional surgery, a retrospective study.

    Science.gov (United States)

    Rabie, M Ezzedien; Al Refeidi, Abdullah A; Al Haizaee, Abdullah; Hilal, Saleh; Al Ajmi, Hassan; Al Amri, Abdul Aziz

    2007-03-01

    Pilonidal disease is a disease of relatively young people, the exact aetiology of which is unknown. Treatment options vary from simple incision to complex flap procedures. Each method has its advocates and they all have a variable recurrence rate. The multiplicity of procedures testifies to the lack of an optimal treatment method. The objective of this study is to compare sinotomy, that is, simply laying the sinus open with the more popular radical surgery, where the sinus-bearing tissues are excised. Patients who were admitted to Aseer Central Hospital, Saudi Arabia with a pilonidal sinus or abscess, in the period from April 1999 to January 2005, were identified. The medical records were reviewed and data related to the patient characteristics, disease process and the procedures carried out were noted. Identified patients were contacted by phone to check recurrence of the disease and their abidance to instructions regarding regular hair removal from the area. Eighty-one patients were included in the study. The median age was 24.2 years (range 16-60 years). There were 9 women and 72 men. All procedures were carried out under general anaesthesia except sinotomy, which was carried out under general or local anaesthesia. The surgical procedure was incision and drainage of abscess in 16 cases (19.8%), excision with primary closure in 29 cases (35.8%), excision by the open method in 15 cases (18.5%), sinotomy in 14 cases (17.3%) and rhomboid flap construction in 8 cases (9.9%). The overall recurrence rate was 26.9%, and the mean hospital stay was 4.1 days. Sinotomy had a low recurrence rate (12.5%) and a short hospital stay (2.8 days). Sinotomy has the advantages of simplicity, the possibility of operating under local anaesthesia, with an acceptable recurrence rate. We recommend sinotomy for pilonidal sinus and abscess alike, both in primary and recurrent cases.

  19. [Thymus surgery in a general surgery department].

    Science.gov (United States)

    Mega, Raquel; Coelho, Fátima; Pimentel, Teresa; Ribero, Rui; Matos, Novo de; Araújo, António

    2005-01-01

    Evaluation of thymectomy cases between 1990-2003, in a General Surgery Department. Evaluation of the therapeutic efficacy in Miastenia Gravis patients. Retrospective study based on evaluation of data from Serviço de Cirurgia, Neurologia and Consult de Neurology processes, between 1990-2003, of 15 patients submitted to total thymectomy. 15 patients, aged 17 to 72, 11 female and 4 male. Miastenia Gravis was the main indication for surgery, for uncontrollable symptoms or suspicion of thymoma. In patients with myasthenia, surgery was accomplish after compensation of symptoms. There weren't post-surgery complications. Pathology were divided in thymic hyperplasia and thymoma. Miastenia patients have there symptoms diminished or stable with reduction or cessation of medical therapy. Miastenia was the most frequent indication for thymectomy. Surgery was good results, with low morbimortality, as long as the protocols are respected.

  20. Age and Workers' Perceptions of Workplace Safety: A Comparative Study

    Science.gov (United States)

    Gyekye, Seth Ayim; Salminen, Simo

    2009-01-01

    The study examined the relationship between age and I) safety perception; ii) job satisfaction; iii) compliance with safety management policies; and (iv) accident frequency. Participants were Ghanaian industrial workers (N = 320) categorized into 4 age groups: 19-29 years; 30-39 years; 40-50 years; and 51 years and above. Workplace safety…

  1. Pharmacoepidemiological safety studies in children: a systematic review

    NARCIS (Netherlands)

    O.U. Osokogu (Osemeke); Dukanovic, J. (Julijana); C. Ferrajolo (Carmen); C. Dodd (Caitlin); A.C. Pacurariu (Alexandra C.); W.M. Bramer (Wichor); 'tJong, G. (Geert); D.M. Weibel (Daniel); M.C.J.M. Sturkenboom (Miriam); F. Kaguelidou (Florentia)

    2016-01-01

    textabstractPurpose: In order to identify challenges in pediatric pharmacoepidemiological safety studies, we assessed the characteristics of such (published) studies. Methods: Relevant articles from inception to 2013 were retrieved from Embase and Medline. We sequentially screened titles, abstracts

  2. Motorcycle safety device investigation: A case study on airbags

    Indian Academy of Sciences (India)

    A Chawla; S Mukherjee

    2007-08-01

    The present standard for assessing the effectiveness of safety measures for motorcycle riders defined in ISO 13232 is unique and it incorporates evaluation by computer simulation supplemented by full-scale crash tests. This report describes the process of using FE (Finite Element) simulations to investigate safety options for motorcycle riders. The experience of developing finite element models acceptable as per ISO 13232 standards has been described. The variation in dummy head accelerations on impact with inflating airbags has been studied in an environment acceptable as per ISO 13232 standards. Based on the simulations, it may be concluded that inflating airbags in motorcycles do not pose a significant injury threat.

  3. A Retrospective Study of Combined Cardiac and Carotid Surgery

    Directory of Open Access Journals (Sweden)

    Fabrizio Sansone

    2012-08-01

    Full Text Available Introduction: A combined carotid endarterectomy (CEA and cardiac procedure has higher early risk of stroke than isolated CEA because of the widespread atherosclerosis in patients selected for simultaneous procedures. In this retrospective study, we review the results of combined coronary artery bypass grafting (CABG and carotid endarterectomy (CEA procedures. Materials and methods: Between January 2000 and December 2007, 91 patients with a mean age of 69.2+6.6 (24/67 female/male underwent combined operations (CEA-CABG on cardiopulmonary bypass (CPB as elective surgery. The study population was divided, as follows: Group A: 83 patients (91.2% had both venous and arterial revascularization; Group B: 8 patients (8.8% had total arterial revascularization. CEA was performed in case of stenosis more than 80% and always before cardiac operation. These techniques were used: standard procedure (54.8%, eversion (39.2%, patch enlargement (6%. Immediately after the vascular procedure, CABGs were performed through median sternotomy. The mean EUROscore was 6.9+2.5%. Results: All neurological complications were in the group who underwent both venous and arterial revascularization (Group A, where a proximal anastomosis was made. All complications and deaths were in group A. Six patients had stroke (6.6% and 2 had acute myocardial infarction (AMI (2.2%. There were 8 in-hospital deaths (8.8% and 1 late death (for stroke after five months. Conclusions: In our center, the incidence of stroke in simultaneous cardiovascular procedures was 5.5 times greater than in isolated cardiac or vascular procedures, which was probably related to the widespread vessels disease. An aortic cross clamp and surgical procedure on the ascending aorta are relevant risk factors for developing neurological events; much attention should be paid to aortic manipulation. In the sub-group who underwent total arterial revascularization with associated CEA procedures, we had no neurological

  4. Use and Evaluation of a Cooling Aid in Laser-Assisted Dental Surgery: An Innovative Study.

    Science.gov (United States)

    Bernardi, Sara; Mummolo, Stefano; Zeka, Keti; Pajewski, Leonardo; Continenza, Maria Adelaide; Marzo, Giuseppe

    2016-06-01

    The aim of this study was to evaluate the beneficial effect of NeoHeal during laser-assisted oral surgery. Laser-assisted surgery is a less invasive technique than conventional surgery using a blade; however, the heat produced by the laser can damage tissue proximal to the treated area. We hypothesized the hydrogel NeoHeal could be applied during oral surgery and have similar benefits as those already described for dermatological surgery. In our randomized controlled trial, we first selected 30 patients who were to undergo laser surgical intervention using a diode laser. Both at the end of intervention and at follow-up, each patient filled out a questionnaire comprising two questions. The answers to the questions were statistically analyzed with regard to frequency of each response, and validated by the Wilcoxon test with a p value cooling aid in laser-assisted dental surgery.

  5. Comparison of commercial fibrin sealants in facelift surgery: a prospective study

    Directory of Open Access Journals (Sweden)

    Botti G

    2013-11-01

    Full Text Available Giovanni Botti,1 Michele Pascali,2 Chiara Botti,1 Florian Bodog,3 Pietro Gentile,2 Valerio Cervelli2 1Villa Bella Clinic, Salò, 2Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Italy; 3University of Oradea, Oradea, Romania Background: The aim of this study was to compare the effects of two types of fibrin glue in patients undergoing facelift surgery. Methods: A prospective, controlled "right-left side" study was carried out in 20 patients. The two fibrin sealants used were Quixil® and Tissucol®. The two sealants were used at the same time, ie, one on one side of the face and the other on the contralateral side. Comparisons were made with regard to rates of hematoma and seroma, degree of induration, edema, ecchymosis, pain levels, and patient satisfaction. Results: The results were almost equivalent. The only exception was a significant (40 mL hematoma in a patient treated with Quixil. Bleeding was most likely due to a sudden rise in blood pressure during the immediate postoperative period. However, it must be emphasized that, while Tissucol actually seals the undermined area, thus virtually eliminating the dead space, Quixil acts differently, in that its effectiveness in preventing hematoma is linked mainly to its hemostatic effect. Conclusion: The two fibrin sealants used were nearly identical with regard to patient safety and quality of the result. Nevertheless, it is noted that, while Tissucol has both hemostatic and "gluing" effects, Quixil is mainly effective in securing hemostasis. Keywords: facelift surgery, rhytidectomy, fibrin sealants, hematoma

  6. Pharmaceuticals Safety Practices-A Comparative Pilot Study

    Science.gov (United States)

    Tawfik, Kamilia A.; Jabeen, Arshia

    2013-01-01

    Introduction The safety of medicine is essential for the safety of patients. Inappropriate drug storage, expiration dates, sharing prescription drugs, self medication habits and misuse of some drugs are contributing factors affecting medication safety. One or more of these factors may lead to serious health complications and even death. Objectives The purpose of this study was to highlight the common errors and pharmaceutical malpractices that people usually engage in on a daily basis and to correlate these to culture, gender and educational levels. This may spread awareness in an easy and understandable manner and provide certain guidelines to drug consumers ensuring that pharmaceutical preparations are used correctly and safely. Methods Two hundred questionnaires were randomly distributed in two countries; Saudi Arabia and India. The collected data were statistically analyzed. Outcomes and conclusion Results showed that alarming percentages of various participants were using pharmaceuticals inappropriately due to carelessness, unawareness or intentional mistakes. Therefore, active participation by health care professionals is essential for the prevention of drug misuse. Increasing population awareness about self medication, products expiration, pharmaceuticals labels and optimum storage conditions would minimize the adverse effects and may even be life saving. PMID:24533025

  7. A study on safety assessment methodology for a vitrification plant

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Y. C.; Lee, G. S.; Choi, Y. C.; Kim, G. H. [Yonsei Univ., Seoul (Korea, Republic of)

    2002-03-15

    In this study, the technical and regulatory status of radioactive waste vitrification technologies in foreign and domestic plants is investigated and analyzed, and then significant factors are suggested which must be contained in the final technical guideline or standard for the safety assessment of vitrification plants. Also, the methods to estimate the stability of vitrified waste forms are suggested with property analysis of them. The contents and scope of the study are summarized as follows : survey of the status on radioactive waste vitrification technologies in foreign and domestic plants, survey of the characterization methodology for radioactive waste form, analysis of stability for vitrified waste forms, survey and analysis of technical standards and regulations concerned with them in foreign and domestic plants, suggestion of significant factors for the safety assessment of vitrification plants, submission of regulated technical standard on radioactive waste vitrification plats.

  8. Hemodynamic challenge to early mobilization after cardiac surgery: A pilot study

    Directory of Open Access Journals (Sweden)

    Tiziano Cassina

    2016-01-01

    Full Text Available Background: Active mobilization is a key component in fast-track surgical strategies. Following major surgery, clinicians are often reluctant to mobilize patients arguing that circulatory homeostasis would be impaired as a result of myocardial stunning, fluid shift, and autonomic dysfunction. Aims: We examined the feasibility and safety of a mobilization protocol 12-24 h after elective cardiac surgery. Setting and Design: This observational study was performed in a tertiary nonacademic cardiovascular Intensive Care Unit. Materials and Methods: Over a 6-month period, we prospectively evaluated the hemodynamic response to a two-staged mobilization procedure in 53 consecutive patients. Before, during, and after the mobilization, hemodynamics parameters were recorded, including the central venous oxygen saturation (ScvO 2 , lactate concentrations, mean arterial pressure (MAP, heart rate (HR, right atrial pressure (RAP, and arterial oxygen saturation (SpO 2 . Any adverse events were documented. Results: All patients successfully completed the mobilization procedure. Compared with the supine position, mobilization induced significant increases in arterial lactate (34.6% [31.6%, 47.6%], P = 0.0022 along with reduction in RAP (−33% [−21%, −45%], P 10% and nine of them (17% required treatment. Hypotensive patients experienced a greater decrease in ScvO 2 (−18 ± 5% vs. −9 ± 4%, P = 0.004 with similar changes in RAP and HR. All hemodynamic parameters, but arterial lactate, recovered baseline values after resuming the horizontal position. Conclusions: Early mobilization after cardiac surgery appears to be a safe procedure as far as it is performed under close hemodynamic and clinical monitoring in an intensive care setting.

  9. Collateral Weight Loss in Children Living with Adult Bariatric Surgery Patients: A Case Control Study

    Science.gov (United States)

    Hirsch, Annemarie G.; Wood, G. Craig; Bailey-Davis, Lisa; Lent, Michelle R.; Gerhard, Glenn S.; Still, Christopher D.

    2014-01-01

    Objective To evaluate the impact of adult bariatric surgery on the Body Mass Index (BMI) of children living in the same household. Design and Methods A retrospective case-control study. Case dyads (n=128) were composed of one adult who had bariatric surgery and one child at the same address. Control dyads (n=384) were composed of an adult with obesity but no bariatric surgery and a child at the same address. We used a two-sample t-test to determine whether the differences between actual and expected BMI at follow-up (post-surgery) differed between children in the case and control dyads. Results Among boys who were overweight, boys who lived with a surgery patient had a lower than expected BMI post-surgery, while boys who did not live with a surgery patient had a higher than expected BMI at follow-up (p=0.045). Differences between actual and expected BMIs of children were not significantly different between cases and controls in girls or in children in other weight classes. Conclusions Overweight boys who lived with an adult bariatric surgery patient had a lower than expected BMI after surgery as compared to controls. Future studies may be warranted to determine the mechanisms by which these children experience collateral weight loss. PMID:24989939

  10. Esophageal adenocarcinoma after obesity surgery in a population-based cohort study.

    Science.gov (United States)

    Maret-Ouda, John; Tao, Wenjing; Mattsson, Fredrik; Brusselaers, Nele; El-Serag, Hashem B; Lagergren, Jesper

    2017-01-01

    Obesity is strongly associated with esophageal adenocarcinoma (EAC), yet it is unclear whether weight loss reduces the risk of EAC. To test the hypothesis that the risk of EAC decreases after weight reduction achieved by obesity surgery. Nationwide register-based cohort study. This study included a majority of individuals who underwent obesity surgery in Sweden in 1980 to 2012. The incidence of EAC after obesity surgery was compared with the incidence in the corresponding background population of Sweden by means of calculation of standardized incidence ratios (SIRs) with 95% confidence intervals (CIs). The risk of EAC after obesity surgery also was compared with the risk in obese individuals who did not undergo obesity surgery by means of multivariable Cox regression, providing hazard ratios with 95% CIs, adjusted for potential confounders. Among 34,437 study participants undergoing obesity surgery and 239,775 person-years of follow-up, 8 cases of EAC occurred (SIR 1.6; 95% CI .7-3.2). No clear trend of decreased SIRs was observed in relation to increased follow-up time after surgery. The SIR of EACs (n = 53) among 123,695 obese individuals who did not undergo obesity surgery (673,238 person-years) was increased to a similar extent as in the obesity surgery cohort (SIR = 1.9, 95% CI 1.4-2.5). Cox regression demonstrated no difference in risk of EAC between participants who underwent obesity surgery and those who did not (adjusted hazard ratio = .9, 95% CI .4-1.9). The risk of EAC might not decrease after obesity surgery, but larger studies with longer follow-up are needed to establish this association. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  11. Collaborating to increase access to clinical and educational resources for surgery: a case study.

    Science.gov (United States)

    Tomasko, Jonathan M; Adams, Nancy E; Garritano, Frank G; Santos, Mary C; Dillon, Peter W

    2014-01-01

    A case study is described in which collaborations between a Department of Surgery, a Department of Information Technology, and an academic health sciences library resulted in the development of an electronic surgical library available at the bedside, the deployment of tablet devices for surgery residents, and implementation of a tablet-friendly user interface for the institution's electronic medical record.

  12. Partners' experiences of the postdischarge period after day surgery - a qualitative study

    DEFF Research Database (Denmark)

    Majholm, Birgitte; Esbensen, Bente A; Thomsen, Thordis;

    2012-01-01

    Aims and objectives.  Day surgery shifts the responsibility of care from the hospital to patients and their families. This study explored how partners of day surgery patients experienced their role after patient discharge. Background.  Many surgical procedures formerly requiring inpatient care...... are now carried out on a day surgery basis, shifting responsibility of care to patients and their partners/relatives. Little is known about how partners of day surgery patients manage this responsibility. Design.  Qualitative descriptive. Methods.  Individual semi-structured interviews with 11 partners...... of day surgery patients who had undergone shoulder surgery. Systematic text condensation was used to analyse data. Results.  The following aspects were identified: the first is 'It's all about being there for the patient by taking care of the patient's needs and by mobilising one's network,' referring...

  13. Hyperbilirubinemia after extracorporeal circulation surgery: A recent and prospective study

    Institute of Scientific and Technical Information of China (English)

    Yong An; Ying-Bin Xiao; Qian-Jin Zhong

    2006-01-01

    AIM: To clarify the incidence and nature of postoperative hyperbilirubinemia in patients after modern extracorporeal circulation, to analyze possible perioperative risk factors, and to elucidate the clinical significance of postoperative hyperbilirubinemia associated morality and morbidity.METHODS: Between March 2005 and May 2006, three hundred and eighty six consecutive patients undergoing extracorporeal circulation surgery due to a variety of cardiac lesions were investigated prospectively. The incidence of postoperative hyperbilirubinemia was defined as a serum total bilirubin concentration of more than 51 μmol/L. Several perioperative parameters were compared by logistic regression between hyperbilirubinemia and non-hyperbilirubinemia patients to determine possible risk factors contributing to postoperative hyperbilirubinemia and mortality.RESULTS: Overall incidence of postoperative hyperbilirubinemia was 25.3% (98/386). In patients with postoperative hyperbilirubinemia, 56.2%reached peak total bilirubin concentration on the first postoperative day, 33.5% on the second day, and 10.3%on the seventh day. Eighty percent of the increase of total bilirubin resulted from an increase of both conjugated and unconjugated bilirubin. Development of postoperative hyperbilirubinemia was associated with a higher mortality (P < 0.01), longer duration of mechanical ventilation (P < 0.05) and longer ICU stay time (P < 0.05). Preoperative total bilirubin concentration, preoperative right atrium pressure,numbers of valves replaced and of blood transfusion requirement were identified as important predictors for postoperative hyperbilirubinemia.CONCLUSION: Early postoperative hyperbilirubinemia after modern extracorporeal circulation is mainly caused by an increase in both conjugated and unconjugated bilirubin, and is associated with a high mortality.Important contributing factors are the preoperative total bilirubin concentration, preoperative severity of right atrial

  14. Psychological change after aesthetic plastic surgery: a prospective controlled outcome study.

    Science.gov (United States)

    Moss, Timothy P; Harris, David L

    2009-10-01

    Aesthetic plastic surgery has been long practiced for primarily psychological rather than physical benefit to patients. However, evaluation of the psychological impact of aesthetic plastic surgery has often been of limited methodological rigor in both study design and appropriate measurement. This study is intended to evaluate the psychological impact of aesthetic surgery on patients seeking such intervention in regard to concerns about breasts, nose or upper limbs using standardised psychometric instruments. Participants were recruited through the Plastic Surgery Unit (Patients) and general surgery, ENT surgery and Maxillo-facial surgery (Comparisons) at a UK General Hospital. Outcome measures included the Crown-Crisp Experiential Inventory anxiety scale, Beck Depression Inventory and Derriford Appearance Scale-24, a valid and reliable measure of distress and dysfunction in relation to self-consciousness of appearance. Data were collected pre-operatively (T1) and 3 months post-operatively (T2) for both groups. Longitudinal appearance adjustment for the plastic surgery group was also assessed at 12 months (T3). Both groups were less depressed and anxious post-operatively. The improvement in anxiety was significantly greater in the plastic surgery group. Body site specific appearance distress was significantly improved for the plastics group only, and the level of improvement was related to the body site affected.

  15. Long-term outcomes of epilepsy surgery in Sweden: a national prospective and longitudinal study.

    Science.gov (United States)

    Edelvik, Anna; Rydenhag, Bertil; Olsson, Ingrid; Flink, Roland; Kumlien, Eva; Källén, Kristina; Malmgren, Kristina

    2013-10-01

    To investigate prospective, population-based long-term outcomes concerning seizures and antiepileptic drug (AED) treatment after resective epilepsy surgery in Sweden. Ten- and 5-year follow-ups were performed in 2005 to 2007 for 278/327 patients after resective epilepsy surgery from 1995 to 1997 and 2000 to 2002, respectively. All patients had been prospectively followed in the Swedish National Epilepsy Surgery Register. Ninety-three patients, who were presurgically evaluated but not operated, served as controls. In the long term (mean 7.6 years), 62% of operated adults and 50% of operated children were seizure-free, compared to 14% of nonoperated adults (p seizure freedom since surgery, compared to none of the controls (p seizures/month at baseline and long epilepsy duration as negative predictors and positive MRI to be a positive predictor of long-term seizure-free outcome. Ten years after surgery, 86% of seizure-free children and 43% of seizure-free adults had stopped AEDs in the surgery groups compared to none of the controls (p seizure outcomes after resective epilepsy surgery. The majority of the patients who are seizure-free after 5 and 10 years have sustained seizure freedom since surgery. Many patients who gain seizure freedom can successfully discontinue AEDs, more often children than adults. This study provides Class III evidence that more patients are seizure-free and have stopped AED treatment in the long term after resective epilepsy surgery than nonoperated epilepsy patients.

  16. Risk factors associated with postoperative pain after ophthalmic surgery: a prospective study

    Directory of Open Access Journals (Sweden)

    Lesin M

    2016-01-01

    Full Text Available Mladen Lesin,1,* Mirna Dzaja Lozo,1,* Zeljka Duplancic-Sundov,1 Ivana Dzaja,1 Nikolina Davidovic,2 Adriana Banozic,3 Livia Puljak3 1Department of Ophthalmology, 2Department of Psychiatry, University Hospital Split, 3Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia *These authors contributed equally to this work Background: Risk factors associated with postoperative pain intensity and duration, as well as consumption of analgesics after ophthalmic surgery are poorly understood. Methods: A prospective study was conducted among adults (N=226 who underwent eye surgery at the University Hospital Split, Croatia. A day before the surgery, the patients filled out questionnaires assessing personality, anxiety, pain catastrophizing, sociodemographics were given and details about the procedure, anesthesia, and analgesia for each postoperative day. All scales were previously used for the Croatian population. The intensity of pain was measured using a numerical rating scale from 0 to 10, where 0 was no pain and 10 was the worst imaginable pain. The intensity of pain was measured before the surgery and then 1 hour, 3 hours, 6 hours, and 24 hours after surgery, and then once a day until discharge from the hospital. Univariate and multivariate analyses were performed. Results: A multivariate analysis indicated that independent predictors of average pain intensity after the surgery were: absence of premedication before surgery, surgery in general anesthesia, higher pain intensity before surgery and pain catastrophizing level. Independent predictors of postoperative pain duration were intensity of pain before surgery, type of anesthesia, and self-assessment of health. Independent predictors of pain intensity ≥5 during the first 6 hours after the procedure were the type of procedure, self-assessment of health, premedication, and the level of pain catastrophizing. Conclusion: Awareness about independent predictors associated

  17. Fire safety case study of a railway tunnel: Smoke evacuation

    Directory of Open Access Journals (Sweden)

    van Maele Karim

    2007-01-01

    Full Text Available When a fire occurs in a tunnel, it is of great importance to assure the safety of the occupants of the tunnel. This is achieved by creating smoke-free spaces in the tunnel through control of the smoke gases. In this paper, results are presented of a study concerning the fire safety in a real scale railway tunnel test case. Numerical simulations are performed in order to examine the possibility of natural ventilation of smoke in inclined tunnels. Several aspects are taken into account: the length of the simulated tunnel section, the slope of the tunnel and the possible effects of external wind at one portal of the tunnel. The Fire Dynamics Simulator of the National Institute of Standards and Technology, USA, is applied to perform the simulations. The simulations show that for the local behavior of the smoke during the early stages of the fire, the slope of the tunnel is of little importance. Secondly, the results show that external wind and/or pressure conditions have a large effect on the smoke gases inside the tunnel. Finally, some idea for the value of the critical ventilation velocity is given. The study also shows that computational fluid dynamics calculations are a valuable tool for large scale, real life complex fire cases. .

  18. Patient safety in plastic surgery: identifying areas for quality improvement efforts.

    Science.gov (United States)

    Hernandez-Boussard, Tina; McDonald, Kathryn M; Rhoads, Kim F; Curtin, Catherine M

    2015-05-01

    Improving quality of health care is a global priority. Before quality benchmarks are established, we first must understand rates of adverse events (AEs). This project assessed risk-adjusted rates of inpatient AEs for soft tissue reconstructive procedures.Patients receiving soft tissue reconstructive procedures from 2005 to 2010 were extracted from the Nationwide Inpatient Sample. Inpatient AEs were identified using patient safety indicators (PSIs), established measures developed by Agency for Healthcare Research and Quality.We identified 409,991 patients with soft tissue reconstruction and 16,635 (4.06%) had a PSI during their hospital stay. Patient safety indicators were associated with increased risk-adjusted mortality, longer length of stay, and decreased routine disposition (P plastic surgery patients had significantly lower risk-adjusted rate compared to other surgical inpatients for all events evaluated except for failure to rescue and postoperative hemorrhage or hematoma, which were not statistically different. Risk-adjusted rates of hematoma hemorrhage were significantly higher in patients receiving size-reduction surgery, and these rates were further accentuated when broken down by sex and payer. In general, plastic surgery patients had lower rates of in-hospital AEs than other surgical disciplines, but PSIs were not uncommon. With the establishment of national basal PSI rates in plastic surgery patients, benchmarks can be devised and target areas for quality improvement efforts identified. Further prospective studies should be designed to elucidate the drivers of AEs identified in this population.

  19. A study of an assisting robot for mandible plastic surgery based on augmented reality.

    Science.gov (United States)

    Shi, Yunyong; Lin, Li; Zhou, Chaozheng; Zhu, Ming; Xie, Le; Chai, Gang

    2017-02-01

    Mandible plastic surgery plays an important role in conventional plastic surgery. However, its success depends on the experience of the surgeons. In order to improve the effectiveness of the surgery and release the burden of surgeons, a mandible plastic surgery assisting robot, based on an augmented reality technique, was developed. Augmented reality assists surgeons to realize positioning. Fuzzy control theory was used for the control of the motor. During the process of bone drilling, both the drill bit position and the force were measured by a force sensor which was used to estimate the position of the drilling procedure. An animal experiment was performed to verify the effectiveness of the robotic system. The position error was 1.07 ± 0.27 mm and the angle error was 5.59 ± 3.15°. The results show that the system provides a sufficient accuracy with which a precise drilling procedure can be performed. In addition, under the supervision's feedback of the sensor, an adequate safety level can be achieved for the robotic system. The system realizes accurate positioning and automatic drilling to solve the problems encountered in the drilling procedure, providing a method for future plastic surgery.

  20. Enhancing Patient Safety Using Clinical Nursing Data: A Pilot Study.

    Science.gov (United States)

    Choi, Jeeyae; Choi, Jeungok E

    2016-01-01

    To enhance patient safety from falls, many hospital information systems have been implemented to collect clinical data from the bedside and have used the information to improve fall prevention care. However, most of them use administrative data not clinical nursing data. This necessitated the development of a web-based Nursing Practice and Research Information Management System (NPRIMS) that processes clinical nursing data to measure nurses' delivery of fall prevention care and its impact on patient outcomes. This pilot study developed computer algorithms based on a falls prevention protocol and programmed the prototype NPRIMS. It successfully measured the performance of nursing care delivered and its impact on patient outcomes using clinical nursing data from the study site. Results of the study revealed that NPRIMS has the potential to pinpoint components of nursing processes that are in need of improvement for preventing patient from falls.

  1. A Comparative Study of Single-Port Laparoscopic Surgery Versus Robotic-Assisted Laparoscopic Surgery for Rectal Cancer

    DEFF Research Database (Denmark)

    Levic, Katarina; Donatsky, Anders Meller; Bulut, Orhan

    2015-01-01

    INTRODUCTION: Conventional laparoscopic surgery is the treatment of choice for many abdominal procedures. To further reduce surgical trauma, new minimal invasive procedures such as single-port laparoscopic surgery (SPLS) and robotic assisted laparoscopic surgery (RALS) have emerged. The aim...... in either of the groups. There was no difference in median follow-up time between groups (P = .58). CONCLUSION: Both SPLS and RALS may have a role in rectal surgery. The short-term oncological outcomes were similar, although RALS harvested more lymph nodes than the SPLS procedure. However, SPLS seems...

  2. Psychological and health comorbidities before and after bariatric surgery: a longitudinal study

    Directory of Open Access Journals (Sweden)

    Susana Sofia Pereira da Silva

    2013-12-01

    Full Text Available INTRODUCTION: Morbid obesity has multiple implications for psychological and physical health. Bariatric surgery has been selected as the treatment of choice for this chronic disease, despite the controversial impact of the surgery on psychosocial health. The objective of this study was to describe candidates for bariatric surgery and analyze changes in weight, psychopathology, personality, and health problems and complaints at 6- and 12- month follow-up assessments. METHODS: Thirty obese patients (20 women and 10 men with a mean age of 39.17±8.81 years were evaluated in different dimensions before surgery and 6 and 12 months after the procedure. RESULTS: Six and 12 months after bariatric surgery, patients reported significant weight loss and a significant reduction in the number of health problems and complaints. The rates of self-reported psychopathology were low before surgery, and there were no statistically significant changes over time. The conscientiousness, extraversion, and agreeableness dimensions increased, but neuroticism and openness remained unchanged. All changes had a medium effect size. CONCLUSIONS: Our results suggest that patients experience significant health improvements and some positive personality changes after bariatric surgery. Even though these findings underscore the role of bariatric surgery as a relevant treatment for morbid obesity, more in-depth longitudinal studies are needed to elucidate the evolution of patients after the procedure.

  3. A peripherally inserted central catheter line, inserted the day before surgery, decreases the time from induction to incision for spinal deformity surgery and safely provides central venous access during surgery: a pilot study.

    Science.gov (United States)

    Stuedemann, Anne E; Schwend, Richard M; Thomas, Valorie K; Leamon, Julia M; Lightner, Tammy S

    2017-02-24

    Pediatric patients undergoing surgery for spinal deformity may benefit from central venous access to provide intraoperative monitoring and fluid resuscitation. For pediatric surgical patients requiring central access, we hypothesized that placing a peripherally inserted central catheter (PICC) line preoperatively should decrease time from induction of anesthesia to incision and result in improved patient safety and decreased operating room charges. This was a retrospective, nonrandomized, and case comparison study. Clinical records of all children with adolescent idiopathic scoliosis or neuromuscular scoliosis treated surgically by the senior author between December 2007 and April 2012 were reviewed. Control group patients had a central venous catheter (CVC) placed by the anesthesiologist after induction of anesthesia. The trial group had a PICC placed under local anesthesia the day before surgery by an experienced vascular access team. The time from induction of anesthesia to the time for the surgical incision was determined for each study group. The CVC line placement charges were determined by the operating room time charges at $214/min. Charges saved were the mean time difference multiplied by the operating room time charge, less the charge for PICC line insertion ($1282). There were 29 neuromuscular patients, the mean age was 13 years (SD: 4 years). The mean time from induction to incision for the PICC group was 91 min [95% confidence interval (CI): 67-115 min] and for the CVC group 113 min (95% CI: 99-127 min, P=0.083). For this mean time difference of 22 min, the estimated cost savings would be $3426 per patient. There were 59 patients with adolescent idiopathic scoliosis, the mean age was 14 years (SD: 2 years). The mean time from induction to incision for the PICC group was 78 min (95% CI: 74-82 min) and for the CVC group 106 min (95% CI: 96-116  min, P≤0.001). For this mean time difference of 28 min, the estimated cost savings would

  4. Cataract surgery rates in latin america: a four-year longitudinal study of 19 countries.

    Science.gov (United States)

    Lansingh, Van C; Resnikoff, Serge; Tingley-Kelley, Kimberly; Nano, María E; Martens, Marion; Silva, Juan C; Duerksen, Rainald; Carter, Marissa J

    2010-03-01

    To collect cataract surgery rates data in 19 Latin American countries over a 4-year period as data published to date have been limited. Cataract surgery rates were obtained from National Society of Ophthalmology, National VISION 2020/Prevention of Blindness Committee and Ministry of Health representatives for each country for 2005 to 2008. Economic (gross national income per capita) and other data were collected from publicly available databases. Linear and power correlations between gross national incomes and cataract surgery rates were calculated. Over the study period, most countries increased their cataract surgery rates, with the largest increases observed for Venezuela (186%), Nicaragua (183%), Costa Rica (100%), Uruguay (97%), and Peru (88%). Mean cataract surgery rates for 2005, 2006, 2007, and 2008 for the ensemble of countries were 1545, 1684, 1660, and 1822 per million population, respectively, with a growth over the study period of 17.9%, concurrent with an increase of 57 million (11.5%) in the population. A good correlation between cataract surgery rate and gross national income per capita was found (P < .001). Although progress is being made in the region, the cataract surgery rates represent only one parameter. When they are examined in the context of cataract surgical coverage it is clear that substantial proportions of bilaterally blind persons are still not receiving surgery.

  5. Minimally invasive strabismus surgery versus paralimbal approach: A randomized, parallel design study is minimally invasive strabismus surgery worth the effort?

    Directory of Open Access Journals (Sweden)

    Richa Sharma

    2014-01-01

    Full Text Available Introduction : Minimal access surgery is common in all fields of medicine. We compared a new minimally invasive strabismus surgery (MISS approach with a standard paralimbal strabismus surgery (SPSS approach in terms of post-operative course. Materials and Methods: This parallel design study was done on 28 eyes of 14 patients, in which one eye was randomized to MISS and the other to SPSS. MISS was performed by giving two conjunctival incisions parallel to the horizontal rectus muscles; performing recession or resection below the conjunctival strip so obtained. We compared post-operative redness, congestion, chemosis, foreign body sensation (FBS, and drop intolerance (DI on a graded scale of 0 to 3 on post-operative day 1, at 2-3 weeks, and 6 weeks. In addition, all scores were added to obtain a total inflammatory score (TIS. Statistical Analysis: Inflammatory scores were analyzed using Wilcoxon′s signed rank test. Results: On the first post-operative day, only FBS (P = 0.01 and TIS (P = 0.04 showed significant difference favoring MISS. At 2-3 weeks, redness (P = 0.04, congestion (P = 0.04, FBS (P = 0.02, and TIS (P = 0.04 were significantly less in MISS eye. At 6 weeks, only redness (P = 0.04 and TIS (P = 0.05 were significantly less. Conclusion: MISS is more comfortable in the immediate post-operative period and provides better cosmesis in the intermediate period.

  6. Colorectal Cancer Prognosis Following Obesity Surgery in a Population-Based Cohort Study.

    Science.gov (United States)

    Tao, Wenjing; Konings, Peter; Hull, Mark A; Adami, Hans-Olov; Mattsson, Fredrik; Lagergren, Jesper

    2017-05-01

    Obesity surgery involves mechanical and physiological changes of the gastrointestinal tract that might promote colorectal cancer progression. Thus, we hypothesised that obesity surgery is associated with poorer prognosis in patients with colorectal cancer. This nationwide population-based cohort study included all patients with an obesity diagnosis who subsequently developed colorectal cancer in Sweden from 1980 to 2012. The exposure was obesity surgery, and the main and secondary outcomes were disease-specific mortality and all-cause mortality, respectively. Cox proportional hazard survival models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for sex, age, calendar year and education level. The exposed and unexposed cohort included 131 obesity surgery and 1332 non-obesity surgery patients with colorectal cancer. There was a statistically significant increased rate of colorectal cancer deaths following obesity surgery (disease-specific HR 1.50, 95% CI 1.00-2.19). When analysed separately, the mortality rate was more than threefold increased in rectal cancer patients with prior obesity surgery (disease-specific HR 3.70, 95% CI 2.00-6.90), while no increased mortality rate was found in colon cancer patients (disease-specific HR 1.10, 85% CI 0.67-1.70). This population-based study among obese individuals found a poorer prognosis in colorectal cancer following obesity surgery, which was primarily driven by the higher mortality rate in rectal cancer.

  7. On Safety Management. A Frame of Reference for Studies of Safety Management with Examples From Non-Nuclear Contexts of Relevance for Nuclear Safety

    Energy Technology Data Exchange (ETDEWEB)

    Svensson, Ola; Salo, Ilkka; Allwin, Pernilla (Risk Analysis, Social and Decision Research Unit, Dept. of Psychology, Stockholm Univ., Stockholm (Sweden))

    2004-11-15

    A good knowledge about safety management from risk technologies outside the area of nuclear power may contribute to both broaden the perspectives on safety management in general, and point at new opportunities for improving safety measures within the nuclear industry. First, a theoretical framework for the study of safety management in general is presented, followed by three case studies on safety management from different non-nuclear areas with potential relevance for nuclear safety. The chapters are written as separate reports and can be read independently of each other. The nuclear industry has a long experience about the management of risky activities, involving all the stages from planing to implementation, both on a more generalized level and in the specific branches of activities (management, administration, operation, maintenance, etc.). Here, safety management is a key concept related to these areas of activities. Outside the field of nuclear power there exist a number of different non-nuclear risk technologies, each one with their own specific needs and experiences about safety management. The differences between the areas consist partly of the different experiences caused by the different technologies. Besides using own experiences in safety practices within the own areas of activities, it may be profitable to take advantage in knowledge and experiences from one area and put it in practice in another area. In order to facilitate knowledge transfer from one technological area to another it may be possible to adapt a common theoretical model, for descriptions and explanations, to the different technologies. Such a model should admit that common denominators for safety management across the areas might be identified and described with common concepts. Systems theory gives the opportunity to not only create models that are descriptive for events within the limits of a given technology, but also to generate knowledge that can be transferred to other

  8. On Safety Management. A Frame of Reference for Studies of Safety Management with Examples From Non-Nuclear Contexts of Relevance for Nuclear Safety

    Energy Technology Data Exchange (ETDEWEB)

    Svensson, Ola; Salo, Ilkka; Allwin, Pernilla (Risk Analysis, Social and Decision Research Unit, Dept. of Psychology, Stockholm Univ., Stockholm (Sweden))

    2004-11-15

    A good knowledge about safety management from risk technologies outside the area of nuclear power may contribute to both broaden the perspectives on safety management in general, and point at new opportunities for improving safety measures within the nuclear industry. First, a theoretical framework for the study of safety management in general is presented, followed by three case studies on safety management from different non-nuclear areas with potential relevance for nuclear safety. The chapters are written as separate reports and can be read independently of each other. The nuclear industry has a long experience about the management of risky activities, involving all the stages from planing to implementation, both on a more generalized level and in the specific branches of activities (management, administration, operation, maintenance, etc.). Here, safety management is a key concept related to these areas of activities. Outside the field of nuclear power there exist a number of different non-nuclear risk technologies, each one with their own specific needs and experiences about safety management. The differences between the areas consist partly of the different experiences caused by the different technologies. Besides using own experiences in safety practices within the own areas of activities, it may be profitable to take advantage in knowledge and experiences from one area and put it in practice in another area. In order to facilitate knowledge transfer from one technological area to another it may be possible to adapt a common theoretical model, for descriptions and explanations, to the different technologies. Such a model should admit that common denominators for safety management across the areas might be identified and described with common concepts. Systems theory gives the opportunity to not only create models that are descriptive for events within the limits of a given technology, but also to generate knowledge that can be transferred to other

  9. Cotton-derived oxidized cellulose in minimally invasive thoracic surgery: a clinicopathological study.

    Science.gov (United States)

    Witte, Biruta; Kroeber, Stefan M; Hillebrand, Hubertus; Wolf, Michael; Huertgen, Martin

    2013-01-01

    The aim of this study was to identify resorption, clinical performance, and safety of cotton-derived oxidized cellulose gauze applied as a hemostat in minimally invasive oncologic thoracic surgery. This is a pilot prospective noncomparative observational human in vivo study. A piece of cotton-derived oxidized cellulose gauze measuring 5 × 20 cm was inserted into the subcarinal space of patients with potentially resectable lung carcinoma at the time of video-assisted mediastinoscopic lymphadenectomy and reexamined several days later for macroscopic and histologic evaluation at the time of subsequent lung resection. The primary endpoint was the local situation at the implantation site described by cellulose remnants, fluid collections, and adhesions. The secondary endpoint was safety, described by the number of adverse events and surgical reinterventions. Twenty-five consecutive eligible patients with potentially resectable lung carcinoma were included. The desired hemostatic effect was achieved in all cases. No adverse events were observed. At re-exploration 10.5 (5-28) days later, the cellulose gauze was found to lose its solid structure from the fifth day on. Remnants were last detected 14 days after insertion. The implantation site exhibited no inflammatory changes and a remarkable small amount of fluid collections and adhesions. Mediastinal application of cotton-derived oxidized cellulose is safe and effective. A piece of gauze measuring 5 × 20 cm seems to be absorbed completely within 15 days, thus precluding any interference with oncologic restaging and follow-up. The absence of relevant adhesions facilitates further surgical procedures. Larger comparative confirmatory studies are required. For large-scale resorption studies, our clinical model should be translated into a porcine model.

  10. Evaluation of safety and usefulness of submental intubation in panfacial trauma surgery

    Science.gov (United States)

    2016-01-01

    Objectives Submental intubation has been advocated as an alternative to classical tracheostomy for certain indicated panfacial trauma surgeries. Surgeons should have various options for airway management in maxillofacial trauma patients. Most maxillofacial injuries involve occlusal derangements, which might require intraoperative occlusal corrections; hence, orotracheal intubation is not ideal. Maxillofacial surgeons generally prefer nasotracheal intubation; however, in cases with concomitant skull base fracture or nasal bone fracture, nasotracheal intubation might not be suitable; in these situations, tracheostomy is typically performed. However, the possible complications of tracheostomy are well known. Due to trauma situations and to avoid the complications of tracheostomy, submental intubation would be an ideal alternative procedure in selected maxillofacial trauma surgery patients. This study aimed to evaluate the safety and usefulness of a submental intubation technique for panfacial trauma surgery. Moreover, we intended to share our experience of submental intubation and to recommend this simple, safe procedure for certain panfacial trauma surgeries. Materials and Methods In five panfacial trauma patients, we performed submental intubation for airway management; the mean time required for the procedure was only eight minutes. Results We were able to execute this procedure safely in a short time without any intraoperative or postoperative complications. Conclusion Submental intubation is a safe and simple technique for airway management in indicated panfacial trauma surgery patients. PMID:27162750

  11. Exploration of the methodological basis of patient safety research in thyroid surgery

    Directory of Open Access Journals (Sweden)

    Pardal-Refoyo JL

    2014-02-01

    Full Text Available Introduction and objective: The investigation of incidents that affect the safety of patients undergoing thyroidectomy is a priority. Objective: To review the methodology in order to investigate security incidents that affect the patient in thyroid surgery. Material and methods: literature review about risk management and complications in thyroid surgery. Results: Comments on methods of root cause analysis (RCA and failure mode analysis and effects (FMEA. A risk matrix with security incidents and failure modes in thyroid surgery is designed. Conclusions: Patient safety in thyroid surgery is related to structural and process elements. Some contributing factors of security incidents are related to the patient, thyroid pathology, surgical technique and technology employed. The most complete systems to investigate security incidents and assist in risk management are FMEA (HFMEA and RCA. For each risk its criticality (severity and frequency and its detectability must be assessed. The most effective measures to improve patient safety are organizational measures and processes automation and computerization.

  12. Risk factors for acute surgical site infections after lumbar surgery: a retrospective study.

    Science.gov (United States)

    Lai, Qi; Song, Quanwei; Guo, Runsheng; Bi, Haidi; Liu, Xuqiang; Yu, Xiaolong; Zhu, Jianghao; Dai, Min; Zhang, Bin

    2017-07-19

    Currently, many scholars are concerned about the treatment of postoperative infection; however, few have completed multivariate analyses to determine factors that contribute to the risk of infection. Therefore, we conducted a multivariate analysis of a retrospectively collected database to analyze the risk factors for acute surgical site infection following lumbar surgery, including fracture fixation, lumbar fusion, and minimally invasive lumbar surgery. We retrospectively reviewed data from patients who underwent lumbar surgery between 2014 and 2016, including lumbar fusion, internal fracture fixation, and minimally invasive surgery in our hospital's spinal surgery unit. Patient demographics, procedures, and wound infection rates were analyzed using descriptive statistics, and risk factors were analyzed using logistic regression analyses. Twenty-six patients (2.81%) experienced acute surgical site infection following lumbar surgery in our study. The patients' mean body mass index, smoking history, operative time, blood loss, draining time, and drainage volume in the acute surgical site infection group were significantly different from those in the non-acute surgical site infection group (p surgical site infection group were significantly different than those in the non-acute surgical site infection group (p surgical site infection following lumbar surgery. In order to reduce the risk of infection following lumbar surgery, patients should be evaluated for the risk factors noted above.

  13. Clinical and neuropsychiatric correlates of lumbar spinal surgery in older adults: results of a pilot study.

    Science.gov (United States)

    Karp, Jordan F; McGovern, Jonathan; Marron, Megan M; Gerszten, Peter; Weiner, Debra K; Okonkwo, David; Kanter, Adam S

    2016-11-01

    To improve selection of older lumbar surgical candidates, we surveyed correlates of functioning and satisfaction with surgery. Prospective sample at lumbar spine surgery clinic. Patients (n = 48) were evaluated before surgery and after 3 months. Dependent variables were functioning and surgical satisfaction. Baseline variables associated with disability at 3 months included cognitive status and widespread pain. There was clinically significant improvement with moderate effects sizes for anxiety and depression at follow-up. Patients with at least a 30% improvement in disability had better physical health-related quality of life and were less likely to report widespread pain before surgery. Although preliminary, two novel potential predictors of lumbar surgery outcome include diminished cognitive functioning and widespread pain. Further study of these variables on post-surgical functioning and satisfaction may improve patient selection.

  14. Visual Outcome of Phacoemulsification versus Small Incision Cataract Surgery in Pseudoexfoliation Syndrome – A Pilot Study

    Science.gov (United States)

    Gadewar, Shveta Bhimashankar

    2017-01-01

    Introduction Available data has highlighted the efficacy of both Phacoemulsification (PHACO) and Small Incision Cataract Surgery (SICS) in the presence of Pseudoexfoliation (PEX) syndrome. In developing countries, both are commonly performed procedures for cataract extraction. But, no direct comparison between these two procedures is available in the setting of PEX syndrome. With this lacuna in mind, this pilot study decided to compare the visual outcomes of both these techniques in the setting of PEX syndrome. Aim To compare and analyze the efficacy and safety of PHACO versus SICS in patients of PEX syndrome who underwent cataract surgery. Materials and Methods A prospective, conveniently sampled, observational, pilot study was conducted over six months in ophthalmology department of a tertiary eye institute in India. A total of 200 eyes of 100 patients conforming to pre-defined criteria were conveniently sampled and allotted to two groups of 50 patients each. First group underwent PHACO and second underwent SICS. The demographic profile, pre-operative, intra-operative and post-operative details and complications as well as visual acuity were recorded. Data obtained was analyzed using chi-square test. Statistical significance was set at 95% Confidence Intervals (CI), i.e., at a p-value of <0.05. Results Of 76 males and 24 females, the mean age was 67.95 years. No statistically significant differences were observed between PHACO and SICS groups with regards to intra-operative complications {overall n=13 in PHACO versus n=21 in SICS, p=0.13}. Controlled sphincterotomy was required in a significantly higher number of SICS cases (p=0.03). No statistically significant differences were observed in terms of post-operative complications (overall n=5 in PHACO versus n=10 in SICS, p=0.26). Conclusion With careful pre-operative assessment, due to intra-operative modifications and surgical expertise, both PHACO and SICS are apparently safe procedures in PEX syndrome.

  15. Construction Safety Assessment Framework for Developing Countries: A Case Study of Sri Lanka

    National Research Council Canada - National Science Library

    Kanchana Priyadarshani; Gayani Karunasena; Sajani Jayasuriya

    2013-01-01

    ... management in developing countries. [...]the aim of this study is to develop a method for measuring safety management on construction sites by identifying factors that affect construction safety performance...

  16. Outpatient Latarjet surgery for gleno-humeral instability: Prospective comparative assessment of feasibility and safety.

    Science.gov (United States)

    Bohu, Y; Klouche, S; Gerometta, A; Herman, S; Lefevre, N

    2016-06-01

    Some surgical procedures are rarely done on an outpatient basis. The primary objective of this study was to assess the safety of outpatient surgical shoulder stabilisation using the Latarjet procedure. The Latarjet procedure is safe when performed on an outpatient basis provided the patients are managed according to a specifically designed programme starting at the decision to undergo surgery and ending at the end of the early postoperative period. Consecutive patients with unidirectional anterior shoulder instability managed in 2013-2014 by primary open, minimally invasive surgery involving coracoid process transfer as described by Latarjet was included prospectively. One of the surgeons routinely offered outpatient surgery to patients who met none of the usual exclusion criteria (age>60years, ASA 3-4, and long distance from home to hospital). Standardised protocols were applied for anaesthesia and analgesia. The primary evaluation criterion was failure of the admission modality, defined as inpatient admission of a patient after outpatient surgery either without prior discharge or within 1week after discharge. Secondary evaluation criteria were early postoperative symptoms and functional outcomes after at least 1year. All self-reported criteria were entered online by the patients. Of 46 included patients, 17 had outpatient surgery and 29 inpatient surgery. There were 41 males and 5 females, with a mean age of 25.3±6.4years. No significant baseline differences were found between the two groups. None of the outpatients required inpatient admission or readmission. No postoperative complications were recorded. After a mean follow-up of 18.5±5.2months, the two groups showed no significant differences for return to sports, apprehension, avoidance behaviours, or functional outcomes. Most patients were satisfied with their management and outcomes. No serious adverse events were recorded in this first French prospective evaluation of the safety of open, minimally

  17. Changes in surgical team performance and safety climate attitudes following expansion of perioperative services: a repeated-measures study.

    Science.gov (United States)

    Gillespie, Brigid M; Harbeck, Emma; Kang, Evelyn; Steel, Catherine; Fairweather, Nicole; Chaboyer, Wendy

    2017-08-10

    Objective The aim of the present study was to describe process changes in surgical team performance and team members' attitudes to safety culture following hospital relocation and expansion of perioperative services.Methods The study was a naturalistic study using structured observations and surveys to assess non-technical skills (NTS; i.e. communication, teamwork, situational awareness, decision making and leadership) in surgery. This interrupted time series design used mixed-linear regression models to examine the effect of phase (before and after hospital relocation) on surgical teams' NTS and their processes that may affect performance. Differences in self-reported teamwork and safety climate attitudes were also examined.Results In all, 186 procedures (100 before and 81 after hospital relocation) were observed across teams working in general, paediatric, orthopaedic and thoracic surgeries. Interobserver agreement ranged from 86% to 95%. An effect of phase was found, indicating that there were significant improvements after relocation in the use of NTS by the teams observed (P=0.020; 95% confidence interval 1.9-4.7).Conclusions The improvements seen in surgical teams' NTS performance and safety culture attitudes may be related to the move to a new state-of-the-art perioperative department.What is known about the topic? Patient safety in surgery relies on optimal team performance, underpinned by effective NTS.What does this paper add? The NTS of surgical teams may be improved through ergonomic innovations that promote teams' shared mental models.What are the implications for practitioners? Effective multidisciplinary teamwork relies on a combination of NTS and ergonomic factors, which inherently contribute to team performance and safety climate attitudes.

  18. Resident work hour restrictions do not improve patient safety in surgery: a critical appraisal based on 7 years of experience in Switzerland

    Directory of Open Access Journals (Sweden)

    Businger Adrian P

    2012-07-01

    Full Text Available Abstract In 2005 the Swiss government implemented new work-hour limitations for all residency programs in Switzerland, including a 50-hour weekly limit. The reduction in the working hours of doctors in training implicate an increase in their rest time and suggest an amelioration of doctors' clinical performance and consequently in patients' outcomes and safety - which was not detectable in a preliminary study at a large referral center in Switzerland. It remains elusive why work-hour restrictions did not improve patient safety. We are well advised to thoroughly examine and eliminate the known adverse effects of reduced work-hours to improve our patients' safety.

  19. Phenomenological studies on sodium for CSP applications: A safety review

    Science.gov (United States)

    Armijo, Kenneth M.; Andraka, Charles E.

    2016-05-01

    Sodium Heat transfer fluids (HTF) such as sodium, can achieve temperatures above 700°C to obtain power cycle performance improvements for reducing large infrastructure costs of high-temperature systems. Current concentrating solar power (CSP) sensible HTF's (e.g. air, salts) have poor thermal conductivity, and thus low heat transfer capabilities, requiring a large receiver. The high thermal conductivity of sodium has demonstrated high heat transfer rates on dish and towers systems, which allow a reduction in receiver area by a factor of two to four, reducing re-radiation and convection losses and cost by a similar factor. Sodium produces saturated vapor at pressures suitable for transport starting at 600°C and reaches one atmosphere at 870°C, providing a wide range of suitable operating conditions that match proposed high temperature, isothermal power cycles. This advantage could increase the efficiency while lowering the cost of CSP tower systems. Although there are a number of desirable thermal performance advantages associated with sensible sodium, its propensity to rapidly oxidize presents safety challenges. This investigation presents a literature review that captures historical operations/handling lessons for advanced sodium receiver designs, and the current state-of-knowledge related to sodium combustion behavior. Technical and operational solutions addressing sodium safety and applications in CSP will be discussed, including unique safety hazards and advantages using latent sodium. Lessons obtained from the nuclear industry with sensible and latent systems will also be discussed in the context of safety challenges and risk mitigation solutions.

  20. Compliance with a time-out procedure intended to prevent wrong surgery in hospitals: results of a national patient safety programme in the Netherlands.

    Science.gov (United States)

    van Schoten, Steffie M; Kop, Veerle; de Blok, Carolien; Spreeuwenberg, Peter; Groenewegen, Peter P; Wagner, Cordula

    2014-07-03

    To prevent wrong surgery, the WHO 'Safe Surgery Checklist' was introduced in 2008. The checklist comprises a time-out procedure (TOP): the final step before the start of the surgical procedure where the patient, surgical procedure and side/site are reviewed by the surgical team. The aim of this study is to evaluate the extent to which hospitals carry out the TOP before anaesthesia in the operating room, whether compliance has changed over time, and to determine factors that are associated with compliance. Evaluation study involving observations. Operating rooms of 2 academic, 4 teaching and 12 general Dutch hospitals. A random selection was made from all adult patients scheduled for elective surgery on the day of the observation, preferably involving different surgeons and different procedures. Mean compliance with the TOP was 71.3%. Large differences between hospitals were observed. No linear trend was found in compliance during the study period. Compliance at general and teaching hospitals was higher than at academic hospitals. Compliance decreased with the age of the patient, general surgery showed lower compliance in comparison with other specialties and compliance was higher when the team was focused on the TOP. Large differences in compliance with the TOP were observed between participating hospitals which can be attributed at least in part to the type of hospital, surgical specialty and patient characteristics. Hospitals do not comply consistently with national guidelines to prevent wrong surgery and further implementation as well as further research into non-compliance is needed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. A Prospective Clinical Study on Blood Mercury Levels Following Endodontic Root-end Surgery with Amalgam.

    Science.gov (United States)

    Saatchi, Masoud; Shadmehr, Elham; Talebi, Seyed Morteza; Nazeri, Mohsen

    2013-01-01

    The purpose of this clinical study was to compare the blood mercury levels before and after endodontic surgery using amalgam as a root-end filling material. Fourteen patients requiring periradicular surgery participated in this prospective clinical study. A zinc-free amalgam was employed as root-end filling material. Blood samples were collected at three intervals: immediately before, immediately after and one week postoperatively. Mercury content of the blood was determined using gold amalgamation cold-vapor atomic absorption spectrometry. Obtained data were analyzed using analysis of variance for repeated measures and paired t-test. The mean (SD) of blood mercury levels was 2.20 (0.24) ng/mL immediately before surgery, 2.24 (0.28) ng/mL immediately after surgery and 2.44 (0.17) ng/mL one week after the periradicular surgery. The blood mercury level one week post-operative was significantly higher than both blood mercury levels immediately before (P<0.001) and immediately after (P=0.005) the surgery. Placement of an amalgam retroseal during endodontic surgery can increase blood mercury levels after one week. The mercury levels however, are still lower than the toxic mercury levels. We suggest using more suitable and biocompatible root-end filling materials.

  2. Key aspects in managing safety when working with multiple contractors: A case study

    NARCIS (Netherlands)

    Drupsteen, L.; Rasmussen, H.B.; Ustailieva, E.; Kampen, J. van

    2015-01-01

    Working with multiple contractors in a shared workplace can introduce and increase safety risks due to complexity. The aim of this study was to explore how safety issues are recognized in a specific case and to identify whether clients and contractors perceive problems similarly. The safety issues a

  3. Use of Chinese Medicine and Subsequent Surgery in Women with Uterine Fibroid: A Retrospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Shan-Yu Su

    2012-01-01

    Full Text Available Background. Chinese medicine (CM has been used to relieve symptoms relevant to uterine fibroids. Objective. This study investigated the association between the use of CM and the incidence of uterine surgery in women with uterine fibroids. Subjects and Methods. This retrospective cohort study extracted records for 16,690 subjects diagnosed with a uterine fibroid between 2000 and 2003 from the National Health Insurance reimbursement database. The risk factors for surgery were examined via Cox proportional hazard analysis, and the difference in incidence of surgery between CM users and nonusers was compared using incidence rate ratios (IRRs derived from Poisson's models. Results. After an average follow-up period of 4.5 years, the cumulative incidence of uterine surgery was significantly lower in CM users than CM nonusers (P<0.0001. Compared to CM nonusers, CM users were more unlikely to undergo uterine surgery (adjusted hazard ratio = 0.18, 95% confidence interval (CI = 0.17, 0.19. The incidence of surgery in CM users was dramatically different from that for CM nonusers (IRR = 0.17, 95% CI = 0.16, 0.18. Conclusion. The risk of uterine surgery among fibroid patients who used CM was significantly decreased, implying an effective treatment of fibroid-related symptoms provided by CM.

  4. [Risk of laparoscopic surgery. 100 records of complications. A qualitative study].

    Science.gov (United States)

    Hureau, J; Vayre, P; Chapuis, Y; Germain, M A; Jost, J L; Murat, J; Spay, G

    1996-01-01

    A total of 100 accidents occurring during laparoscopic surgery between 1969 and 1993 were studied. Fifty-five of the cases concerned gynaecology surgery over a 24 year period. The other 45 concerned digestive surgery over a 5 year period (1989-1993). The surgical risk was not statistically greater compared with open surgery. Overall morbidity was 1%. Overall mortality was 0.5/1000. A more precise statistical analysis was recently reported. The examination of the 100 cases was qualitative rather than quantitative. The study demonstrated an imbalance between age (mean age 38 years) in patients with major pathology initially and the gravity of the induced accidents: 26 deaths for 100 observations. These deaths were related to technology trocar, capnoperitoneum, electrocoagulation. Technical skill, cautiousness, vigilance and humility are qualities the surgeon must have to perform successful operations. The irreversible acceleration of the new surgical technique should not cloud the basic precepts of sound surgical technique.

  5. The impact of pelvic floor surgery on female sexual function: a mixed quantitative and qualitative study.

    Science.gov (United States)

    Roos, A M; Thakar, R; Sultan, A H; de Leeuw, J W; Paulus, A T G

    2014-01-01

    To assess whether the current condition-specific sexual function questionnaire provides full insight into sexual function following pelvic floor surgery. Prospective, mixed quantitative and qualitative study. Urogynaecology clinic in a large university hospital. Thirty-seven women undergoing surgery for pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI). Women were seen before surgery and 3 months postoperatively. At both visits the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ) was completed and a qualitative face-to-face semi-structured interview was conducted. PISQ total and domain scores, as well as the change in the preoperative and postoperative score, were calculated and analysed using Wilcoxon signed rank test and one-sample t-test. The qualitative data were systematically analysed using data-matrices. The impact of pelvic floor surgery on female sexual function. Significant improvement was seen for PISQ total score (P = 0.003) as well as Physical (P qualitative data showed that improvement in sexual function was a result of cure of POP and SUI symptoms. Deterioration of sexual function was due to dyspareunia, fear of causing damage to the surgical result, new symptoms and a disappointing result of surgery. Our qualitative data show that PISQ is limited in the assessment of sexual function after pelvic floor surgery as it does not assess most surgery-specific negative effects on sexual function. © 2013 Royal College of Obstetricians and Gynaecologists.

  6. Comparison of combined and sequential surgery for proliferative diabetic retinopathy: a single surgeon study.

    Directory of Open Access Journals (Sweden)

    Ye Yang

    Full Text Available PURPOSE: To compare the results of combined and consecutive surgeries to treat proliferative diabetic retinopathy and cataract. METHODS: Retrospective comparative study. Forty-one patients with proliferative diabetic retinopathy (PDR were enrolled. Twenty-nine eyes for the combined surgery group and twelve eyes for the sequential group were included. All surgeries were performed by one surgeon. Phacoemulsification was performed using a clear cornea incision. The vitrectomy was performed using a 20-gauge vitreous cutter. RESULTS: The best corrected visual acuity (BCVA and intra- and post-operative complications were the main outcome measures. In the combined surgery group, the BCVA increased in 18 (62.1% eyes, while eight (27.6% eyes remained stable and three (10.3% eyes decreased. Postoperative complications included fibrinous exudation in nine eyes, macular edema in three eyes and vitreous hemorrhage in three eyes. In the sequential surgery group, the BCVA increased in seven (58.3% eyes, remained the same in four (33.3% eyes and was reduced in one (8.3% eye. Postoperative complications included macular edema in two eyes, neovascular glaucoma in two eyes and vitreous hemorrhage in one eye. CONCLUSIONS: Both combined and sequential surgeries are safe and effective for treating PDR and cataracts. The combined surgery had a higher incidence of fibrinous exudation.

  7. Astigmatism management in cataract surgery with Precizon® toric intraocular lens: a prospective study

    Science.gov (United States)

    Vale, Carolina; Menezes, Carlos; Firmino-Machado, J; Rodrigues, Pedro; Lume, Miguel; Tenedório, Paula; Menéres, Pedro; Brochado, Maria do Céu

    2016-01-01

    Purpose The purpose of this study was to evaluate the visual and refractive outcomes and rotational stability of the new aspheric Precizon® toric intraocular lens (IOL) for the correction of corneal astigmatism in cataract surgery. Setting Department of Ophthalmology, Hospital Geral de Santo António – Centro Hospitalar do Porto, EPE and Hospital de Pedro Hispano, Matosinhos, Portugal. Design This was a prospective clinical study. Patients and methods A total of 40 eyes of 27 patients with corneal astigmatism greater than 1.0 diopter (D) underwent cataract surgery with implantation of Precizon® toric IOL. IOL power calculation was performed using optical coherence biometry (IOLMaster®). Outcomes of uncorrected (UDVA) and best-spectacle corrected distance visual acuities (BCDVA), refraction, and IOL rotation were analyzed at the 1st week, 1st, 3rd, and 6th month’s evaluations. Results The median postoperative UDVA was better than preoperative best-spectacle corrected distance visual acuity (0.02 [0.06] logMAR vs 0.19 [0.20] logMAR, P<0.001). At 6 months, postoperative UDVA was 0.1 logMAR or better in 95% of the eyes. At last follow-up, the mean spherical equivalent was reduced from −3.35±3.10 D to −0.02±0.30 D (P<0.001) with 97.5% of the eyes within ±0.50 D of emmetropia. The mean preoperative keratometric cylinder was 2.34±0.95 D and the mean postoperative refractive cylinder was 0.24±0.27 D (P<0.001). The mean IOL rotation was 2.43°±1.55°. None of the IOLs required realignment. Conclusion Precizon® toric IOL revealed very good rotational stability and performance regarding predictability, efficacy, and safety in the correction of preexisting regular corneal astigmatism associated with cataract surgery. PMID:26855559

  8. Key aspects in managing safety when working with multiple contractors: A case study

    NARCIS (Netherlands)

    Drupsteen, L.; Rasmussen, H.B.; Ustailieva, E.; Kampen, J. van

    2015-01-01

    Working with multiple contractors in a shared workplace can introduce and increase safety risks due to complexity. The aim of this study was to explore how safety issues are recognized in a specific case and to identify whether clients and contractors perceive problems similarly. The safety issues

  9. GammaKnife surgery: safety and the identity of users.

    Science.gov (United States)

    Dinka, David; Nyce, James M; Timpka, Toomas

    2005-01-01

    In this study we investigated safety-related usability issues of an advanced medical technology, a radiosurgery system. We were interested in which criteria are important for users when a system's usability and safety is to be improved. The data collection was based on interviews and observations at three different sites where the Leksell GammaKnife is used. The analysis was qualitative. The main finding was that the user's identity or professional background has a significant impact both on how he or she views his or her role in the clinical setting, and on how he or she defines what improvements are necessary and general safety issues. In fact, the opinion even of users experienced in safety-related problems was highly influenced by how they related to the technology and its development. None of the users actually considered Leksell GammaKnife as lacking in safety, instead, their assessment was directed towards potential future system improvements. Our findings suggest that the importance of user identity or professional background cannot be neglected during the development of advanced technology. They also suggest that the user feedback should always be related to user background and identity in order to understand how important different issues are for particular users.

  10. Efficacy and Safety of Low Molecular Weight Heparin Prophylaxis for Venous Thromboembolism Following Lumbar Decompression Surgery

    Institute of Scientific and Technical Information of China (English)

    Zhi-jian Sun; Xiang Li; Yu Zhao; Giu-xing Qiu; Yi-peng Wang; Xi-sheng Weng; Hong Zhao; Jian-xiong Shen; Yu Jiang; Ye Li

    2011-01-01

    Objective To evaluate the efficacy and safety of low molecular weight heparin (LMWH) prophylaris for venous thromboembolism (VTE) after lumbar decompression surgery.Methods Patients at high or the highest risk of VTE who underwent lumbar spine surgery in Peking Union Medical College Hospital from January 2004 to April 2011 were included in the present study.All the patients received a half dose of LMWH 6 hours after surgery followed by a full dose LMWH once per day until discharge.We recorded incidences of deep venous thrombosis (DVT),pulmonary embolism (PE),bleeding complications,and medication side effects.Results Seventy-eight consecutive patients were eligible and enrolled in this study.The mean hospital stat was 8.5+4.5 days.No symptomatic DVT,PE,or major bleeding events were observed.One patient developed wound ecchymosis,another developed wound bleeding,four had mild hepatic aminotransferase level elevation,and one developed a suspicious allergic reaction.Conclusion LMWH may be applied as an effective and safe prophylaxis for VTE in high-risk patients undergoing lumbar decompression surgery.

  11. 3D Endoscope to Boost Safety, Cut Cost of Surgery

    Science.gov (United States)

    2015-01-01

    Researchers at the Jet Propulsion Laboratory worked with the brain surgeon who directs the Skull Base Institute in Los Angeles to create the first endoscope fit for brain surgery and capable of producing 3D video images. It is also the first to be able to steer its lens back and forth. These improvements to visibility are expected to improve safety, speeding patient recovery and reducing medical costs.

  12. Urogenital function in robotic vs laparoscopic rectal cancer surgery: a comparative study

    OpenAIRE

    Panteleimonitis, Sofoklis; Ahmed, Jamil; Ramachandra, Meghana; Farooq, Muhammad; Harper, Mick; Parvaiz, Amjad

    2016-01-01

    Purpose - Urological and sexual dysfunction are recognised risks of rectal cancer surgery; however, there is limited evidence regarding urogenital function comparing robotic to laparoscopic techniques. The aim of this study was to assess the urogenital functional outcomes of patients undergoing laparoscopic and robotic rectal cancer surgery. Methods - Urological and sexual functions were assessed using gender-specific validated standardised questionnaires. Questionnaires were sent a minimum o...

  13. Weight regain among women after metabolic and bariatric surgery: a qualitative study in Brazil

    Directory of Open Access Journals (Sweden)

    Ataliba de Carvalho Jr.

    2014-09-01

    Full Text Available INTRODUCTION: Due to the increased number of bariatric surgeries over the years, aspects contributing or hindering the achievement of outcomes, among them weight regain, have acquired increased significance. Psychological factors directly influence on this unwanted situation, but there are few studies and controversies about the degree of participation of these factors. We propose a qualitative investigation to analyze the meanings of weight regain after surgery among women and how these factors influence this outcome.METHOD: This study uses the clinical-qualitative method, by means of a semi-structured interview with open questions in an intentional sample, closed by saturation, with eight women who underwent surgery at the Bariatric Surgery Outpatient Clinic of Hospital das Clínicas, Universidade Estadual de Campinas (UNICAMP, in the state of São Paulo, Brazil.RESULTS: A feeling of defeat and failure emerges with weight regain, which contributes to social isolation; there is no regret, but gratitude for the surgery; among patients, there is a sense of feeling rejected greater than a rejection that actually exists.CONCLUSION: We found out the need for further qualitative studies that help the health team to better understand the dynamic psychological factors involved in the meaning of weight regain after bariatric surgery among women, in order to adopt appropriate conducts to deal with this problem.

  14. A study on the safety evaluation of concentrated tritium storage

    Energy Technology Data Exchange (ETDEWEB)

    Lee, K. J.; Kim, K. K.; Lee, S. Y.; Lee, Y. E.; Hong, D. S.; Jung, H. Y.; Song, M. C.; Hwang, K. H.; Kim, S. I.; Yook, D. S.; Sheen, J. J. [Korea Advanced Institute of Science and Technology, Taejeon (Korea)

    2001-03-01

    In this study, hazards of hydrogen and the risk due to storage of tritium are reviewed. The safety related factors are suggested in terms of classification of hydrogen hazards and problems related to the tritium storage. The major design parameters of the vessel of foreign countries for the storage and transport of tritium are reviewed. By review of major safety parameters related to the tritium storage, the results of this study can be applied and helpful to the development and design of tritium storage vessel in Korea. Also, the results can be useful at design of the tritium treatment facility. The integrity of tritium storage vessel material was evaluated with considering the embrittlement of metal material in hydrogen environment. The tritium storage is one of the most important problems for the safety of tritium removal facility. The research for tritium storage could be divided into two parts, one is for the metal getter of tritium and the other is for the integrity of tritium storage vessel. Especially, the integrity of tritium storage vessel is up to the tritium embrittlement of vessel materials, for tritium vessel is mostly made of metal material. In this work, the evaluation of the tritium embrittlement for the tritium storage vessel material is performed with the equipment that is made for high temperature and high vacuum. 33 refs., 56 figs., 23 tabs. (Author)

  15. A study of the safety of tenoxicam in general practice.

    Science.gov (United States)

    Caughey, D; Waterworth, R F

    1989-11-08

    An open, noncomparative study was undertaken to examine the safety of tenoxicam, a new nonsteroidal antiinflammatory drug (NSAID) in general practice. One thousand two hundred and sixty-seven patients with rheumatic conditions were recruited by 392 general practitioners throughout New Zealand. Forty-three point six percent of patients recruited were over 65 years of age, 62.5% had some form of concomitant disease and 76.3% of patients were already receiving NSAIDs. Three hundred and four (23.9%) patients experienced adverse drug reactions, the commonest being gastrointestinal (11.4%), central and peripheral nervous system disorders (2.8%) and skin reactions (2.5%). The profile of adverse drug reactions in those more than 65 was similar to those in patients under 65 years. Of the reactions reported, 14.7% were considered severe. Three peptic ulcers were reported. There were no unexpected adverse drug reactions. Eight hundred and forty-nine patients completed 6 months treatment. Subjective assessments of overall efficacy, pain at night, pain on movement and stiffness made before treatment and at 1, 3 and 6 months posttreatment showed that tenoxicam significantly improved all parameters. The clinical response was maintained throughout the 6 month study period and was not different in patients less than or greater than 65 years.

  16. A study on safety measure of LMR coolant

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Sung Tai; Choi, Y. D.; Choi, J. H.; Kim, T. J.; Jeong, K. C.; Kwon, S. W.; Kim, B. H.; Jeong, J. Y.; Park, J. H.; Kim, K. R.; Jo, B. R.

    1997-08-01

    A study on safety measures of LMR coolant showed the results as follows: 1. Sodium fire characteristics. A. Sodium pool temp., gas temp., oxygen concentration calculated by flame combustion model were generally higher than those calculated by surface combustion model. B. Basic and detail designs for medium sodium fire test facility were carried out and medium sodium fire test facility was constructed. 2. Sodium/Cover gas purification technology. A. Construction and operation of calibration loop. B. Purification analysis and conceptual design of the packing for a cold trap. 3. Analysis of sodium-water reaction characteristics. We have investigated the characteristics analysis for micro and small leaks phenomena, development of the computer code for analysis of initial and quasi steady-state spike pressures to analyze large leak accident. Also, water mock-up test facility for the analysis of large leak accident phenomena was designed and manufactured. 4. Development of water leak detection technology. Detection signals were appeared when the hydrogen detector is operated to Ar-H{sub 2} gas system. The technology for the passive acoustic detection with respect to large leakage of water into sodium media was reviewed. And water mock-up test equipment and instrument system were designed and constructed. (author). 19 refs., 45 tabs., 52 figs.

  17. Comparison of clinical outcome of periapical surgery in endodontic and oral surgery units of a teaching dental hospital: a retrospective study.

    Science.gov (United States)

    Rahbaran, S; Gilthorpe, M S; Harrison, S D; Gulabivala, K

    2001-06-01

    The aims of this retrospective study were (1) to compare the outcome of periapical surgery performed in endodontic and in oral surgery units of a teaching dental hospital and (2) to evaluate the influence of factors affecting outcome. A total of 176 teeth (endodontic unit, 83; oral surgery unit, 93) surgically treated more than 4 years previously were examined clinically and radiographically by means of strict criteria. Multiple logistic regression analysis was used. The rate of complete healing for patients treated in the endodontic unit (37.4%) was significantly (P = .009) higher than that for patients treated in the oral surgery unit (19.4%). The technical quality of surgery (P < .001), placement of root-end filling (P = .039), absence of a preoperative periapical lesion (P = .042), absence of a post (P = .047), and presence of an adequate coronal restoration (P = .056, odds ratio = 3.71) had significant effects on treatment outcome. The technical quality of periapical surgery, the presence of a periapical lesion, and adequate apical and coronal seal are important prognostic determinants of successful periapical surgery.

  18. Assessment of Safety Condition in One of the Teaching Hospitals in Kermanshah (2015: A Case Study

    Directory of Open Access Journals (Sweden)

    Masod Ghanbari Kakavand

    2016-09-01

    Full Text Available Background & Aims of the Study: Many working conditions-related stress factors that can produce injuries and illnesses are important in hospital environments. So, the health and safety of nurses and patients from workplace-induced injuries and illnesses is important. In this study, we have assessed the safety condition of one of the teaching hospitals in Kermanshah (2015. Materials and Methods: This descriptive and cross-sectional study was conducted in one of the teaching hospital of Kermanshah University of medical sciences. For this aim a checklist was prepared based on the Occupational Safety and Health Administration's standards and Part 3 of the manual of National Building Regulations. These checklists comprised (The final checklist had 239 questions of 9 dimensions various sections of safety including; fire safety, building safety, electrical safety, emergency exit routes safety, heating and cooling equipment safety, operating room and laundry room and salty home safety. Eventually, using SPSS 16 and descriptive statistics, data were analyzed. Results: According to the results of this study, 66.6% of the units had poor safety and 33.4% of them were moderately safe. As well as, only ICU and CCU unit, heating and cooling equipment and operational room showed moderate compliance with safety requirements and other sections were poorly complied. Conclusion: The results of this study showed that safety conditions of hospital were not at favorable level. These poor safety statues can jeopardize patients and hospital personnel. Thus some interventions such as improvement of working conditions, compliance with safety acts and implementation of health, safety and environmental management system would be necessary.

  19. Robotic surgery in trauma and orthopaedics: a systematic review.

    Science.gov (United States)

    Karthik, K; Colegate-Stone, T; Dasgupta, P; Tavakkolizadeh, A; Sinha, J

    2015-03-01

    The use of robots in orthopaedic surgery is an emerging field that is gaining momentum. It has the potential for significant improvements in surgical planning, accuracy of component implantation and patient safety. Advocates of robot-assisted systems describe better patient outcomes through improved pre-operative planning and enhanced execution of surgery. However, costs, limited availability, a lack of evidence regarding the efficiency and safety of such systems and an absence of long-term high-impact studies have restricted the widespread implementation of these systems. We have reviewed the literature on the efficacy, safety and current understanding of the use of robotics in orthopaedics.

  20. Operation and Organization of Ambulatory Surgery in France. Results of a Nationwide Survey; The OPERA study.

    Science.gov (United States)

    Beaussier, Marc; Albaladejo, Pierre; Sciard, Didier; Jouffroy, Laurent; Benhamou, Dan; Ecoffey, Claude; Aubrun, Frederic

    2017-08-04

    Operation and organization of ambulatory surgical activity in France remains largely undocumented. Because organizational processes are a major determinant of the quality of care and patient safety, this could appear in contrast with the strong encouragement by French authorities to physicians and hospitals to further develop surgery in an ambulatory setting. This nationwide observational prospective survey, carried out between December 2013 and December 2014, was undertaken to characterize the organizational processes of ambulatory surgery in France. Three hundred centers were randomly chosen from a list of 891 hospitals practicing ambulatory surgery, with stratification according to the type of facility (public general hospital, university hospital, private hospital) and region. An email was sent to the board of the randomly chosen facilities with an attached information letter explaining how the survey worked. Hospitals who did not reply to this email were contacted by phone. Among the 206 hospitals that answered the survey, 92 were private, 78 were public and 36 were university hospitals. Median accommodation capacities of ambulatory units were 8 beds, mostly distinct from conventional surgical ward. Patient pathways dedicated to ambulatory surgery appear as the current predominant practice. 77% of the French ambulatory units have a head nurse in charge of logistics and coordination. Several items have still to be improved, such as the adherence to modern fasting rules and the unnecessary use of stretcher to move the patient. Objective discharge score is used in 77% of ambulatory units. Information was provided on operations (number of beds, dedicated pathways, dedicated staff, governance) and on organizational processes (information, preoperative fasting rules, pre-and postoperative contacts, postoperative care, discharge criteria, follow-up and outcomes). This survey highlights the implementation of some positive organizational parameters corresponding to

  1. Femtosecond laser-assisted cataract surgery: A current review

    Directory of Open Access Journals (Sweden)

    Majid Moshirfar

    2011-01-01

    Full Text Available To evaluate the safety, efficacy, advantages, and limitations of femtosecond laser-assisted cataract surgery through a review of the literature. A PubMed search was conducted using topic-appropriate keywords to screen and select articles. Initial research has shown appropriate safety and efficacy of femtosecond laser-assisted cataract surgery, with improvements in anterior capsulotomy, phacofragmentation, and corneal incision. Limitations of these studies include small sample size and short-term follow-up. Cost-benefit analysis has not yet been addressed. Preliminary data for femtosecond laser-assisted cataract surgery shows appropriate safety and efficacy, and possible advantage over conventional cataract surgery. Questions to eventually be answered include comparisons of long-term postoperative complication rates-including infection and visual outcomes-and analysis of contraindications and financial feasibility.

  2. Feasibility and safety of augmented reality-assisted urological surgery using smartglass.

    Science.gov (United States)

    Borgmann, H; Rodríguez Socarrás, M; Salem, J; Tsaur, I; Gomez Rivas, J; Barret, E; Tortolero, L

    2017-06-01

    To assess the feasibility, safety and usefulness of augmented reality-assisted urological surgery using smartglass (SG). Seven urological surgeons (3 board urologists and 4 urology residents) performed augmented reality-assisted urological surgery using SG for 10 different types of operations and a total of 31 urological operations. Feasibility was assessed using technical metadata (number of photographs taken/number of videos recorded/video time recorded) and structured interviews with the urologists on their use of SG. Safety was evaluated by recording complications and grading according to the Clavien-Dindo classification. Usefulness of SG for urological surgery was queried in structured interviews and in a survey. The implementation of SG use during urological surgery was feasible with no intrinsic (technical defect) or extrinsic (inability to control the SG function) obstacles being observed. SG use was safe as no grade 3-5 complications occurred for the series of 31 urological surgeries of different complexities. Technical applications of SG included taking photographs/recording videos for teaching and documentation, hands-free teleconsultation, reviewing patients' medical records and images and searching the internet for health information. Overall usefulness of SG for urological surgery was rated as very high by 43 % and high by 29 % of surgeons. Augmented reality-assisted urological surgery using SG is both feasible and safe and also provides several useful functions for urological surgeons. Further developments and investigations are required in the near future to harvest the great potential of this exciting technology for urological surgery.

  3. The Zelnorm epidemiologic study (ZEST: a cohort study evaluating incidence of abdominal and pelvic surgery related to tegaserod treatment

    Directory of Open Access Journals (Sweden)

    Seeger John D

    2012-11-01

    Full Text Available Abstract Background Pre-marketing clinical studies of tegaserod suggested an increased risk of abdominal surgery, particularly cholecystectomy. We sought to quantify the association between tegaserod use and the occurrence of abdominal or pelvic surgery, including cholecystectomy. Methods This cohort study was conducted within an insured population. Tegaserod initiators and similar persons who did not initiate tegaserod were followed for up to six months for the occurrence of abdominal or pelvic surgery. Surgical procedures were identified from health insurance claims validated by review of medical records. The incidence of confirmed outcomes was compared using both as-matched and as-treated analyses. Results Among 2,762 tegaserod initiators, there were 94 abdominal or pelvic surgeries (36 gallbladder: among 2,762 comparators there were 134 abdominal or pelvic surgeries (37 gallbladder (hazard ratio HR] = 0.70, 95% confidence interval [C.I.] = 0.54-0.91 overall, HR = 0.98, 95% C.I. = 0.62-1.55 for gallbladder. Current tegaserod exposure compared to nonexposure was associated with a rate ratio [RR] of 0.68 (95% C.I. = 0.48-0.95 overall, while the RR was 0.99 (95% C.I. = 0.56-1.77 for gallbladder surgery. Conclusions In this study, tegaserod use was not found to increase the risk of abdominal or pelvic surgery nor the specific subset of gallbladder surgery.

  4. Incidence of myofascial pain syndrome in breast cancer surgery: a prospective study.

    Science.gov (United States)

    Torres Lacomba, María; Mayoral del Moral, Orlando; Coperias Zazo, José Luís; Gerwin, Robert D; Goñí, Alvaro Zapico

    2010-05-01

    Pain after breast cancer therapy is a recognized complication found to have an adverse impact on patient's quality of life, increasing psychosocial distress. In recent years, case reports about myofascial pain syndrome are emerging in thoracic surgery as a cause of postsurgery pain. Myofascial pain syndrome is a regional pain syndrome characterized by myofascial trigger points in palpable taut bands of skeletal muscle that refers pain a distance, and that can cause distant motor and autonomic effects. The objective of this study was to assess the incidence of myofascial pain syndrome prospectively 12 months after breast cancer surgery. Each participant was assessed preoperatively, postoperatively between day 3 and day 5, and at 1, 3, 6, and 12 months after surgery. A physical therapist, expert in the diagnosis of myofascial pain syndrome, performed follow-up assessments. Pain descriptions by the patients and pain pattern drawings in body forms guided the physical examination. The patients were not given any information concerning myofascial pain or other muscle pain syndromes. One year follow-up was completed by 116 women. Of these, 52 women developed myofascial pain syndrome (44.8%, 95% confidence interval: 35.6, 54.3). Myofascial pain syndrome is a common source of pain in women undergoing breast cancer surgery that includes axillary lymph node dissection at least during the first year after surgery. Myofascial pain syndrome is one potential cause of chronic pain in breast cancer survivors who have undergone this kind of surgery.

  5. The influence of general anesthesia and surgery on cognition in old age: A twin study

    DEFF Research Database (Denmark)

    Dokkedal, Unni; Hansen, Tom G.; Rasmussen, Lars S;

    Introduction: There is a pronounced variation in level of cognitive function and rate of cognitive decline in late life. Results from smaller human and animal studies suggest that exposure to anesthesia may be a risk factor for cognitive impairment. Using a twin design, the objective of the present...... study was to examine whether exposure to anesthesia and surgery is associated with level of cognitive function in middle and old age. Materials and Methods: The study is based on two population-based surveys comprising 8,503 Danish twins aged 45–102 years at study intake during 1995–2001. Through...... linkage to the Danish National Patient Register, we obtained information on surgeries performed in hospitals in Denmark from 1977 and until study intake. Four exposure groups were defined based on type of surgery (major, minor, knee and hip replacement, other). A cognitive test battery consisting of five...

  6. Urogenital function in robotic vs laparoscopic rectal cancer surgery: a comparative study.

    Science.gov (United States)

    Panteleimonitis, Sofoklis; Ahmed, Jamil; Ramachandra, Meghana; Farooq, Muhammad; Harper, Mick; Parvaiz, Amjad

    2017-02-01

    Urological and sexual dysfunction are recognised risks of rectal cancer surgery; however, there is limited evidence regarding urogenital function comparing robotic to laparoscopic techniques. The aim of this study was to assess the urogenital functional outcomes of patients undergoing laparoscopic and robotic rectal cancer surgery. Urological and sexual functions were assessed using gender-specific validated standardised questionnaires. Questionnaires were sent a minimum of 6 months after surgery, and patients were asked to report their urogenital function pre- and post-operatively, allowing changes in urogenital function to be identified. Questionnaires were sent to 158 patients (89 laparoscopy, 69 robotic) of whom 126 (80 %) responded. Seventy-eight (49 male, 29 female) of the responders underwent laparoscopic and 48 (35 male, 13 female) robotic surgery. Male patients in the robotic group deteriorated less across all components of sexual function and in five components of urological function. Composite male urological and sexual function score changes from baseline were better in the robotic cohort (p function. However, composite female urological function score change from baseline was better in the robotic group (p = 0.003). Robotic rectal cancer surgery might offer better post-operative urological and sexual outcomes compared to laparoscopic surgery in male patients and better urological outcomes in females. Larger scale, prospective randomised control studies including urodynamic assessment of urogenital function are required to validate these results.

  7. Pregnancy and foetal outcome after bariatric surgery: a review of recent studies.

    Science.gov (United States)

    Dalfrà, Maria Grazia; Busetto, Luca; Chilelli, Nino Cristiano; Lapolla, Annunziata

    2012-09-01

    It is well known that maternal obesity has adverse effects on the health of offspring, causing immediate and long-term morbidities. The various types of procedure coming under the heading of bariatric surgery have proved effective in preventing some maternal and foetal complications in morbidly obese pregnant women. This review aims to assess the role, the risks and the benefits of bariatric surgery for mothers and offspring. According to recent findings, pregnancy and neonatal outcomes in morbidly obese women who have undergone bariatric surgery depend to some extent on the type of surgery used. Maternal complications, nutritional defects and intestinal obstruction are more frequently reported after Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) than after laparoscopic adjustable gastric banding (LAGB) procedures, whereas caesarean section, preterm delivery and neonatal death are more commonly reported after RYGB than after LAGB. The authors of the only long-term follow-up study conducted on this subject reported that the rate of obesity in the children dropped by 52% after bariatric surgery for the mother, and the cases of severe obesity decreased by 45%. Data on pregnancy and bariatric surgery confirm that the procedure is more effective than dietary measures alone in morbidly obese women, and that pregnancy outcome is generally favorable after surgery. Some studies have indicated, nonetheless, that pregnancies after bariatric surgery are at higher risk: the women affected require special medical attention, particularly as concerns gastrointestinal symptoms and vitamin deficiencies, warranting nutritional/dietary counselling by a multidisciplinary team before, during and after pregnancy.

  8. Safety, Efficacy, and Cost-effectiveness of Tranexamic Acid in Orthopedic Surgery.

    Science.gov (United States)

    Lin, Zilan X; Woolf, Shane K

    2016-01-01

    Perioperative bleeding and postsurgical hemorrhage are common in invasive surgical procedures, including orthopedic surgery. Tranexamic acid (TXA) is a pharmacologic agent that acts through an antifibrinolytic mechanism to stabilize formed clots and reduce active bleeding. It has been used successfully in orthopedics to reduce perioperative blood loss, particularly in total hip and knee arthroplasty and spine surgery. Numerous research studies have reported favorable safety and efficacy in orthopedic cases, although there is no universal standard on its administration and its use has not yet become the standard of practice. Reported administration methods often depend on the surgeon's preference, with both topical and intravenous routes showing efficacy. The type and anatomic site of the surgery seem to influence the decision making but also result in conflicting opinions. Reported complication rates with TXA use are low. The incidence of both arterial and venous thromboembolic events, particularly deep venous thrombosis and pulmonary embolism, has not been found to be significantly different with TXA use for healthy patients. The route of administration and dosage do not appear to affect complication rates either. However, data on patients with higher-risk conditions are deficient. In addition, TXA has shown potential to reduce blood loss, transfusion rates and volumes, perioperative hemoglobin change, and hospital-related costs at various degrees among the published studies. Conservation of blood products, reduced laboratory costs, and shorter hospital stays are likely the major factors driving the cost savings associated with TXA use. This article reviews current data supporting the safety, efficacy, and cost-effectiveness of TXA in orthopedic surgery.

  9. Improving outpatient safety through effective electronic communication: a study protocol

    Directory of Open Access Journals (Sweden)

    Espadas Donna

    2009-09-01

    Full Text Available Abstract Background Health information technology and electronic medical records (EMRs are potentially powerful systems-based interventions to facilitate diagnosis and treatment because they ensure the delivery of key new findings and other health related information to the practitioner. However, effective communication involves more than just information transfer; despite a state of the art EMR system, communication breakdowns can still occur. 123 In this project, we will adapt a model developed by the Systems Engineering Initiative for Patient Safety (SEIPS to understand and improve the relationship between work systems and processes of care involved with electronic communication in EMRs. We plan to study three communication activities in the Veterans Health Administration's (VA EMR: electronic communication of abnormal imaging and laboratory test results via automated notifications (i.e., alerts; electronic referral requests; and provider-to-pharmacy communication via computerized provider order entry (CPOE. Aim Our specific aim is to propose a protocol to evaluate the systems and processes affecting outcomes of electronic communication in the computerized patient record system (related to diagnostic test results, electronic referral requests, and CPOE prescriptions using a human factors engineering approach, and hence guide the development of interventions for work system redesign. Design This research will consist of multiple qualitative methods of task analysis to identify potential sources of error related to diagnostic test result alerts, electronic referral requests, and CPOE; this will be followed by a series of focus groups to identify barriers, facilitators, and suggestions for improving the electronic communication system. Transcripts from all task analyses and focus groups will be analyzed using methods adapted from grounded theory and content analysis.

  10. Complications of epilepsy surgery in Sweden 1996-2010: a prospective, population-based study.

    Science.gov (United States)

    Bjellvi, Johan; Flink, Roland; Rydenhag, Bertil; Malmgren, Kristina

    2015-03-01

    Detailed risk information is essential for presurgical patient counseling and surgical quality assessments in epilepsy surgery. This study was conducted to investigate major and minor complications related to epilepsy surgery in a large, prospective series. The Swedish National Epilepsy Surgery Register provides extensive population-based data on all patients who were surgically treated in Sweden since 1990. The authors have analyzed complication data for therapeutic epilepsy surgery procedures performed between 1996 and 2010. Complications are classified as major (affecting daily life and lasting longer than 3 months) or minor (resolving within 3 months). A total of 865 therapeutic epilepsy surgery procedures were performed between 1996 and 2010, of which 158 were reoperations. There were no postoperative deaths. Major complications occurred in 26 procedures (3%), and minor complications in 65 (7.5%). In temporal lobe resections (n = 523), there were 15 major (2.9%) and 41 minor complications (7.8%); in extratemporal resections (n = 275) there were 9 major (3.3%) and 22 minor complications (8%); and in nonresective procedures (n = 67) there were 2 major (3%) and 2 minor complications (3%). The risk for any complication increased significantly with age (OR 1.26 per 10-year interval, 95% CI 1.09-1.45). Compared with previously published results from the same register, there is a trend toward lower complication rates, especially in patients older than 50 years. This is the largest reported prospective series of complication data in epilepsy surgery. The complication rates comply well with published results from larger single centers, confirming that epilepsy surgery performed in the 6 Swedish centers is safe. Patient age should be taken into account when counseling patients before surgery.

  11. Topical diclofenac patch for postoperative wound pain in laparoscopic gynecologic surgery: a randomized study.

    Science.gov (United States)

    Alessandri, Franco; Lijoi, Davide; Mistrangelo, Emanuela; Nicoletti, Annamaria; Crosa, Marco; Ragni, Nicola

    2006-01-01

    To compare pain management of standard analgesic and standard analgesic plus diclofenac transdermal patch in patients who undergo laparoscopic gynecologic surgery. Randomized prospective study (Canadian Task Force classification I). University hospital. One hundred twenty patients requiring laparoscopic surgery for gynecologic benign diseases. Patients were divided into two groups, one medicated with a diclofenac patch (diclofenac group) and the other medicated with standard skin medication (placebo; control group) at all incisional areas at the end of the operation. The principal measures of outcome were pain intensity at 6, 12, and 24 hours after surgery and consumption of analgesics. The two treatment groups were comparable with respect to demographic and intraoperative characteristics. No significant difference was observed between the two groups in mean pain intensity at 6 hours after surgery. Mean pain intensity at 12 and 24 hours, respectively, after surgery was significantly lower in the diclofenac group (3.7 +/- 1.3 and 2.0 +/- 0.6) than that observed in the control group (5.7 +/- 1.9 and 4.6 +/- 0.5) (p value, respectively, .002 and diclofenac group required analgesics in the first 36 hours after the operation versus 43 patients (71.7%) in the control group (p diclofenac group (28 +/- 5 hours vs 39 +/- 3 hours; p = .031). Diclofenac transdermal administration seems a valid help to standard analgesic treatment in postoperative pain control and could also help reduce the period of hospitalization of patients who undergo laparoscopic benign gynecologic surgery. Copyright 2006 AAGL

  12. Safety and efficacy of endovascular therapy and gamma knife surgery for brain arteriovenous malformations in China: Study protocol for an observational clinical trial

    Directory of Open Access Journals (Sweden)

    Hengwei Jin

    2017-09-01

    Discussion: The most confusion on BAVM treatment is whether to choose interventional therapy or medical therapy, and the choice of interventional therapy modes. This study will provide evidence for evaluating the safety and efficacy of microinvasive treatment in China, to characterize the microinvasive treatment strategy for BAVMs.

  13. Efficiency and safety of leukocyte filtration during cardiopulmonary bypass for cardiac surgery

    NARCIS (Netherlands)

    Smit, JJJ; de Vries, AJ; Gu, YJ; van Oeveren, W

    1999-01-01

    Background. Leukocyte filtration of systemic blood during cardiopulmonary bypass surgery to reduce post-operative morbidity has not yet been established because of the enormous leukocyte release from the third space. This study was designed to examine the efficiency and safety of leukocyte filtratio

  14. A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study.

    Science.gov (United States)

    Li, Liang; Yang, Jian; Chu, Yakui; Wu, Wenbo; Xue, Jin; Liang, Ping; Chen, Lei

    2016-01-01

    To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery. In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems. The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D) virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons. The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon's skills and knowledge, not as a substitute.

  15. A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study

    Science.gov (United States)

    Li, Liang; Yang, Jian; Chu, Yakui; Wu, Wenbo; Xue, Jin; Liang, Ping; Chen, Lei

    2016-01-01

    Objective To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery. Materials and Methods In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems. Results The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D) virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons. Conclusion The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon’s skills and knowledge, not as a substitute. PMID:26757365

  16. A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study.

    Directory of Open Access Journals (Sweden)

    Liang Li

    Full Text Available To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery.In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems.The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons.The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon's skills and knowledge, not as a substitute.

  17. On the safety of aircraft systems: A case study

    Energy Technology Data Exchange (ETDEWEB)

    Martinez-Guridi, G.; Hall, R.E.; Fullwood, R.R.

    1997-05-14

    An airplane is a highly engineered system incorporating control- and feedback-loops which often, and realistically, are non-linear because the equations describing such feedback contain products of state variables, trigonometric or square-root functions, or other types of non-linear terms. The feedback provided by the pilot (crew) of the airplane also is typically non-linear because it has the same mathematical characteristics. An airplane is designed with systems to prevent and mitigate undesired events. If an undesired triggering event occurs, an accident may process in different ways depending on the effectiveness of such systems. In addition, the progression of some accidents requires that the operating crew take corrective action(s), which may modify the configuration of some systems. The safety assessment of an aircraft system typically is carried out using ARP (Aerospace Recommended Practice) 4761 (SAE, 1995) methods, such as Fault Tree Analysis (FTA) and Failure Mode and Effects Analysis (FMEA). Such methods may be called static because they model an aircraft system on its nominal configuration during a mission time, but they do not incorporate the action(s) taken by the operating crew, nor the dynamic behavior (non-linearities) of the system (airplane) as a function of time. Probabilistic Safety Assessment (PSA), also known as Probabilistic Risk Assessment (PRA), has been applied to highly engineered systems, such as aircraft and nuclear power plants. PSA encompasses a wide variety of methods, including event tree analysis (ETA), FTA, and common-cause analysis, among others. PSA should not be confused with ARP 4761`s proposed PSSA (Preliminary System Safety Assessment); as its name implies, PSSA is a preliminary assessment at the system level consisting of FTA and FMEA.

  18. A study on Impact of Safety Culture on Safety Behavior: Moderating effect of Prevention Focus

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Sun Chul; Jung, Su Jin; Choi, Young Sung [KAERI, Daejeon (Korea, Republic of)

    2016-05-15

    In modern society, it has been acknowledged that disasters caused by civilization became inevitable. With growing attention to role of human as one component of the system to cope with accident to prevent disasters, various efforts have been deployed to keep safety. Most of the industries with high hazard have adopted the term as their banner in the efforts to promote safety in their installations and operations. Recently, the Fukushima nuclear power plants(NPPs) accident happened in Japan in 2011 resulted in great impact over the world and have highlighted the importance of safety culture again.

  19. Compliance with a time-out procedure intended to prevent wrong surgery in hospitals : results of a national patient safety programme in the Netherlands

    NARCIS (Netherlands)

    van Schoten, Steffie M; Kop, Veerle; de Blok, Carolien; Spreeuwenberg, Peter; Groenewegen, Peter P; Wagner, Cordula

    2014-01-01

    OBJECTIVE: To prevent wrong surgery, the WHO 'Safe Surgery Checklist' was introduced in 2008. The checklist comprises a time-out procedure (TOP): the final step before the start of the surgical procedure where the patient, surgical procedure and side/site are reviewed by the surgical team. The aim

  20. Attitude is everything? The impact of workload, safety climate, and safety tools on medical errors: a study of intensive care units.

    Science.gov (United States)

    Steyrer, Johannes; Schiffinger, Michael; Huber, Clemens; Valentin, Andreas; Strunk, Guido

    2013-01-01

    Hospitals face an increasing pressure toward efficiency and cost reduction while ensuring patient safety. This warrants a closer examination of the trade-off between production and protection posited in the literature for a high-risk hospital setting (intensive care). On the basis of extant literature and concepts on both safety management and organizational/safety culture, this study investigates to which extent production pressure (i.e., increased staff workload and capacity utilization) and safety culture (consisting of safety climate among staff and safety tools implemented by management) influence the occurrence of medical errors and if/how safety climate and safety tools interact. A prospective, observational, 48-hour cross-sectional study was conducted in 57 intensive care units. The dependent variable is the incidence of errors affecting those 378 patients treated throughout the entire observation period. Capacity utilization and workload were measured by indicators such as unit occupancy, nurse-to-patient/physician-to-patient ratios, levels of care, or NEMS scores. The safety tools considered include Critical Incidence Reporting Systems, audits, training, mission statements, SOPs/checklists, and the use of barcodes. Safety climate was assessed using a psychometrically validated four-dimensional questionnaire.Linear regression was employed to identify the effects of the predictor variables on error rate as well as interaction effects between safety tools and safety climate. Higher workload has a detrimental effect on safety, whereas safety climate-unlike the examined safety tools-has a virtually equal opposite effect. Correlations between safety tools and safety climate as well as their interaction effects on error rate are mostly nonsignificant. Increased workload and capacity utilization increase the occurrence of medical error, an effect that can be offset by a positive safety climate but not by formally implemented safety procedures and policies.

  1. The clinical effect of LLLT in endodontic surgery: a prospective study on 72 cases.

    Science.gov (United States)

    Payer, Michael; Jakse, Norbert; Pertl, Christoph; Truschnegg, Astrid; Lechner, Evelyn; Eskici, Antranik

    2005-09-01

    The purpose of this prospective study was to evaluate a possible clinical benefit of LLLT in endodontic surgery. Seventy-two endosurgery cases on incisors and premolars were included to the study and were split randomly into an LLLT test group, a placebo group, and a control group. In the LLLT group, irradiation was performed intraoperatively and postoperatively 1, 3, and 7 days after surgery. In the placebo group, irradiation was performed without laser activation. In the control group, neither LLLT nor placebo therapy was used. Swelling, wound healing, and pain were evaluated by a blinded investigator 1, 3, and 7 days postoperatively. No statistically relevant differences between the LLLT and the placebo groups were found. Patients in the control group reported on statistically relevant stronger pain. In routine endodontic surgery cases, LLLT does not achieve a significant clinical benefit. Further, the results indicate a prominent placebo effect of the soft laser therapy.

  2. Gamma Knife surgery for patients with facial nerve schwannomas: a multiinstitutional retrospective study in Japan.

    Science.gov (United States)

    Hasegawa, Toshinori; Kato, Takenori; Kida, Yoshihisa; Hayashi, Motohiro; Tsugawa, Takahiko; Iwai, Yoshiyasu; Sato, Mitsuya; Okamoto, Hisayo; Kano, Tadashige; Osano, Seiki; Nagano, Osamu; Nakazaki, Kiyoshi

    2016-02-01

    The aim of this study was to explore the efficacy and safety of stereotactic radiosurgery for patients with facial nerve schwannomas (FNSs). This study was a multiinstitutional retrospective analysis of 42 patients with FNSs treated with Gamma Knife surgery (GKS) at 1 of 10 medical centers of the Japan Leksell Gamma Knife Society (JLGK1301). The median age of the patients was 50 years. Twenty-nine patients underwent GKS as the initial treatment, and 13 patients had previously undergone surgery. At the time of the GKS, 33 (79%) patients had some degree of facial palsy, and 21 (50%) did not retain serviceable hearing. Thirty-five (83%) tumors were solid, and 7 (17%) had cystic components. The median tumor volume was 2.5 cm(3), and the median prescription dose to the tumor margin was 12 Gy. The median follow-up period was 48 months. The last follow-up images showed partial remission in 23 patients and stable tumors in 19 patients. Only 1 patient experienced tumor progression at 60 months, but repeat GKS led to tumor shrinkage. The actuarial 3- and 5-year progression-free survival rates were 100% and 92%, respectively. During the follow-up period, 8 patients presented with newly developed or worsened preexisting facial palsy. The condition was transient in 3 of these patients. At the last clinical follow-up, facial nerve function improved in 8 (19%) patients, remained stable in 29 (69%), and worsened in 5 (12%; House-Brackmann Grade III in 4 patients, Grade IV in 1 patient). With respect to hearing function, 18 (90%) of 20 evaluated patients with a pure tone average of ≤ 50 dB before treatment retained serviceable hearing. GKS is a safe and effective treatment option for patients with either primary or residual FNSs. All patients, including 1 patient who required repeat GKS, achieved good tumor control at the last follow-up. The incidence of newly developed or worsened preexisting facial palsy was 12% at the last clinical follow-up. In addition, the risk of hearing

  3. The Impact of Surgery on the Developmental Status of Late Preterm Infants – A Cohort Study

    Science.gov (United States)

    Trivedi, Amit; Walker, Karen; Loughran-Fowlds, Alison; Halliday, Robert; J. A. Holland, Andrew; Badawi, Nadia

    2015-01-01

    Aims: Despite increasing evidence in the literature regarding the impact of late prematurity on subsequent developmental impairment, the developmental outcome of late preterm infants who undergo major surgery remains unclear. The aim of this study therefore was to determine the developmental outcome for a cohort of late preterm surgical population. Methods: Late preterm infants with a gestational age from 34-36 weeks inclusive who were enrolled in the state-wide prospective Development After Infant Surgery (DAISy) study and who had undergone non-cardiac major surgery within the first ninety days of life were eligible for inclusion. Infants were assessed at one and three years of ages. Results: Forty-six infants were enrolled in the study, of which 38 infants had a complete developmental assessment at one year of age. Of these infants, late preterm infants scored significantly lower than the standardized norms of the assessment on the expressive language and gross motor subscales. At three years of age 26 infants were reassessed: late preterm infants who underwent major surgery only scored significantly lower than the standardized norms on the cognitive subscale (p less than 0.001). Conclusions: These data provide the evidence that late preterm infants who undergo major non-cardiac surgery are at risk of developmental impairment and consideration should be given to enrolling this cohort in multi-disciplinary developmental follow-up clinics. PMID:26023526

  4. The Impact of Surgery on the Developmental Status of Late Preterm Infants – A Cohort Study

    Directory of Open Access Journals (Sweden)

    Amit Trivedi

    2015-01-01

    Full Text Available Aims: Despite increasing evidence in the literature regarding the impact of late prematurity on subsequent developmental impairment, the developmental outcome of late preterm infants who undergo major surgery remains unclear. The aim of this study therefore was to determine the developmental outcome for a cohort of late preterm surgical population.Methods: Late preterm infants with a gestational age from 34-36 weeks inclusive who were enrolled in the state-wide prospective Development After Infant Surgery (DAISy study and who had undergone non-cardiac major surgery within the first ninety days of life were eligible for inclusion. Infants were assessed at one and three years of ages.Results: Forty-six infants were enrolled in the study, of which 38 infants had a complete developmental assessment at one year of age. Of these infants, late preterm infants scored significantly lower than the standardized norms of the assessment on the expressive language and gross motor subscales. At three years of age 26 infants were reassessed: late preterm infants who underwent major surgery only scored significantly lower than the standardized norms on the cognitive subscale (p<0.001.Conclusions: These data provide the evidence that late preterm infants who undergo major non-cardiac surgery are at risk of developmental impairment and consideration should be given to enrolling this cohort in multi-disciplinary developmental follow-up clinics.

  5. Ultrasonic root-end preparation in apical surgery : a prospective randomized study

    NARCIS (Netherlands)

    de Lange, Jan; Putters, Thomas; Baas, Erik M.; van Ingen, Johan M.

    2007-01-01

    Objective. The purpose of this study was to evaluate the potential benefit of an ultrasonic device in apical surgery on the outcome of treatment. Study design. A randomized prospective design was used in a standardized treatment protocol. Patients were allocated to treatment with an ultrasonic devic

  6. A RETROSPECTIVE CLINICAL STUDY OF LAPAROSCOPIC AND OPEN SURGERY FOR CHOLECYSTECTOMY PROCEDURE

    Directory of Open Access Journals (Sweden)

    Konduru Siva Prasada Raju

    2017-03-01

    Full Text Available BACKGROUND The gall stone is one of the commonest ailments for which the hospital doors are knocked in India. Recent statistics suggest that about 15 to 30 percent of women in the fourth and fifth decade of life commonly suffer from this. The gall bladder should not be removed just considering the fact that the stones are there but the stones are formed in it and one major problem is its recurrence. Recent non – operative procedures like shock wave therapy and drugs are non - promising. Minimal access surgery is now the trend in any kind of surgery and cholecystectomy is no exception. Initially there was a huge benefit seen but now more and more complications are reported. In this study an effort has been put to understand the complications involved in both the Laparoscopic and Open type of surgery. This study is intended to help the practicing surgeon to anticipate the commonly involved complications in both the type of surgeries and also to help them understand the pros and cons of each type especially in resource challenged settings. MATERIALS AND METHODS This study was done in the Department of General Surgery in RIMS Medical College at Ongole. This study was done from January 2014 to December 2016. A sample size of 131 patients was selected and the retrospective analysis was done. RESULTS The mean age of the population in the sample size was 44.18 years and the range of the patients included from 10 years to 81 years. There were thirty seven males and ninety four females in the total study population. Female preponderance was seen which was statistically significant. Open surgery is the method of choice in an emergencyod of choice in case of emergency.All twenty three patients who underwent open surgery had significant post operative pain complained of post - operative pain requiring analgesic intervention. Only two patients complained of post – operative pain in case of laparoscopic procedure and none of them needed analgesics. Other

  7. Labial frenectomy with Nd:YAG laser and conventional surgery: a comparative study.

    Science.gov (United States)

    Medeiros Júnior, Rui; Gueiros, Luiz Alcino; Silva, Igor Henrique; de Albuquerque Carvalho, Alessandra; Leão, Jair Carneiro

    2015-02-01

    Labial frenulums are sagittal fibrous folds of oral mucosa with a periosteal insertion that extend from the lips to the alveolar or gingival mucosa. Occasionally, they assume inadequate size or location and may lead to functional and esthetic limitations. The aim of the present study was to compare pre-, trans-, and postsurgical clinical parameters of labial frenectomies performed with conventional surgery and neodymium-doped yttrium aluminum garnet (Nd:YAG) laser. Forty individuals were assessed as a convenience sample and were divided into two groups according to the treatment: group 1 (G1), conventional surgery (n = 22), and G2, Nd:YAG laser surgery (n = 18). Clinical parameters such as frenulum insertion, location, bleeding, surgical time, suturing, preoperative fear, and postoperative discomfort/functional limitations were evaluated. All surgeries were performed by the same operator, and the level of fear, pain, and discomfort related to oral functions were assessed with a visual numeric scale. Most of the frenulums (90%) were classified as papillary or transpapillary insertion. Preoperative fear was similar between groups (p = 0.593). All G2 patients did not require suture (p frenectomies reduces transoperative bleeding, avoiding the need of suturing, and promotes a significant reduction of surgical time in comparison with conventional surgery. Therefore, further studies are necessary to provide a complete understanding and standardization of the technique as well as the expected clinical results.

  8. Electroacupuncture Reduces Postoperative Pain and Analgesic Consumption in Patients Undergoing Thoracic Surgery: A Randomized Study

    Science.gov (United States)

    Chen, Tongyu; Xu, Jianjun; Ma, Wen; Zhou, Jia

    2016-01-01

    The aim of this study was to evaluate the effect of electroacupuncture (EA) on postoperative pain management in patients undergoing thoracic surgery. A randomized study was conducted. Ninety-two thoracic surgical patients were randomly divided into an EA group and a sham group. Postoperative intravenous analgesia was applied with a half dose of the conventional drug concentration in both groups. In the EA group, EA treatment was administered for three consecutive days after the surgery with 6 sessions of 30 min each. Compared with the sham group, patients in the EA group had a lower visual analogue scale (VAS) score at 2, 24, 48, and 72 hours and consumed less analgesic after surgery. The incidence of opioid-related adverse effects of nausea was lower in the EA group. The time to first flatus and defecation was also shorter in the EA group. Furthermore, the plasma β-endorphin (β-EP) level was higher by radioimmunoassay and the plasma 5-hydroxytryptamine (5-HT) level was lower in the EA group by enzyme-linked immunosorbent assay during the first 72 hr after thoracic surgery. Therefore, EA is suitable as an adjunct treatment for postoperative pain management after thoracic surgery. PMID:27073400

  9. Electroacupuncture Reduces Postoperative Pain and Analgesic Consumption in Patients Undergoing Thoracic Surgery: A Randomized Study

    Directory of Open Access Journals (Sweden)

    Tongyu Chen

    2016-01-01

    Full Text Available The aim of this study was to evaluate the effect of electroacupuncture (EA on postoperative pain management in patients undergoing thoracic surgery. A randomized study was conducted. Ninety-two thoracic surgical patients were randomly divided into an EA group and a sham group. Postoperative intravenous analgesia was applied with a half dose of the conventional drug concentration in both groups. In the EA group, EA treatment was administered for three consecutive days after the surgery with 6 sessions of 30 min each. Compared with the sham group, patients in the EA group had a lower visual analogue scale (VAS score at 2, 24, 48, and 72 hours and consumed less analgesic after surgery. The incidence of opioid-related adverse effects of nausea was lower in the EA group. The time to first flatus and defecation was also shorter in the EA group. Furthermore, the plasma β-endorphin (β-EP level was higher by radioimmunoassay and the plasma 5-hydroxytryptamine (5-HT level was lower in the EA group by enzyme-linked immunosorbent assay during the first 72 hr after thoracic surgery. Therefore, EA is suitable as an adjunct treatment for postoperative pain management after thoracic surgery.

  10. Early Oral Feeding After Surgery for Upper Gastrointestinal Malignancies: A Prospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Saeed Shoar

    2016-05-01

    Full Text Available Objectives: Poor nutritional status following abdominal surgeries for esophageal and gastric cancers remains a major challenge in postoperative care. Our study aimed to investigate the efficacy of starting early oral feeding (EOF in patients undergoing surgical resection of upper gastrointestinal malignancies. Methods: A total of 180 consecutive patients with a diagnosis of esophageal or gastric malignancies undergoing elective surgical resection between January 2008 and February 2011 were enrolled in this prospective cohort study. Seventy-two patients were assigned to the EOF group, and 108 patients received late oral feeding (LOF. Postoperative endpoints were compared between the two groups. Results: Nasogastric tubes were removed from patients on average 3.3±1.6 days after the surgery in the EOF group and 5.2±2.5 days in the LOF group (p 0.050. Conclusions: EOF is safe following esophageal and gastric cancer surgery and results in faster recovery and hospital discharge.

  11. Organizational Factors and Long-Term Mortality after Hip Fracture Surgery. A Cohort Study of 6143 Consecutive Patients Undergoing Hip Fracture Surgery

    DEFF Research Database (Denmark)

    Lund, Caterina A; Møller, Ann M; Wetterslev, Jørn

    2014-01-01

    OBJECTIVE: In hospital and health care organizational factors may be changed to reduce postoperative mortality. The aim of this study is to evaluate a possible association between mortality and 'length of hospital stay', 'priority of surgery', 'time of surgery', or 'surgical delay' in hip fracture......, anaesthetic and surgical procedures were retrieved. PARTICIPANTS: 6143 patients aged more than 65 years undergoing hip fracture surgery. MAIN OUTCOME MEASURES: All-cause mortality. RESULTS: The one year mortality was 30% (28-31%, 95% Confidence interval (CI)). In a multivariate model 'length of hospital stay...

  12. A study to evaluate cephalometric hard tissue profile of Tamil population for orthognathic surgery.

    Science.gov (United States)

    Nachiappan, S; Tharanikumar, S; Chandran, Ajay; Anusudha, P; Nandini, G D; Balasubramaniam, Murali

    2015-08-01

    The primary aim of this study is to compare, the cephalometric hard tissue profile values and analysis between Tamil and Caucasian population. The study also aims to create a better understanding in the facial proportions of Tamil Nadu population and to have better diagnosis and treatment planning for orthognathic surgery for Tamil population in Tamil Nadu.

  13. Open surgery versus retroperitoneal laparoscopic nephrectomy for renal tuberculosis: a retrospective study of 120 patients

    Directory of Open Access Journals (Sweden)

    Su Zhang

    2016-11-01

    Full Text Available Background Laparoscopic renal surgery has been widely used in the treatment of renal diseases. However, there is still little research about its application in addressing renal tuberculosis. The purpose of this study is to retrospectively investigate the surgical results of laparoscopic and open surgery for nonfunctional tuberculous kidneys. Methods Between May 2011 and June 2016, 120 nephrectomies were performed in patients with a nonfunctional tuberculous kidney. Of these, 69 patients underwent retroperitoneal laparoscopic nephrectomy, and 51 patients underwent open nephrectomy. Data about the patients’ characteristics and surgical outcomes were collected from their electronic medical records. Outcomes were compared between these two groups. Results Our results showed that a number of renal tuberculosis patients presented no significant symptoms during their disease. Lower urinary tract symptoms (LUTS were the most common at a rate of 73/120, followed by flank pain or accidently discovery (66/120, urine abnormality (30/120 and fever (27/120. Patients who underwent open surgery were similar to laparoscopic patients with regard to sex, BMI, location, previous tuberculous history, grade, anemia, adhesion, hypertension, diabetes and preoperative serum creatinine level, but were generally older than laparoscopic patients. There were no significant differences between open and laparoscopic surgery in estimated blood loss, transfusion, postoperative hospital days and perioperative complication rate. However, the median operation time of laparoscopic operation was much longer than open surgery (180 [150–225] vs 135 [120–165] minutes, P < 0.01. Seven of the 69 laparoscopic operations were converted to open surgery because of severe adhesions. Conclusion Laparoscopic nephrectomy is as an effective treatment as open surgery for a nonfunctional tuberculous kidney, although it requires more time during the surgical procedure. No significant

  14. A study of assessment of patient safety climate in tertiary care hospitals.

    Science.gov (United States)

    Chakravarty, Abhijit; Sahu, Anupam; Biswas, Manash; Chatterjee, Kaustuv; Rath, Subrata

    2015-04-01

    Medical errors are being detected with increasing frequency in healthcare environment, in many cases leading to patient harm. Measurement and improvement of patient safety climate has been identified as a strategic effort towards addressing this vital issue. Safety Attitude Questionnaire (SAQ), validated by previous research was administered to 300 respondents in three tertiary care hospitals of India, the respondents representing various categories of healthcare workers and variations in safety scale score was analyzed by various statistical tools. No variation was observed in the Patient Safety Index score among the study hospitals. However, significant variations were observed among different categories of healthcare workers across dimensions of Teamwork, Perception of Management and Stress Recognition. Multiple Regression models identified Teamwork and Perception of Management to have significant correlation with Patient Safety Index Score. Patient Safety Climate can be effectively assessed and such assessment utilized for focused improvement efforts towards safety in healthcare organizations.

  15. Going home after infant cardiac surgery: a UK qualitative study.

    Science.gov (United States)

    Tregay, Jenifer; Wray, Jo; Crowe, Sonya; Knowles, Rachel; Daubeney, Piers; Franklin, Rodney; Barron, David; Hull, Sally; Barnes, Nick; Bull, Catherine; Brown, Katherine L

    2016-04-01

    To qualitatively assess the discharge processes and postdischarge care in the community for infants discharged after congenital heart interventions in the first year of life. Qualitative study using semistructured interviews and Framework Analysis. UK specialist cardiac centres and the services their patients are discharged to. Twenty-five cardiologists and nurses from tertiary centres, 11 primary and secondary health professionals and 20 parents of children who had either died after discharge or had needed emergency readmission. Participants indicated that going home with an infant after cardiac intervention represents a major challenge for parents and professionals. Although there were reported examples of good care, difficulties are exacerbated by inconsistent pathways and potential loss of information between the multiple teams involved. Written documentation from tertiary centres frequently lacks crucial contact information and contains too many specialist terms. Non-tertiary professionals and parents may not hold the information required to respond appropriately when an infant deteriorates, this contributing to the stressful experience of managing these infants at home. Where they exist, the content of formal 'home monitoring pathways' varies nationally, and families can find this onerous. Service improvements are needed for infants going home after cardiac intervention in the UK, focusing especially on enhancing mechanisms for effective transfer of information outside the tertiary centre and processes to assist with monitoring and triage of vulnerable infants in the community by primary and secondary care professionals. At present there is no routine audit for this stage of the patient journey. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  16. Impact of individual resilience and safety climate on safety performance and psychological stress of construction workers: A case study of the Ontario construction industry.

    Science.gov (United States)

    Chen, Yuting; McCabe, Brenda; Hyatt, Douglas

    2017-06-01

    The construction industry has hit a plateau in terms of safety performance. Safety climate is regarded as a leading indicator of safety performance; however, relatively little safety climate research has been done in the Canadian construction industry. Safety climate may be geographically sensitive, thus it is necessary to examine how the construct of safety climate is defined and used to improve safety performance in different regions. On the other hand, more and more attention has been paid to job related stress in the construction industry. Previous research proposed that individual resilience may be associated with a better safety performance and may help employees manage stress. Unfortunately, few empirical research studies have examined this hypothesis. This paper aims to examine the role of safety climate and individual resilience in safety performance and job stress in the Canadian construction industry. The research was based on 837 surveys collected in Ontario between June 2015 and June 2016. Structural equation modeling (SEM) techniques were used to explore the impact of individual resilience and safety climate on physical safety outcomes and on psychological stress among construction workers. The results show that safety climate not only affected construction workers' safety performance but also indirectly affected their psychological stress. In addition, it was found that individual resilience had a direct negative impact on psychological stress but had no impact on physical safety outcomes. These findings highlight the roles of both organizational and individual factors in individual safety performance and in psychological well-being. Construction organizations need to not only monitor employees' safety performance, but also to assess their employees' psychological well-being. Promoting a positive safety climate together with developing training programs focusing on improving employees' psychological health - especially post-trauma psychological

  17. Bacterial contamination of suction catheter tips during aortic valve replacement surgery: a prospective observational cohort study.

    Science.gov (United States)

    Larsson, Johanna; Sutherland, Sofia; Söderström, Åsa; Roman-Emanuel, Christine; Jeppsson, Anders; Olofsson, Elisabeth Hansson; Svensson, Per-Arne

    2015-01-01

    Bacterial mediastinitis is a severe complication after open heart surgery. The infection causes prolonged hospitalization and an increased mortality risk. Observations from orthopaedic surgery showed that the suction catheter used during surgery is commonly contaminated with bacteria. The aim of this study was to describe the prevalence of suction catheter contamination in cardiac surgery and to study if suction time influences the contamination risk. Fifty suction catheter tips were collected during 25 aortic valve replacement operations. The suction tip was exchanged once during the operation (after aortotomy closure). The tips were subjected to bacterial contamination analysis. In 20 of the 25 investigated cases (80%), bacterial contamination was detected on one or both tips. The tip used during the beginning of the operation showed bacterial contamination in 13/25 cases (52%) and the second tip in 12/25 (48%). In 5/25 cases (20%) both tips were contaminated. There was no association between bacterial contamination and suction time. Coagulase-negative staphylococcus was the most commonly detected microorganism. The suction device should be considered as a potential source of bacterial contamination in cardiac surgery. The results suggest that the suction catheter should be replaced before key moments like valve implantation and sternal closure.

  18. Suspensory Materials for Surgery of Blepharoptosis: A Systematic Review of Observational Studies

    Science.gov (United States)

    Pacella, Elena; Mipatrini, Daniele; Pacella, Fernanda; Amorelli, Giulia; Bottone, Andrea; Smaldone, Gianpaolo; Turchetti, Paolo; La Torre, Giuseppe

    2016-01-01

    Background Frontalis suspension surgery is considered the procedure of choice in cases of blepharoptosis. Among all the materials used in this type of surgery, ophthalmic and plastic surgeons prefer to use autologous Fascia Lata. However, during years, other autogenous and exogenous materials have been introduced. Objectives The aim of this study was therefore that of systematically reviewing the functional results and the rate of complications of different synthetic materials, as compared to autogenous Fascia Lata. The primary objective was to determine the rates of Successful Surgeries (SSs) of these materials. The secondary objective was to assess the onset of complications. The following materials were investigated: Fascia Lata, Mersilene, polytetrafluoroethylene (PTFE) and Silicon. Data Source and Methods Following the Prisma procedure, on January 30th, 2016 we used the following electronic databases to select the studies: MEDLINE and Scopus. Results The search strategy retrieved 48 publications that met the eligibility criteria of the systematic review. All studies were non-comparative. PTFE (n = 5) showed the best rate of SSs among the materials compared (statistically significant). Surgeries performed with autogenous Fascia Lata (n = 19) had a 87% rate of success those performed with Mersilene (n = 12)had 92% and those performed with Silicon (n = 17)88%. PTFE had the best outcome, with 99% success rate. As for complications, surgeries performed with PTFE had a higher rate of suture infections (1.9%) as compared to Fascia Lata, but lower incidence for all other complications. Conclusions Although most studies were good quality cohort studies, the overall quality of this evidence should be regarded as low due to their non-comparative design. Our data suggest that PTFE seems to be the most valid alternative material for frontalis suspension surgery, with low recurrence rates and good cosmetic and functional results. PMID:27631781

  19. Factors predisposing to wound infection in cardiac surgery. A prospective study of 517 patients.

    Science.gov (United States)

    Wilson, A P; Livesey, S A; Treasure, T; Grüneberg, R N; Sturridge, M F

    1987-01-01

    Postoperative wound infection can greatly prolong hospital stay after cardiac surgery, so the identification of predisposing factors may help in prevention or early institution of treatment. Transfer of organisms from the leg to the sternum during coronary artery surgery has been proposed as a major additional cause of sepsis. The definition of wound infection is not standardised and therefore makes comparison between centres difficult. In a prospective study of 517 patients, a wound scoring method (ASEPSIS) has been used to register all abnormal wounds to maximise the chances of identifying factors predisposing to infection. Abnormal healing was noted in 99 (19%) sternal wounds and 29 (8%) leg wounds. Obesity was the principal risk factor (P less than 0.005). Diabetes, reoperation, length of preoperative hospital stay, age, sex, or previous cardiac surgery had little effect on wound healing. The range of bacteria isolated from chest wounds after coronary artery surgery was similar to that after valvular surgery, but the rate of isolation was significantly greater. With careful attention to technique, leg wound infection rarely presented a clinical problem and did not appear to be a source of bacteria infecting the chest wound.

  20. A comparative study of Sterofundin and Ringer lactate based infusion protocol in scoliosis correction surgery

    Science.gov (United States)

    Sharma, Ashima; Yadav, Monu; Kumar, B. Rajesh; Lakshman, P. Sai; Iyenger, Raju; Ramchandran, Gopinath

    2016-01-01

    Background: A major change in anesthesia practice as regards to intraoperative infusion therapy is the present requirement. Switching over to balanced fluids can substantially decrease the incidence of lactic acidosis and hyperchloremic acidosis. The deleterious effects of unbalanced fluids are more recognizable during major surgeries. We prospectively studied the influence of Sterofundin (SF) and Ringer lactate (RL) on acid–base changes, hemodynamics, and readiness for extubation during scoliosis surgery. Subjects and Methods: Thirty consecutive children posted for scoliosis surgery were randomized to receive either RL (n = 15) or SF (n = 15) as intraoperative fluid at 10 mg/kg/h. Fluid boluses were added according to the study fluid algorithm. Arterial blood was sampled and analyzed at hourly intervals during surgery. Red blood cell transfusion was guided by hematocrit below 27. Patients were followed for 24 h postoperatively in the Intensive Care Unit. Results: There was no statistically significant difference in the volume of infused fluid (2400 ± 512 ml in Group RL and 2200 ± 640 ml in Group SF. There were no significant changes in pH of patients infused with SF. Statistically, significant higher lactate levels were seen in RL-infused group. The strong ion difference was decreased in both groups, but it normalized earlier with SF. Conclusions: SF-infused patients had nonremarkable changes in acid–base physiology in scoliosis surgery. PMID:27746547

  1. Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: a randomized study.

    Science.gov (United States)

    Bauer, Brent A; Cutshall, Susanne M; Wentworth, Laura J; Engen, Deborah; Messner, Penny K; Wood, Christina M; Brekke, Karen M; Kelly, Ryan F; Sundt, Thoralf M

    2010-05-01

    Integrative therapies such as massage have gained support as interventions that improve the overall patient experience during hospitalization. Cardiac surgery patients undergo long procedures and commonly have postoperative back and shoulder pain, anxiety, and tension. Given the promising effects of massage therapy for alleviation of pain, tension, and anxiety, we studied the efficacy and feasibility of massage therapy delivered in the postoperative cardiovascular surgery setting. Patients were randomized to receive a massage or to have quiet relaxation time (control). In total, 113 patients completed the study (massage, n=62; control, n=51). Patients receiving massage therapy had significantly decreased pain, anxiety, and tension. Patients were highly satisfied with the intervention, and no major barriers to implementing massage therapy were identified. Massage therapy may be an important component of the healing experience for patients after cardiovascular surgery.

  2. Postoperative bacteremia in periodontal flap surgery, with and without prophylactic antibiotic administration: A comparative study

    Directory of Open Access Journals (Sweden)

    Asi Kanwarjit

    2010-01-01

    Full Text Available Objectives: Many a times in clinical periodontology, the decision whether to prescribe prophylactic antibiotics or not , is perplexing.The present study was conducted to compare the bacteremias induced after periodontal flap surgeries with and without prophylactic antibiotics. Materials and Methods: The occurrence of postoperative bacteremia following periodontal flap surgery was studied in 30 patients. On these patients, 30 quadrant wise flap surgeries were carried out without any preoperative prophylactic antibiotics and 30 surgeries carried out after prophylactic administration of amoxycillin preoperatively. A blood sample was taken from each patient at the time of maximum surgical trauma and was cultured for micro-organisms and antibiotic sensitivity. Results: 18 out of 60 blood samples were positive for micro-organisms. There was a significant reduction in post operative bacteremia after amoxycillin prophylaxis (x - 7.96 with P< 0.01 as post operative bacteremia was found in 14 of the non medicated patients as compared to only 4 of the pre medicated patients. The micro-organisms encountered in the study are as follows:- 1 Staphylococcus albus coagulase negative, 2 Klebsiella, 3 Psedomonas aerugenosa, 4 Streptococcus viridans, 5 Alpha hemolytic streptococcus, 6 Neisseria catarrhalis Conclusion: On the basis of the study, it is concluded that the incidence of postoperative bacteremia following periodontal flap surgery is not as high as previously reported. The clinical results show that Amoxicillin is highly effective in reducing postoperative bacteremia in periodontal flap surgery and thus in preventing the possible sequelae (Infective Endocarditis and other systemic maladies in susceptible patients. However, cefotaxime and cephalexin may prove to be more effective in preventing the same.

  3. Factors predicting surgical site infection after posterior lumbar surgery: A multicenter retrospective study.

    Science.gov (United States)

    Wang, Tao; Wang, Hui; Yang, Da-Long; Jiang, Li-Qiang; Zhang, Li-Jun; Ding, Wen-Yuan

    2017-02-01

    This is a retrospective study.The purpose of this study is to explore incidence and risk factors for surgical site infection (SSI) after posterior lumbar surgery.SSI is a common complication after posterior lumbar surgery, bringing mental and physical pain and prolonging hospital stay. However, predisposing factors, as reported less, remain controversial.Patients who underwent posterior lumbar surgery at 3 centers between 2006 and 2016 were included. The possible factors include 3 aspects: demographic variables-age, sex, body mass index (BMI), waist-to-hip radio (WHR), hypertension, diabetes, heart disease, smoking, drinking, steroidal injection, surgical time between June and September, preoperative shower; blood test variables-white blood cell (WBC), neutrophil, red blood cell (RBC), hemoglobin (Hb), total protein (TP), albumin, albumin/globulin (A/G), C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR) and surgical related variables-operation time, blood loss, operative level, instrumentation, incision length. Factors related with SSI were also performed by multivariate analysis.The prevalence of SSI was 3.00% (267 cases of 8879) had a postoperative wound infection. There were significant difference in WHR (0.92 vs 0.83), WBC (4.31 vs 6.69), TP (58.7 vs 65.2), albumin (36.9 vs 43.2), CRP (2.01 vs 0.57), PCT (0.097 vs 0.067), operation time (217.9 vs 195.7), blood loss (997.1 vs 915.3) and operative level (3.05 vs 2.45) and incision length (24.1 vs 20.0) between SSI group and non-SSI group. >60 years old, female, BMI 30.0, diabetes, male smoking, preoperative steroidal injection, surgical time between June and September, no preoperative shower, instrumentation surgery were risk factors for SSI after posterior lumbar surgery.Many factors, >60 years old, female, BMI, WHR, diabetes, male smoking, preoperative steroidal injection, surgical time between June and September, preoperative shower, WBC, TP, albumin, CRP, PCT, operation time

  4. Is testis-sparing surgery safe in small testicular masses? Results of a multicentre study

    Science.gov (United States)

    Keske, Murat; Canda, Abdullah Erdem; Yalcin, Serdar; Kilicarslan, Aydan; Kibar, Yusuf; Tuygun, Can; Onder, Evrim; Atmaca, Ali Fuat; Yildirim, Asif; Ozkanli, Sidika Seyma; Kandemir, Olcay; Kargi, Taner; Sar, Mehmet; Tugcu, Volkan; Resorlu, Berkan; Aslan, Yilmaz; Sarikaya, Selcuk; Boylu, Ugur; Cicek, Ali Fuat; Basar, Halil; Tuncel, Altug; Balbay, Mevlana Derya

    2017-01-01

    Introduction Our goal was to evaluate benign and malignant lesions and testicular intraepithelial neoplasia (TIN) in the neighbouring normal-appearing testis tissue in men who underwent radical orchiectomy for testicular mass with a pathologic tumour size of ≤3cm. Methods In this retrospective, multicentre study, data of 252 patients from 11 different institutions were included. Patients were divided into three groups based on tumour size: Group 1 (0–1 cm; n=35), Group 2 (1.1–2cm; n=99), and Group 3 (2.1–3 cm; n=118). Benign lesions and TIN were sought in the neighbouring testicular tissue and compared between groups. Results Mean patient age was 32.3 years. Benign lesions were reported in 54.3%, 33.3%, and 14.4% of Groups 1, 2, and 3, respectively (p0.05 for Groups 2 vs. 3). Multifocality was detected in 8.6%, 4%, and 0% of Groups 1, 2, and 3, respectively (p0.05 for Group 1 vs. Group 2). A tumour cutoff size of 1.5 cm was found to be significant for detecting benign tumour. TIN and multifocality rates were similar in patients with a tumour size of ≤1.5 vs. >1.5 cm (p>0.05). Conclusions Benign lesions and TIN in the neighbouring testis were significantly decreased and multifocality was increased in patients with a tumour mass size of ≤1 cm. Testis-sparing surgery should be performed with caution and a safety rim of normal tissue should also be excised.

  5. Challenges to and the future of medication safety in Saudi Arabia: A qualitative study.

    Science.gov (United States)

    Aljadhey, Hisham; Mahmoud, Mansour Adam; Hassali, Mohamed Azmi; Alrasheedy, Alian; Alahmad, Amjad; Saleem, Fahad; Sheikh, Aziz; Murray, Michael; Bates, David W

    2014-09-01

    Medication safety is a global concern among healthcare providers. However, the challenges to and the future of medication safety in Saudi Arabia have not been explored. We explored the perspectives of healthcare practitioners on current issues about medication safety in hospitals and community settings in Saudi Arabia in order to identify challenges to improving it and explore the future of medication safety practice. A total of 65 physicians, pharmacists, academics and nurses attended a one-day meeting in March 2010, designed especially for the purpose of this study. The participants were divided into nine round-table discussion sessions. Three major themes were explored in these sessions, including: major factors contributing to medication safety problems, challenges to improving medication safety practice, and participants' suggestions for improving medication safety. The round-table discussion sessions were videotaped and transcribed verbatim and analyzed by two independent researchers. The round-table discussions revealed that major factors contributing to medication safety problems included unrestricted public access to medications from various hospitals and community pharmacies, communication gaps between healthcare institutions, limited use of important technologies such as computerized provider order entry, and the lack of medication safety programs in hospitals. Challenges to current medication safety practice identified by participants included underreporting of medication errors and adverse drug reactions, multilingualism and differing backgrounds of healthcare professionals, lack of communication between healthcare providers and patients, and high workloads. Suggestions for improving medication safety practices in Saudi Arabia included continuous education for healthcare professionals and competency assessment focusing on medication safety, development of a culture that encourages medication error and adverse drug reactions reporting, use of technology

  6. Academic plastic surgery: a study of current issues and future challenges.

    Science.gov (United States)

    Zetrenne, Eleonore; Kosins, Aaron M; Wirth, Garrett A; Bui, Albert; Evans, Gregory R D; Wells, James H

    2008-06-01

    The objectives of this study were (1) to evaluate the role of a full-time academic plastic surgeon, (2) to define the indicators predictive of a successful career in academic plastic surgery, and (3) to understand the current issues that will affect future trends in the practice of academic plastic surgery. A questionnaire was developed to evaluate the role of current full-time academic plastic surgeons and to understand the current issues and future challenges facing academic plastic surgery. Each plastic surgery program director in the United States was sent the survey for distribution among all full-time academic plastic surgeons. Over a 6-week period, responses from 143 full-time academic plastic surgeons (approximately 31%) were returned. Fifty-three percent of respondents had been academic plastic surgeons for longer than 10 years. Seventy-three percent of respondents defined academic plastic surgeons as clinicians who are teachers and researchers. However, 53% of respondents believed that academic plastic surgeons were not required to teach or practice within university hospitals/academic centers. The 3 factors reported most frequently as indicative of a successful career in academic plastic surgery were peer recognition, personal satisfaction, and program reputation. Dedication and motivation were the personal characteristics rated most likely to contribute to academic success. Forty-four percent of respondents were unable to identify future academic plastic surgeons from plastic surgery residency applicants, and 27% were not sure. Most (93%) of the respondents believed that academic surgery as practiced today will change. The overall job description of a full-time academic plastic surgeon remains unchanged (teacher and researcher). Whereas peer recognition, personal satisfaction, and program reputation were most frequently cited as indicative of a successful plastic surgery career, financial success was rated the least indicative. Similarly, whereas the

  7. A PRELIMINARY STUDY FOR SIX SIGMA IMPLEMENTATION IN LASER IN SITU KERATOMILEUSIS (LASIK SURGERIES

    Directory of Open Access Journals (Sweden)

    Mehmet Tolga Taner

    2014-01-01

    Full Text Available The purpose of this study is to show how a private eye care center in Turkey developed a Six Sigma infrastructure to investigate the root causes of complications occuring during LASIK surgeries. To analyze the collected data, main tools of Six Sigma’s Define-Measure-Analyze-Improve-Control(DMAIC improvement cycle such as SIPOC table, Fishbone Diagram and, Failure, Mode and Effect Analysis were implemented. Experience of the refractive surgeons, type of microkeratome and hygiene of microkeratome were identified to be Critical-to-Quality (CTQ factors for a successful LASIK surgery. The most frequent complications of LASIK surgeries were found to be dry eye syndrome, subconjunctival haemorrhage and flap edge melt. The process sigma level was found to be 3.7135.

  8. Benefits of Bariatric Surgery and Perioperative Surgical Safety

    Directory of Open Access Journals (Sweden)

    Ji Chung Tham

    2015-11-01

    Full Text Available Obesity is a worldwide problem with numerous associated health problems. The number of patients eligible for surgery outnumber surgical capacity and so patients need to be prioritised based on their obesity- related health burden and comorbidities. Weight loss as a result of bariatric surgery is significant and maintained in the long term. In addition to weight loss, patient health improves in terms of metabolic, macrovascular, and microvascular disease. As a result, quality of life is better, along with psychosocial wellbeing. Bariatric surgery is associated with a relatively low number of complications and appears to result in a reduction in mortality risk due to the resolution of comorbidities. Hence, surgery can now be routinely considered as an adjunct to medical therapy in the management of obesity.

  9. [Laparoscopic versus open surgery for colorectal cancer. A comparative study].

    Science.gov (United States)

    Arribas-Martin, Antonio; Díaz-Pizarro-Graf, José Ignacio; Muñoz-Hinojosa, Jorge Demetrio; Valdés-Castañeda, Alberto; Cruz-Ramírez, Omar; Bertrand, Martin Marie

    2014-01-01

    Antecedentes: la cirugía laparoscópica para tratar pacientes con cáncer colorrectal ha sido ampliamente aceptada y difundida en todo el mundo. Sin embargo, dependiendo de la experiencia en este abordaje los resultados quirúrgicos y oncológicos a corto plazo pueden variar. En nuestra población existen pocos estudios que comparan los resultados de esta técnica con los de la cirugía abierta. Objetivos: determinar la superioridad de la técnica laparoscópica o abierta en cirugía de cáncer colorrectal. Material y métodos: estudio retrospectivo y comparativo de pacientes operados con técnica abierta o laparoscópica por cáncer de colon y recto entre 1999 y 2011 en nuestro centro. Resultados: se incluyeron 47 pacientes intervenidos de manera convencional y 35 por laparoscopia. El tiempo operatorio fue menor en el grupo de cirugía abierta (p= 0.008). No se encontraron diferencias en: sangrado intraoperatorio (p= 0.3980), número de ganglios resecados (p= 0.27), inicio de la vía oral (p= 0.31), tiempo de estancia hospitalaria (p= 0.12), y dolor referido por el paciente (p= 0.19). En el grupo de cirugía laparoscópica se requirieron menos dosis de analgésicos (p= 0.04) y menor necesidad de catéter epidural para analgesia postoperatoria (p= 0.01). Las tasas de morbilidad (p= 0.44) y mortalidad (p= 0.39) fueron similares en ambos grupos. Conclusiones: la cirugía laparoscópica es equiparable a la técnica abierta en cuanto a estándares oncológicos y resultados técnicos. Este trabajo demuestra que en nuestro hospital la cirugía laparoscópica en pacientes con cáncer de colon y recto es tan segura como la cirugía abierta.

  10. The Safety and Efficacy of Routine Administration of Intracameral Vancomycin during Cataract Surgery

    Directory of Open Access Journals (Sweden)

    Sloan W. Rush

    2015-01-01

    Full Text Available Purpose. To evaluate the safety and efficacy of intracameral vancomycin during cataract surgery using a standardized dosage and delivery technique. Methods. The charts of 20,719 consecutive eyes that underwent phacoemulsification with intraocular lens implantation in a single ambulatory surgery center were retrospectively reviewed over a 5-year period. Results. The first 11,333 consecutive cases did not receive intracameral vancomycin, whereas the next 9,386 consecutive cases all received intracameral vancomycin. There were no significant differences in the baseline characteristics between the cohort of subjects who received intracameral vancomycin and the cohort of subjects that did not. There were a total of 11 subjects (0.97 cases per 1,000 that developed postoperative endophthalmitis in the group that did not receive intracameral vancomycin, whereas there were no cases of postoperative endophthalmitis in the group that received intracameral vancomycin (p = 0.0015. The overall rate of intraoperative and postoperative complications and the final postoperative visual acuities were similar among cohorts. There were no cases of toxic anterior segment syndrome occurring in either group during the study period. Conclusions. Routine administration of intracameral vancomycin during cataract surgery significantly decreased the incidence of postoperative endophthalmitis and was not associated with an increased incidence of postoperative adverse events.

  11. [Surgery for phimosis with Plastibell. A follow-up study].

    Science.gov (United States)

    Jensen, M K

    1998-06-22

    Fifty-three boys were interviewed 11 years (9-14 years) after an operation for phimosis using the Plastibell technique. The interview concentrated on the cosmetic result, sexual function and late complications. Seventeen patients (31%) experienced cosmetic complications, and 11 patients (21%) claimed to have experienced psycho-social problems due to the appearance of the penis after the operation. Nonetheless an overall of 44 patients (83%) were fully satisfied/satisfied with the cosmetic result. Four patients (8%) claimed to have pain or discomfort on erection or intercourse. One patient (2%) was re-operated three years after the primary operation because of a recurrence of the symptoms. Overall 48 patients (91%) were fully satisfied or satisfied with the result after the operation. In conclusion we find the Plastibell procedure to be a safe and reliable method in treating phimosis. There are some minor technical pitfalls that have to be addressed in learning the technique, but performed in trained hands, the technique offers a very high satisfaction rate at long term follow-up.

  12. The Safety and Efficacy of Dexmedetomidine versus Sufentanil in Monitored Anesthesia Care during Burr-Hole Surgery for Chronic Subdural Hematoma: A Retrospective Clinical Trial

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    Wenming Wang

    2016-11-01

    Full Text Available Background: Chronic subdural hematoma (CSDH is a very common clinical emergency encountered in neurosurgery. While both general anesthesia (GA and monitored anesthesia care (MAC can be used during CSDH surgery, MAC is the preferred choice among surgeons. Further, while dexmedetomidine (DEX is reportedly a safe and effective agent for many diagnostic and therapeutic procedures, there have been no trials to evaluate the safety and efficacy of DEX vs. sufentanil in CSDH surgery. Objective: To evaluate the safety and efficacy of DEX vs. sufentanil in MAC during burr-hole surgery for CSDH.Methods: In all, 215 fifteen patients underwent burr-hole surgery for CSDH with MAC and were divided into three groups: Group D1 (n=67, DEX infusion at 0.5 μg·kg–1 for 10 min, Group D2 (n=75, DEX infusion at 1 μg·kg–1 for 10 min, and Group S (n=73, sufentanil infusion 0.3 μg·kg–1 for 10 min. Ramsay sedation scale (RSS of all three groups was maintained at 3. Anesthesia onset time, total number of intraoperative patient movements, hemodynamics, total cumulative dose of DEX, time to first dose and amount of rescue midazolam or fentanyl, percentage of patients converted to alternative sedative or anesthetic therapy, postoperative recovery time, adverse events, and patient and surgeon satisfaction scores were recorded.Results: The anesthesia onset time was significantly less in group D2 (17.36±4.23 vs. 13.42±2.12 vs. 15.98±4.58 min, respectively, for D1, D2, S; P<0.001. More patients in groups D1 and S required rescue midazolam to achieve RSS=3 (74.63% vs. 42.67% vs. 71.23%, respectively, for D1, D2, S; P<0.001. However, the total dose of rescue midazolam was significantly higher in group D1 (2.8±0.3 vs. 1.9±0.3 vs. 2.0±0.4 mg, respectively, for D1, D2, S; P<0.001. The time to first dose of rescue midazolam was significantly longer in group D2 (17.32±4.47 vs. 23.56±5.36 vs. 16.55±4.91 min, respectively, for D1, D2, S; P<0.001. Significantly fewer

  13. Image-guided endoscopic spine surgery: Part I. A feasibility study.

    Science.gov (United States)

    Assaker, R; Cinquin, P; Cotten, A; Lejeune, J P

    2001-08-01

    A feasibility study was performed to determine the efficacy of computer assistance in endoscopic spine surgery. To assess a new method for computer assistance based on image guidance during thoracoscopic or any endoscopic spine procedure. To evaluate the reproducibility, the sensitivity and the reliability of the technique first in vitro and second in clinical use. The computer-based, image-guided surgery is now a routine tool used in open spine surgery. Exposure of the anatomy of the vertebra is needed for registration. This methodology is inapplicable in endoscopic approach. Fluoroscopic-based navigation combines the technology of image-guided surgery and C-arm fluoroscopy. The navigation is based on the fluoroscopic images acquired before surgery. This technology is applicable to endoscopic surgery but the navigation is based on fluoroscopic image. The computed tomography images are not exploited. There are no published data on a technique that allows image-guided surgery based on computed tomography and magnetic resonance imaging. A laboratory study was performed on a thoracic human spine. One vertebra was marked on the right lateral side of the body with five titanium marks. A percutaneous reference frame was specifically designed to be placed in the pedicle of the same marked vertebrae. The reference frame acted as a 3D localizer and a registration tool. The spine model was scanned including the reference frame. A standard Stealth station treatment guidance platform (Medtronic, Sofamor Danek, Memphis, TN) was used for simulation. The registration was obtained using the reference frame. Twenty navigation procedure trials were done and the error was recorded based on the distance between the anatomical point and the corresponding virtual one. Registration was always possible using the stealth station and a standard spine navigational software (spine 3, Medtronic Sofamor Danek, Memphis, TN). The mean error after registration given by the computer was 0.96 mm

  14. Post-operative rounds by anaesthesiologists after hip fracture surgery: a pilot study

    DEFF Research Database (Denmark)

    Foss, Nicolai Bang; Christensen, Dorte Stig; Krasheninnikoff, Michael

    2006-01-01

    conditions. CONCLUSION: This pilot study, with insufficient power to show significant differences in outcome, supports further evaluation of the concept of intensified orthopaedic-anaesthesiological co-operation after hip fracture surgery. Such a randomized trial should evaluate economic and clinical outcome...

  15. Surgery for posttraumatic syringomyelia: a retrospective study of seven patients

    Institute of Scientific and Technical Information of China (English)

    CAO Fei; YANG Xiao-feng; LIU Wei-guo; LI Gu; ZHENG Xue-sheng; WEN Liang

    2007-01-01

    Objective: To analyze retrospectively the clinical symptoms, signs, radiological findings and results of treatment of posttraumatic syringomyelia.Methods: The data of 7 patients with posttraumatic syringomyelia confirmed by computerized tomography(CT) and magnetic resonance imaging (MRI) in our hospital between 1999 and 2004 were reviewed retrospectively. The patients underwent decompressive laminectomy or syringo-subarachnoid (S-S) shunting with microsurgery. Long-term follow-up was available (range:13-65 months).Results: The major clinical manifestations of posttraumatic syringomyelia usually included the onset of increasing signs and the development of new symptoms after an apparently stable period. The clinical symptoms included pain, sensory disturbance, weakness, and problems in autonomic nerves. Syrinx existed merely at the cervical level in 4 cases and extended downward to the thoracic levels in the other 3 cases. One case underwent decompressive laminectomy, 6 cases were treated by S-S shunting. During the early postoperative period, all the patients showed an improvement of symptoms of syrinx without major complication or death. The decreased size or collapse of the syrinx was demonstrated by postoperative MRI.Conclusions: Posttraumatic syringomyelia is a disabling sequela of spinal cord injury, developing months to years after spinal injury. MRI is the standard diagnostic technique for syringomyelia. The patients with posttraumatic syringomyelia combined with progressive neurological deterioration should be treated with operations. S-S shunting procedure is effective in some patients with posttraumatic syringomyelia. Decompressive procedure may be an alternative primary surgical treatment for patients with kyphosis and cord compression.

  16. [Errors in surgery. Strategies to improve surgical safety].

    Science.gov (United States)

    Arenas-Márquez, Humberto; Anaya-Prado, Roberto

    2008-01-01

    Surgery is an extreme experience for both patient and surgeon. The patient has to be rescued from something so serious that it may justify the surgeon to violate his/her integrity in order to resolve the problem. Nevertheless, both physician and patient recognize that the procedure has some risks. Medical errors are the 8th cause of death in the U.S., and malpractice can be documented in >50% of the legal prosecutions in Mexico. Of special interest is the specialty of general surgery where legal responsibility can be confirmed in >80% of the cases. Interest in mortality attributed to medical errors has existed since the 19th century; clearly identifying the lack of knowledge, abilities, and poor surgical and diagnostic judgment as the cause of errors. Currently, poor organization, lack of team work, and physician/ patient-related factors are recognized as the cause of medical errors. Human error is unavoidable and health care systems and surgeons should adopt the culture of error analysis openly, inquisitively and permanently. Errors should be regarded as an opportunity to learn that health care should to be patient centered and not surgeon centered. In this review, we analyze the causes of complications and errors that can develop during routine surgery. Additionally, we propose measures that will allow improvements in the safety of surgical patients.

  17. Key aspects in managing safety when working with multiple contractors: A case study.

    Science.gov (United States)

    Drupsteen, Linda; Rasmussen, Hanna B; Ustailieva, Erika; van Kampen, Jakko

    2015-01-01

    Working with multiple contractors in a shared workplace can introduce and increase safety risks due to complexity. The aim of this study was to explore how safety issues are recognized in a specific case and to identify whether clients and contractors perceive problems similarly. The safety issues are explored through a brief survey and a workshop in the maintenance department of a logistics company. The results indicate that culture and behavior are recognized differently by clients and by contractors. The contractors and client had different perceptions of involvement of contractors by the client. The contractors complained on lack of involvement, which was not fully recognized by the client. The case study used a practical approach to show differences in perception of safety within a project. The study illustrates the need for more applied studies and interventions on contractor safety.

  18. A Study into Safety Perceptions of Tourist Visiting İstanbul

    Directory of Open Access Journals (Sweden)

    Cihan Seçilmiş

    2009-09-01

    Full Text Available Safety is one of the priorities of a tourist when choosing his/her destination. The need of safety is one of the natural characteristics of a human being. People need to feel safe in order to live a peaceful life. The goal of this study is to draw attention to safety in tourism by determining whether İstanbul is regareded as safe by tourists, and to produce ideas towards the subject. In this research, the concept of safety has been covered from different aspects and connecting with the tourism sector; thus, safety issues are examined from the point of law. Tourists’ safety perception about Istanbul has been putted via a survey applied to local and foreign tourists. The results reveal that İstanbul has an image as an unsafe venue in some aspects.

  19. Cataract Surgery Performed by High Frequency LDV Z8 Femtosecond Laser: Safety, Efficacy, and Its Physical Properties

    Directory of Open Access Journals (Sweden)

    Bojan Pajic

    2017-06-01

    Full Text Available Background: The aim of our study was to investigate the safety and efficacy of the LDV Z8 femtosecond laser in cataract surgery compared to the conventional procedure. Methods: This prospective study was performed at the Swiss Eye Research Foundation, Eye Clinic ORASIS, Reinach, Switzerland. The study included 130 eyes from 130 patients: 68 treated with femtosecond laser-assisted cataract surgery (FLACS using the FEMTO LDV Z8 and 62 treated with conventional phacoemulsification. Capsulotomy and lens fragmentation in the laser group were performed with the FEMTO LDV Z8 femtosecond laser system, which employs a new, low-energy, high repetition rate laser process for cataract surgery. In the conventional group, the capsulotomy was performed by a cystotome, and lens fragmentation was achieved by the stop-and-chop. Results: Ease of phacoemulsification (on a 4-point scale, the completeness of capsulotomy (on a 10-point scale, effective phacoemulsification time (seconds, uncorrected distance visual acuity (UCVA, best spectacle-corrected distance visual acuity (BSCVA, spherical equivalent (SE, and safety of the procedure were evaluated. The total follow-up time was three months. Conclusions: FLACS with the FEMTO LDV Z8 system was characterized by complete and reproducible capsulotomy and highly effective lens fragmentation. Postoperative visual outcomes were excellent, and the safety of the procedure was optimal.

  20. Safety and 6-month effectiveness of minimally invasive sacroiliac joint fusion: a prospective study

    Directory of Open Access Journals (Sweden)

    Duhon BS

    2013-12-01

    Full Text Available Bradley S Duhon,1 Daniel J Cher,2 Kathryn D Wine,2 Harry Lockstadt,3 Don Kovalsky,4 Cheng-Lun Soo5On behalf of the SIFI Study Group1Neurosurgical and Spine Specialists, Parker, CO, 2SI-BONE, Inc, San Jose, CA, 3Bluegrass Orthopaedics and Hand Care, Lexington, KY, 4Orthopaedic Center of Southern Illinois, Mount Vernon, IL, 5Health Research Institute, Oklahoma City, OK, USABackground: Sacroiliac (SI joint pain is an often overlooked cause of low back pain. SI joint arthrodesis has been reported to relieve pain and improve quality of life in patients suffering from degeneration or disruption of the SI joint who have failed non-surgical care. We report herein early results of a multicenter prospective single-arm cohort of patients with SI joint degeneration or disruption who underwent minimally invasive fusion using the iFuse Implant System®.Methods: The safety cohort includes 94 subjects at 23 sites with chronic SI joint pain who met study eligibility criteria and underwent minimally invasive SI joint fusion with the iFuse Implant System® between August 2012 and September 2013. Subjects underwent structured assessments preoperatively, immediately postoperatively, and at 1, 3, and 6 months postoperatively, including SI joint and back pain visual analog scale (VAS, Oswestry Disability Index (ODI, Short Form-36 (SF-36, and EuroQoL-5D (EQ-5D. Patient satisfaction with surgery was assessed at 6 months. The effectiveness cohort includes the 32 subjects who have had 6-month follow-up to date.Results: Mean subject age was 51 years (n=94, safety cohort and 66% of patients were women. Subjects were highly debilitated at baseline (mean VAS pain score 78, mean ODI score 54. Three implants were used in 80% of patients; two patients underwent staged bilateral implants. Twenty-three adverse events occurred within 1 month of surgery and 29 additional events occurred between 30 days and latest follow-up. Six adverse events were severe but none were device

  1. Study on analgesic effect and safety of meloxicam injection after orthopaedic surgery%美洛昔康针剂用于骨科术后镇痛效果及安全性研究

    Institute of Scientific and Technical Information of China (English)

    王碧菠; 张伟滨

    2011-01-01

    目的 研究美洛昔康针剂用于骨科术后镇痛的效果及安全性.方法 :在上海4家不同医院骨科各随机选取40例手术患者共160例,使用美洛昔康针剂进行术后镇痛.入组患者术后1h接受美洛昔康针剂15mg肌注,术后24h接受15mg肌注.对镇痛疗效不佳者予以枸橼酸芬太尼注射液补充镇痛.采用视觉模拟评分(VAS)在术后1h(用药前)、2h、4h、8h、12h、24h、48h分别评估疼痛程度,并记录补充镇痛药物枸橼酸芬太尼的用量.术前及术后1周行血常规、肝肾功能、心电图检查,观察有无与药物相关的不良事件产生.结果 :入组男性患者105例(65.63%),女性患者55例(34.37%),平均年龄46.36岁(21-65岁).接受大手术85例(53.1%),中手术者42例(26.3%),小手术者33例(20.6%).用药前(术后1h)VAS平均评分为8.3,用药后各时间点VAS平均评分分别为7.8、7.1、6.8,5.5、3.7、2.4,提示美洛昔康针剂术后镇痛总体疗效满意.按手术大小分类观察各时间点VAS评分,并比较各组疼痛缓解率,可见美洛昔康针剂对于不同类型的骨科手术均有较好的镇痛疗效,但对大、中型骨科手术,还需加用中枢性阿片类镇痛药物加强镇痛效果.用药前后血常规、肝肾功能和心电图结果的差异无统计学意义,提示美洛昔康针剂临床安全性良好.结论 :使用美洛昔康针剂可有效缓解骨科术后疼痛,并能减少中枢性镇痛药的使用剂量,且无明显不良反应,是一种有效的骨科术后镇痛药物.%Objective To study the effect and safety of post-operative analgesic with meloxicam (Mobic) injection. Methods Fourty patients each, 160 in all, were chosen randomly from 4 hospitals in Shanghai. Meloxicam injection was applied to relieve pain for those patients after orthopsadic surgery. Meloxicam injection of 15 mg was administered one hour and 24 hours postoperation by intramuscular respectively. Fentanyl citrate was added in those whose pain was

  2. Surgical glove perforation among nurses in ophthalmic surgery: a case-control study.

    Science.gov (United States)

    Shek, Karen Mei-Yan; Chau, Janita Pak-Chun

    2014-04-01

    Many of the ophthalmic surgical instruments are extremely fine and sharp. Due to the dim light environment required for ophthalmic surgical procedures, the passing of sharp instruments among surgeons and scrub nurses also poses a risk for glove perforations. A case-control study was performed to determine the number and site of perforations in the surgical gloves used by a group of scrub nurses during ophthalmic surgery. All six nurses working in an eye and refractive surgery centre in Hong Kong participated in the study. A total of 100 (50 pairs) used surgical gloves were collected following 50 ophthalmic surgeries. Fifty pairs of new surgical gloves were also collected. Every collected surgical glove underwent the water leak test. The surgical procedure perforation rate was 8%, and none of the perforations were detected by the scrub nurses. No perforations were found in any unused gloves. The findings indicate that glove perforations for scrub nurses during ophthalmic surgery do occur and mostly go unnoticed. Future studies should continue to explore factors contributing to surgical glove perforation.

  3. Quality of life among patients undergoing bariatric surgery: associations with mental health- A 1 year follow-up study of bariatric surgery patients

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    Stubhaug Bjarte

    2011-09-01

    Full Text Available Abstract Background Preoperative mental health seems to have useful predictive value for Health Related Quality of Life (HRQOL after bariatric surgery. The aim of the present study was to assess pre- and postoperative psychiatric disorders and their associations with pre- and postoperative HRQOL. Method Data were assessed before (n = 127 and one year after surgery (n = 87. Psychiatric disorders were assessed by Mini International Neuropsychiatric Interview (M.I.N.I. and Structured Clinical Interview (SCID-II. HRQOL was assessed by the Short Form 36 (SF-36 questionnaire. Results Significant improvements were found in HRQOL from preoperative assessment to follow-up one year after surgery. For the total study population, the degree of improvement was statistically significant (p values Conclusion This study reports the novel finding that patients without postoperative psychiatric disorders achieved a HRQOL comparable to the general population one year after bariatric surgery; while patients with postoperative psychiatric disorders did not reach the HRQOL level of the general population. Our results support monitoring patients with psychiatric disorders persisting after surgery for suboptimal improvements in quality of life after bariatric surgery. Trial Registration The trial is registered at http://www.clinicaltrials.gov prior to patient inclusion (ProtocolID16280.

  4. Open surgery versus retroperitoneal laparoscopic nephrectomy for renal tuberculosis: a retrospective study of 120 patients.

    Science.gov (United States)

    Zhang, Su; Luo, You; Wang, Cheng; Xiong, Hu; Fu, Sheng-Jun; Yang, Li

    2016-01-01

    Laparoscopic renal surgery has been widely used in the treatment of renal diseases. However, there is still little research about its application in addressing renal tuberculosis. The purpose of this study is to retrospectively investigate the surgical results of laparoscopic and open surgery for nonfunctional tuberculous kidneys. Between May 2011 and June 2016, 120 nephrectomies were performed in patients with a nonfunctional tuberculous kidney. Of these, 69 patients underwent retroperitoneal laparoscopic nephrectomy, and 51 patients underwent open nephrectomy. Data about the patients' characteristics and surgical outcomes were collected from their electronic medical records. Outcomes were compared between these two groups. Our results showed that a number of renal tuberculosis patients presented no significant symptoms during their disease. Lower urinary tract symptoms (LUTS) were the most common at a rate of 73/120, followed by flank pain or accidently discovery (66/120), urine abnormality (30/120) and fever (27/120). Patients who underwent open surgery were similar to laparoscopic patients with regard to sex, BMI, location, previous tuberculous history, grade, anemia, adhesion, hypertension, diabetes and preoperative serum creatinine level, but were generally older than laparoscopic patients. There were no significant differences between open and laparoscopic surgery in estimated blood loss, transfusion, postoperative hospital days and perioperative complication rate. However, the median operation time of laparoscopic operation was much longer than open surgery (180 [150-225] vs 135 [120-165] minutes, P treatment as open surgery for a nonfunctional tuberculous kidney, although it requires more time during the surgical procedure. No significant differences in other surgical outcomes were observed.

  5. Is the Use of a Drain for Thyroid Surgery Realistic? A Prospective Randomized Interventional Study

    Directory of Open Access Journals (Sweden)

    Ugur Deveci

    2013-01-01

    Full Text Available Background. The use of a suction drain in thyroid surgery is common practice in order to avoid hematomas or seromas. The aim of this study was to determine the efficacy of routine drainage after thyroid surgery. Methods. In this prospective randomized trial, 400 patients who underwent either a total thyroidectomy or lobectomy for thyroid disorders were randomly allocated to either the nondrainage (group 1 or the drainage (group 2 group. The volume of fluid collection in the operative bed, postoperative pain, complications, and length of hospital stay were then recorded. Results. Both groups were homogeneous according to age, gender, thyroid volume, type of procedure performed, and histopathological diagnosis. After assessment by USG, no significant difference was found between the groups in the fluid collection of the thyroid bed (, but the length of hospital stay was significantly reduced in group 1 (. Conclusions. In our experience, the use of drain for thyroid surgery is not a routine procedure. However, it should be used in the presence of extensive dead space, particularly when there is retrosternal or intrathoracic extension, or when the patient is on anticoagulant treatment. This trial was registered with clinical Trials.gov NCT01771523.

  6. Laparoscopic surgery for colorectal cancer is safe and has survival outcomes similar to those of open surgery in elderly patients with a poor performance status: subanalysis of a large multicenter case-control study in Japan.

    Science.gov (United States)

    Niitsu, Hiroaki; Hinoi, Takao; Kawaguchi, Yasuo; Ohdan, Hideki; Hasegawa, Hirotoshi; Suzuka, Ichio; Fukunaga, Yosuke; Yamaguchi, Takashi; Endo, Shungo; Tagami, Soichi; Idani, Hitoshi; Ichihara, Takao; Watanabe, Kazuteru; Watanabe, Masahiko

    2016-01-01

    It remains controversial whether open or laparoscopic surgery should be indicated for elderly patients with colorectal cancer and a poor performance status. In those patients aged 80 years or older with Eastern Cooperative Oncology Group performance status score of 2 or greater who received elective surgery for stage 0 to stage III colorectal adenocarcinoma and had no concomitant malignancies and who were enrolled in a multicenter case-control study entitled "Retrospective study of laparoscopic colorectal surgery for elderly patients" that was conducted in Japan between 2003 and 2007, background characteristics and short-term and long-term outcomes for open surgery and laparoscopic surgery were compared. Of the 398 patients included, 295 underwent open surgery and 103 underwent laparoscopic surgery. There were no significant differences in the baseline characteristics between open surgery and laparoscopic surgery patients, except for previous abdominal surgery and TNM stage. The median operation duration was shorter with open surgery (open surgery, 153 min; laparoscopic surgery, 202 min; P cancer patients with a poor performance status is safe and not inferior to open surgery in terms of overall survival.

  7. Fracture Risk After Bariatric Surgery: A 12-Year Nationwide Cohort Study.

    Science.gov (United States)

    Lu, Chia-Wen; Chang, Yu-Kang; Chang, Hao-Hsiang; Kuo, Chia-Sheng; Huang, Chi-Ting; Hsu, Chih-Cheng; Huang, Kuo-Chin

    2015-12-01

    Bariatric surgery has been shown to impair bone health. This study aimed to investigate the fracture risk in patients after bariatric surgery versus propensity score-matched controls. The authors used the National Health Insurance Research Database of Taiwan and identified 2064 patients who underwent bariatric surgery during 2001 to 2009. These patients were matched to 5027 obese patients who did not receive bariatric surgery, using propensity score matching accounting for age, sex, Charlson Comorbidity Index, diabetes, hypertension, hyperlipidemia and the year morbid obesity was diagnosed. The authors followed the surgical and control cohorts to death, any diagnosis of fracture, or December 31, 2012, whichever occurred first. Cox proportional hazard regression models were used to calculate relative rates of fractures in the surgical group and control group. At the end of the 12-year study period, there were 183 fractures in the surgical group (mean follow-up 4.8 years) and 374 fractures in the matched control group (mean follow-up 4.9 years). Overall, there was a 1.21-fold [95% confidence interval (CI): 1.02-1.43] significantly increased risk of fracture in the surgical group compared with the control group. Stratified by surgical procedures, malabsorptive procedures showed a significantly higher fracture risk (1.47, 95% CI: 1.01-2.15). The Kaplan-Meier estimated fracture rates were 1.60% at 1 year, 2.37% at 2 years, 1.69% at 5 years, and 2.06% after 5 years for the surgical patients, compared with 1.51%, 1.65%, 1.53%, and 1.42%, respectively, for the matched controls. Adjusted analysis showed a trend towards an increased fracture risk, 1 to 2 years after bariatric surgery. (1.42, 95% CI: 0.99-2.05). Bariatric surgery was significantly associated with an increased risk of fractures, mainly with malabsorptive procedures, with a trend of an increased fracture risk 1 to 2 years after surgery. These results provide further evidence for the adverse effects of bariatric

  8. A stepped strategy that aims at the nationwide implementation of the Enhanced Recovery After Surgery programme in major gynaecological surgery: study protocol of a cluster randomised controlled trial

    NARCIS (Netherlands)

    Groot, J.J.A.M. de; Maessen, J.M.; Slangen, B.F.; Winkens, B.; Dirksen, C.D.; Weijden, T.T. van der

    2015-01-01

    BACKGROUND: Enhanced Recovery After Surgery (ERAS) programmes aim at an early recovery after surgical trauma and consequently at a reduced length of hospitalisation. This paper presents the protocol for a study that focuses on large-scale implementation of the ERAS programme in major gynaecological

  9. A stepped strategy that aims at the nationwide implementation of the Enhanced Recovery After Surgery programme in major gynaecological surgery: study protocol of a cluster randomised controlled trial

    NARCIS (Netherlands)

    Groot, J.J.A.M. de; Maessen, J.M.; Slangen, B.F.; Winkens, B.; Dirksen, C.D.; Weijden, T.T. van der

    2015-01-01

    BACKGROUND: Enhanced Recovery After Surgery (ERAS) programmes aim at an early recovery after surgical trauma and consequently at a reduced length of hospitalisation. This paper presents the protocol for a study that focuses on large-scale implementation of the ERAS programme in major gynaecological

  10. Non-inferiority of short-term urethral catheterization following fistula repair surgery: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Barone Mark A

    2012-03-01

    Full Text Available Abstract Background A vaginal fistula is a devastating condition, affecting an estimated 2 million girls and women across Africa and Asia. There are numerous challenges associated with providing fistula repair services in developing countries, including limited availability of operating rooms, equipment, surgeons with specialized skills, and funding from local or international donors to support surgeries and subsequent post-operative care. Finding ways of providing services in a more efficient and cost-effective manner, without compromising surgical outcomes and the overall health of the patient, is paramount. Shortening the duration of urethral catheterization following fistula repair surgery would increase treatment capacity, lower costs of services, and potentially lower risk of healthcare-associated infections among fistula patients. There is a lack of empirical evidence supporting any particular length of time for urethral catheterization following fistula repair surgery. This study will examine whether short-term (7 day urethral catheterization is not worse by more than a minimal relevant difference to longer-term (14 day urethral catheterization in terms of incidence of fistula repair breakdown among women with simple fistula presenting at study sites for fistula repair service. Methods/Design This study is a facility-based, multicenter, non-inferiority randomized controlled trial (RCT comparing the new proposed short-term (7 day urethral catheterization to longer-term (14 day urethral catheterization in terms of predicting fistula repair breakdown. The primary outcome is fistula repair breakdown up to three months following fistula repair surgery as assessed by a urinary dye test. Secondary outcomes will include repair breakdown one week following catheter removal, intermittent catheterization due to urinary retention and the occurrence of septic or febrile episodes, prolonged hospitalization for medical reasons, catheter blockage, and

  11. Nurses' educational needs for pain management of post-cardiac surgery patients: a qualitative study.

    Science.gov (United States)

    Leegaard, Marit; Watt-Watson, Judy; McGillion, Michael; Costello, Judy; Elgie-Watson, Jeanne; Partridge, Kim

    2011-01-01

    Inadequate knowledge among health care providers is a key barrier to good pain management, and nurses have a major role to provide education to patients. The purpose of this study was to identify nurses' learning needs to prepare patients for managing pain before and after discharge home from cardiac surgery. The overall aim is to develop a pain education intervention for nurses working with cardiac surgical patients. This was a focus groups study. Participants (N=22) were asked about their perceptions of patients' education needs for pain management after cardiac surgery and approaches to help nurses meet these needs. The Pain Beliefs Scale was used to capture nurses' own misbeliefs about pain that would need clarification in a successful pain education intervention. Nurses identified pain management challenges in the hospital, particularly related to patients' age, patient concerns about the use of opioids, the need to use multiple management strategies, and preparing patients to manage pain at home. Pain Beliefs Scale scores were low related to opioid dosing and adverse effects. Participants identified their most helpful educational approaches being brief in-services, hands-on learning, lunch-and-learn sessions, and designated education days. Participants identified the most common pain knowledge gaps for patients before and after discharge after cardiac surgery. These data will be used to develop an education intervention for nurses to help their cardiac surgery patients with more effective pain management strategies before and after discharge home. Copyright © 2011 Lippincott Williams & Wilkins.

  12. A Study on Performance and Safety Tests of Electrosurgical Equipment

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    Tavakoli Golpaygani A.

    2016-09-01

    Full Text Available Introduction: Modern medicine employs a wide variety of instruments with different physiological effects and measurements. Periodic verifications are routinely used in legal metrology for industrial measuring instruments. The correct operation of electrosurgical generators is essential to ensure patient’s safety and management of the risks associated with the use of high and low frequency electrical currents on human body. Material and Methods: The metrological reliability of 20 electrosurgical equipment in six hospitals (3 private and 3 public was evaluated in one of the provinces of Iran according to international and national standards. Results: The achieved results show that HF leakage current of ground-referenced generators are more than isolated generators and the power analysis of only eight units delivered acceptable output values and the precision in the output power measurements was low. Conclusion: Results indicate a need for new and severe regulations on periodic performance verifications and medical equipment quality control program especially in high risk instruments. It is also necessary to provide training courses for operating staff in the field of meterology in medicine to be acquianted with critical parameters to get accuracy results with operation room equipment.

  13. Feasibility Study of Utilization of Action Camera, GoPro Hero 4, Google Glass, and Panasonic HX-A100 in Spine Surgery.

    Science.gov (United States)

    Lee, Chang Kyu; Kim, Youngjun; Lee, Nam; Kim, Byeongwoo; Kim, Doyoung; Yi, Seong

    2017-02-15

    Study for feasibility of commercially available action cameras in recording video of spine. Recent innovation of the wearable action camera with high-definition video recording enables surgeons to use camera in the operation at ease without high costs. The purpose of this study is to compare the feasibility, safety, and efficacy of commercially available action cameras in recording video of spine surgery. There are early reports of medical professionals using Google Glass throughout the hospital, Panasonic HX-A100 action camera, and GoPro. This study is the first report for spine surgery. Three commercially available cameras were tested: GoPro Hero 4 Silver, Google Glass, and Panasonic HX-A100 action camera. Typical spine surgery was selected for video recording; posterior lumbar laminectomy and fusion. Three cameras were used by one surgeon and video was recorded throughout the operation. The comparison was made on the perspective of human factor, specification, and video quality. The most convenient and lightweight device for wearing and holding throughout the long operation time was Google Glass. The image quality; all devices except Google Glass supported HD format and GoPro has unique 2.7K or 4K resolution. Quality of video resolution was best in GoPro. Field of view, GoPro can adjust point of interest, field of view according to the surgery. Narrow FOV option was the best for recording in GoPro to share the video clip. Google Glass has potentials by using application programs. Connectivity such as Wi-Fi and Bluetooth enables video streaming for audience, but only Google Glass has two-way communication feature in device. Action cameras have the potential to improve patient safety, operator comfort, and procedure efficiency in the field of spinal surgery and broadcasting a surgery with development of the device and applied program in the future. N/A.

  14. Nutritional status in Parkinson's disease patients undergoing deep brain stimulation surgery: a pilot study.

    Science.gov (United States)

    Sheard, J M; Ash, S; Silburn, P A; Kerr, G K

    2013-02-01

    People with Parkinson's disease (PD) are at higher risk of malnutrition due to PD symptoms and pharmacotherapy side effects. When pharmacotherapy is no longer effective for symptom control, deep-brain stimulation (DBS) surgery may be considered. The aim of this study was to assess the nutritional status of people with PD who may be at higher risk of malnutrition related to unsatisfactory symptom management with optimised medical therapy. This was an observational study using a convenience sample. Participants were seen during their hospital admission for their deep brain stimulation surgery. People with PD scheduled for DBS surgery were recruited from a Brisbane neurological clinic (n=15). The Patient-Generated Subjective Global Assessment (PG-SGA), weight, height and body composition were assessed to determine nutritional status. Six participants (40%) were classified as moderately malnourished (SGA-B). Eight participants (53%) reported previous unintentional weight loss (average loss of 13%). On average, participants classified as well-nourished (SGA-A) were younger, had shorter disease durations, lower PG-SGA scores, higher body mass (BMI) and fat free mass indices (FFMI) when compared to malnourished participants (SGA-B). Five participants had previously received dietetic advice but only one in relation to unintentional weight loss. Malnutrition remains unrecognised and untreated in this group despite unintentional weight loss and presence of nutrition impact symptoms. Improving nutritional status prior to surgery may improve surgical outcomes.

  15. Pilot study of laser induced breakdown spectroscopy for tissue differentiation by monitoring the plume created during laser surgery — An approach on a feedback Laser control mechanism

    Energy Technology Data Exchange (ETDEWEB)

    Kanawade, Rajesh, E-mail: Rajesh.Kanawade@aot.uni-erlangen.de [Clinical Photonics Lab, Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Paul-Gordan-Str. 6, 91052 Erlangen (Germany); Institute of Photonics Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Paul-Gordan-Str. 3, 91052 Erlangen (Germany); Mehari, Fanuel [Master Programme in Advanced Optical Technologies (MAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Paul-Gordan-Str. 6, 91052 Erlangen (Germany); Knipfer, Christian; Rohde, Maximilian [Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Glueckstrasse 11, 91054 Erlangen (Germany); Tangermann-Gerk, Katja [Bayerisches Laserzentrum GmbH, Konrad-Zuse-Strasse 2-6, 91052 Erlangen (Germany); Schmidt, Michael [Clinical Photonics Lab, Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Paul-Gordan-Str. 6, 91052 Erlangen (Germany); Institute of Photonics Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Paul-Gordan-Str. 3, 91052 Erlangen (Germany); Bayerisches Laserzentrum GmbH, Konrad-Zuse-Strasse 2-6, 91052 Erlangen (Germany); and others

    2013-09-01

    This study focuses on tissue differentiation using ‘Laser Induced Breakdown Spectroscopy’ (LIBS) by monitoring the plasma plume created during laser surgery processes. This technique is aimed at controlling a laser surgery feedback system in real time. An Excimer laser (Ar-F 193 nm) was used for the ablation of tissue samples. Fat, muscle, nerve and skin tissue samples of bisected ex-vivo pig heads were prepared as test objects for the ablation procedure. A single fiber was used to collect emissions and deliver them to a spectrometer. The obtained LIBS spectra in the measured emissions were analyzed to determine each tissue type according to their chemical composition. The elements found in the samples and their emission spectra were in agreement with those described in literature. The collected LIBS spectra were analyzed to differentiate the tissues using statistical data analysis: Principal Component Analysis (PCA), Linear Discriminant Analysis (LDA) and Receiver Operating Characteristics (ROC). The obtained preliminary results suggest a successful differentiation of the target tissues with high sensitivity and specificity. The main goal of this study was to qualitatively identify tissue types during laser ablation, which will provide a real time feedback mechanism for clinical Laser surgery applications to significantly improve the accuracy and safety of laser surgery procedures. - Graphical abstract: Skin, fat, muscle and nerve tissue differentiation. - Highlights: • Methods to differentiate tissues for the application in a laser surgery feedback control system • Successful differentiation of the target tissues with high sensitivity and specificity for laser surgery application • Real time feedback mechanism for clinical Laser surgery applications • Laser surgery requirements • Biomedical applications of LIBS.

  16. Bleeding during laparoscopic gastric bypass surgery as a risk factor for less favorable outcome. A cohort study from the Scandinavian Obesity Surgery Registry.

    Science.gov (United States)

    Stenberg, Erik; Szabo, Eva; Näslund, Ingmar; Ottosson, Johan

    2017-06-02

    Intraoperative adverse events are known to be associated with postoperative complications; however, little is known about whether or not blood loss during laparoscopic gastric bypass surgery affects the outcome. To see if intraoperative bleeding was associated with a less favorable outcome, and to identify patient-specific risk factors for intraoperative bleeding. Nationwide, Sweden. Patients who underwent laparoscopic gastric bypass surgery between January 8, 2007, and September 15, 2015, were included in the study. The volume of intraoperative blood loss was compared with data from follow-up at day 30 and 1 and 2 years after surgery. Patient-specific factors were analyzed as potential risk factors for intraoperative bleeding. The study included 43,157 patients. Intraoperative bleeding was associated with an increased risk for postoperative complication (100-499 mL, odds ratio [OR] 2.97, 95% confidence interval [95%CI] 2.53-3.50;>500 mL OR 3.34, 95%CI 2.05-5.44), lower weight loss (500 mL 76.9±23.89 %EBMIL, P = .063) and lower reported quality-of-life 2 years after surgery (500 mL, OP 25.2±24.46, P = .272). Diabetes (OR 1.30, 95%CI 1.08-1.58), age (OR 1.02, 95%CI 1.02-1.03), and body mass index (OR 1.03, 95%CI 1.02-1.05) were patient-specific risk factors for intraoperative bleeding≥100 mL, whereas intentional preoperative weight loss was associated with a lower risk (OR .50, 95%CI .43-.57). Intraoperative bleeding was associated with less favorable outcome after laparoscopic gastric bypass surgery. Age, body mass index, and diabetes were risk factors for intraoperative bleeding, while preoperative weight reduction seems to be protective. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  17. A STUDY OF EFFECTS OF ORAL CLONIDINE ON PREMEDICATION AND HAEMODYNAMIC CHANGES DURING LAPAROSCOPIC SURGERY

    Directory of Open Access Journals (Sweden)

    Sanjeev Rao

    2016-02-01

    Full Text Available BACKGROUND Use of Clonidine as a premedicant started incidentally. Clonidine is a potent antihypertensive drug that suppresses RAAS. Clonidine may be beneficial during laparoscopy in patients with hypertension, cardiovascular and/or renal diseases. AIM OF STUDY To determine the effects of Oral Clonidine on premedication and haemodynamic changes during Laparoscopic surgery. MATERIAL AND METHODS Study was conducted on 60 adult patients belonging to ASA physical status I & II. They were randomly assigned to 2 groups of 30 each. Group C received oral clonidine 150 mcg 90 minutes before surgery and group P received oral ranitidine 150 mg 90 minutes before surgery. Sedation score was noted on arrival to operation theatre. All vital parameters were recorded at regular intervals intra-operatively. RESULTS Clonidine premedication was able to achieve haemodynamic stability during pneumoperitoneum. CONCLUSION Premedication with 150mcg oral Clonidine has been found to be relatively safe as well as effective method that provides stable haemodynamics and protection against stress response triggered by pneumoperitoneum in patients undergoing laparoscopic surgeries.

  18. A nationwide epidemiologic study of breast cancer incidence following breast reduction surgery in a large cohort of Swedish women.

    Science.gov (United States)

    Fryzek, Jon P; Ye, Weimin; Nyrén, Olof; Tarone, Robert E; Lipworth, Loren; McLaughlin, Joseph K

    2006-05-01

    While it has been demonstrated that prophylactic mastectomy reduces breast cancer incidence among women at high risk, many women often consider this disfiguring surgery unacceptable. One alternative approach may be breast reduction surgery. In order to evaluate the long-term incidence of breast cancer following surgical removal of breast tissue, we have extended by 9 years the follow-up period of our earlier retrospective cohort study of Swedish women electing cosmetic breast reduction surgery (n=30,444) between 1965 and 1993, yielding an average of nearly 16 years of follow-up. Cancer incidence through 2002 was ascertained via the Swedish Cancer Registry. Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated comparing women who underwent breast reduction surgery with women in the general Swedish population. Breast cancer was observed in 443 women versus 624 expected for a statistically significant reduced SIR of 0.71 (95% CI=0.65-0.78). Analyses by age at surgery, time since surgery or calendar year of surgery revealed similar reductions in risk. Our study of over 30,000 women with long-term follow-up offers further evidence that women undergoing breast reduction surgery have reduced breast cancer risk. As the evidence from large-scale cohort studies accumulates, direct testing of this reduction in risk through clinical trials should be considered.

  19. Safety and efficacy of prothrombin complex concentrate as first-line treatment in bleeding after cardiac surgery.

    Science.gov (United States)

    Cappabianca, Giangiuseppe; Mariscalco, Giovanni; Biancari, Fausto; Maselli, Daniele; Papesso, Francesca; Cottini, Marzia; Crosta, Sandro; Banescu, Simona; Ahmed, Aamer B; Beghi, Cesare

    2016-01-06

    Bleeding after cardiac surgery requiring surgical reexploration and blood component transfusion is associated with increased morbidity and mortality. Although prothrombin complex concentrate (PCC) has been used satisfactorily in bleeding disorders, studies on its efficacy and safety after cardiopulmonary bypass are limited. Between January 2005 and December 2013, 3454 consecutive cardiac surgery patients were included in an observational study aimed at investigating the efficacy and safety of PCC as first-line coagulopathy treatment as a replacement for fresh frozen plasma (FFP). Starting in January 2012, PCC was introduced as solely first-line treatment for bleeding following cardiac surgery. After one-to-one propensity score-matched analysis, 225 pairs of patients receiving PCC (median dose 1500 IU) and FFP (median dose 2 U) were included. The use of PCC was associated with significantly decreased 24-h post-operative blood loss (836 ± 1226 vs. 935 ± 583 ml, p surgery setting, the use of PCC compared with FFP was associated with decreased post-operative blood loss and RBC transfusion requirements. However, PCC administration may be associated with a higher risk of post-operative AKI.

  20. Fetal growth in pregnancies conceived after gastric bypass surgery in relation to surgery-to-conception interval: a Danish national cohort study.

    Directory of Open Access Journals (Sweden)

    Lone Nikoline Nørgaard

    Full Text Available OBJECTIVE: To describe early and late fetal growth in pregnancies conceived after gastric bypass surgery in relation to time from surgery to conception of pregnancy. METHODS: National cohort study on 387 Danish women, who had laparoscopic or open gastric bypass surgery prior to a singleton pregnancy in which first trimester screening was performed between January 2008 and June 2011. Data were derived from national registers (Danish National Registry of Patients and Danish National Birth Registry, Pregnancy Complications and Abortion-clinical quality database (PreCAb and the Danish Fetal Medicine Database. Main outcome measures were early and late fetal growth in relation to time from bariatric surgery to conception of the pregnancy. Early fetal growth was expressed as "Fetal Growth Index": the ratio between the estimated number of days from first trimester ultrasound to second trimester ultrasound biometries and the actual calender time elapsed in days. Late fetal growth was expressed as the observed versus expected birthweight according to gestational age (GA. RESULTS: The surgery-to-conception interval ranged from 3 to 1851 days with a mean value of 502 (SD, 351 days. The mean "fetal growth index" was 0.99 (SD, 0.02 days/day and thus significantly lower than in the background population (mean, 1.04 (SD, 0.09 days/day, p<0.0001. The proportion of infants being small for gestational age was 18.8% and the proportion of large for gestational age infants was 6.7%. The correlation coefficients between surgery-to-conception time and "fetal growth index" and birthweight according to GA were 0.01 (p = 0.8 and 0.04 (p = 0.4, respectively. CONCLUSION: Fetal growth index was lower than reported in the background population. No correlation was found between the surgery-to-conception interval and early or late fetal growth in pregnancies conceived after gastric bypass surgery.

  1. A STUDY OF EFFECTS OF ORAL CLONIDINE ON PREMEDICATION AND HAEMODYNAMIC CHANGES DURING LAPAROSCOPIC SURGERY

    OpenAIRE

    Sanjeev Rao; Mahesh,

    2016-01-01

    BACKGROUND Use of Clonidine as a premedicant started incidentally. Clonidine is a potent antihypertensive drug that suppresses RAAS. Clonidine may be beneficial during laparoscopy in patients with hypertension, cardiovascular and/or renal diseases. AIM OF STUDY To determine the effects of Oral Clonidine on premedication and haemodynamic changes during Laparoscopic surgery. MATERIAL AND METHODS Study was conducted on 60 adult patients belonging to ASA physical...

  2. [Clinical safety audits for primary care centers. A pilot study].

    Science.gov (United States)

    Ruiz Sánchez, Míriam; Borrell-Carrió, Francisco; Ortodó Parra, Cristina; Fernàndez I Danés, Neus; Fité Gallego, Anna

    2013-01-01

    To identify organizational processes, violations of rules, or professional performances that pose clinical levels of insecurity. Descriptive cross-sectional survey with customized externally-behavioral verification and comparison of sources, conducted from June 2008 to February 2010. Thirteen of the 53 primary care teams (PCT) of the Catalonian Health Institute (ICS Costa de Ponent, Barcelona). Employees of 13 PCT classified into: director, nurse director, customer care administrators, and general practitioners. Non-random selection, teaching (TC)/non-teaching, urban (UC)/rural and small/large (LC) health care centers (HCC). A total of 33 indicators were evaluated; 15 of procedures, 9 of attitude, 3 of training, and 6 of communication. Level of uncertainty: <50% positive answers for each indicator. no collaboration. A total of 55 professionals participated (84.6% UC, 46.2% LC and 76.9% TC). Rank distribution: 13 customer care administrators, 13 nurse directors, 13 HCC directors, and 16 general practitioners. Levels of insecurity emerged from the following areas: reception of new medical professionals, injections administration, nursing weekend home calls, urgent consultations to specialists, aggressive patients, critical incidents over the agenda of the doctors, communication barriers with patients about treatment plans, and with immigrants. Clinical safety is on the agenda of the health centers. Identified areas of uncertainty are easily approachable, and are considered in the future system of accreditation of the Catalonian Government. General practitioners are more critical than directors, and teaching health care centers, rural and small HCC had a better sense of security. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  3. Creating an advance-care-planning decision aid for high-risk surgery: a qualitative study.

    Science.gov (United States)

    Schuster, Anne Lr; Aslakson, Rebecca A; Bridges, John Fp

    2014-01-01

    High-risk surgery patients may lose decision-making capacity as a result of surgical complications. Advance care planning prior to surgery may be beneficial, but remains controversial and is hindered by a lack of appropriate decision aids. This study sought to examine stakeholders' views on the appropriateness of using decision aids, in general, to support advance care planning among high-risk surgery populations and the design of such a decision aid. Key informants were recruited through purposive and snowball sampling. Semi-structured interviews were conducted by phone until data collected reached theoretical saturation. Key informants were asked to discuss their thoughts about advance care planning and interventions to support advance care planning, particularly for this population. Researchers took de-identified notes that were analyzed for emerging concordant, discordant, and recurrent themes using interpretative phenomenological analysis. Key informants described the importance of initiating advance care planning preoperatively, despite potential challenges present in surgical settings. In general, decision aids were viewed as an appropriate approach to support advance care planning for this population. A recipe emerged from the data that outlines tools, ingredients, and tips for success that are needed to design an advance care planning decision aid for high-risk surgical settings. Stakeholders supported incorporating advance care planning in high-risk surgical settings and endorsed the appropriateness of using decision aids to do so. Findings will inform the next stages of developing the first advance care planning decision aid for high-risk surgery patients.

  4. Study of a Comprehensive Assessment Method for Coal Mine Safety Based on a Hierarchical Grey Analysis

    Institute of Scientific and Technical Information of China (English)

    LIU Ya-jing; MAO Shan-jun; LI Mei; YAO Ji-ming

    2007-01-01

    Coal mine safety is a complex system, which is controlled by a number of interrelated factors and is difficult to estimate. This paper proposes an index system of safety assessment based on correlated factors involved in coal mining and a comprehensive evaluation model that combines the advantages of the AHP and a grey clustering method to guarantee the accuracy and objectivity of weight coefficients. First, we confirmed the weight of every index using the AHP, then did a general safety assessment by means of a grey clustering method. This model analyses the status of mining safety both qualitatively and quantitatively. It keeps management and technical groups informed of the situation of the coal production line in real time, which aids in making correct decisions based on practical safety issues. A case study in the application of the model is presented. The results show that the method is applicable and realistic with regard to the core of a coal mine's safety management. Consequently, the safe production of a mine and the awareness of advanced safe production management is accelerated.

  5. The benefits of hypopharyngeal packing in nasal surgery: a pilot study.

    LENUS (Irish Health Repository)

    Fennessy, B G

    2012-02-01

    BACKGROUND: Hypopharyngeal packs are used in nasal surgery to reduce the risk of aspiration and postoperative nausea and vomiting. Side effects associated with their use range from throat pain to retained packs postoperatively. AIM: To evaluate, as a pilot study, postoperative nausea\\/vomiting and throat pain scores for patients undergoing nasal surgery in whom a wet or dry hypopharyngeal pack was placed compared with patients who received no packing. METHODS: A randomized, double-blind prospective trial in a general ENT unit. RESULTS: The study failed to show a statistically significant difference between the three groups in terms of their postoperative nausea\\/vomiting and throat pain scores at 2 and 6 h postoperatively. This is the first study in which dry packs have been compared with wet and absent packs. CONCLUSION: Based on our findings, the authors recommend against placing hypopharyngeal packs for the purpose of preventing postoperative nausea and vomiting.

  6. Safety culture assessment in petrochemical industry: a comparative study of two algerian plants.

    Science.gov (United States)

    Boughaba, Assia; Hassane, Chabane; Roukia, Ouddai

    2014-06-01

    To elucidate the relationship between safety culture maturity and safety performance of a particular company. To identify the factors that contribute to a safety culture, a survey questionnaire was created based mainly on the studies of Fernández-Muñiz et al. The survey was randomly distributed to 1000 employees of two oil companies and realized a rate of valid answer of 51%. Minitab 16 software was used and diverse tests, including the descriptive statistical analysis, factor analysis, reliability analysis, mean analysis, and correlation, were used for the analysis of data. Ten factors were extracted using the analysis of factor to represent safety culture and safety performance. The results of this study showed that the managers' commitment, training, incentives, communication, and employee involvement are the priority domains on which it is necessary to stress the effort of improvement, where they had all the descriptive average values lower than 3.0 at the level of Company B. Furthermore, the results also showed that the safety culture influences the safety performance of the company. Therefore, Company A with a good safety culture (the descriptive average values more than 4.0), is more successful than Company B in terms of accident rates. The comparison between the two petrochemical plants of the group Sonatrach confirms these results in which Company A, the managers of which are English and Norwegian, distinguishes itself by the maturity of their safety culture has significantly higher evaluations than the company B, who is constituted of Algerian staff, in terms of safety management practices and safety performance.

  7. A Study on the Construct Validity of Safety Culture Oversight Model for Nuclear Power Operating Organization

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Su Jin; Choi, Young Sung; Oh, Jang Jin [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

    2015-05-15

    In Korea, the safety policy statement declared in 1994 by government stressed the importance of safety culture and licensees were encouraged to manage and conduct their self-assessments. A change in regulatory position about safety culture oversight was made after the event of SBO cover-up in Kori unit 1 and several subsequent falsification events. Since then KINS has been developing licensee's safety culture oversight system including conceptual framework of oversight, prime focus area for oversight, and specific details on regulatory expectations, all of which are based on defence-in-depth (DiD) safety enhancement approach. Development and gathering of performance data which is related to actual 'safety' of nuclear power plant are needed to identify the relationship between safety culture and safety performance. Authors consider this study as pilot which has a contribution on verifying the construct validity of the model and the effectiveness of survey based research. This is the first attempt that the validity of safety culture oversight model has been investigated with empirical data obtained from Korean nuclear power operating organization.

  8. Iatrogenic facial nerve injuries during chronic otitis media surgery: a multicentre retrospective study.

    Science.gov (United States)

    Linder, T; Mulazimoglu, S; El Hadi, T; Darrouzet, V; Ayache, D; Somers, T; Schmerber, S; Vincent, C; Mondain, M; Lescanne, E; Bonnard, D

    2017-06-01

    To give an insight into why, when and where iatrogenic facial nerve (FN) injuries may occur and to explain how to deal with them in an emergency setting. Multicentre retrospective study in eight tertiary referral hospitals over 17 years. Twenty patients with partial or total FN injury during surgery for chronic otitis media (COM) were revised. Indication and type of surgery, experience of the surgeon, intra- and postoperative findings, value of CT scanning, patient management and final FN outcome were recorded. In 12 cases, the nerve was completely transected, but the surgeon was unaware in 11 cases. A minority of cases occurred in academic teaching hospitals. Tympanic segment, second genu and proximal mastoid segments were the sites involved during injury. The FN was not deliberately identified in 18 patients at the time of injury, and nerve monitoring was only applied in one patient. Before revision surgery, CT scanning correctly identified the lesion site in 11 of 12 cases and depicted additional lesions such as damage to the lateral semicircular canal. A greater auricular nerve graft was interposed in 10 cases of total transection and in one partially lesioned nerve: seven of them resulted in an HB III functional outcome. In two of the transected nerves, rerouting and direct end-to-end anastomosis was applied. A simple FN decompression was used in four cases of superficially traumatised nerves. We suggest checklists for preoperative, intraoperative and postoperative management to prevent and treat iatrogenic FN injury during COM surgery. © 2016 John Wiley & Sons Ltd.

  9. A study on the necessity of medical facilities safety design adoption.

    Science.gov (United States)

    Park, Bora; Yang, Yeongae; Yang, Dongjoo; Shin, Joong-Il; Park, Sujong; Park, Soohee; Park, Yunhee

    2013-07-01

    [Purpose] The purpose of this study was to investigate the requirements of the introduction of a safety design and certification system for medical facilities. [Subjects] A survey was carried out of one hundred nurses, physical therapists, occupational therapists, speech and language therapists from May to August in 2012. [Methods] The survey was conducted after giving subjects some information about safety design. [Results] The participants were aware of the need for establishing a safety design certification system. Total responses to services, facilities and space were analyzed in order to evaluate the priorities of safety, user characteristics, functionality, convenience and aesthetics. Regarding the application of a safety design certification system to services, items were prioritized in the order of children's items, household supplies and hospital supplies. For facilities, the priorities were, living space, social welfare and medical facilities; space, they were public and transportation-related places. The requirements for operating a safety design system were in order development of: highly skilled manpower, the legal system, educational promotion and qualifying facilities. [Conclusion] In conclusion, in order to implement safety design in medical facilities, a safety design certification system should be introduced first, and to do this a systematic and comprehensive study is needed.

  10. A study of a pre-operative intervention in patients with diabetes undergoing cardiac surgery.

    Science.gov (United States)

    Lee, G A; Wyatt, S; Topliss, D; Walker, K Z; Stoney, R

    2014-01-01

    Coronary heart disease is common in Type 2 diabetes and often requires cardiac surgery. However poorer outcomes have been reported including increased rates of post-operative infection and prolonged hospital stay. The aim of the study was to determine the feasibility and acceptability of a specialist consultation model (pre-operative medical and educational intervention) for type 2 diabetes in the cardiac surgery setting. Twenty four patients were assigned usual care or to the intervention group. The intervention group were assessed by a diabetes clinical nurse consultant, dietitian, and endocrinologist during a pre-operative visit. Specific diabetes questionnaires were administered, education was delivered, and protocol-driven changes to the medical regimen were instituted. Length of stay, incidence of post-operative complications, and number of post-operative inpatient review endocrinology visits required were recorded. Twenty four patients with a pre-operative HbA(1c) greater than 6.5% (48 mmol/mol) were studied (17 males and 7 females). In the usual care group (n = 15), HbA(1c) pre-operatively was 7.2% (55.2 mmol/mol) compared to 10.1% (86.9 mmol/mol) in the intervention group (n = 9). Six weeks post-operatively HbA(1c) fell significantly in the intervention group by 1.9% (to 8.2% [66.1 mmol/mol]) compared to a reduction of 1.2% (to 7.0% [53 mmol/mol]) in the usual care group (p cardiac surgery.

  11. Quality, Safety, and Value in Pediatric Orthopaedic Surgery.

    Science.gov (United States)

    Glotzbecker, Michael P; Wang, Kevin; Waters, Peter M; McCarthy, James; Flynn, John M; Vitale, Michael G

    2016-09-01

    Enhancing patient safety and the quality of care continues to be a focus of considerable public and professional interest. We have made dramatic strides in our technical ability to care for children with pediatric orthopaedic problems, but it has become increasingly obvious that there are also significant opportunities to improve the quality, safety, and value of the care we deliver. The purpose of this article is to introduce pediatric orthopaedic surgeons to the rationale for and principles of quality improvement and to provide an update on quality, safety, and value projects within Pediatric Orthopaedic Society of North America.

  12. Predictors of red blood cell transfusion after cardiac surgery: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Camila Takao Lopes

    2015-12-01

    Full Text Available Abstract OBJECTIVE To identify predictors of red blood cell transfusion (RBCT after cardiac surgery. METHOD A prospective cohort study performed with 323 adults after cardiac surgery, from April to December of 2013. A data collection instrument was constructed by the researchers containing factors associated with excessive bleeding after cardiac surgery, as found in the literature, for investigation in the immediate postoperative period. The relationship between risk factors and the outcome was assessed by univariate analysis and logistic regression. RESULTS The factors associated with RBCT in the immediate postoperative period included lower height and weight, decreased platelet count, lower hemoglobin level, higher prevalence of platelet count <150x10 3/mm3, lower volume of protamine, longer duration of anesthesia, higher prevalence of intraoperative RBCT, lower body temperature, higher heart rate and higher positive end-expiratory pressure. The independent predictor was weight <66.5Kg. CONCLUSION Factors associated with RBCT in the immediate postoperative period of cardiac surgery were found. The independent predictor was weight.

  13. Postmarketing Safety Study Tool: A Web Based, Dynamic, and Interoperable System for Postmarketing Drug Surveillance Studies

    Directory of Open Access Journals (Sweden)

    A. Anil Sinaci

    2015-01-01

    Full Text Available Postmarketing drug surveillance is a crucial aspect of the clinical research activities in pharmacovigilance and pharmacoepidemiology. Successful utilization of available Electronic Health Record (EHR data can complement and strengthen postmarketing safety studies. In terms of the secondary use of EHRs, access and analysis of patient data across different domains are a critical factor; we address this data interoperability problem between EHR systems and clinical research systems in this paper. We demonstrate that this problem can be solved in an upper level with the use of common data elements in a standardized fashion so that clinical researchers can work with different EHR systems independently of the underlying information model. Postmarketing Safety Study Tool lets the clinical researchers extract data from different EHR systems by designing data collection set schemas through common data elements. The tool interacts with a semantic metadata registry through IHE data element exchange profile. Postmarketing Safety Study Tool and its supporting components have been implemented and deployed on the central data warehouse of the Lombardy region, Italy, which contains anonymized records of about 16 million patients with over 10-year longitudinal data on average. Clinical researchers in Roche validate the tool with real life use cases.

  14. The interplay between teamwork, clinicians' emotional exhaustion, and clinician-rated patient safety: a longitudinal study.

    Science.gov (United States)

    Welp, Annalena; Meier, Laurenz L; Manser, Tanja

    2016-04-19

    Effectively managing patient safety and clinicians' emotional exhaustion are important goals of healthcare organizations. Previous cross-sectional studies showed that teamwork is associated with both. However, causal relationships between all three constructs have not yet been investigated. Moreover, the role of different dimensions of teamwork in relation to emotional exhaustion and patient safety is unclear. The current study focused on the long-term development of teamwork, emotional exhaustion, and patient safety in interprofessional intensive care teams by exploring causal relationships between these constructs. A secondary objective was to disentangle the effects of interpersonal and cognitive-behavioral teamwork. We employed a longitudinal study design. Participants were 2100 nurses and physicians working in 55 intensive care units. They answered an online questionnaire on interpersonal and cognitive-behavioral aspects of teamwork, emotional exhaustion, and patient safety at three time points with a 3-month lag. Data were analyzed with cross-lagged structural equation modeling. We controlled for professional role. Analyses showed that emotional exhaustion had a lagged effect on interpersonal teamwork. Furthermore, interpersonal and cognitive-behavioral teamwork mutually influenced each other. Finally, cognitive-behavioral teamwork predicted clinician-rated patient safety. The current study shows that the interrelations between teamwork, clinician burnout, and clinician-rated patient safety unfold over time. Interpersonal and cognitive-behavioral teamwork play specific roles in a process leading from clinician emotional exhaustion to decreased clinician-rated patient safety. Emotionally exhausted clinicians are less able to engage in positive interpersonal teamwork, which might set in motion a vicious cycle: negative interpersonal team interactions negatively affect cognitive-behavioral teamwork and vice versa. Ultimately, ineffective cognitive

  15. Early continuous venovenous hemodialysis in dialysis-dependent patients after cardiac surgery: safety and efficacy.

    Science.gov (United States)

    Nakasuji, Masato; Nishi, Shinichi; Nakasuji, Kae; Hamaoka, Naoya; Ikeshita, Kazutoshi; Asada, Akira

    2007-06-01

    The present study assessed the safety and efficacy of continuous venovenous hemodialysis (CVVHD) early after cardiac surgery. Retrospective database and medical record review. University teaching hospital. Forty-five dialysis-dependent patients who underwent cardiac surgery with cardiopulmonary bypass. CVVHD was begun postoperatively after confirmation of hemostasis, irrespective of circulatory status. In the last 5 patients, the ratio of extravascular lung water (EVLW) to intrathoracic blood volume (ITBV) was measured using a single-indicator thermodilution catheter and compared with patients of normal renal function undergoing cardiac surgery. CVVHD was started at 4 hours after ICU admission. The maximum decrease in blood pressure within 60 minutes after initiation of CVVHD was 11 +/- 9 mmHg in the unstable hemodynamics group (defined as patients who required continuous intravenous adrenaline or intra-aortic balloon pump on admission to the ICU [n = 15]) and 7 +/- 8 mmHg in the stable hemodynamics group (n = 30, not significant). Circulatory status and oxygenation improved significantly 12 hours after CVVHD initiation in the unstable hemodynamics group. Blood volume from the chest tube did not increase after CVVHD. Early mortality (2.2%) was lower than that reported previously. The EVLW/ITBV ratio after ICU admission in dialysis-dependent patients was significantly higher than in patients with normal renal function. Early CVVHD after cardiac surgery in dialysis-dependent patients was safe and effective. There was no associated increased postoperative bleeding or hemodynamic instability. Fluid removal improved respiratory status, particularly in patients requiring circulatory assistance, and overall early morality rates were lower that those previously published.

  16. A Pilot Study of an Acceptance-Based Behavioral Intervention for Weight Regain After Bariatric Surgery.

    Science.gov (United States)

    Bradley, Lauren E; Forman, Evan M; Kerrigan, Stephanie G; Butryn, Meghan L; Herbert, James D; Sarwer, David B

    2016-10-01

    Tens of thousands of bariatric surgery patients each year experience sub-optimal weight loss, significant regain, or both. Weight regain can contribute to a worsening of weight-related co-morbidities, and for some, leads to secondary surgical procedures. Poor weight outcomes have been associated with decreased compliance to the recommended postoperative diet. Decreased compliance may be partially due to a lack of psychological skills necessary to engage in healthy eating behaviors over the long term, especially as the effects of surgery (on appetite, hunger, and desire for food) decrease. Many behavioral interventions do not sufficiently address these challenges and often have limited effectiveness. The study aimed to evaluate the feasibility, acceptability, and preliminary effectiveness of a novel 10-week acceptance-based behavioral intervention to stop postoperative weight regain. A sample of bariatric surgery patients (n = 11) who regained at least 10 % of their maximum lost postoperative weight was recruited. All participants received the intervention, which emphasized psychological skills thought to be integral to successful weight control post-surgery. The intervention was shown to be feasible and acceptable, with 72 % retention and high mean rating (4.25 out of 5.00) of program satisfaction among completers. Weight regain was stopped, and even reversed, with a mean total body weight loss of 3.58 ± 3.02 % throughout the 10-week intervention. There were also significant improvements in eating-related and acceptance-related variables. These findings provide initial support for the use of a psychological acceptance-based intervention for weight regain in bariatric surgery patients.

  17. Efficacy and safety of combined piroxicam, dexamethasone, orphenadrine, and cyanocobalamin treatment in mandibular molar surgery

    Directory of Open Access Journals (Sweden)

    Barroso A.B.

    2006-01-01

    Full Text Available Third molar extraction is a common procedure frequently accompanied by moderate or severe pain, and involves sufficient numbers of patients to make studies relatively easy to perform. The aim of the present study was to determine the efficacy and safety of the therapeutic combination of 10 mg piroxicam, 1 mg dexamethasone, 35 mg orphenadrine citrate, and 2.5 mg cyanocobalamin (Rheumazin® when compared with 20 mg piroxicam alone (Feldene® in mandibular third molar surgery. Eighty patients scheduled for removal of the third molar were included in this randomized and double-blind study. They received (vo Rheumazin or Feldene 30 min after tooth extraction and once daily for 4 consecutive days. Pain was determined by a visual analogue scale and by the need for escape analgesia (paracetamol. Facial swelling was evaluated with a measuring tape and adverse effects and patient satisfaction were recorded. There was no statistically significant difference in facial swelling between Rheumazin and Feldene (control group. Both drugs were equally effective in the control of pain, with Rheumazin displaying less adverse effects than Feldene. Therefore, Rheumazin appears to provide a better risk/benefit ratio in the mandibular molar surgery. Since the side effects resulting from nonsteroidal anti-inflammatory drug administration are a severe limitation to the routine use of these drugs in clinical practice, our results suggest that Rheumazin can be a good choice for third molar removal treatment.

  18. Efficacy and safety of combined piroxicam, dexamethasone, orphenadrine, and cyanocobalamin treatment in mandibular molar surgery

    Directory of Open Access Journals (Sweden)

    A.B. Barroso

    Full Text Available Third molar extraction is a common procedure frequently accompanied by moderate or severe pain, and involves sufficient numbers of patients to make studies relatively easy to perform. The aim of the present study was to determine the efficacy and safety of the therapeutic combination of 10 mg piroxicam, 1 mg dexamethasone, 35 mg orphenadrine citrate, and 2.5 mg cyanocobalamin (Rheumazin® when compared with 20 mg piroxicam alone (Feldene® in mandibular third molar surgery. Eighty patients scheduled for removal of the third molar were included in this randomized and double-blind study. They received (vo Rheumazin or Feldene 30 min after tooth extraction and once daily for 4 consecutive days. Pain was determined by a visual analogue scale and by the need for escape analgesia (paracetamol. Facial swelling was evaluated with a measuring tape and adverse effects and patient satisfaction were recorded. There was no statistically significant difference in facial swelling between Rheumazin and Feldene (control group. Both drugs were equally effective in the control of pain, with Rheumazin displaying less adverse effects than Feldene. Therefore, Rheumazin appears to provide a better risk/benefit ratio in the mandibular molar surgery. Since the side effects resulting from nonsteroidal anti-inflammatory drug administration are a severe limitation to the routine use of these drugs in clinical practice, our results suggest that Rheumazin can be a good choice for third molar removal treatment.

  19. Efficacy and Safety Performance of ProsealTM Laryngeal Mask Airway in Laparoscopic Surgery: Experience of 1000 Cases

    Directory of Open Access Journals (Sweden)

    Bimla Sharma

    2008-01-01

    Full Text Available The ProSeal TM laryngeal mask airway (PLMA has been especially designed for positive pressure ventilation and protection against aspiration. We tested the efficacy and safety of the PLMA as a ventilatory device for a variety of commonly performed laparoscopic surgeries. The PLMA was used for the airway management of one thousand; consecutive anaesthetized, paralysed patients, aged 13-86 years belonging to ASA physical status I-III scheduled for elective laparoscopic and extraperitoneal endoscopic surgeries. Details of insertion, oropharyngeal seal pressure (OSP, ventilatory performance and safety data of the PLMA were recorded. During surgery, oxygenation and ventilation variables were adjusted to maintain SpO2 > 95 %, as measured by pulse oximetry and EtCO2 55 mm Hg. Twenty five (2.5% patients showed gastric regurgitation, suctioned through the oesophageal channel of the PLMA, but no case of pulmonary aspiration was detected. Median OSP was 36 cm H2O. The median peak inspiratory pressure (PIP before and after CO2- insufflation were 10 and 18 cm H2O, respectively (P < 0.001. Our study demonstrated that the PLMA, in experienced hands, is an efficient and safe airway tool for the airway management of patients undergoing elective laparoscopic surgery.

  20. Plastic surgery residents' attitudes and understanding of biostatistics: a pilot study.

    Science.gov (United States)

    Susarla, Srinivas M; Redett, Richard J

    2014-01-01

    To assess plastic surgery residents' knowledge, attitudes, and comfort with biostatistics. Cross-sectional study. Department of Plastic and Reconstructive Surgery at Johns Hopkins Hospital. A total of 22 plastic surgery residents (91% response rate) completed the study. The study sample consisted of 18 residents in the integrated training path and 4 in the independent training track and was equally divided between junior and senior residents. Most respondents (>54%) had taken at least 1 course in biostatistics or epidemiology. More than 90% of residents reported reading at least 1 plastic surgical journal on a regular basis (mean 2.1 ± 1.5 journals/month). Most residents expressed a desire to learn more about biostatistics (68.2%), reported using statistical information in forming clinical opinions (86.3%), and placed a high value on knowledge of biostatistics in appraising the surgical literature (90.9%). However, only 45% of respondents reported being able to understand all the statistical terms encountered in journal articles. Only 50% of respondents felt comfortable with assessing whether the appropriate statistical tests were used to answer a research question. In case studies, the mean percentage of correct responses was 53.0 ± 24.5% (range: 0-83.3). Higher performance scores were associated with a prior course in biostatistics (p = 0.04) and the number of journals read monthly (p = 0.003). Respondents had difficulty with study design (45.5% correct), analysis of variance (45.5% correct), time to event analysis (9.1% correct), and interpreting a 95% confidence interval (45.5% correct). The number of correct responses strongly correlated with respondent confidence in biostatistics (r = 0.70, p biostatistics but have only a fair understanding of core statistical concepts. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  1. Muscular workload of veterinary students during simulated open and laparoscopic surgery: A pilot study.

    Science.gov (United States)

    Kilkenny, Jessica; Larson, Dennis J; MacCormick, Mathew; Brown, Stephen H M; Singh, Ameet

    2017-08-01

    To compare upper extremity muscle activity and workload between simulated open surgery, multiple port laparoscopic surgery (MLS), and single incision laparoscopic surgery (SLS) techniques in veterinary students. Pilot study. Veterinary students (n = 10) from years 1 to 4. Bipolar skin surface electrodes were fixed bilaterally to the forearm flexor, forearm extensor, biceps brachii, triceps brachii, and upper trapezius muscles. Electromyography data were recorded during one repetition of 2 simulated surgical exercises via open surgery, MLS, and SLS. Participants completed a validated workload survey after each simulated surgical technique. Muscle activity and perceived workload were compared between surgical techniques with 1-way ANOVAs and Fisher's LSD post hoc tests. Muscle activity during peg transfer was higher with MLS and SLS compared to simulated open surgery in the right and left forearm extensors (both P < .0001), right (P < .0001) and left biceps (P = .0005), right triceps (P = .0004), and right upper trapezius muscles (P = .0211). Similar results were found for the right and left forearm extensors (both P < .0001), right (P = .0381) and left (P = .0147) forearm flexors, right biceps (P < .0001), and right triceps (P = .0004) during a simulated suture task. Participants found laparoscopic techniques more mentally demanding, physically demanding, complex, and stressful compared to a simulated open surgical technique. In veterinary students, average muscle activity and perceived workload were highest using MLS and SLS compared to an open surgical technique when performing simulated surgical exercises in a laparoscopic box trainer. © 2017 The American College of Veterinary Surgeons.

  2. Antiphospholipid antibodies in vascular surgery patients. A cross-sectional study.

    Science.gov (United States)

    Taylor, L M; Chitwood, R W; Dalman, R L; Sexton, G; Goodnight, S H; Porter, J M

    1994-01-01

    BACKGROUND: Autoantibodies to phospholipid (aPL) have been associated with vascular thromboses in cerebral, coronary, and peripheral venous and arterial sites. To date, no large cross-sectional study has examined the incidence of occurrence of aPL in patients with peripheral arterial disease. METHODS: A cross-sectional study was performed with patients admitted for vascular surgery procedures to treat peripheral arterial disease for 23 months between January 1, 1990 and November 1, 1991. Consecutive patients were evaluated for the presence of aPL. Medical records for each patient were reviewed in detail, and historic, operative, and postoperative parameters were tabulated for relationship to the presence of aPL. RESULTS: Two hundred thirty-four patients underwent complete testing for aPL. All patients were receiving chronic aspirin therapy. This represented 86% of admissions. Antiphospholipid antibodies were detected in 60 patients (26%). No differences in age, sex, operation performed, or postoperative outcome were found between patients with and without aPL. However, patients with aPL were 1.8 times more likely to have undergone previous lower extremity (LE) vascular surgery than patients without aPL (95% confidence interval = 1.0 - 3.6, p = 0.047). Patients with aPL and previous LE vascular surgery were 5.6 times more likely to have had occlusion of that procedure than patients without aPL (95% confidence interval = 1.9 - 16.8, p = 0.03). The occluded previous LE procedures had a shorter duration of patency before occlusion in patients with aPL than in those without (mean duration of patency 17 months vs. 50 months, p < 0.003). Patients with occluded previous LE procedures and aPL were 4 times more likely to be female (95% C.I. = 1.4 - 11.3, p = 0.018). CONCLUSIONS: The incidence of aPL in vascular surgery patients is substantial. Vascular surgery patients with aPL are more likely to have failure of previous LE bypass procedures and to be female and the bypass

  3. Rehabilitative challenges in the bilateral aural stenosis post chronic suppurative otitis media surgery: A case study

    Directory of Open Access Journals (Sweden)

    Himanshu Verma

    2015-01-01

    Full Text Available Introduction: Chronic suppurative otitis media (CSOM is an infection characterized by recurrent ear discharge through a persistent tympanic membrane perforation. In cases such as these, an ASLP is concerned with early prevention, assessment and provision of suitable client based rehabilitation options. Case Report: A 3.5yrs old male with bilateral aural stenosis post CSOM surgery reported to clinic with a complaint of reduced hearing sensitivity to soft sounds with delayed in speech and language. A test battery approach for Audiological and Speech and Language evaluation was conducted. Recommendations and referrals were suggested at the end. Discussion: Regardless of all the restrictions, this study highlights the challenges encountered by an ASLP in dealing with post operative aural stenotic case. This case study highlights the occurrence of stenosis post surgery of bilateral CSOM, which is rarely found.

  4. Effect of cataract surgery volume constraints on recently graduated ophthalmologists: a population-based cohort study

    Science.gov (United States)

    Campbell, Robert J.; El-Defrawy, Sherif R.; Bell, Chaim M.; Gill, Sudeep S.; Hooper, Philip L.; Whitehead, Marlo; Campbell, Erica de L.P.; Nesdole, Robert; Warder, Daniel; ten Hove, Martin

    2017-01-01

    BACKGROUND: Across Canada, graduates from several medical and surgical specialties have recently had difficulty securing practice opportunities, especially in specialties dependent on limited resources such as ophthalmology. We aimed to investigate whether resource constraints in the health care system have a greater impact on the volume of cataract surgery performed by recent graduates than on established physicians. METHODS: We used population-based administrative data from Ontario for the period Jan. 1, 1994, to June 30, 2013, to compare health services provided by recent graduates and established ophthalmologists. The primary outcome was volume of cataract surgery, a resource-intensive service for which volume is controlled by the province. RESULTS: When cataract surgery volume in Ontario entered a period of government-mandated zero growth in 2007, the mean number of cataract operations performed by recent graduates dropped significantly (−46.37 operations/quarter, 95% confidence interval [CI] −62.73 to −30.00 operations/quarter), whereas the mean rate for established ophthalmologists remained stable (+5.89 operations/quarter, 95% CI 95% CI −1.47 to +13.24 operations/quarter). Decreases in service provision among recent graduates did not occur for services without volume control. The proportion of recent graduates providing exclusively cataract surgery increased over the study period, and recent graduates in this group were 5.24 times (95% CI 2.15 to 12.76 times) more likely to fall within the lowest quartile for cataract surgical volume during the period of zero growth in provincial cataract volume (2007–2013) than in the preceding period (1996–2006). INTERPRETATION: Recent ophthalmology graduates performed many fewer cataract surgery procedures after volume controls were implemented in Ontario. Integrated initiatives involving multiple stakeholders are needed to address the issues facing recently graduated physicians in Canada. PMID:27920012

  5. Gamma Knife surgery for patients with jugular foramen schwannomas: a multiinstitutional retrospective study in Japan.

    Science.gov (United States)

    Hasegawa, Toshinori; Kato, Takenori; Kida, Yoshihisa; Sasaki, Ayaka; Iwai, Yoshiyasu; Kondoh, Takeshi; Tsugawa, Takahiko; Sato, Manabu; Sato, Mitsuya; Nagano, Osamu; Nakaya, Kotaro; Nakazaki, Kiyoshi; Kano, Tadashige; Hasui, Koichi; Nagatomo, Yasushi; Yasuda, Soichiro; Moriki, Akihito; Serizawa, Toru; Osano, Seiki; Inoue, Akira

    2016-10-01

    OBJECTIVE This study aimed to explore the efficacy and safety of stereotactic radiosurgery in patients with jugular foramen schwannomas (JFSs). METHODS This study was a multiinstitutional retrospective analysis of 117 patients with JFSs who were treated with Gamma Knife surgery (GKS) at 18 medical centers of the Japan Leksell Gamma Knife Society. The median age of the patients was 53 years. Fifty-six patients underwent GKS as their initial treatment, while 61 patients had previously undergone resection. At the time of GKS, 46 patients (39%) had hoarseness, 45 (38%) had hearing disturbances, and 43 (36%) had swallowing disturbances. Eighty-five tumors (73%) were solid, and 32 (27%) had cystic components. The median tumor volume was 4.9 cm(3), and the median prescription dose administered to the tumor margin was 12 Gy. Five patients were treated with fractionated GKS and maximum and marginal doses of 42 and 21 Gy, respectively, using a 3-fraction schedule. RESULTS The median follow-up period was 52 months. The last follow-up images showed partial remission in 62 patients (53%), stable tumors in 42 patients (36%), and tumor progression in 13 patients (11%). The actuarial 3- and 5-year progression-free survival (PFS) rates were 91% and 89%, respectively. The multivariate analysis showed that pre-GKS brainstem edema and dumbbell-shaped tumors significantly affected PFS. During the follow-up period, 20 patients (17%) developed some degree of symptomatic deterioration. This condition was transient in 12 (10%) of these patients and persistent in 8 patients (7%). The cause of the persistent deterioration was tumor progression in 4 patients (3%) and adverse radiation effects in 4 patients (3%), including 2 patients with hearing deterioration, 1 patient with swallowing disturbance, and 1 patient with hearing deterioration and hypoglossal nerve palsy. However, the preexisting hoarseness and swallowing disturbances improved in 66% and 63% of the patients, respectively

  6. The role of rehabilitative camouflage after cervicofacial reconstructive surgery: a preliminary study

    Directory of Open Access Journals (Sweden)

    Nicoletti G

    2014-01-01

    Full Text Available Giovanni Nicoletti,1–3 Andrea Sasso,1 Alberto Malovini,4,5 Luisa Ponchio,6 Silvia Scevola,2 Angela Faga,1–3 Aldo Pontone1 1Plastic and Reconstructive Surgery, Department of Clinical Surgical Diagnostic and Pediatric Sciences, 2Advanced Technologies for Regenerative Medicine and Inductive Surgery Research Centre, University of Pavia, Pavia, Italy; 3Plastic and Reconstructive Surgery Unit, Salvatore Maugeri Research and Care Institute, Pavia, Italy; 4Department of Computer Engineering and Systems Science, University of Pavia, Pavia, Italy; 5Laboratory of Informatics and Systems Engineering for Clinical Research, 6Oncology Unit, Salvatore Maugeri Research and Care Institute, Pavia, Italy Abstract: A randomized, prospective, controlled study was carried out at the Plastic and Reconstructive Surgery Unit of the University of Pavia, Salvatore Maugeri Research and Care Institute, Pavia, Italy, to evaluate the psychological benefits from corrective medical camouflage (CMC following surgical treatment for skin cancer of the face. Twenty-four female patients, following recovery from facial skin cancer surgery, were enrolled in the study over a period of 1 year. The study was performed using two health-related quality of life tests, the Satisfaction Profile (SAT-P test and the Body Uneasiness Test (BUT. The patients were randomized into two groups: group A, patients undergoing CMC; and group B, controls. Both the SAT-P and BUT demonstrated statistically significant better results in the treated patients versus the controls in the following functional parameters: Psychological Functionality (PsF, Physical Functionality (PhF, and Work Performance (WP for the SAT-P test and Compulsive Self-Monitoring (CSM for the BUT. The PsF demonstrated a better result 6 months post-treatment. Such a difference was particularly significant when comparing the performance at 6 months versus that at 3 months. The PhF demonstrated a better outcome at 6 months post

  7. Self-determination and motivation for bariatric surgery: a qualitative study.

    Science.gov (United States)

    Park, Juyeon

    2016-10-01

    This study examined how obese individuals acquire their motivation to undergo weight loss surgery and characterized the motivations within the framework of the self-determination theory (SDT). Participants expecting to have bariatric surgery were recruited and participated in semi-structured interviews. Interview accounts characterized different types of motivation for individuals seeking surgical weight loss treatments on the SDT continuum of relative autonomy. This study demonstrated that the more one's motivation was internally regulated, related to one's personal life and supported for competency, the more personal and hopeful were the anecdotes participants mentioned in accounts, thus the more positive the surgical outcomes were anticipated. Study limitations and future research were discussed as was the need for a systematic scheme to categorize types of motivation within the SDT, a longitudinal approach to measure actual weight loss outcomes based on the patient's pre-surgical motivation, and a further investigation with a larger sample size and balanced gender ratio. Practical implications of the study findings were also discussed as a novel strategy to internalize bariatric patients' motivation, further helping to improve their long-term quality of life post-surgery.

  8. The Efficacy and Clinical Safety of Various Analgesic Combinations for Post-Operative Pain after Third Molar Surgery: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Alvin Ho Yeung Au

    Full Text Available To run a systematic review and meta-analysis of randomized clinical trials aiming to answer the clinical question "which analgesic combination and dosage is potentially the most effective and safe for acute post-operative pain control after third molar surgery?".A systematic search of computer databases and journals was performed. The search and the evaluations of articles were performed by 2 independent reviewers in 3 rounds. Randomized clinical trials related to analgesic combinations for acute post-operative pain control after lower third molar surgery that matched the selection criteria were evaluated to enter in the final review.Fourteen studies with 3521 subjects, with 10 groups (17 dosages of analgesic combinations were included in the final review. The analgesic efficacy were presented by the objective pain measurements including sum of pain intensity at 6 hours (SPID6 and total pain relief at 6 hours (TOTPAR6. The SPID6 scores and TOTPAR6 scores of the reported analgesic combinations were ranged from 1.46 to 6.44 and 3.24 - 10.3, respectively. Ibuprofen 400mg with oxycodone HCL 5mg had superior efficacy (SPID6: 6.44, TOTPAR6: 9.31. Nausea was the most common adverse effect, with prevalence ranging from 0-55%. Ibuprofen 200mg with caffeine 100mg or 200mg had a reasonable analgesic effect with fewer side effects.This systematic review and meta-analysis may help clinicians in their choices of prescribing an analgesic combination for acute post-operative pain control after lower third molar surgery. It was found in this systematic review Ibuprofen 400mg combined with oxycodone HCL 5mg has superior analgesic efficacy when compared to the other analgesic combinations included in this study.

  9. The Efficacy and Clinical Safety of Various Analgesic Combinations for Post-Operative Pain after Third Molar Surgery: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Au, Alvin Ho Yeung; Choi, Siu Wai; Cheung, Chi Wai; Leung, Yiu Yan

    2015-01-01

    Objectives To run a systematic review and meta-analysis of randomized clinical trials aiming to answer the clinical question “which analgesic combination and dosage is potentially the most effective and safe for acute post-operative pain control after third molar surgery?”. Materials and Methods A systematic search of computer databases and journals was performed. The search and the evaluations of articles were performed by 2 independent reviewers in 3 rounds. Randomized clinical trials related to analgesic combinations for acute post-operative pain control after lower third molar surgery that matched the selection criteria were evaluated to enter in the final review. Results Fourteen studies with 3521 subjects, with 10 groups (17 dosages) of analgesic combinations were included in the final review. The analgesic efficacy were presented by the objective pain measurements including sum of pain intensity at 6 hours (SPID6) and total pain relief at 6 hours (TOTPAR6). The SPID6 scores and TOTPAR6 scores of the reported analgesic combinations were ranged from 1.46 to 6.44 and 3.24 – 10.3, respectively. Ibuprofen 400mg with oxycodone HCL 5mg had superior efficacy (SPID6: 6.44, TOTPAR6: 9.31). Nausea was the most common adverse effect, with prevalence ranging from 0-55%. Ibuprofen 200mg with caffeine 100mg or 200mg had a reasonable analgesic effect with fewer side effects. Conclusion This systematic review and meta-analysis may help clinicians in their choices of prescribing an analgesic combination for acute post-operative pain control after lower third molar surgery. It was found in this systematic review Ibuprofen 400mg combined with oxycodone HCL 5mg has superior analgesic efficacy when compared to the other analgesic combinations included in this study. PMID:26053953

  10. A major safety overhaul

    CERN Multimedia

    2003-01-01

    A redefined policy, a revamped safety course, an environmental project... the TIS (Technical Inspection and Safety) Division has begun a major safety overhaul. Its new head, Wolfgang Weingarten, explains to the Bulletin why and how this is happening.

  11. Suction drain tip culture in orthopaedic surgery: a prospective study of 214 clean operations

    OpenAIRE

    Sankar, B.; P Ray; Rai, J.

    2004-01-01

    We conducted a prospective cohort study in order to determine whether suction drain specimen cultures from orthopaedic surgery predicted an early wound infection. We included 218 consecutive clean orthopaedic operations requiring drains in one unit over a period of 1 year. The suction drain tip, drain fluid and wound discharge specimens were cultured, and the surgical wound was followed up for 3 months. There were six deep and two superficial wound infections. Wound infection was significantl...

  12. Quality Improvement in Surgery Combining Lean Improvement Methods with Teamwork Training: A Controlled Before-After Study.

    Directory of Open Access Journals (Sweden)

    Eleanor Robertson

    Full Text Available To investigate the effectiveness of combining teamwork training and lean process improvement, two distinct approaches to improving surgical safety. We conducted a controlled interrupted time series study in a specialist UK Orthopaedic hospital incorporating a plastic surgery team (which received the intervention and an Orthopaedic theatre team acting as a control.We used a 3 month intervention with 3 months data collection period before and after it. A combined teamwork training and lean process improvement intervention was delivered by an experienced specialist team. Before and after the intervention we evaluated team non-technical skills using NOTECHS II, technical performance using the glitch rate and WHO checklist compliance using a simple 3 point scale. We recorded complication rate, readmission rate and length of hospital stay data for 6 months before and after the intervention.In the active group, but not the control group, full compliance with WHO Time Out (T/O increased from 14 to 71% (p = 0.032, Sign Out attempt rate (S/O increased from 0% to 50% (p<0.001 and Oxford NOTECHS II scores increased after the intervention (P = 0.058. Glitch rate decreased in the active group and increased in the control group (p = 0.001. Complications and length of stay appeared to rise in the control group and fall in the active group.Combining teamwork training and systems improvement enhanced both technical and non-technical operating team process measures, and were associated with a trend to better safety outcome measures in a controlled study comparison. We suggest that approaches which address both system and culture dimensions of safety may prove valuable in reducing risks to patients.

  13. A study to develop the domestic functional requirements of the specific safety systems of CANDU

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Man Woong [Korea Institute of Nuclear Safety, Taejon (Korea, Republic of); Lee, Jae Young; Park, Kun Chul [Handong Global Univ., Pohang (Korea, Republic of)] (and others)

    2003-03-15

    The present research has been made to develop and review critically the functional requirements of the specific safety systems of CANDU such as SDS-1, SDS2, ECCS, and containment. Based on R documents for this, a systematic study was made to develop the domestic regulation statements. Also, the conventional laws are carefully reviewed to see the compatibility to CANDU. Also, the safety assessment method for CANDU was studied by reviewing C documents and recommendation of IAEA. Through the present works, the vague policy in the CANDU safety regulation is cleaning up in a systematic form and a new frame to measure the objective risk of nuclear power plants was developed.

  14. A study to develop the domestic functional requirements of the specific safety systems of CANDU

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Man Woong; Lee, Jae Young; Bang, Kwang Hyun [Handong Global Univ., Pohang (Korea, Republic of)] (and others)

    2001-03-15

    The present research has been made to develop and review critically the functional requirements of the specific safety systems of CANDU such as SOS-1, SOS-2, ECCS and containment. Based on R documents for this, a systematic study was made to develop the domestic regulation statements. Also, the conventional laws are carefully reviewed to see the compatibility to CANDU. Also, the safety assessment method for CANDU was studied by reviewing C documents and recommendation of IAEA. Through the present works, the vague policy in the CANDU safety regulation is cleaning up in a systematic form and a new frame to measure the objective risk of nuclear power plants was developed.

  15. Dexmedetomidine as an adjunct in postoperative analgesia following cardiac surgery: A randomized, double-blind study

    Directory of Open Access Journals (Sweden)

    Shio Priye

    2015-01-01

    Full Text Available Objectives: The purpose of this study was to determine analgesic efficacy of dexmedetomidine used as a continuous infusion without loading dose in postcardiac surgery patients. Settings and Design: A prospective, randomized, double-blind clinical study in a single tertiary care hospital on patients posted for elective cardiac surgery under cardiopulmonary bypass. Interventions: Sixty-four patients who underwent elective cardiac surgery under general anesthesia were shifted to intensive care unit (ICU and randomly divided into two groups. Group A (n = 32 received a 12 h infusion of normal saline and group B (n = 32 received a 12 h infusion of dexmedetomidine 0.4 μg/kg/h. Postoperative pain was managed with bolus intravenous fentanyl. Total fentanyl consumption, hemodynamic monitoring, Visual Analogue Scale (VAS pain ratings, Ramsay Sedation Scale were charted every 6 th hourly for 24 h postoperatively and followed-up till recovery from ICU. Student′s t-test, Chi-square/Fisher′s exact test has been used to find the significance of study parameters between the groups. Results: Dexmedetomidine treated patients had significantly less VAS score at each level (P < 0.001. Total fentanyl consumption in dexmedetomidine group was 128.13 ± 35.78 μg versus 201.56 ± 36.99 μg in saline group (P < 0.001. A statistically significant but clinically unimportant sedation was noted at 6 and 12 h (P < 0.001, and P = 0.046 respectively. Incidence of delirium was less in dexmedetomidine group (P = 0.086+. Hemodynamic parameters were statistically insignificant. Conclusions: Dexmedetomidine infusion even without loading dose provides safe, effective adjunct analgesia, reduces narcotic consumption, and showed a reduced trend of delirium incidence without undesirable hemodynamic effects in the cardiac surgery patients.

  16. "The study on surgical services for the United States": a valid prescription for American surgery?

    Science.gov (United States)

    Hughes, E F; Lewit, E M; Pauly, M V

    1977-01-01

    The overall approach of SOSSUS to the study of surgical services, the interpretation of findings, and policy recommendations are rightly called into question. But singular concern with the consequences of monopolistic control by the profession is no substitute for analysis of the dynamics among demand, production, and supply of surgery. Any delivery system--and many models are feasible--involving consumers, providers, and payers is a market in which multidimensional behavior must be anticipated.

  17. Safety and tolerability of grass pollen tablets in sublingual immunotherapy--a phase-1 study

    DEFF Research Database (Denmark)

    Larsen, T H; Poulsen, Lars K.; Melac, M

    2006-01-01

    A single-centre, randomized, double-blind, placebo-controlled study. Aims: To compare the safety and tolerability of four different sublingual immunotherapy (SLIT) regimes in grass pollen allergic rhinitis....

  18. Irritable bowel syndrome--prognosis and diagnostic safety. A 5-year follow-up study

    DEFF Research Database (Denmark)

    Svendsen, Jesper Hastrup; Munck, L K; Andersen, J R

    1985-01-01

    The irritable bowel syndrome is the commonest diagnosis in gastroenterological clinics, although diagnostic criteria and investigatory programs vary. To elucidate the diagnostic safety and prognosis of the syndrome, a retrospective study was conducted. One hundred and twelve consecutive patients ...

  19. Sedation in oral and maxillofacial day care surgery: A comparative study between intravenous dexmedetomidine and midazolam.

    Science.gov (United States)

    Mishra, Niranjan; Birmiwal, Krishna Gopal; Pani, Nibedita; Raut, Subhrajit; Sharma, Gaurav; Rath, Krushna Chandra

    2016-01-01

    Sedation is an important component of day care oral and maxillofacial surgical procedures under local anesthesia. Although various sedative drugs in different regimens have been used for sedation, an ideal agent and regimen are yet to be established. The aim of this study is to compare the efficacy of intravenous (IV) dexmedetomidine and midazolam as a sedative agent for day care oral and maxillofacial surgical procedures. The study was conducted in the Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India. A total of sixty adult patients of age group 18-65 years, of either sex were randomly selected equally in two groups for the study. One group named Group D received dexmedetomidine and the other named Group M received midazolam. Patients were evaluated for oxygen saturation (SPO2), respiration rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), Ramsay sedation score, bispectral index (BIS) score, amnesia, Aldrete score, relaxation during the surgery, and drug preference. Midazolam was associated with greater amnesia. Dexmedetomidine was associated with lower heart rate, SBP, and DBP. There was no significant difference in SPO2, RR, Aldrete score, Ramsay sedation score, and BIS score between the two drugs. Patient preference and relaxation were more in dexmedetomidine group. IV dexmedetomidine is a comparable alternative to midazolam for sedation in day care oral and maxillofacial surgery under local anesthesia. It is the preferred drug when a lower heart rate and blood pressure or less amnesia is needed without any serious side effects.

  20. Efficacy of fentanyl transdermal patch in pain control after lower third molar surgery: A preliminary study

    Science.gov (United States)

    Vasovic, Miroslav; Andric, Miroslav; Todorovic, Ljubomir; Kokovic, Vladimir

    2016-01-01

    Background Surgical removal of impacted lower third molars is a common oral surgical procedure, generally followed by moderate to severe postoperative pain. Transdermal drug delivery as a concept offers interesting possibilities for postoperative pain control. The aim of this study was to evaluate the efficacy of transdermal system with fentanyl in relieving pain following impacted lower third molar surgery. Material and Methods Seventeen patients with bilateral impacted lower third molars were included in this preliminary study. For postoperative pain control, patients randomly received a fentanyl patch plus placebo tablet after the first operation and regular (placebo) patch and an analgesic, after the second operation. Analgesia was evaluated during first 24 hours postoperatively according to patients’ reports about time of first pain appearance and additional analgesic consumption. Pain severity was rated using a 10 cm long visual analogue scale (VAS). Results Intensity of postoperative pain and postoperative analgesic consumption were significantly lower after the Fentanyl Transdermal System (FTS) was applied (p<0.05). Duration of postoperative analgesia was significantly higher with FTS when compared to control treatment (p<0.05). Conclusions Based on the results of this preliminary study, transdermal system with fentanyl significantly reduced postoperative pain after third molar surgery. Key words:Analgesia, fentanyl, transdermal administration, third molar surgery, acute pain, postoperative care. PMID:27475691

  1. Effect of massage therapy on pain, anxiety, relaxation, and tension after colorectal surgery: A randomized study.

    Science.gov (United States)

    Dreyer, Nikol E; Cutshall, Susanne M; Huebner, Marianne; Foss, Diane M; Lovely, Jenna K; Bauer, Brent A; Cima, Robert R

    2015-08-01

    The purpose of this randomized controlled trial was to evaluate the effect of postoperative massage in patients undergoing abdominal colorectal surgery. One hundred twenty-seven patients were randomized to receive a 20-min massage (n = 61) or social visit and relaxation session (no massage; n = 66) on postoperative days 2 and 3. Vital signs and psychological well-being (pain, tension, anxiety, satisfaction with care, relaxation) were assessed before and after each intervention. The study results indicated that postoperative massage significantly improved the patients' perception of pain, tension, and anxiety, but overall satisfaction was unchanged. In conclusion, massage may be beneficial during postoperative recovery for patients undergoing abdominal colorectal surgery. Further studies are warranted to optimize timing and duration and to determine other benefits in this clinical setting.

  2. Application of fast-track surgery concept in perioperative patients with biliary calculi and liver cirrhosis: a prospective study

    Directory of Open Access Journals (Sweden)

    WANG Hua

    2014-11-01

    Full Text Available ObjectiveTo investigate the advantage and safety of the concept of fast-track surgery (FTS applied in perioperative patients with biliary calculi and liver cirrhosis. MethodsFifty-two patients undergoing operation for biliary calculi and liver cirrhosis from January 2011 to September 2013 were included in this study. These patients were randomly divided into FTS group (n = 30 and control group (n = 22. Patients in the FTS group received perioperative care measures guided by FTS concept, while patients in the control group received traditional perioperative management measures. The intraoperative situation of patients, time to postoperative recovery of intestinal function, length of postoperative hospital stay, total medical expenses during hospitalization, and postoperative complications were compared between the two groups. Continuous data and categorical data were compared by t-test and χ2 test, respectively. ResultsAs compared with the control group, the FTS group had significantly time to postoperative recovery of intestinal function (t = 2.239, P = 0.045, a significantly shortened length of postoperative stay (t = 4.246, P = 0.038, and significantly reduced total medical expenses during hospitalization (t = 3.045, P = 0.033. No significant difference in postoperative complications was observed between the two groups (P>0.05. ConclusionThe concept of FTS can be safely and effectively applied in perioperative patients with biliary calculi and liver cirrhosis, which can accelerate rehabilitation without increasing the risk of surgery.

  3. Hemostatic function to regulate perioperative bleeding in patients undergoing spinal surgery: A prospective observational study

    OpenAIRE

    KIMURA, Atsushi; Ohmori, Tsukasa; Sakata, Asuka; Endo, Teruaki; Inoue, Hirokazu; Nishimura, Satoshi; Takeshita, Katsushi

    2017-01-01

    Although bleeding is a common complication of surgery, routine laboratory tests have been demonstrated to have a low ability to predict perioperative bleeding. Better understanding of hemostatic function during surgery would lead to identification of high-risk patients for bleeding. Here, we aimed to elucidate hemostatic mechanisms to determine perioperative bleeding. We prospectively enrolled 104 patients undergoing cervical spinal surgery without bleeding diathesis. Blood sampling was perfo...

  4. [Safety culture of nursing staff. A descriptive study in a Piedmont Hospital].

    Science.gov (United States)

    Basso, Ines; Dogliotti, Daniele; Poletti, Piera; Gambarini, Lorella

    2012-01-01

    Assessing safety culture is the first step towards a responsible and wary system to the errors and to the quality of the performance. The aim of the study was to assess nurses' safety culture, in order to identify improvement's priorities. A survey of nursing staff, using a questionnaire was carried out in a Piedmont hospital. Of 1056 health care workers, 707 participated (67%). The staff's perception of patient safety was positive: the results of the domains "Information and communication", "Suggestions and development" and "Safety guarantees" tend to be fair, while "Teamwork" was sufficient. The weakest areas were related to involvement (Items: "We are consulted when choosing equipment and devices to be used", 25.9% agreement, "At the end of the year we discuss together activities carried out and results" 31,8%), and "Work organization (shifts, workload) doesn't cause overload and stress", 25.3% agreement, "When an error occurs we know how to communicate with the patient as we have a guideline to lead us" 35.8% agreement. The study shows that, even if the safety culture is overall positive, there are some critical aspects that lead to distress and uncertainty between nursing staff. Improvement strategies may include: staff training to improve teamwork skills and staff involvement, increasing opportunities for discussion, organizing systematic multi-professional audit, to reflect in a structured way on clinical practice.

  5. Clinical attitudes towards pain treatment post-orthopedic surgery: a multicenter study in Beijing

    Institute of Scientific and Technical Information of China (English)

    WANG Zhi-qiang; ZHAN Si-yan; Marlene Fransen; LIN Jian-hao

    2012-01-01

    Background Pain is a common post-operative complication.Incidence of pain directly affects patients' quality of life in terms of patient physiology,psychology,and social characteristics.This study was to understand clinical attitudes with regards to Beijing surgeons,and patients' attitude towards pain treatment after orthopedic surgery.Methods A hospital-based cross-sectional and cluster sample survey of 40 hospitals in Beijing was conducted,including 20 level Ⅲ (tier three) and 20 level Ⅱ (tier two) general hospitals.Enrolled subjects completed a specifically designed interview-questionnaire.Results The prevalence of pain 2 weeks post-orthopedic surgery was high in Beijing (96.1%).Meanwhile,collected data indicated most subjects in Beijing suffered moderate to severe pain,45.1% and 41.4%,respectively,post-surgery.And for the concern of patients before surgery,most subjects chose full recovery from surgery (78.6%),as well as,the pain after operation was 39.2% ranked the third.According to the data from the study,Tramadol use was more common in Level Ⅲ hospitals,where Somiton was preferred in Level Ⅱ hospitals.When it came to the education of pain before and after operation,more patients get educated before operation than after it,In our study,case physicians or attending physicians enacted education before and after surgery.Related to the sense of patients,among the surgeons preferring post-operative analgesia,67.6% considered administration when receiving complaints of moderate level pain,50.0%indicated they will terminate analgesic treatment once pain degree scale wise decreases to benign pain.Conclusions The majority of orthopedic patients experience post-operative pain.Identification of post-operative pain will facilitate future awareness on pain treatment and nursing care in Beijing hospitals,with pain relief through regulated improvements in strategic pain management.

  6. Systematic Video Documentation in Laparoscopic Colon Surgery Using a Checklist: A Feasibility and Compliance Pilot Study.

    Science.gov (United States)

    O'Mahoney, Paul R A; Trencheva, Koiana; Zhuo, Changhua; Shukla, Parul J; Lee, Sang W; Sonoda, Toyooki; Milsom, Jeffrey W

    2015-09-01

    High-quality images can be readily captured during laparoscopic colon surgery, but there are no guidelines for documentation of these video data or how to best measure surgical quality from an operative video. This study evaluates the feasibility and compliance in documenting key steps during laparoscopic right hemicolectomy and sigmoid colectomy. A retrospective review of previously recorded videos of patients undergoing laparoscopic right hemicolectomy or sigmoid colectomy from September to December 2011 in a single institution was performed. Patients' demographics, intraoperative features, postoperative complications, and variables for video recording and editing were collected. Compliance of key surgical steps was assessed using a checklist by two independent surgeons. Sixteen laparoscopic operations (seven right hemicolectomies and nine sigmoid colectomies) were recorded. Twelve (75%) were laparoscopic-assisted, and four (25%) were hand-assisted laparoscopic operations. Compliance with key surgical steps in laparoscopic right hemicolectomy and sigmoid colectomy was demonstrated in the majority of patients, with steps ranging in compliance from 42.9% to 100% and from 77.8% to 100%, respectively. The edited video had a median duration of 3 minutes 47 seconds (range, 1 minute 44 seconds-5 minutes 38 seconds) with a production time of nearly 1 hour and a resolution of 1440 × 1080 pixels. Key surgical steps during laparoscopic right hemicolectomy and sigmoid colectomy can be documented and edited into a short representative video. Standardization of this process should allow video documentation to improve quality in laparoscopic colon surgery.

  7. Understanding the life experiences of Brazilian women after bariatric surgery: a qualitative study.

    Science.gov (United States)

    Magdaleno, Ronis; Chaim, Elinton Adami; Turato, Egberto Ribeiro

    2010-08-01

    The increase in bariatric surgeries has called into question the aspects that contribute to or impair the results. Psychosocial factors directly influence the results of the surgery, but a lot of controversy exists in relation to the degree of influence of these factors. We propose a qualitative investigation to understand the significance of the surgery for women and how these factors influence the outcomes. This study is a clinical-qualitative method, through the semi-directed interview with open-ended questions in an intentional sample, closed by saturation, with seven women operated in a period of 1.5-3 years, following the definition of emergent categories and qualitative content analysis. The experience of acceptance and social reinsertion is a motivating factor to keep up the challenge of weight loss; social discrimination is a risk factor leading to losing the stimulus to continue the process; the recuperation of self-esteem and personal identity is a factor that improves the quality of life and psychopathological symptoms; disillusionment is an important risk factor, linked principally to the experiences of failure. We observe the necessity of qualitative studies that serve the health team in the handling of these patients, aiming for a greater understanding of their psychological dynamics and of the meanings that weight loss has for them.

  8. A hybrid simulation approach for integrating safety behavior into construction planning: An earthmoving case study.

    Science.gov (United States)

    Goh, Yang Miang; Askar Ali, Mohamed Jawad

    2016-08-01

    One of the key challenges in improving construction safety and health is the management of safety behavior. From a system point of view, workers work unsafely due to system level issues such as poor safety culture, excessive production pressure, inadequate allocation of resources and time and lack of training. These systemic issues should be eradicated or minimized during planning. However, there is a lack of detailed planning tools to help managers assess the impact of their upstream decisions on worker safety behavior. Even though simulation had been used in construction planning, the review conducted in this study showed that construction safety management research had not been exploiting the potential of simulation techniques. Thus, a hybrid simulation framework is proposed to facilitate integration of safety management considerations into construction activity simulation. The hybrid framework consists of discrete event simulation (DES) as the core, but heterogeneous, interactive and intelligent (able to make decisions) agents replace traditional entities and resources. In addition, some of the cognitive processes and physiological aspects of agents are captured using system dynamics (SD) approach. The combination of DES, agent-based simulation (ABS) and SD allows a more "natural" representation of the complex dynamics in construction activities. The proposed hybrid framework was demonstrated using a hypothetical case study. In addition, due to the lack of application of factorial experiment approach in safety management simulation, the case study demonstrated sensitivity analysis and factorial experiment to guide future research.

  9. Vessel traffic safety in busy waterways: A case study of accidents in western shenzhen port.

    Science.gov (United States)

    Mou, J M; Chen, P F; He, Y X; Yip, Tsz Leung; Li, W H; Tang, J; Zhang, H Z

    2016-08-03

    Throughout the world, busy waterways near large ports witness heavy vessel traffic in recent decades. The waterways are characterized by high risk in terms of loss of life, property, and pollution to environment. To facilitate maritime safety management with satisfactory efficiency and efficacy, the authors propose a framework of safety indexes to evaluate the risk level in busy waterways according to the accident severity, fatality rate and special indicators of maritime transportation. The safety indexes consist of Safety Evaluation Index (SEI) and Safety Warning Index (SWI), and are derived from the proposed risk criteria of Chinese vessel traffic. As a case study, data on vessel traffic accidents reported in the Western Shenzhen Port, South China from 1995 to 2015 are analyzed. The actual risk level of this area during the period is calculated under the framework. The implementation of the safety indexes indicate that the risk criteria and safety indexes are practicable and effective for the vessel traffic management. The methodology based on long-term accident data can significantly support the risk analysis in the macroscopic perspective for busy ports and waterways, such that SWI can act as threshold to trigger actions, while SEI can act as an indicator to measure safety status.

  10. A study on the safety regulation of byproduct material (II)

    Energy Technology Data Exchange (ETDEWEB)

    Song, Jong Sun; Song, Yang Su [Chosun Univ., Gwangju (Korea, Republic of)

    2000-03-15

    The scope of this study consists of : in relating to the domestic license of byproduct material, a survey of technical criteria and status of regulation in U.S.A., a determination of range of application and contents of byproduct material, a tentative suggestion of related technical criteria and regulatory system. A study was performed about the above topics to establish the safe regulation of byproduct material institutionally, and this can be contributed in establishing the proper domestic technical criteria related.

  11. Model quality and safety studies

    DEFF Research Database (Denmark)

    Petersen, K.E.

    1997-01-01

    The paper describes the EC initiative on model quality assessment and emphasizes some of the problems encountered in the selection of data from field tests used in the evaluation process. Further, it discusses the impact of model uncertainties in safety studies of industrial plants. The model...... that most of these have never been through a procedure of evaluation, but nonetheless are used to assist in making decisions that may directly affect the safety of the public and the environment. As a major funder of European research on major industrial hazards, DGXII is conscious of the importance......-tain model is appropriate for use in solving a given problem. Further, the findings from the REDIPHEM project related to dense gas dispersion will be highlighted. Finally, the paper will discuss the need for model quality assessment in safety studies....

  12. Safety of Continuous Infusion Ketorolac in Postoperative Coronary Artery Bypass Graft Surgery Patients

    Directory of Open Access Journals (Sweden)

    Meredith L. Howard

    2016-06-01

    Full Text Available Background:Continuous infusion ketorolac is sometimes utilized for analgesia in postoperative coronary artery bypass graft (CABG patients despite contraindications for use. Limited literature surrounds this topic; therefore, this study was conducted to evaluate the safety of this practice. Methods: This retrospective cohort study evaluated the primary outcome of mortality and secondary outcomes of incidence of bleeding and myocardial infarction (MI. All patients who underwent isolated CABG surgeries and received continuous infusion ketorolac during the study period were included. An equal number of randomly selected isolated CABG patients served as control patients. Electronic medical records and the Society of Thoracic Surgeons (STS database were utilized to determine baseline characteristics and outcomes; Results: One hundred and seventy-eight patients met inclusion; 89 in each group. More patients in the control group underwent on-pump surgeries (78.6% vs. 29.2%, p = 0.01 and had higher STS risk scores (1.1% vs. 0.6%, p = 0.003. There was no difference in mortality between the ketorolac group and control group (2.2% vs. 3.3%, p = 0.605. Additionally, no patients experienced a MI and there was no difference in bleeding incidence (5.5% vs. 6.7%, p = 0.58; Conclusions: No association was found between continuous infusion ketorolac and increased risk of mortality, MI, or bleeding events in postoperative CABG patients. Considerations to differences in baseline characteristics must be made when interpreting results.

  13. Pomegranate Supplementation Protects against Memory Dysfunction after Heart Surgery: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Susan A. Ropacki

    2013-01-01

    Full Text Available Memory dysfunction is a common complaint following heart surgery and may be related to a diffuse ischemic state induced by microemboli dislodged during the procedure. Ischemia can induce damage by a number of mechanisms, including oxidative stress. Because pomegranates contain a variety of polyphenols with antioxidant and other potentially beneficial effects, we tested whether supplementation with a pomegranate extract before and after heart surgery could protect against postoperative cognitive dysfunction. Patients undergoing elective coronary artery bypass graft and/or valve surgery were given either 2 g of pomegranate extract (in 2 POMx pills or placebo (pills containing no pomegranate ingredients per day from one week before surgery to 6 weeks after surgery. The patients were also administered a battery of neuropsychological tests to assess memory function at 1 week before surgery (baseline, 2 weeks after surgery, and 6 weeks after surgery. The placebo group had significant deficits in postsurgery memory retention, and the pomegranate treatment not only protected against this effect, but also actually improved memory retention performance for up to 6 weeks after surgery as compared to presurgery baseline performance.

  14. Current challenges in providing bariatric surgery in France: A nationwide study.

    Science.gov (United States)

    Czernichow, Sébastien; Paita, Michel; Nocca, David; Msika, Simon; Basdevant, Arnaud; Millat, Bertrand; Fagot-Campagna, Anne

    2016-12-01

    Bariatric surgery is a well-accepted procedure for severe and massive obesity management. We aimed to determine trends, geographical variations, and factors influencing bariatric surgery and the choice of procedure in France in a large observational study.The Health Insurance Fund for Salaried Workers (Caisse National Assurance Maladie Travailleurs Salariés) covers about 86% of the French population. The Système National d'Information Inter-régimes de l'Assurance Maladie database contains individualized and anonymized patient data on all reimbursements for healthcare expenditure. All types of primary bariatric procedures (Roux-en-Y gastric bypass [RYGB] or omega loop, adjustable gastric banding [AGB], or longitudinal sleeve gastrectomy [LSG]) performed during 2011 to 2013 were systematically recorded. Surgical techniques performed by region of residence and age-range relative risks with 95% confidence intervals of undergoing LSG or RYGB versus AGB were computed.In 2013, LSG was performed more frequently than RYGB and AGB (57% vs 31% and 13%, respectively). A total of 41,648 patients underwent a bariatric procedure; they were predominantly female (82%) with a mean (±standard deviation) age of 40 (±12) years and a body mass index ≥40 kg/m for 68% of them. A total of 114 procedures were performed in patients younger than 18 years and 2381 procedures were performed in patients aged 60 years and older. Beneficiaries of the French universal health insurance coverage for low-income patients were more likely to undergo surgery than the general population. Large nationwide variations were observed in the type choice of bariatric surgical procedures. Significant positive predictors for undergoing RYGB compared to those for undergoing AGB were as follows: referral to a center performing a large number of surgeries or to a public hospital, older age, female gender, body mass index ≥50 kg/m, and treatment for obstructive sleep apnea syndrome, diabetes, or

  15. Collagen implant with gentamicin sulphate reduces surgical site infection in vascular surgery: a prospective cohort study.

    Science.gov (United States)

    Costa Almeida, Carlos Eduardo Perdigão; Reis, Luis; Carvalho, Luis; Costa Almeida, Carlos Manuel

    2014-10-01

    Surgical site infection (SSI) is a common complication after vascular surgery. It may cause exposure of the underlying prosthesis causing graft infection, which may require the removal of the vascular graft, increasing amputation and mortality risks. Graft contamination usually occurs during operative procedure or by direct spread from an infected wound. It is therefore advisable to a strong effort in reducing SSI. Topic antibiotics have not been fully studied in vascular surgery, but collagen implant with gentamicin sulphate has shown to reduce SSI in cardiac surgery, orthopaedics, and general surgery procedures. Sixty (60) non-diabetic and non-obese patients with lower limb ischaemia with indication for femoropopliteal PTFE prosthetic bypass were allocated into 2 groups of 30 patients. A collagen implant impregnated with gentamicin sulphate (Collatamp(®)) was applied in the groin incision adjacent to the prosthesis in one group, and the other was a control group. The same surgical team operated all patients. Szilagyi classification was used. There was no SSI (0% - 0/30) in the collagen implant with gentamicin sulphate group, contrasting with 6 cases (20% - 6/30) of SSI (grade I and II) in the control group (p = 0.024). In-hospital day's data shows a significant difference between the two groups (p = 0.004) with a mean of 5.66 days for implant group and 8.10 days for control group. There was no SSI grade III. Collagen implant with gentamicin sulphate (Collatamp(®)) reduces SSI in the groin incision in ischaemic patients submitted to femoropopliteal PTFE prosthetic bypass. Days of hospitalization are also reduced. Decreasing SSI rate and in-hospital days, this implant may also reduce health care costs. Because this is a small pilot study, a multicentre RCT is necessary for validation. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  16. [Anesthesia in the pleuropulmonary complications surgery of tuberculosis: a 79 cases study].

    Science.gov (United States)

    Kane, O; Diouf, E; Beye, M D; Diarra, O; Ndoye Diop, M; Diouf, M; Ndiaye, M; Ka Sall, B

    2003-01-01

    Reported is a retrospective study carried out from Aristide Le Dantec Hospital in patients who underwent pleuropulmonary surgery after tuberculosis complication, from June 1995 to June 1999. The aim of this study was to evaluate the anaesthesiology procedures and outcomes of tuberculosis pleuropulmonary complications surgery. Seventy nine patients were studied. Their mean age was 34.63 years, and the sex ratio was 3.14. They all underwent general anaesthesia procedures with barbituric, morphinics et myorelaxants drugs. The peroperative complications noted were distributed as follow: 50 cases of haemorrhage needing transfusion, 18 cases of hypotension associated to the anaesthesia. In the intensive care period, we have noticed 30 atelectasia cases associated to a spastic bronchopathy, 3 cases of pulmonary oedema and 1 case of pulmonary infarctus. In the postoperative period, 8 cases of hemodynamic instability occurred, including 5 cases of cardiovascular collapsus treated by filling, and 2 septic shocks cases. An infectious bronchopneumopathy was noticed on 11 patients with two cases of septicaemia. The mortality rate was 6.3% (5 cases of death). The pleuropulmonary surgery in tuberculosis complication is very haemorrhagic, and therefore require an adequate preoperative preparation.

  17. Barriers to nurse-patient communication in cardiac surgery wards: a qualitative study.

    Science.gov (United States)

    Shafipour, Vida; Mohammad, Eesa; Ahmadi, Fazlollah

    2014-08-15

    An appropriate and effective nurse-patient communication is of the most important aspect of caring. The formation and continuation of such a relationship depends on various factors such as the conditions and context of communication and a mutual understanding between the two. A review of the literature shows that little research is carried out on identification of such barriers in hospital wards between the patients and the healthcare staff. The present study was therefore conducted to explore the experiences of nurses and patients on communication barriers in hospital cardiac surgery wards. This qualitative research was carried out using a content analysis method (Graneheim & Lundman, 2004). The participants were selected by a purposeful sampling and consist of 10 nurses and 11 patients from the cardiac surgery wards of three teaching hospitals in Tehran, Iran. Data was gathered by unstructured interviews. All interviews were audio-taped and transcribed verbatim. Findings were emerged in three main themes including job dissatisfaction (with the sub-themes of workload tension and decreased motivation), routine-centered care (with the sub-themes of habitual interventions, routinized and technical interventions, and objective supervision), and distrust in competency of nurses (with the sub-themes of cultural contrast, less responsible nurses, and their apathy towards the patients). Compared to other studies, our findings identified different types of communication barriers depending on the nursing settings. These findings can be used by the ward clinical nursing managers at cardiac surgery wards to improve the quality of nursing care.

  18. Postoperative pain management with transdermal fentanyl after forefoot surgery: a randomized, placebo-controlled study

    Directory of Open Access Journals (Sweden)

    Merivirta R

    2015-01-01

    Full Text Available Riika Merivirta,1 Mikko Pitkänen,2 Jouko Alanen,3 Elina Haapoja,1 Mari Koivisto,4 Kristiina Kuusniemi11Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine of Turku University Hospital and University of Turku, Turku, 2Department of Anaesthesia, Hospital Orton, Invalid Foundation, Helsinki, 3Terveystalo Clinic Hospital, Helsinki, 4Department of Biostatistics, University of Turku, Turku, FinlandBackground: Quality of life is decreased in patients with hallux valgus deformity, mainly because of pain. Significant improvement is usually achieved by surgery. However, postoperative pain can be moderate to severe for 2–3 days. The aim of the present study was to evaluate the use of transdermal fentanyl for postoperative pain management after forefoot surgery.Methods: Sixty patients undergoing hallux valgus or hallux rigidus surgery were allocated to receive a patch delivering either fentanyl 12 µg/hour or placebo for postoperative pain. The consumption of rescue opioid oxycodone, the primary outcome measure, was evaluated daily until the fourth postoperative day. Total consumption of oxycodone during the study period was also assessed. Pain scores and possible adverse effects were evaluated every 6 hours during the first 24 hours and on the fourth postoperative day.Results: The use of rescue opioid was low in both groups, the median (range consumption of oxycodone being 10 (0–50 mg on the day of surgery (no difference between the groups, P=0.31 and 0 (0–35 mg thereafter. The total combined consumption was 10 (0–105 mg in the fentanyl group and 20 (0–70 mg in the placebo group (P=0.23. There were no statistically significant differences in pain scores or adverse effects between the groups.Conclusion: As a part of multimodal analgesia with ibuprofen and acetaminophen, a patch delivering fentanyl 12 µg/hour did not significantly decrease the consumption of rescue opioid or pain scores after forefoot surgery

  19. The efficacy, safety and cost-effectiveness of intra-operative cell salvage in high-bleeding-risk cardiac surgery with cardiopulmonary bypass: a prospective randomized and controlled trial.

    Science.gov (United States)

    Xie, Yihong; Shen, Sheliang; Zhang, Jun; Wang, Wenyuan; Zheng, Jiayin

    2015-01-01

    Intra-operative cell salvage (CS) was reported to be ineffective, safe and not cost-effective in low-bleeding-risk cardiac surgery with cardiopulmonary bypass (CPB), but studies in high-bleeding-risk cardiac surgery are limited. The objective of this study is to evaluate the efficacy, safety and cost-effectiveness of intra-operative CS in high-bleeding-risk cardiac surgery with CPB. One hundred and fifty patients were randomly assigned to either with intra-operative CS group (Group CS) or without intra-operative CS group (Group C). Study endpoints were defined as perioperative allogeneic red blood cell (RBC) transfusion, perioperative impairment of blood coagulative function, postoperative adverse events and costs of transfusion-related. Both the proportion and quantity of perioperative allogeneic RBC transfusion were significantly lower in Group CS than that in Group C (p=0.0002, after surgery, the incidence of postoperative excessive bleeding, were significantly higher in Group CS than that in Group C (p=0.018, 0.042, 0.034, respectively). Cost of both allogeneic RBC transfusion and total allogeneic blood transfusion were significantly lower in Group CS than that in Group C (pbleeding-risk cardiac surgery with CPB is effective, generally safe, and cost-effective in developed countries but not in China.

  20. A Quantitative Feasibility Study on Potential Safety Improvement Effects of Advanced Safety Features in APR-1400 when Applied to OPR-1000

    Energy Technology Data Exchange (ETDEWEB)

    Ualikhan Zhiyenbayev [KAIST, Daejeon (Korea, Republic of); Chung, Dae Wook [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

    2015-10-15

    This study aims to test the feasibility of the applications using Probabilistic Safety Assessment (PSA). Particularly, three of those advanced safety features are selected as follows: 1. Providing an additional Emergency Diesel Generator (EDG); 2. Increasing the capacity of Class 1E batteries; 3. Placing a Refueling Water Storage Tank (RWST) inside containment, i.e., change from RWST to IRWST. The Advanced Power Reactor 1400 (APR-1400) adopts several advanced safety features compared to its predecessor, the Optimized Power Reactor 1000 (OPR-1000), which includes an additional Emergency Diesel Generator, increase in battery capacity, in-containment refueling water storage tank (IRWST), and so on. Considering the remarkable advantages of these safety features in safety improvement and the design similarities between APR-1400 and OPR-1000, it is feasible to apply key advanced safety features of APR-1400 to OPR-1000 to enhance the safety. The selected safety features are incorporated into OPR-1000 PSA model using the Advanced Information Management System (AIMS) for PSA and CDFs are re-evaluated for each application and combination of three applications. Based on current results, it is concluded that three of key advanced safety features of APR-1400 can be effectively applied to OPR-1000, resulting in considerable safety improvement. In aggregate, three advanced safety features, which are an additional EDG, increased battery capacity and IRWST, can reduce the CDF of OPR-1000 by more than 15% when applied altogether.

  1. Surgery or general medicine: a study of the reasons underlying the choice of medical specialty

    Directory of Open Access Journals (Sweden)

    Patrícia Lacerda Bellodi

    Full Text Available CONTEXT: The reality of medical services in Brazil points towards expansion and diversification of medical knowledge. However, there are few Brazilian studies on choosing a medical specialty. OBJECTIVE: To investigate and characterize the process of choosing the medical specialty among Brazilian resident doctors, with a comparison of the choice between general medicine and surgery. TYPE OF STUDY: Stratified survey. SETTING: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP. METHODS: A randomized sample of resident doctors in general medicine (30 and surgery (30 was interviewed. Data on sociodemographic characteristics and the moment, stability and reasons for the choice of specialty were obtained. RESULTS: The moment of choice between the two specialties differed. Surgeons (30% choose the specialty earlier, while general doctors decided progressively, mainly during the internship (43%. Most residents in both fields (73% general medicine, 70% surgery said they had considered another specialty before the current choice. The main reasons for general doctors' choice were contact with patients (50%, intellectual activities (30% and knowledge of the field (27%. For surgeons the main reasons were practical intervention (43%, manual activities (43% and the results obtained (40%. Personality was important in the choice for 20% of general doctors and for 27% of surgeons. DISCUSSION: The reasons found for the choice between general medicine and surgery were consistent with the literature. The concepts of wanting to be a general doctor or a surgeon are similar throughout the world. Personality characteristics were an important influencing factor for all residents, without statistical difference between the specialties, as was lifestyle. Remuneration did not appear as a determinant. CONCLUSION: The results from this group of Brazilian resident doctors corroborated data on choosing a medical specialty from other countries

  2. Study on safety cost and insurance degree of coal enterprises

    Energy Technology Data Exchange (ETDEWEB)

    Liang, M.; Han, C.; Yang, G. [Shandong Institute of Business and Technology, Yantai (China)

    2007-06-15

    The study confirmed the safety insurance degree of coal enterprises based on the various components of safety cost and analysed the connection between safety cost of component parts and safety insurance degree. Using Matlab software, a functional relationship was derived between mimesis curves of safety losing expenses, safety assets and management expenses, safety cost and safety insurance degree. The cost of a safety programme was forecast on the basis of this functional relationship. 3 figs., 3 tabs.

  3. Are nurse presenteeism and patient safety culture associated: a cross-sectional study.

    Science.gov (United States)

    Brborović, Hana; Brborović, Ognjen; Brumen, Vlatka; Pavleković, Gordana; Mustajbegović, Jadranka

    2014-06-01

    Working as a nurse involves great dedication and sacrifice: working night shifts, working overtime, and coming to work sick. The last is also known as presenteeism. Research has shown that poor nurse performance can affect both caregiver's and patient's safety. The aim of this cross-sectional study was to investigate whether nurse presenteeism affected patient safety culture and to look deeper into the characteristics of nurse presenteeism and patient safety culture in Croatia. The study was conducted in one general hospital in Croatia over April and May 2012 and specifically targeted medical nurses as one of the largest groups of healthcare professionals. They were asked to fill two questionnaires: the six-item Stanford Presenteeism Scale (SPS-6) and the Hospital Survey on Patient Safety Culture (HSOPSC). We found no association between presenteeism and patient safety culture. Overall positive perception of safety was our sample's strength, but other dimensions were positively rated by less than 65 % of participants. The lowest positive response concerned "nonpunitive response to error", which is consistent with previous studies. Presenteeist nurses did not differ in their characteristics from nurses without presenteeism (gender, age, years of experience, working hours, contact with patients and patient safety grades). Our future research will have to include a broader healthcare population for us to be able to identify weak spots and suggest improvements toward high-quality and cost-effective health care.

  4. Study on the KALIMER safety approach

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eui Kwang; Han, Do Hee; Kim, Young Cheol

    1997-01-01

    This study describes KALIMER`s safety approach, how to establish the safety criteria and temperature limit, how to define safety evaluation events, and some safety research and development needs items. It is recommended that the KALIMER`s approach to safety use seven levels of safety design and a defense-in-depth design approach with particular emphasis on inherent passive features. In order to establish as set DBEs for KALIMER safety evaluation, the procedure is explained how to define safety evaluation events. Final selection is to be determined later with the final establishment of design concepts. On the basis of preliminary studies and evaluation of the plant safety related areas, the KALIMER and PRISM have following three main difference that may require special research and development for KALIMER. (author). 7 refs., 6 tabs., 6 figs.

  5. Gingival recession following apical surgery in the esthetic zone: a clinical study with 70 cases

    DEFF Research Database (Denmark)

    von Arx, Thomas; Salvi, Giovanni E; Janner, Simone

    2009-01-01

    The present study evaluated gingival recession 1 year following apical surgery of 70 maxillary anterior teeth (central and lateral incisors, canines, and first premolars). A visual assessment of the mid-facial aspect of the gingival level and of papillary heights of treated teeth was carried out...... using photographs taken at pre-treatment and 1-year follow-up appointments. In addition, changes in the gingival margin (GM) and clinical attachment levels (CAL) were calculated with the use of clinical measurements, that is, pre-treatment and 1-year follow-up pocket probing depth and level of gingival...... margin. Changes in GM and CAL were then correlated with patient-, tooth-, and surgery-related parameters. The following parameters were found to significantly influence changes in GM and CAL over time: gingival biotype (P gingival recession than thick biotype...

  6. Evaluation of quality of life in Chilean patients with orthognathic surgery. A cohort study.

    Directory of Open Access Journals (Sweden)

    Macarena Cea-Herrera

    2016-12-01

    Full Text Available To compare the presurgical and immediate postsurgical quality of life in Chilean patients with orthognathic surgery. Material and Methods: Cohort study. The study included 30 patients (mean age 20.73, 53.33% male who underwent orthognathic surgery primarily for severe skeletal abnormalities, (17 surgeries, 56.7% and moderate skeletal abnormalities (12 surgeries, 40%, from three Chilean hospitals between February and June 2016. Patients were asked to answer the World Health Organization quality of life Bref version questionnaire (WHOQOL-BREF validated in Spanish to measure quality of life (QoL two weeks before and three months after the surgery. Scores for general QoL and for every domain of QoL were described. Variations in the scores of general QoL were analyzed according to sex and severity of orofacial malformation (mild, moderate or severe (t-test p<0.05; STATA 10.0. Results: The average score for QoL according to the WHOQOL-BREF scale was 76.43±13.83 before surgery and 90.5±7.18 three months after surgery (p<0.001. Statistically significant differences according to sex and type of orofacial malformation were found (p<0.01. An increase in the score in all the domains of the WHOQOOL-BREF scale was observed. Conclusion: Orthognathic surgery significantly improved QoL scores in Chilean patients according to the WHOQOL-BREF scale.

  7. Safety culture in a pharmacy setting using a pharmacy survey on patient safety culture: a cross-sectional study in China

    OpenAIRE

    Jia, P L; Zhang, L. H.; Zhang, M.M; Zhang, L.L.; Zhang,C.; Qin, S F; Li, X. L.; Liu, K. X.

    2014-01-01

    Objective To explore the attitudes and perceptions of patient safety culture for pharmacy workers in China by using a Pharmacy Survey on Patient Safety Culture (PSOPSC), and to assess the psychometric properties of the translated Chinese language version of the PSOPSC. Design Cross-sectional study. Participants Data were obtained from 20 hospital pharmacies in the southwest part of China. Methods We performed χ2 test to explore the differences on pharmacy staff in different hospital and quali...

  8. An excellent navigation system and experience in craniomaxillofacial navigation surgery: a double-center study.

    Science.gov (United States)

    Dai, Jiewen; Wu, Jinyang; Wang, Xudong; Yang, Xudong; Wu, Yunong; Xu, Bing; Shi, Jun; Yu, Hongbo; Cai, Min; Zhang, Wenbin; Zhang, Lei; Sun, Hao; Shen, Guofang; Zhang, Shilei

    2016-06-16

    Numerous problems regarding craniomaxillofacial navigation surgery are not well understood. In this study, we performed a double-center clinical study to quantitatively evaluate the characteristics of our navigation system and experience in craniomaxillofacial navigation surgery. Fifty-six patients with craniomaxillofacial disease were included and randomly divided into experimental (using our AccuNavi-A system) and control (using Strker system) groups to compare the surgical effects. The results revealed that the average pre-operative planning time was 32.32 mins vs 29.74 mins between the experimental and control group, respectively (p > 0.05). The average operative time was 295.61 mins vs 233.56 mins (p > 0.05). The point registration orientation accuracy was 0.83 mm vs 0.92 mm. The maximal average preoperative navigation orientation accuracy was 1.03 mm vs 1.17 mm. The maximal average persistent navigation orientation accuracy was 1.15 mm vs 0.09 mm. The maximal average navigation orientation accuracy after registration recovery was 1.15 mm vs 1.39 mm between the experimental and control group. All patients healed, and their function and profile improved. These findings demonstrate that although surgeons should consider the patients' time and monetary costs, our qualified navigation surgery system and experience could offer an accurate guide during a variety of craniomaxillofacial surgeries.

  9. Nonshaved cranial surgery in black Africans: technical report and a medium-term prospective outcome study.

    Science.gov (United States)

    Adeleye, Amos O

    2016-07-01

    Nonshaved neurosurgery, cranial or spinal, is well reported among Caucasians but hardly among native Africans. The ungroomed scalp hairs of black Africans have unique anthropological characteristics needing special attention for shaveless cranial surgery. A technical report of the execution of this surgical procedure among an indigenous patient population in a sub-Sahara African country is presented, as well as an outcome analysis in a prospective cohort over a 7-year period. A total of 303 patients (211 males, 70 %) fulfilled the criteria for this study. The surgical procedure was primary in 278 (92 %) and redo in 8 %. It was emergency surgery in 153 (51 %). They were trauma craniotomies or decompressive craniectomies in 95 cases (31 %), craniotomies for tumour resections in 86 (28 %), and the surgical dissections for other conditions in 122 (41 %). The duration of surgery ranged from 30 min to 8.5 h, mean 2.5 (SD, 1.6), median 2. In-hospital clinical outcome was good (normal status or moderate deficit on dichotomized Glasgow outcome scale (GOS)) in 273 (90.1 %) cases while surgical site infections occurred in only 10 cases (3.3 %). The type of surgery, redo or primary, did not have any significant association with the in-hospital outcome (p = 0.5), nor with the presence of surgical site infection (SSI) (p = 0.7). The length of follow-up ranged from 2 to 63 months (mean, 7) with no untoward complications reported so far. Medium-term outcome of nonshaved neurosurgery in this indigenous black Africans remains favourable with no attendant significant adverse after-effects.

  10. Are non-cardiac surgeries safe for dialysis patients? - A population-based retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Yih-Giun Cherng

    Full Text Available BACKGROUND: End-stage renal disease represents a risk complex that complicates surgical results. The surgical outcomes of dialysis patients have been studied in specific fields, but the global features of postoperative adverse outcomes in dialysis patients receiving non-cardiac surgeries have not been examined. METHODS: Taiwan's National Health Insurance Research Database was used to study 8,937 patients under regular dialysis with 8,937 propensity-score matched-pair controls receiving non-cardiac surgery between 2004 and 2007. We investigated the influence of hemodialysis and peritoneal dialysis, effects of hypertension and diabetes, and impact of additional comorbidities on postoperative adverse outcomes. RESULTS: Postoperative mortality in dialysis patients was higher than in controls (odds ratio [OR] 3.33, 95% confidence interval [CI] 2.56 to 4.33 when receiving non-cardiac surgeries. Complications such as acute myocardial infarction, pneumonia, bleeding, and septicemia were significantly increased. Postoperative mortality was significantly increased among peritoneal dialysis patients (OR 2.71, 95% CI 1.70 to 4.31 and hemodialysis patients (OR 3.42, 95% CI 2.62 to 4.47 than in controls. Dialysis patients with both hypertension and diabetes had the highest risk of postoperative complications; these risks increased with number of preoperative medical conditions. Patients under dialysis also showed significantly increased length of hospitalization, more ICU stays and higher medical expenditures. CONCLUSION: Surgical patients under dialysis encountered significantly higher postoperative complications and mortality than controls when receiving non-cardiac surgeries. Different dialysis techniques, pre-existing hypertension/diabetes, and various comorbidities had complication-specific impacts on surgical adverse outcomes. These findings can help surgical teams provide better risk assessment and postoperative care for dialysis patients.

  11. Sexual dysfunction following surgery for rectal cancer - a clinical and neurophysiological study

    Directory of Open Access Journals (Sweden)

    Sperduti Isabella

    2009-09-01

    Full Text Available Abstract Background Sexual dysfunction following surgery for rectal cancer may be frequent and often severe. The aim of the present study is to evaluate the occurrence of this complication from both a clinical point of view and by means of neurophysiological tests. Methods We studied a group of 57 patients submitted to rectal resection for adenocarcinoma. All the patients underwent neurological, psychological and the following neurophysiological tests: sacral reflex (SR, pudendal somatosensory evoked potentials (PEPs, motor evoked potential (MEPs and sympathetic skin responses (SSRs. The results were compared with a control group of 67 rectal cancer patients studied before surgery. Only 10 of these patients could be studied both pre- and postoperatively. 10 patients submitted to high dose preoperative chemoradiation were studied to evaluate the effect of this treatment on sexual function. Statistical analysis was performed by means of the two-tailed Student's t test for paired observations and k concordance test. Results 59.6% of patients operated reported sexual dysfunction, while this symptom occurred in 16.4% in the control group. Moreover, a significantly higher rate of alterations of the neurophysiological tests and longer mean latencies of the SR, PEPs, MEPs and SSRs were observed in the patients who had undergone resection. In the 10 patients studied both pre and post-surgery impotence occurred in 6 of them and the mean latencies of SSRs were longer after operation. In the 10 patients studied pre and post chemoradiation impotence occurred in 1 patient only, showing the mild effect of these treatments on sexual function. Conclusion Patients operated showed severe sexual dysfunctions. The neurophysiological test may be a useful tool to investigate this complication. The neurological damage could be monitored to decide the rehabilitation strategy.

  12. Sexual dysfunction following surgery for rectal cancer - a clinical and neurophysiological study.

    Science.gov (United States)

    Pietrangeli, Alberto; Pugliese, Patrizia; Perrone, Maria; Sperduti, Isabella; Cosimelli, Maurizio; Jandolo, Bruno

    2009-09-17

    Sexual dysfunction following surgery for rectal cancer may be frequent and often severe. The aim of the present study is to evaluate the occurrence of this complication from both a clinical point of view and by means of neurophysiological tests. We studied a group of 57 patients submitted to rectal resection for adenocarcinoma. All the patients underwent neurological, psychological and the following neurophysiological tests: sacral reflex (SR), pudendal somatosensory evoked potentials (PEPs), motor evoked potential (MEPs) and sympathetic skin responses (SSRs). The results were compared with a control group of 67 rectal cancer patients studied before surgery. Only 10 of these patients could be studied both pre- and postoperatively. 10 patients submitted to high dose preoperative chemoradiation were studied to evaluate the effect of this treatment on sexual function. Statistical analysis was performed by means of the two-tailed Student's t test for paired observations and k concordance test. 59.6% of patients operated reported sexual dysfunction, while this symptom occurred in 16.4% in the control group. Moreover, a significantly higher rate of alterations of the neurophysiological tests and longer mean latencies of the SR, PEPs, MEPs and SSRs were observed in the patients who had undergone resection. In the 10 patients studied both pre and post-surgery impotence occurred in 6 of them and the mean latencies of SSRs were longer after operation. In the 10 patients studied pre and post chemoradiation impotence occurred in 1 patient only, showing the mild effect of these treatments on sexual function. Patients operated showed severe sexual dysfunctions. The neurophysiological test may be a useful tool to investigate this complication. The neurological damage could be monitored to decide the rehabilitation strategy.

  13. Are general surgery residents adequately prepared for hepatopancreatobiliary fellowships? A questionnaire-based study

    Science.gov (United States)

    Osman, Houssam; Parikh, Janak; Patel, Shirali; Jeyarajah, D Rohan

    2015-01-01

    Background The present study was conducted to assess the preparedness of hepatopancreatobiliary (HPB) fellows upon entering fellowship, identify challenges encountered by HPB fellows during the initial part of their HPB training, and identify potential solutions to these challenges that can be applied during residency training. Methods A questionnaire was distributed to all HPB fellows in accredited HPB fellowship programmes in two consecutive academic years (n = 42). Reponses were then analysed. Results A total of 19 (45%) fellows responded. Prior to their fellowship, 10 (53%) were in surgical residency and the rest were in other surgical fellowships or surgical practice. Thirteen (68%) were graduates of university-based residency programmes. All fellows felt comfortable in performing basic laparoscopic procedures independently at the completion of residency and less comfortable in performing advanced laparoscopy. Eight (42%) fellows cited a combination of inadequate case volume and lack of autonomy during residency as the reasons for this lack of comfort. Thirteen (68%) identified inadequate preoperative workup and management as their biggest fear upon entering practice after general surgery training. A total of 17 (89%) fellows felt they were adequately prepared to enter HPB fellowship. Extra rotations in transplant, vascular or minimally invasive surgery were believed to be most helpful in preparing general surgery residents pursing HPB fellowships. Conclusions Overall, HPB fellows felt themselves to be adequately prepared for fellowship. Advanced laparoscopic procedures and the perioperative management of complex patients are two of the challenges facing HPB fellows. General surgery residents who plan to pursue an HPB fellowship may benefit from spending extra rotations on certain subspecialties. Focus on perioperative workup and management should be an integral part of residency and fellowship training. PMID:25387852

  14. Speaking up behaviours (safety voices) of healthcare workers: A metasynthesis of qualitative research studies.

    Science.gov (United States)

    Morrow, Kelly J; Gustavson, Allison M; Jones, Jacqueline

    2016-12-01

    A critical characteristic of effective teams in any setting is when each member is willing to speak up to share thoughts and ideas to improve processes. In spite of attempts by healthcare systems to encourage employees to speak up, employee silence remains a common cause of communication breakdowns, contributing to errors and suboptimal care delivery. Nurses in particular have reported low confidence in their communication abilities, and cite the belief that speaking up will not make a difference. To develop an understanding of how nurses and other healthcare workers relate to safety voice behaviors and how this might influence clinical practice. A search of the PubMed, CINAHL, and Academic Search Premier databases was conducted using keywords employee, nurse, qualitative, speak up, silence, safety, voice, and safety voice identified 372 articles with 11 retained after a review of the abstracts. Studies took place in Australia, Bulgaria, Canada, Hong Kong, East Africa, Ireland, Korea, New Zealand, Sweden, Switzerland, and the United States representing 504 healthcare workers including 354 nurses. This interpretive meta-synthesis of 11 qualitative articles published from 2005 to 2015 was conducted using a social constructivist approach with thematic analysis. The four themes identified are: 1) hierarchies and power dynamics negatively affect safety voice, 2) open communication is unsafe and ineffective, 3) embedded expectations of nurse behavior affect safety voice, and 4) nurse managers have a powerful positive or negative affect on safety voice. Healthcare workers worldwide report multiple social and hierarchy related fears surrounding the utilization of safety voice behaviors. Hesitance to speak up is pervasive among nurses, as is low self-efficacy related to safety voice. The presence of caring leaders, peer support, and an organizational commitment to safe, open cultures, may improve safety voice utilization among nurses and other healthcare workers. Copyright

  15. The effectiveness of Google GLASS as a vital signs monitor in surgery: A simulation study.

    Science.gov (United States)

    Iqbal, Mohammed Husnain; Aydin, Abdullatif; Lowdon, Alexandra; Ahmed, Hamza Ibn; Muir, Gordon H; Khan, M Shamim; Dasgupta, Prokar; Ahmed, Kamran

    2016-12-01

    To assess the effectiveness of the Google GLASS as a vital signs monitor in a surgical setting and identify potential uses. This prospective, observational and comparative study recruited novice (n = 24), intermediate (n = 8) and expert urologists (n = 5). All candidates performed a procedure on the GreenLight Simulator within a simulated setting using a standard vital signs monitor and then the Google GLASS. The time taken to respond to abnormal vital signs during both sessions was recorded. A quantitative survey was used to assess the usability and acceptability of the Google GLASS surgery. The majority (84%) of participants responded quicker to abnormal signs with the Google GLASS compared to a standard monitor (p = 0.0267). The average simulation score during a standard-monitor and GLASS-session scored to be statistically insignificant (p = 0.253). All parameters of simulation were also similar in both sessions including average sweep speed (p = 0.594), average blood loss (p = 0.761) and average grams vaporised (p = 0.102). Surgical performance between both sessions was similar and not hampered by the use of Google GLASS. Furthermore, 81% of candidates stated the GLASS was comfortable to wear during the procedure. This study has demonstrated that head-mounted displays such as the Google GLASS are potentially useful in surgery to aid patient care without hampering the surgeons view. It is hoped that the innovation and evolution of these devices triggers the potential future application of such devices within the medical field. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  16. The effect of the Ontario Bariatric Network on health services utilization after bariatric surgery: a retrospective cohort study

    Science.gov (United States)

    Elnahas, Ahmad; Jackson, Timothy D.; Okrainec, Allan; Austin, Peter C.; Bell, Chaim M.; Urbach, David R.

    2016-01-01

    Background: In 2009, the Ontario Bariatric Network was established to address the exploding demand by Ontario residents for bariatric surgery services outside Canada. We compared the use of postoperative hospital services between out-of-country surgery recipients and patients within the Ontario Bariatric Network. Methods: We conducted a population-based, comparative study using administrative data held at the Institute for Clinical Evaluative Sciences. We included Ontario residents who underwent bariatric surgery between 2007 and 2012 either outside the country or at one of the Ontario Bariatric Network's designated centres of excellence. The primary outcome was use of hospital services in Ontario within 1 year after surgery. Results: A total of 4852 patients received bariatric surgery out of country, and 5179 patients underwent surgery through the Ontario Bariatric Network. After adjustment, surgery at a network centre was associated with a significantly lower utilization rate of postoperative hospital services than surgery out of country (rate ratio 0.90, 95% confidence interval [CI] 0.84 to 0.97). No statistically significant differences were found with respect to time in critical care or mortality. However, the physician assessment and reoperation rates were significantly higher among patients who received surgery at a network centre than among those who had bariatric surgery out of country (rate ratio 4.10, 95% CI 3.69 to 4.56, and rate ratio 1.84, 95% CI 1.34 to 2.53, respectively). Interpretation: The implementation of a comprehensive, multidisciplinary provincial program to replace outsourcing of bariatric surgical services was associated with less use of postoperative hospital services by Ontario residents undergoing bariatric surgery. Future research should include an economic evaluation to determine the costs and benefits of the Ontario Bariatric Network. PMID:27730113

  17. Explosion approach for external safety assessment: a case study

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, D. Michael; Halford, Ann [Germanischer Lloyd, Loughborough (United Kingdom); Mendes, Renato F. [PETROBRAS S.A., Rio de Janeiro, RJ (Brazil)

    2009-07-01

    Several questions related to the potential for explosions are explored as this became an important subject during an enterprise risk analysis. The understanding of explosions underwent a substantial evolution in the final 20 years of the 20{sup th} century following international research projects in Europe involving several research institutes, as well gas and oil companies. This led to the development of techniques that could be used to assess the potential consequences of explosions on oil, gas and petrochemical facilities. This paper presents an overview of the potential for explosions in communities close to industrial sites or pipelines right of way (RoW), where the standard explosion assessment methods cannot be applied. With reference to experimental studies, the potential for confined explosions in buildings and Vapor Cloud Explosions is explored. Vapor Cloud Explosion incidents in rural or urban areas are also discussed. The method used for incorporating possible explosion and fire events in risk studies is also described using a case study. Standard explosion assessment methodologies and a revised approach are compared as part of an on going evaluation of risk (author)

  18. Integrating psychosocial safety climate in the JD-R model: A study amongst Malaysian workers

    OpenAIRE

    Mohd A. Idris; Dollard, Maureen F.; Winefield, Anthony H.

    2011-01-01

    Orientation: Job characteristics are well accepted as sources of burnout and engagement amongst employees; psychosocial safety climate may precede work conditions.Research purpose: We expanded the Job Demands and Resources (JD-R) model by proposing psychosocial safety climate (PSC) as a precursor to job demands and job resources. As PSC theoretically influences the working environment, the study hypothesized that PSC has an impact on performance via both health erosion (i.e. burnout) and moti...

  19. Impact of health education intervention on food safety and hygiene of street vendors: A pilot study.

    Science.gov (United States)

    Singh, Ansk Kumar; Dudeja, Puja; Kaushal, Nitin; Mukherji, Sandip

    2016-07-01

    Street foods are major source of food to millions of people. However, these are frequently associated with food-borne illnesses. It is imperative that street food vendors are educated to maintain hygiene and hence safety of food. With this background, a pilot study was undertaken to assess the impact of health education intervention on food safety and hygiene of street vendors. The aim of this study was to assess impact of health education intervention on food safety of street vendors. It was a before and after study conducted in twenty street vendors of an urban area. Tool based on Bureau of Indian Standards (BIS) 2012 was prepared with scoring system to rate hygiene and sanitation of street vendors (score 0-156). Health education was given to all and scores of these vendors on same tool were reassessed after four weeks. Mean age of the study subjects was 35 ± 13.2 years. Highest score attained in BIS tool for food safety was 104 out of 156 (66.6%). No vendor was found to have achieved excellent score. Reasons for poor score were poor condition of vending cart, location, lack personal hygiene and incorrect and unsafe food handling practices. After intervention, it was observed that there was no significant improvement in overall score of vendors. However, scores in domains of personal habits, hygiene and food handling practices improved significantly after intervention (p safety. Health education alone can only partly improve food safety practices of street vendors.

  20. Surgical treatment of tricuspid regurgitation after mitral valve surgery: a retrospective study in China

    Directory of Open Access Journals (Sweden)

    Li Zong-Xiao

    2012-04-01

    Full Text Available Abstract Background Functional tricuspid regurgitation (TR occurs in patients with rheumatic mitral valve disease even after mitral valve surgery. The aim of this study was to analyze surgical results of TR after previous successful mitral valve surgery. Methods From September 1996 to September 2008, 45 patients with TR after previous mitral valve replacement underwent second operation for TR. In those, 43 patients (95.6% had right heart failure symptoms (edema of lower extremities, ascites, hepatic congestion, etc. and 40 patients (88.9% had atrial fibrillation. Twenty-six patients (57.8% were in New York Heart Association (NYHA functional class III, and 19 (42.2% in class IV. Previous operations included: 41 for mechanical mitral valve replacement (91.1%, 4 for bioprosthetic mitral valve replacement (8.9%, and 7 for tricuspid annuloplasty (15.6%. Results The tricuspid valves were repaired with Kay's (7 cases, 15.6% or De Vega technique (4 cases, 8.9%. Tricuspid valve replacement was performed in 34 cases (75.6%. One patient (2.2% died. Postoperative low cardiac output (LCO occurred in 5 patients and treated successfully. Postoperative echocardiography showed obvious reduction of right atrium and ventricle. The anterioposterior diameter of the right ventricle decreased to 25.5 ± 7.1 mm from 33.7 ± 6.2 mm preoperatively (P Conclusion TR after mitral valve replacement in rheumatic heart disease is a serious clinical problem. If it occurs or progresses late after mitral valve surgery, tricuspid valve annuloplasty or replacement may be performed with satisfactory results. Due to the serious consequence of untreated TR, aggressive treatment of existing TR during mitral valve surgery is recommended.

  1. A study on the safety regulation of byproduct material

    Energy Technology Data Exchange (ETDEWEB)

    Song, Jong Soon; Song, Yang Su [Chosun Univ., Gwangju (Korea, Republic of)

    1999-04-15

    The objective of this study is to develop the technical criteria and regulatory system for establishing the safe regulation of byproduct material institutionally. Up to this point, domestically, though many byproduct materials are distributed and used already, it seems that there are no related technical criteria and regulatory system and it becomes an obstacle in the development of relating industry. Since this kind of situation may give negative impact on the proper recognizance of the radiation to public, it is very urgent to establish the safe regulation of byproduct material. In relating to the domestic license of byproduct material, a survey of technical criteria and status of regulation in U.S.A. A determination of range of application and contents of byproduct material. A tentative suggestion of related technical criteria and regulatory system. A study was performed about the above topics to establish the safe regulation of byproduct material institutionally, and this can be contributed in establishing the proper domestic technical criteria related.

  2. A Study on Enhancement of Understanding of Radiation and Safety Management

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Dong Han; Park, Ji Young; Lee, Jae Uk; Bae, Jun Woo; Kim, Hee Reyoung [Ulsan National Institute of Science and Technology, Ulsan (Korea, Republic of)

    2014-10-15

    Concerns for radiation exposure have been increased from small and big radiation works or experiments with radiation generator (RG) or radiation isotopes (RI) at institutions using radiation in Korea. Actually, due to radiation exposure occurred on the process of handling RI, etc., The exposure should be maintained as low as reasonably possible. To do this, above all, suitable training and establishment of safety culture have to be preceded. In this respect, an education institution is a place where people learn first about handling radiations in various specialties with purposes including academic research, and the first learned habits and practices acts as the basis for safety management of radiation when they continue to do radiation work after going into the society. Hereford, it is needed to establish the right safety culture on radiation for its safe managing. In the present study, the direction for the right understandings and safety improvement are suggested through the radiation survey on education institutions and preparation of safety guidances for users. The basic guidance at the radiation experiment was prepared for the right understanding of the radiation to prevent radiation accidents from careless handling by workers based on the surveyed results for education institutions. It is expected to be used as fundamentals for improvement for radiation safety management of workers and researchers and, further, safety policy for national nuclear energy and radiations.

  3. Medication reconciliation as a medication safety initiative in Ethiopia: a study protocol.

    Science.gov (United States)

    Mekonnen, Alemayehu B; McLachlan, Andrew J; Brien, Jo-Anne E; Mekonnen, Desalew; Abay, Zenahebezu

    2016-11-24

    Medication related adverse events are common, particularly during transitions of care, and have a significant impact on patient outcomes and healthcare costs. Medication reconciliation (MedRec) is an important initiative to achieve the Quality Use of Medicines, and has been adopted as a standard practice in many developed countries. However, the impact of this strategy is rarely described in Ethiopia. The aims of this study are to explore patient safety culture, and to develop, implement and evaluate a theory informed MedRec intervention, with the aim of minimising the incidence of medication errors during hospital admission. The study will be conducted in a resource limited setting. There are three phases to this project. The first phase is a mixed methods study of healthcare professionals' perspectives of patient safety culture and patients' experiences of medication related adverse events. In this phase, the Hospital Survey on Patient Safety Culture will be used along with semi-structured indepth interviews to investigate patient safety culture and experiences of medication related adverse events. The second phase will use a semi-structured interview guide, designed according to the 12 domains of the Theoretical Domains Framework, to explore the barriers and facilitators to medication safety activities delivered by hospital pharmacists. The third phase will be a single centre, before and after study, that will evaluate the impact of pharmacist conducted admission MedRec in an emergency department (ED). The main outcome measure is the incidence and potential clinical severity of medication errors. We will then analyse the differences in the incidence and severity of medication errors before and after initiation of an ED pharmacy service. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  4. Surgical checklist application and its impact on patient safety in pediatric surgery.

    Science.gov (United States)

    Oak, S N; Dave, N M; Garasia, M B; Parelkar, S V

    2015-01-01

    Surgical care is an essential component of health care of children worldwide. Incidences of congenital anomalies, trauma, cancers and acquired diseases continue to rise and along with that the impact of surgical intervention on public health system also increases. It then becomes essential that the surgical teams make the procedures safe and error proof. The World Health Organization (WHO) has instituted the surgical checklist as a global initiative to improve surgical safety. To assess the acceptance, application and adherence to the WHO Safe Surgery Checklist in Pediatric Surgery Practice at a university teaching hospital. In a prospective study, spanning 2 years, the checklist was implemented for all patients who underwent operative procedures under general anesthesia. The checklist identified three phases of an operation, each corresponding to a specific period in the normal flow of work: Before the induction of anesthesia ("sign in"), before the skin incision ("time out") and before the patient leaves the operating room ("sign out"). In each phase, an anesthesiologist,-"checklist coordinator," confirmed that the anesthesia, surgery and nursing teams have completed the listed tasks before proceeding with the operation and exit. The checklist was used for 3000 consecutive patients. No major perioperative errors were noted. In 54 (1.8%) patients, children had the same names and identical surgical procedure posted on the same operation list. The patient identification tag was missing in four (0.1%) patients. Mention of the side of procedures was missing in 108 (3.6%) cases. In 0.1% (3) of patients there was mix up of the mention of side of operation in the case papers and consent forms. In 78 (2.6%) patients, the consent form was not signed by parents/guardians or the side of the procedure was not quoted. Antibiotic orders were missing in five (0.2%) patients. In 12 (0.4%) cases, immobilization of the patients was suboptimal, which led to displacement of diathermy

  5. Surgical checklist application and its impact on patient safety in pediatric surgery

    Directory of Open Access Journals (Sweden)

    S N Oak

    2015-01-01

    Full Text Available Background: Surgical care is an essential component of health care of children worldwide. Incidences of congenital anomalies, trauma, cancers and acquired diseases continue to rise and along with that the impact of surgical intervention on public health system also increases. It then becomes essential that the surgical teams make the procedures safe and error proof. The World Health Organization (WHO has instituted the surgical checklist as a global initiative to improve surgical safety. Aims: To assess the acceptance, application and adherence to the WHO Safe Surgery Checklist in Pediatric Surgery Practice at a university teaching hospital. Materials and Methods: In a prospective study, spanning 2 years, the checklist was implemented for all patients who underwent operative procedures under general anesthesia. The checklist identified three phases of an operation, each corresponding to a specific period in the normal flow of work: Before the induction of anesthesia ("sign in", before the skin incision ("time out" and before the patient leaves the operating room ("sign out". In each phase, an anesthesiologist,-"checklist coordinator," confirmed that the anesthesia, surgery and nursing teams have completed the listed tasks before proceeding with the operation and exit. The checklist was used for 3000 consecutive patients. Results: No major perioperative errors were noted. In 54 (1.8% patients, children had the same names and identical surgical procedure posted on the same operation list. The patient identification tag was missing in four (0.1% patients. Mention of the side of procedures was missing in 108 (3.6% cases. In 0.1% (3 of patients there was mix up of the mention of side of operation in the case papers and consent forms. In 78 (2.6% patients, the consent form was not signed by parents/guardians or the side of the procedure was not quoted. Antibiotic orders were missing in five (0.2% patients. In 12 (0.4% cases, immobilization of the

  6. Renal biopsy with 16G needle: a safety study.

    Science.gov (United States)

    Guerrero-Ramos, F; Villacampa-Aubá, F; Jiménez-Alcaide, E; García-González, L; Ospina-Galeano, I A; de la Rosa-Kehrmann, F; Rodríguez-Antolín, A; Passas-Martínez, J; Díaz-González, R

    2014-11-01

    The development of percutaneous renal biopsy as a routinary diagnostic procedure for renal masses is topic of discussion for the last few years. However, this technique has been associated with some complications, although infrequent, and morbidity. Our objective is to carry out a descriptive study about complications and outcomes of orthotopic kidney biopsies with 16 G needle. A retrospective review of 180 orthotopic ultrasound-guided renal biopsies performed in our service among January 2008 to May 2010 was carried out. The procedure was developed using an automated biopsy gun (16G needle). Multiple clinical variables, early post-procedure complications and its management were collected. Complication rates as well as the relationship between risk factors and occurrence of complications were studied. Mean age was 55.8 years. The average number of biopsy cylinders per intervention was 2.49. The overall complication rate was 5.6%. An interventionist attitude derived from complication of the procedure was necessary in only 3 patients (1.67%). No surgical interventions were required and no death as consequence of procedure was registered. No relationship between hypertension (P=.09) previous anticoagulation (P=.099) or previous antiaggregation (P=.603) and complications were demonstrated. In 2.8% of biopsies the material obtained was insufficient for diagnosing. Percutaneous ultrasound-guided renal biopsy with 16G needle is a safe technique with high diagnostic performance. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  7. Patient expectations of functional outcomes after rectal cancer surgery: a qualitative study.

    Science.gov (United States)

    Park, Jason; Neuman, Heather B; Bennett, Antonia V; Polskin, Lily; Phang, P Terry; Wong, W Douglas; Temple, Larissa K

    2014-02-01

    Rectal cancer patients' expectations of health and function may affect their disease- and treatment-related experience, but how patients form expectations of postsurgery function has received little study. We used a qualitative approach to explore patient expectations of outcomes related to bowel function after sphincter-preserving surgery for rectal cancer. This was a cohort study of patients who were about to undergo sphincter-preserving surgery for rectal cancer. The study was conducted through individual telephone interviews with participants. Twenty-six patients (14 men and 12 women) with clinical TNM stage I to III disease were enrolled. The semistructured interview script contained open-ended questions on patient expectations of postoperative bowel function and its perceived impact on daily function and life. Two researchers analyzed the interview transcripts for emergent themes using a grounded theory approach. Participant expectations of bowel function reflected 3 major themes: 1) information sources, 2) personal attitudes, and 3) expected outcomes. The expected outcomes theme contained references to specific symptoms and participants' descriptions of the certainty, importance, and imminence of expected outcomes. Despite multiple information sources and attempts at maintaining a positive personal attitude, participants expressed much uncertainty about their long-term bowel function. They were more focused on what they considered more important and imminent concerns about being cancer free and getting through surgery. This study was limited by context in terms of the timing of interviews (relative to the treatment course). The transferability to other contexts requires further study. Patient expectations of long-term functional outcomes cannot be considered outside of the overall context of the cancer experience and the relative importance and imminence of cancer- and treatment-related events. Recognizing the complexities of the expectation formation

  8. Medication reconciliation as a medication safety initiative in Ethiopia: a study protocol

    Science.gov (United States)

    Mekonnen, Alemayehu B; McLachlan, Andrew J; Brien, Jo-anne E; Mekonnen, Desalew; Abay, Zenahebezu

    2016-01-01

    Introduction Medication related adverse events are common, particularly during transitions of care, and have a significant impact on patient outcomes and healthcare costs. Medication reconciliation (MedRec) is an important initiative to achieve the Quality Use of Medicines, and has been adopted as a standard practice in many developed countries. However, the impact of this strategy is rarely described in Ethiopia. The aims of this study are to explore patient safety culture, and to develop, implement and evaluate a theory informed MedRec intervention, with the aim of minimising the incidence of medication errors during hospital admission. Methods and analyses The study will be conducted in a resource limited setting. There are three phases to this project. The first phase is a mixed methods study of healthcare professionals' perspectives of patient safety culture and patients' experiences of medication related adverse events. In this phase, the Hospital Survey on Patient Safety Culture will be used along with semi-structured indepth interviews to investigate patient safety culture and experiences of medication related adverse events. The second phase will use a semi-structured interview guide, designed according to the 12 domains of the Theoretical Domains Framework, to explore the barriers and facilitators to medication safety activities delivered by hospital pharmacists. The third phase will be a single centre, before and after study, that will evaluate the impact of pharmacist conducted admission MedRec in an emergency department (ED). The main outcome measure is the incidence and potential clinical severity of medication errors. We will then analyse the differences in the incidence and severity of medication errors before and after initiation of an ED pharmacy service. PMID:27884844

  9. Bariatric surgery outcomes: a single-center study in the United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Abusnana S

    2015-09-01

    Full Text Available Salah Abusnana,1 Sarah Abdi,1 Brigette Tagure,1 Murtada Elbagir,1 Almantas Maleckas2 1Rashid Center for Diabetes and Research, Ministry of Health, Ajman, United Arab Emirates; 2Kaunas University of Medicine, Kaunas, LithuaniaBackground: Bariatric surgery has become an attractive treatment for severe obesity over the last decade, due to its impacts on weight loss and remission of type 2 diabetes and metabolic syndrome. In the United Arab Emirates, a country where the rate of obesity is dramatically increasing bariatric surgery has gained popularity in recent years; however, published data on its outcomes in the Emirati population are lacking.Methods: We retrospectively reviewed the medical records of 95 patients who underwent bariatric surgery (ie, laparoscopic Roux-en-Y gastric bypass [RYGB] or laparoscopic sleeve gastrectomy at the Rashid Center for Diabetes and Research in Ajman, United Arab Emirates. Weight outcomes and metabolic marker data were abstracted at baseline and at 3, 6, and 12 months postoperatively.Results: Laparoscopic RYGB was the main procedure performed by our bariatric unit. All variables demonstrated postoperative improvement. An average excess weight loss of 68% was observed at 12 months. Fat mass was the body component that decreased the most, with an average reduction of 46%. Additionally, lipid profiles were significantly different (P<0.01 at 12 months, with triglyceride levels improving by 27% and low-density lipoprotein levels improving by 21%. Similarly, glycated hemoglobin (HbA1c levels decreased significantly (P<0.001 in patients with type 2 diabetes, with an average reduction of 73%.Conclusion: Our results show that a substantial short-term reduction in weight and significant improvements in metabolic markers followed bariatric surgery in severely obese Emirati patients. Our results are consistent with the outcomes of other internationally published studies. Additional studies are warranted to determine whether

  10. Colonic stenting as bridge to surgery versus emergency surgery for management of acute left-sided malignant colonic obstruction: a multicenter randomized trial (Stent-in 2 study

    Directory of Open Access Journals (Sweden)

    Scholten Pieter

    2007-07-01

    Full Text Available Abstract Background Acute left-sided colonic obstruction is most often caused by malignancy and the surgical treatment is associated with a high mortality and morbidity rate. Moreover, these operated patients end up with a temporary or permanent stoma. Initial insertion of an enteral stent to decompress the obstructed colon, allowing for surgery to be performed electively, is gaining popularity. In uncontrolled studies stent placement before elective surgery has been suggested to decrease mortality, morbidity and number of colostomies. However stent perforation can lead to peritoneal tumor spill, changing a potentially curable disease in an incurable one. Therefore it is of paramount importance to compare the outcomes of colonic stenting followed by elective surgery with emergency surgery for the management of acute left-sided malignant colonic obstruction in a randomized multicenter fashion. Methods/design Patients with acute left-sided malignant colonic obstruction eligible for this study will be randomized to either emergency surgery (current standard treatment or colonic stenting as bridge to elective surgery. Outcome measurements are effectiveness and costs of both strategies. Effectiveness will be evaluated in terms of quality of life, morbidity and mortality. Quality of life will be measured with standardized questionnaires (EORTC QLQ-C30, EORTC QLQ-CR38, EQ-5D and EQ-VAS. Morbidity is defined as every event leading to hospital admission or prolonging hospital stay. Mortality will be analyzed as total mortality as well as procedure-related mortality. The total costs of treatment will be evaluated by counting volumes and calculating unit prices. Including 120 patients on a 1:1 basis will have 80% power to detect an effect size of 0.5 on the EORTC QLQ-C30 global health scale, using a two group t-test with a 0.05 two-sided significance level. Differences in quality of life and morbidity will be analyzed using mixed-models repeated measures

  11. Correlates of local safety-related concerns in a Swedish Community: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Timpka Toomas

    2009-07-01

    Full Text Available Abstract Background Crime in a neighbourhood has been recognized as a key stressor in the residential environment. Fear of crime is related to risk assessment, which depends on the concentration of objective risk in time and space, and on the presence of subjective perceived early signs of imminent hazard. The aim of the study was to examine environmental, socio-demographic, and personal correlates of safety-related concerns at the local level in urban communities. The specific aim was to investigate such correlates in contiguous neighbourhoods in a Swedish urban municipality. Methods A cross-sectional study design was used to investigate three neighbourhood settings with two pair-wise conterminous but socially contrasting areas within each setting. Crime data were retrieved from police records. Study data were collected through a postal questionnaire distributed to adult residents (n = 2476 (response rate 56%. Composite dimensions of perceived residential safety were derived through a factor analysis. Logistic regression analysis was used to examine associations between high-level scores of the three safety-related dimensions and area-level crime rate, being a victim of crime, area reputation, gender, age, education, country of birth, household civil status and type of housing. Results Three composite dimensions of perceived residential safety were identified: (I structural indicators of social disorder; (II contact with disorderly behavior; and (III existential insecurity. We found that area-level crime rates and individual-level variables were associated with the dimensions structural indicators of social disorder and existential insecurity, but only individual-level variables were associated with the dimension contact with disorderly behavior. Self-assessed less favorable area reputation was found to be strongly associated with all three factors. Being female accorded existential insecurity more than being a victim of crime. Conclusion We

  12. Participants' safety versus confidentiality: A case study of HIV research.

    Science.gov (United States)

    Leyva-Moral, Juan Manuel; Feijoo-Cid, Maria

    2017-05-01

    Background When conducting qualitative research, participants usually share lots of personal and private information with the researcher. As researchers, we must preserve participants' identity and confidentiality of the data. Objective To critically analyze an ethical conflict encountered regarding confidentiality when doing qualitative research. Research design Case study. Findings and discussion one of the participants in a study aiming to explain the meaning of living with HIV verbalized his imminent intention to commit suicide because of stigma of other social problems arising from living with HIV. Given the life-threatening situation, the commitment related to not disclosing the participant's identity and/or the content of the interview had to be broken. To avoid or prevent suicide, the therapist in charge of the case was properly informed about the participant's intentions. One important question arises from this case: was it ethically appropriate to break the confidentiality commitment? Conclusion confidentiality could be broken if a life-threatening event is identified during data collection and participants must know that. This has to be clearly stated in the informed consent form.

  13. Patient safety attitudes of pharmacy students in an Ethiopian university: a cross-sectional study.

    Science.gov (United States)

    Tegegn, Henok Getachew; Abebe, Tamrat Befekadu; Ayalew, Mohammed Biset; Bhagavathula, Akshaya Srikanth

    2017-01-01

    Patient safety is a major health care concern and is being included in an undergraduate curriculum as it plays a major role in lessening harm. Therefore, we aim to assess the attitude of pharmacy students toward patient safety. A cross-sectional study using a self-administered questionnaire containing 21 items was conducted at the University of Gondar among fourth and fifth year students. Data analysis was performed to calculate mean, standard deviation, percentages, and logistic regressions using SPSS software version 22 (IBM Corporation, Armonk, NY, USA). Statistical significance was set at Ppharmacy students (fourth year groups=50, fifth year groups=33) participated in the study with response rate of 92%. Majority of the students 70/83 (84.33%) had the overall positive attitude of patient safety. Most of the respondents (80.7%) agree or strongly agree that after an error occurs, an effective strategy is to work hard to be more careful. Most of them (79.6%) believe that pharmacists should routinely spend part of their professional time working to improve patient care. About half (48.2%) of pharmacy students disagree or strongly disagree that pharmacists should discuss and report errors to an affected patient and their family even if the patient is not harmed. No significant association between the attitude of pharmacy students toward patient safety and their age, sex and year of study was found. Pharmacy students have the overall good attitude to patient safety. However, they claimed the culture and attitude within the pharmacy workplace lacked for patient safety. Moreover, standardized patient safety course should be considered in the curriculum for junior pharmacy students to improve their attitude toward patient safety.

  14. The use of VR distraction to decrease pain after laparoscopic bariatric surgery: a case study.

    Science.gov (United States)

    Hoyus, Kattia Cabas; Cardenas-López, Georgina; Maldonado, Jose Gutierrez; Ruiz-Esquivel, Ma Fernanda; Torres-Villalobos, Gonzalo

    2012-01-01

    One of the advantages of laparoscopic bariatric surgery is the reduced level of postoperative pain. In some cases, however, the pain level may be high. This is a challenge for specialists. This case study explores the use of VR distraction in an 18 year-old patient who had undergone laparoscopic bariatric surgery and who reported pain during the postoperative period. The study was conducted in a Level III Private Hospital in Mexico City where the patient was hospitalized. The patient was administered standard analgesic during VR distraction, which lasted a total of 40 minutes divided into two sessions. The scores of three visual analogue scales and catastrophism were the dependent variables of this study. The scales were administered before and after the VR distraction intervention. The patient reported lower pain levels after VR distraction and reductions in some components of catastrophism. This study proves that VR distraction can be effective not only in reducing the physical component of pain (a notion that is already well established) but also the cognitive/affective component. More controlled studies of the issue are required.

  15. Twelve-Month Efficacy and Safety Data for the "Stress Incontinence Control, Efficacy and Safety Study": A Phase III, Multicenter, Prospective, Randomized, Controlled Study Treating Female Stress Urinary Incontinence Using the Vesair Intravesical Balloon.

    Science.gov (United States)

    Winkler, Harvey; Jacoby, Karny; Kalota, Susan; Snyder, Jeffrey; Cline, Kevin; Robertson, Kaiser; Kahan, Randall; Green, Lonny; McCammon, Kurt; Rovner, Eric; Rardin, Charles

    2017-09-26

    The "Stress Incontinence Control, Efficacy and Safety Study" (SUCCESS) is a phase III study of the Vesair Balloon in women with stress urinary incontinence who had failed conservative therapy, and either failed surgery, were not candidates for surgery, or chose not to have surgery. The safety and efficacy of the balloon at 12 months is reported for those participants in the treatment arm who elected to continue with the SUCCESS trial beyond the primary end point at 3 months. The SUCCESS trial is a multicenter, prospective, single-blinded, randomized, sham-controlled study. Participants were randomized on a 2.33:1 basis to either Vesair Balloon placement or placebo. The primary efficacy end point was a composite of both a greater than 50% reduction from baseline on 1-hour provocative pad weight test and an at least 10-point improvement in symptoms on the Incontinence Quality of Life questionnaire assessed at the 3-month study visit. Patients in the treatment arm who opted to continue in the trial were followed up prospectively up to 12 months. A total of 221 participants were randomized, including 157 in the treatment arm and 64 in the control arm. Sixty-seven participants in the treatment arm (42.7% of participants enrolled) were evaluated at 12 months, with 56.3% achieving the composite end point and 78.7% having greater than 50% reduction in pad weight from baseline in a per-protocol analysis. In an intent-to-treat analysis treating all participants who did not continue with the balloon as failures, 24% of the participants achieved the composite end point and 33.6% had a greater than 50% reduction in pad weight from baseline. Treatment-related adverse events in this group included dysuria (40.1%), gross hematuria (36.9%), and urinary tract infection (26.1%). In this phase III trial, symptom relief was maintained for those participants who continued therapy for 12 months. The balloon was found to be safe with no device- or procedure-related serious adverse events

  16. Pilot study of laser induced breakdown spectroscopy for tissue differentiation by monitoring the plume created during laser surgery — An approach on a feedback Laser control mechanism

    Science.gov (United States)

    Kanawade, Rajesh; Mehari, Fanuel; Knipfer, Christian; Rohde, Maximilian; Tangermann-Gerk, Katja; Schmidt, Michael; Stelzle, Florian

    2013-09-01

    This study focuses on tissue differentiation using 'Laser Induced Breakdown Spectroscopy' (LIBS) by monitoring the plasma plume created during laser surgery processes. This technique is aimed at controlling a laser surgery feedback system in real time. An Excimer laser (Ar-F 193 nm) was used for the ablation of tissue samples. Fat, muscle, nerve and skin tissue samples of bisected ex-vivo pig heads were prepared as test objects for the ablation procedure. A single fiber was used to collect emissions and deliver them to a spectrometer. The obtained LIBS spectra in the measured emissions were analyzed to determine each tissue type according to their chemical composition. The elements found in the samples and their emission spectra were in agreement with those described in literature. The collected LIBS spectra were analyzed to differentiate the tissues using statistical data analysis: Principal Component Analysis (PCA), Linear Discriminant Analysis (LDA) and Receiver Operating Characteristics (ROC). The obtained preliminary results suggest a successful differentiation of the target tissues with high sensitivity and specificity. The main goal of this study was to qualitatively identify tissue types during laser ablation, which will provide a real time feedback mechanism for clinical Laser surgery applications to significantly improve the accuracy and safety of laser surgery procedures.

  17. Exploring the relationship between quality of management and safety climate in a large scale Danish cross‐sectional study

    DEFF Research Database (Denmark)

    Sønderstrup-Andersen, Hans H. K.; Carlsen, Kathrine; Kines, Pete

    2011-01-01

    and transformational leadership and safety climate, and to explore how safety climate is affected by a number of socio-demographic factors and within different industries and company sizes. The analyses are based on data from a recent Danish work environment cross-sectional study including 3681 employees from a wide...... range of industries and who report that safety climate is relevant for their job. We use two safety climate items, (one regarding management safety empowerment; one regarding co-workers’ safety priority), one question about transactional leadership and two scales concerning transformational leadership...... by items related to transactional and transformational leadership have a significant positive association with management safety empowerment, whereas workers’ safety priority is only significantly associated with transformational leadership. Younger workers have significantly lower safety climate ratings...

  18. Applications of piezoelectric surgery in endodontic surgery: a literature review.

    Science.gov (United States)

    Abella, Francesc; de Ribot, Joan; Doria, Guillermo; Duran-Sindreu, Fernando; Roig, Miguel

    2014-03-01

    Piezosurgery (piezoelectric bone surgery) devices were developed to cut bone atraumatically using ultrasonic vibrations and to provide an alternative to the mechanical and electrical instruments used in conventional oral surgery. Indications for piezosurgery are increasing in oral and maxillofacial surgery, as in other disciplines, such as endodontic surgery. Key features of piezosurgery instruments include their ability to selectively cut bone without damaging adjacent soft tissue, to provide a clear operative field, and to cut without generating heat. Although piezosurgery instruments can be used at most stages of endodontic surgery (osteotomy, root-end resection, and root-end preparation), no published data are available on the effect of piezosurgery on the outcomes of endodontic surgery. To our knowledge, no study has evaluated the effect of piezosurgery on root-end resection, and only 1 has investigated root-end morphology after retrograde cavity preparation using piezosurgery. We conducted a search of the PubMed and Cochrane databases using appropriate terms and keywords related to the use and applications of piezoelectric surgery in endodontic surgery. A hand search also was conducted of issues published in the preceding 2 years of several journals. Two independent reviewers obtained and analyzed the full texts of the selected articles. A total of 121 articles published between January 2000 and December 2013 were identified. This review summarizes the operating principles of piezoelectric devices and outlines the applications of piezosurgery in endodontic surgery using clinical examples. Piezosurgery is a promising technical modality with applications in several aspects of endodontic surgery, but further studies are necessary to determine the influence of piezosurgery on root-end resection and root-end preparation. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  19. Impact of rosiglitazone safety alerts on oral antidiabetic sales trends: a countrywide study in Portugal.

    Science.gov (United States)

    Herdeiro, Maria T; Soares, Sara; Silva, Tânia; Roque, Fátima; Figueiras, Adolfo

    2016-10-01

    Pharmacovigilance systems are important to monitor the safety of on-market drugs after approval. The aim of this study was to assess the impact of rosiglitazone safety alerts on trends in the sale of rosiglitazone and other oral antidiabetic drugs. An ecological study was conducted, using temporally aggregated data and linking safety alerts to countrywide sales of all oral antidiabetic drugs in Portugal from January 2002 to December 2012. Sales figures for oral antidiabetic drugs marketed in Portugal were supplied by IMS Health Portugal with a breakdown by active substance and fixed combinations. The number of defined daily doses per 1000 inhabitants per day (DIDs) of each oral antidiabetic drug sold to the estimated diabetic population using oral antidiabetic drugs in Portugal was calculated. Particular attention was paid to the case of rosiglitazone, with the results being adjusted for changes in rosiglitazone reimbursement policies. A total of four safety alerts were issued about rosiglitazone. Rosiglitazone sales registered an increase of 32.9% (0.202 DIDs; P sales fell. Following the January 2006 and January 2008 safety alerts, rosiglitazone sales described a long-term downward trend, with decreases of 3.75% (-0023 DIDs; P > 0.05) and 0.24% (-0.001 DIDs; P > 0.05), respectively. It is important to promote the dissemination and publication of drug safety alerts. © 2016 Société Française de Pharmacologie et de Thérapeutique.

  20. Bone-anchored hearing device surgery: Linear incision without soft tissue reduction. A prospective study.

    Science.gov (United States)

    Altuna, Xabier; Navarro, Juan José; Palicio, Idoia; Álvarez, Leire

    2015-01-01

    The classic surgical procedure for percutaneous bone-anchored hearing devices involves removal of a large area of subcutaneous tissue down to the periosteum. This leads to alopecia and raises the risk of devascularization of the overlying skin with the potential for infection and scarring. The objective of this study was to determine the results of implant placement using a single, linear incision with no underlying soft tissue reduction. A prospective study was conducted in our hospital over a period of 14 months in all consecutive surgeries performed using this technique in adults. Patients were reviewed regularly (week 1, week 3, weeks 4-6 and months 3, 6 and 12) to assess wound healing including evaluation with the Holgers scale. Corresponding to 34 patients, 34 cases were consecutively enrolled in this study. We found that 15% of the patients had minor skin reactions during the first visit (Holgers grade 1 or 2); this number raised to 20% in week 3, but at week 4 only 1 patient had a reaction score of 1 (which was solved by week 6). None of the cases required revision surgery and all skin reactions were treated topically. Our results suggest that the tissue preservation technique is a simple and effective insertion technique with a favourable healing process and cosmesis. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  1. Endoscopic sinus surgery in chronic rhinosinusitis and nasal polyposis: a comparative study.

    Science.gov (United States)

    Nair, Satish; Dutta, Angshuman; Rajagopalan, Ramakrishnan; Nambiar, Sapna

    2011-01-01

    Nasal polyposis are common presentations in patients of chronic rhinosinusitis and are considered to be associated with more severe forms of disease with poor treatment outcome. The presentation and treatment outcome after endoscopic sinus surgery in patients of chronic rhinosinusitis and nasal polyposis have been analysed in this study. A prospective analysis of 90 patients of chronic rhinosinusitis who were classified into two groups depending on presence and absence of nasal polyps was performed in the study. The two groups were evaluated using subjective (patient complaints) and objective (computed tomography scan and endoscopy scores) criteria. Preoperative data were compared with data obtained 12 months post endoscopic sinus surgery. The study included 38 patients of chronic rhinosinusitis and 52 patients of nasal polyps. The patients of nasal polyp group presented with increased severity of symptoms of nasal blockage, nasal discharge and reduced sense of smell as compared to the chronic rhinosinusitis group who had significantly higher presentation of headache and facial pain. The preoperative CT scan revealed significantly higher bilateral disease with increased involvement of multiple sinuses in nasal polyp group. Post endoscopic sinus surgery both the groups showed significant improvement in their symptoms with the nasal polyp group demonstrating reduction in improvement on 1 year follow up. In our study we have found the patients with chronic rhinosinusitis and nasal polyp have varied severity of symptoms with the nasal polyp group having higher nasal symptoms and increased severity as compared to chronic rhinosinusitis group. Though the universal rationale of management by adequate drainage and ventilation of sinus is similar in both groups, there is a reduction in both objective and subjective scores during 1 year follow up in the nasal polyp group.

  2. Robotic Colorectal Surgery: A Systematic Review

    OpenAIRE

    Sami AlAsari; Byung Soh Min

    2012-01-01

    Aim. Robotic colorectal surgery may be a way to overcome the limitations of laparoscopic surgery. It is an emerging field; so, we aim in this paper to provide a comprehensive and data analysis of the available literature on the use of robotic technology in colorectal surgery. Method. A comprehensive systematic search of electronic databases was completed for the period from 2000 to 2011. Studies reporting outcomes of robotic colorectal surgery were identified and analyzed. Results. 41 studies...

  3. Health-related quality of life of patients following selected types of lumbar spinal surgery: A pilot study

    Directory of Open Access Journals (Sweden)

    Androwich Ida

    2007-12-01

    Full Text Available Abstract Background Over 500,000 spinal surgeries are performed annually in the United States. Although pain relief and improved health-related quality of life (HRQOL are expectations following lumbar spinal surgery, there is limited research regarding this experience from the individual's perspective. In addition, no studies have examined the HRQOL of persons who have had this surgery using a comprehensive approach. The intent of this study was to address this deficiency by an assessment of both the individual and environmental factors that impact perceived HRQOL using the Wilson and Cleary Model for Health-Related Quality of Life in persons who have undergone lumbar spinal surgery. Methods This was a pilot study of 57 adult patients undergoing elective lumbar spinal surgery for either herniated disk and/or degenerative changes. Individuals completed questionnaires measuring perceived pain, mood, functional status, general health perceptions, social support and HRQOL preoperatively and three months following surgery. Descriptive statistics, dependent t-tests, and MANOVAs were used to describe and compare the differences of the study variables over time. Results Preliminary results indicate overall perceived physical HRQOL was significantly improved postoperatively (t [56] = 6.45, p Conclusion Although perceived physical HRQOL was significantly improved three months postoperatively, fatigue and lack of vigor were issues for subjects postoperatively. Excessive fatigue and low vigor may have implications for successful rehabilitation and return to work for patients following lumbar spinal surgery. Further research is needed with a larger sample size and subgroup analyses to confirm these results.

  4. A Study of Occupational Radiation Dosimetry During Fluoroscopically Guided Simulated Urological Surgery in the Lithotomy Position.

    Science.gov (United States)

    Horsburgh, Ben A; Higgins, Mike

    2016-12-01

    To quantify through environmental audit the radiation dose that urologists receive during surgery in the lithotomy position, and to quantify the dose reduction achieved by altering exposure techniques and personal protective equipment use. Simulated surgery in the lithotomy position using an anthropomorphic phantom as a patient and a SimMan(®) mannequin as the surgeon. Pulsed fluoroscopy, focus-to-skin distance (FSD), collimation, and addition of a lead shield at the table end were individually and collectively introduced after a control study. Scattered X-ray dose rates to the simulated surgeon's eye, thyroid, trunk, external genitalia, and leg were measured with each of the technique adjustments. The absorbed dose in air at the phantom skin was measured throughout. Results were compared to discover surgeon dose rates with technique alteration. Increasing FSD leads to a rise in surgeon eye dose, and table end lead protection increases the patient skin dose. Use of all the dose-reduction techniques together reduces the dose to the patient, and a surgeon's trunk dose is decreased by 95%, external genitalia dose by 99%, and leg dose by 97%. Sitting to perform fluoroscopically guided surgery in the lithotomy position increases surgeon dose by a median value of 17%, with the external genitalia dose increased by 78% compared with the standing position. This study describes effective methods of dose reduction that are easy to instigate. The resulting reduction in radiation dose during urology procedures meets the requirements of international guidelines and legislation. This change in practice improves patient care and reduces risk to urologists from occupational exposure to radiation. By combining all of the dose-reduction techniques, urologists should never reach the threshold for deterministic radiation effects to their eyes during their career, and they will have a significantly lower chance of stochastic risks such as cancer.

  5. Safety and Efficacy of 5-Aminolevulinic Acid for High Grade Glioma in Usual Clinical Practice: A Prospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Pilar Teixidor

    Full Text Available During the last decade, the use of 5-aminolevulinic acid (5-ALA has been steadily increasing in neurosurgery. The study's main objectives were to prospectively evaluate the effectiveness and safety of 5-ALA when used in clinical practice setting on high-grade gliomas' patients.National, multicenter and prospective observational study.authorized conditions of use of 5-ALA.contraindication to 5-ALA, inoperable or partial resected tumors, pregnancy and children. Epidemiological, clinical, laboratory, radiological, and safety data were collected. Effectiveness was assessed using complete resection of the tumor, and progression-free and overall survival probabilities.Between May 2010 and September 2014, 85 patients treated with 5-ALA were included, and 77 were suitable for the effectiveness analysis. Complete resection was achieved in 41 patients (54%. Surgeons considered suboptimal the fluorescence of 5-ALA in 40% of the patients assessed. The median duration of follow-up was 12.3 months. The progression-free survival probability at 6 months was 58%. The median duration overall survival was 14.2 months. Progression tumor risk factors were grade of glioma, age and resection degree; and death risk factors were grade of glioma and gender. No severe adverse effects were reported. At one month after surgery, new or increased neurological morbidity was 6.5%. Hepatic enzymes were frequently increased within the first month after surgery; however, they subsequently normalized, and this was found to have no clinical significance.In clinical practice, the 5-ALA showed a good safety profile, but the benefits related to 5-ALA have not been yet clearly shown. The improved differentiation expected by fluorescence between normal and tumor cerebral tissue was suboptimal in a relevant number of patients; in addition, the expected higher degree of resection was lower than in clinical trials as well as incomplete resection was not identified as a prognostic factor

  6. Multi-sectoral action for child safety-a European study exploring implicated sectors.

    Science.gov (United States)

    Scholtes, Beatrice; Schröder-Bäck, Peter; Förster, Katharina; MacKay, Morag; Vincenten, Joanne; Brand, Helmut

    2017-06-01

    Injury to children in Europe, resulting in both death and disability, constitutes a significant burden on individuals, families and society. Inequalities between high and low-income countries are growing. The World Health Organisation Health 2020 strategy calls for inter-sectoral collaboration to address injury in Europe and advocates the whole of government and whole of society approaches to wicked problems. In this study we explore which sectors (e.g. health, transport, education) are relevant for four domains of child safety (intentional injury, water, road and home safety). We used the organigraph methodology, originally developed to demonstrate how organizations work, to describe the governance of child safety interventions. Members of the European Child Safety Alliance, working in the field of child safety in 24 European countries, drew organigraphs of evidence-based interventions. They included the different actors involved and the processes between them. We analyzed the organigraphs by counting the actors presented and categorizing them into sectors using a pre-defined analysis framework. We received 44 organigraphs from participants in 24 countries. Twenty-seven sectors were identified across the four domains. Nine of the 27 identified sectors were classified as 'core sectors' (education, health, home affairs, justice, media, recreation, research, social/welfare services and consumers). This study reveals the multi-sectoral nature of child safety in practice. It provides information for stakeholders working in child safety to help them implement inter-sectoral child safety interventions taking a whole-of-government and whole-of-society approach to health governance.

  7. Efficacy and safety of hyaluronidase 75 IU as an adjuvant to mepivacaine for retrobulbar anesthesia in cataract surgery.

    Science.gov (United States)

    Remy, Matthias; Pinter, Florian; Nentwich, Martin M; Kampik, Anselm; Schönfeld, Carl-Ludwig

    2008-11-01

    To evaluate the efficacy and safety of hyaluronidase as an adjuvant to mepivacaine for retrobulbar anesthesia in cataract surgery. Department of Ophthalmology, Ludwig-Maximilians-University, Munich, and Eye Center Munich East, Munich-Haar, Germany. Eyes having cataract surgery at 1 of the 2 centers were included in this prospective randomized double-blind placebo-controlled clinical trial. Retrobulbar anesthesia was administered by the surgeon using a solution of 5 mL mepivacaine 1% with additional hyaluronidase (Hylase Dessau) 75 IU (40 eyes) or additional placebo (40 eyes). The main target parameter was akinesia 5 minutes after administration of the study medication. Secondary parameters were akinesia at later times, additional injections, ptosis of the upper eyelid, time to reach complete anesthesia, assessment of pain using a visual analog scale, assessment of efficacy and tolerability by the patient and the surgeon, and adverse events. Complete akinesia 5 minutes after retrobulbar injection was reached in significantly more cases in the hyaluronidase group (29) than in the placebo group (13) (P mepivacaine for retrobulbar anesthesia in cataract surgery enhanced the safety of the surgical procedure due to more complete akinesia and quicker onset of complete anesthesia.

  8. Structural Safety Assessment of Existing Multiarch Tunnel: A Case Study

    Directory of Open Access Journals (Sweden)

    Jinxing Lai

    2017-01-01

    Full Text Available Structural health assessment is one of the key activities in maintaining the performance of a tunnel during its service life. Due to the development of modern detection technology, comprehensive structural health assessment system is being established for operating tunnels. To evaluate the actual operational state of Shitigou tunnel, overall detection of the liner crack, tunnel seepage, and liner void was conducted by employing the modern detection technology, such as crack width monitoring technology, concrete strength monitoring technology, and electromagnetic wave nondestructive monitoring technology. Through the statistical analysis of the detection results, the distribution characteristic, development law, and damage grade of structural defects were obtained. Tunnel liner cracks are mainly located on the middle wall; serious water leakage is encountered on the side wall, middle wall, and vault; the strength of foundation and liner structure of left tunnel does not meet the design requirement; the liner voids are mostly located at the tunnel entrance section, especially, on the tunnel vault; and the proportion of influence factors of structural defects should be considered. The research results presented for this study can serve as references for effective design and health assessment of existing multiarch tunnel projects.

  9. Awareness during anaesthesia for surgery requiring evoked potential monitoring: A pilot study

    Directory of Open Access Journals (Sweden)

    Pritish J Korula

    2017-01-01

    Full Text Available Background: Evoked potential monitoring such as somatosensory-evoked potential (SSEP or motor-evoked potential (MEP monitoring during surgical procedures in proximity to the spinal cord requires minimising the minimum alveolar concentrations (MACs below the anaesthetic concentrations normally required (1 MAC to prevent interference in amplitude and latency of evoked potentials. This could result in awareness. Our primary objective was to determine the incidence of awareness while administering low MAC inhalational anaesthetics for these unique procedures. The secondary objective was to assess the adequacy of our anaesthetic technique from neurophysiologist′s perspective. Methods: In this prospective observational pilot study, 61 American Society of Anesthesiologists 1 and 2 patients undergoing spinal surgery for whom intraoperative evoked potential monitoring was performed were included; during the maintenance phase, 0.7-0.8 MAC of isoflurane was targeted. We evaluated the intraoperative depth of anaesthesia using a bispectral (BIS index monitor as well as the patients response to surgical stimulus (PRST scoring system. Post-operatively, a modified Bruce questionnaire was used to verify awareness. The adequacy of evoked potential readings was also assessed. Results: Of the 61 patients, no patient had explicit awareness. Intraoperatively, 19 of 61 patients had a BIS value of above sixty at least once, during surgery. There was no correlation with PRST scoring and BIS during surgery. Fifty-four out of 61 patient′s evoked potential readings were deemed ′good′ or ′fair′ for the conduct of electrophysiological monitoring. Conclusions: This pilot study demonstrates that administering low MAC inhalational anaesthetics to facilitate evoked potential monitoring does not result in explicit awareness. However, larger studies are needed to verify this. The conduct of SSEP electrophysiological monitoring was satisfactory with the use of this

  10. Impact of Trichiasis Surgery on Quality of Life: A Longitudinal Study in Ethiopia.

    Directory of Open Access Journals (Sweden)

    Esmael Habtamu

    2016-04-01

    Full Text Available Trachomatous trichiasis significantly reduces vision and health related quality of life (QoL. Although trichiasis surgery is widely performed to treat trichiasis, there is little data on the effect of surgery on QoL. We measured the impact of trichiasis surgery on vision and health related QoL in a longitudinal study from Amhara Region, Ethiopia.We recruited 1000 adult participants with trichiasis (cases and 200 comparison participants, matched to every fifth trichiasis case on age (+/- two years, sex and location. Vision-related quality of life (VRQoL and health-related quality of life (HRQoL were measured using the WHO/PBD-VF20 and WHOQOL-BREF questionnaires respectively, at enrolment and 12 months after enrolment. All trichiasis cases received free standard trichiasis surgery immediately after enrolment. The mean difference in QoL scores between enrolment and follow-up for cases and comparison participants, and the difference-in-differences by baseline trichiasis status was analysed using random effects linear regression, the later adjusted for age, sex and socioeconomic status. At 12-months follow-up, data was collected from 980 (98% and 198 (98% trichiasis cases and comparison participants respectively. At this follow-up visit, VRQoL and HRQoL scores of trichiasis cases improved substantially in all subscales and domains by 19.1-42.0 points (p<0.0001 and 4.7-17.2 points (p<0.0001, respectively. In contrast, among the comparison participants, there was no evidence of improvement in VRQoL and HRQoL domain scores during follow-up. The improvement in VRQoL and HRQoL in cases was independent of the presence of visual acuity improvement at 12 months.Trichiasis surgery substantially improves both VRQoL and HRQoL regardless of visual acuity change. Unprecedented effort is needed to scale-up trichiasis surgical programmes not only to prevent the risk of sight loss but also to improve overall wellbeing and health perception of affected individuals.

  11. Impact of Trichiasis Surgery on Quality of Life: A Longitudinal Study in Ethiopia

    Science.gov (United States)

    Habtamu, Esmael; Wondie, Tariku; Aweke, Sintayehu; Tadesse, Zerihun; Zerihun, Mulat; Mohammed, Aderajew; Zewudie, Zebideru; Callahan, Kelly; Emerson, Paul M.; Bailey, Robin L.; Mabey, David C. W.; Rajak, Saul N.; Kuper, Hannah; Polack, Sarah; Weiss, Helen A.; Burton, Matthew J.

    2016-01-01

    Background Trachomatous trichiasis significantly reduces vision and health related quality of life (QoL). Although trichiasis surgery is widely performed to treat trichiasis, there is little data on the effect of surgery on QoL. We measured the impact of trichiasis surgery on vision and health related QoL in a longitudinal study from Amhara Region, Ethiopia. Methodology/Principal Findings We recruited 1000 adult participants with trichiasis (cases) and 200 comparison participants, matched to every fifth trichiasis case on age (+/- two years), sex and location. Vision-related quality of life (VRQoL) and health-related quality of life (HRQoL) were measured using the WHO/PBD-VF20 and WHOQOL-BREF questionnaires respectively, at enrolment and 12 months after enrolment. All trichiasis cases received free standard trichiasis surgery immediately after enrolment. The mean difference in QoL scores between enrolment and follow-up for cases and comparison participants, and the difference-in-differences by baseline trichiasis status was analysed using random effects linear regression, the later adjusted for age, sex and socioeconomic status. At 12-months follow-up, data was collected from 980 (98%) and 198 (98%) trichiasis cases and comparison participants respectively. At this follow-up visit, VRQoL and HRQoL scores of trichiasis cases improved substantially in all subscales and domains by 19.1–42.0 points (p<0.0001) and 4.7–17.2 points (p<0.0001), respectively. In contrast, among the comparison participants, there was no evidence of improvement in VRQoL and HRQoL domain scores during follow-up. The improvement in VRQoL and HRQoL in cases was independent of the presence of visual acuity improvement at 12 months. Conclusions/Significance Trichiasis surgery substantially improves both VRQoL and HRQoL regardless of visual acuity change. Unprecedented effort is needed to scale-up trichiasis surgical programmes not only to prevent the risk of sight loss but also to improve

  12. Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: A randomized controlled pilot study

    NARCIS (Netherlands)

    Dronkers, J.J.; Lamberts, H.; Reutelingsperger, I.M.M.D.; Naber, R.H.; Dronkers-Landman, C.M.; Veldman, A.; Meeteren, N.L.U. van

    2010-01-01

    Objective: Investigation of the feasibility and preliminary effect of a short-term intensive preoperative exercise programme for elderly patients scheduled for elective abdominal oncological surgery. Design: Single-blind randomized controlled pilot study. Setting: Ordinary hospital in the Netherland

  13. Language barriers and patient safety risks in hospital care: a mixed methods study.

    NARCIS (Netherlands)

    Rosse, F. van; Bruijne, M. de; Suurmond, J.; Essink-Bot, M.L.; Wagner, C.

    2016-01-01

    Introduction: A language barrier has been shown to be a threat for quality of hospital care. International studies highlighted a lack of adequate noticing, reporting, and bridging of a language barrier. However, studies on the link between language proficiency and patient safety are scarce, especial

  14. Language barriers and patient safety risks in hospital care: a mixed methods study.

    NARCIS (Netherlands)

    Rosse, F. van; Bruijne, M. de; Suurmond, J.; Essink-Bot, M.L.; Wagner, C.

    2016-01-01

    Introduction: A language barrier has been shown to be a threat for quality of hospital care. International studies highlighted a lack of adequate noticing, reporting, and bridging of a language barrier. However, studies on the link between language proficiency and patient safety are scarce,

  15. Language barriers and patient safety risks in hospital care: a mixed methods study.

    NARCIS (Netherlands)

    Rosse, F. van; Bruijne, M. de; Suurmond, J.; Essink-Bot, M.L.; Wagner, C.

    2016-01-01

    Introduction: A language barrier has been shown to be a threat for quality of hospital care. International studies highlighted a lack of adequate noticing, reporting, and bridging of a language barrier. However, studies on the link between language proficiency and patient safety are scarce, especial

  16. Safety culture in a pharmacy setting using a pharmacy survey on patient safety culture: a cross-sectional study in China.

    Science.gov (United States)

    Jia, P L; Zhang, L H; Zhang, M M; Zhang, L L; Zhang, C; Qin, S F; Li, X L; Liu, K X

    2014-06-30

    To explore the attitudes and perceptions of patient safety culture for pharmacy workers in China by using a Pharmacy Survey on Patient Safety Culture (PSOPSC), and to assess the psychometric properties of the translated Chinese language version of the PSOPSC. Cross-sectional study. Data were obtained from 20 hospital pharmacies in the southwest part of China. We performed χ(2) test to explore the differences on pharmacy staff in different hospital and qualification levels and countries towards patient safety culture. We also computed descriptive statistics, internal consistency coefficients and intersubscale correlation analysis, and then conducted an exploratory factor analysis. A test-retest was performed to assess reproducibility of the items. A total of 630 questionnaires were distributed of which 527 were responded to validly (response rate 84%). The positive response rate for each item ranged from 37% to 90%. The positive response rate on three dimensions ('Teamwork', 'Staff Training and Skills' and 'Staffing, Work Pressure and Pace') was higher than that of Agency for Healthcare Research and Quality (AHRQ) data (ppatient safety culture at different hospital and qualification levels. The internal consistency of the total survey was comparatively satisfied (Cronbach's α=0.89). The results demonstrated that among the pharmacy staffs surveyed in China, there was a positive attitude towards patient safety culture in their organisations. Identifying perspectives of patient safety culture from pharmacists in different hospital and qualification levels are important, since this can help support decisions about action to improve safety culture in pharmacy settings. The Chinese translation of the PSOPSC questionnaire (V.2012) applied in our study is acceptable. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  17. Predictive factors for bleeding-related re-exploration after cardiac surgery: A prospective cohort study.

    Science.gov (United States)

    Lopes, Camila T; Brunori, Evelise H Fadini Reis; Santos, Vinicius Batista; Moorhead, Sue A; Lopes, Juliana de Lima; de Barros, Alba L Bottura Leite

    2016-04-01

    Bleeding-related re-exploration is a life-threatening complication after cardiac surgery. Nurses must be aware of important risk factors for this complication so that their assessment, monitoring and evaluation activities can be prioritized, focused and anticipated. To identify the predictive factors for bleeding-related re-exploration after cardiac surgery and to describe the sources of postoperative bleeding. This is a prospective cohort study at a tertiary cardiac school-hospital in São Paulo/SP, Brazil. Adult patients (n=323) submitted to surgical correction of acquired cardiac diseases were included. Potential risk factors for bleeding-related re-exploration within the 24 hours following admission to the intensive care unit were investigated in the patients' charts. A univariate analysis and a multiple analysis through logistic regression were conducted to identify the outcome predictors. The area under the receiver-operating characteristic curve was calculated as a measure of accuracy considering the cut-off points with the highest sensitivity and specificity. The univariate factors significantly associated with bleeding-related re-exploration were a lower preoperative platelet count, a lower number of bypasses in coronary artery bypass surgery and postoperatively, a lower body temperature, infusion of lower intravenous volume, a higher positive end-expiratory pressure during mechanical ventilation and transfusion of blood products. The independent predictors of bleeding-related re-exploration included postoperative red blood cell transfusion, and transfusion of fresh frozen plasma, platelet or cryoprecipitate units. These predictors had a sensitivity of 87.5%, a specificity of 99.28% and an accuracy of 97.93%. Blood product transfusion postoperatively is an independent predictor of bleeding-related re-exploration. Surgical errors prevailed as sources of bleeding. © The European Society of Cardiology 2015.

  18. Use of Cortical Bone Screws in Maxillofacial Surgery - A Prospective Study

    Science.gov (United States)

    Satish, Madatanapalli; Rahman, NM Mujeeb; Reddy, V Sridhar; Yuvaraj, A; Muliyar, Sabir; Razak, P Abdul

    2014-01-01

    Background: The aim of this study is to evaluate the various applications of cortical bone screws in oral and maxillofacial surgery. Materials & Methods: The study was conducted in a teaching hospital located in, Bangalore, India, on 20 patients. These patients were categorized into three groups depending on the applications of these screws like, for achieving intermaxillary fixation in Group-1, for treatment of simple, undisplaced fractures by “Tension wire” method in Group-2, and further application of these screws were evaluated in Group-3. Different parameters were used to evaluate the efficacy of these screws. Results: In Group-1(n=12) there was satisfactory occlusion in all the patients with minimal incidence of complications. In Group-2 (n=4) post-operative reduction and fixation was satisfactory and in Group-3 (n=4) the function of these screws was satisfactory when it was used for vestibuloplasty and also as a suspension wiring in treatment of comminuted fracture of zygoma with minimal incidence of complications. Conclusion: Use of cortical bone screws is a valid alternative for achieving intermaxillary fixation, reduction and fixation of simple, undisplaced or minimally displaced fractures through Tension wire method owing to its simplicity, economy and ease of use, and as a fixation method for apically positioned flap in vestibuloplasty procedure. How to cite the article: Satish M, Rahman NM, Reddy VS, Yuvaraj A, Muliyar S, Razak PA. Use of Cortical Bone Screws in Maxillofacial Surgery - A Prospective Study. J Int Oral Health 2014;6(2):62-7. PMID:24876704

  19. Lower Risk of Stroke after Deformity Surgery: Long Term Benefit Demonstrated by a National Cohort Study

    Directory of Open Access Journals (Sweden)

    Liang-Chung Huang

    2015-10-01

    Full Text Available Objectives: This study aimed to investigate the long-term risk of stroke in adult patients with spinal deformity. Specifically, the study addressed the possible protective effect of surgery for spinal deformity against stroke. Methods: Using the National Health Insurance Research Database (NHIRD, a monopolistic national database in Taiwan, this retrospective cohort study analyzed the incidence of stroke in patients with adult spinal deformity (ASD in a 11-year period. A total of 13,503 patients, between 55 and 75 years old, were identified for the diagnosis of ASD. The patients were grouped into two: the surgical group (n = 10,439 who received spinal fusion surgery, and the control group (n = 2124 who received other medical treatment. The incidence rates of all subsequent cerebrovascular accidents, including ischemic and hemorrhagic strokes, were calculated. Hazard ratios for stroke were calculated use a full cohort and a propensity score matched cohort. Adjustments for co-morbidities that may predispose to stroke, including hypertension, diabetes mellitus, arrhythmia and coronary heart disease were conducted. Kaplan-Meier and Cox regression analyses were performed to compare the risk of stroke between the two groups. Results: During the total observation period of 50,450 person-years, the incidence rate of stroke in the surgical group (15.55 per 1000 person-years was significantly lower than that of the control group (20.89 per 1000 person-years, p < 0.001. Stroke was more likely to occur in the control group than in the surgical group (crude hazard ratio 1.34, p < 0.001; adjusted HR 1.28, p < 0.001, by a propensity score matched model. Conclusions: In this national cohort of more than 13,000 ASD patients covering 10 years, stroke was approximately 25% less likely to happen in patients who underwent spinal fusion surgery than those who received medical management. Therefore, spinal fusion surgery may provide a protective effect against stroke

  20. Incidence and risk factors for postoperative cognitive dysfunction in older adults undergoing major noncardiac surgery: A prospective study.

    Science.gov (United States)

    Shoair, Osama A; Grasso Ii, Mario P; Lahaye, Laura A; Daniel, Ronsard; Biddle, Chuck J; Slattum, Patricia W

    2015-01-01

    Postoperative cognitive dysfunction (POCD) is a decline in cognitive function that occurs after surgery. The purpose of this study was to estimate the incidence and identify potential risk factors of POCD in older adults undergoing major noncardiac surgery. A total of 69 patients aged 65 years or older undergoing major noncardiac surgery were enrolled. Patients' cognitive function was assessed before and 3 months after surgery using a computerized neurocognitive battery. A nonsurgical control group of 54 older adults was recruited to adjust for learning effects from repeated administration of neurocognitive tests. Data about potential risk factors for POCD were collected before, during, and after surgery, including patient, medication, and surgery factors. The incidence of POCD was calculated using the Z-score method. A multivariable logistic regression model was used to identify risk factors for POCD. POCD was present in eleven patients (15.9%, 95% confidence interval [CI] = 7.3-24.6) 3 months after major noncardiac surgery. Carrying the apolipoprotein E4 (APOE4) genotype (odds ratio [OR] = 4.74, 95% CI = 1.09-22.19), using one or more highly anticholinergic or sedative-hypnotic drugs at home prior to surgery (OR = 5.64, 95% CI = 1.35-30.22), and receiving sevoflurane for anesthesia (OR = 6.43, 95% CI = 1.49-34.66) were associated with the development of POCD. POCD was observed in 15.9% of older adults after major noncardiac surgery. Risk factors for POCD in these patients were carrying the APOE4 genotype, using one or more highly anticholinergic or sedative-hypnotic drugs prior to surgery, and receiving sevoflurane for anesthesia.

  1. Antibacterial-Coated Suture in Reducing Surgical Site Infection in Breast Surgery: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Enora Laas

    2012-01-01

    Full Text Available Background. To reduce the incidence of microbial colonization of suture material, Triclosan- (TC-coated suture materials have been developed. The aim of this study was to assess the incidence of suture-related complications (SRC in breast surgery with and without the use of TC-coated sutures. Methods. We performed a study on two consecutive periods: 92 patients underwent breast surgery with conventional sutures (Group 1 and 98 with TC-coated sutures (Group 2. We performed subgroups analyses and developed a model to predict SRC in Group 1 and tested its clinical efficacy in Group 2 using a nomogram-based approach. Results. The SRC rates were 13% in Group 1 and 8% in Group 2. We found that some subgroups may benefit from TC-coated sutures. The discrimination obtained from a logistic regression model developed in Group 1 and based on multifocality, age and axillary lymphadenectomy was 0.88 (95% CI 0.77–0.95 (. There was a significant difference in Group 2 between predicted probabilities and observed percentages (. The predicted and observed proportions of complications in the high-risk group were 38% and 13%, respectively. Conclusion. This study used individual predictions of SRC and showed that using TC-coated suture may prevent SRC. This was particularly significant in high-risk patients.

  2. [Effects of carbon dioxide insufflation on regional cerebral oxygenation during laparoscopic surgery in children: a prospective study].

    Science.gov (United States)

    Tuna, Ayca Tas; Akkoyun, Ibrahim; Darcin, Sevtap; Palabiyik, Onur

    2016-01-01

    Laparoscopic surgery has become a popular surgical tool when compared to traditional open surgery. There are limited data on pediatric patients regarding whether pneumoperitoneum affects cerebral oxygenation although end-tidal CO2 concentration remains normal. Therefore, this study was designed to evaluate the changes of cerebral oxygen saturation using near-infrared spectroscope during laparoscopic surgery in children. The study comprised forty children who were scheduled for laparoscopic (Group L, n=20) or open (Group O, n=20) appendectomy. Hemodynamic variables, right and left regional cerebral oxygen saturation (RrSO2 and LrSO2), fraction of inspired oxygen, end-tidal carbon dioxide pressure (PETCO2), peak inspiratory pressure (Ppeak), respiratory minute volume, inspiratory and end-tidal concentrations of sevoflurane and body temperature were recorded. All parameters were recorded after anesthesia induction and before start of surgery (T0, baseline), 15min after start of surgery (T1), 30min after start of surgery (T2), 45min after start of surgery (T3), 60min after start of surgery (T4) and end of the surgery (T5). There were progressive decreases in both RrSO2 and LrSO2 levels in both groups, which were not statistically significant at T1, T2, T3, T4. The RrSO2 levels of Group L at T5 were significantly lower than that of Group O. One patient in Group L had an rSO2 value <80% of the baseline value. Carbon dioxide insufflation during pneumoperitoneum in pediatric patients may not affect cerebral oxygenation under laparoscopic surgery. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  3. Effects of carbon dioxide insufflation on regional cerebral oxygenation during laparoscopic surgery in children: a prospective study.

    Science.gov (United States)

    Tuna, Ayca Tas; Akkoyun, Ibrahim; Darcin, Sevtap; Palabiyik, Onur

    2016-01-01

    Laparoscopic surgery has become a popular surgical tool when compared to traditional open surgery. There are limited data on pediatric patients regarding whether pneumoperitoneum affects cerebral oxygenation although end-tidal CO2 concentration remains normal. Therefore, this study was designed to evaluate the changes of cerebral oxygen saturation using near-infrared spectroscope during laparoscopic surgery in children. The study comprised forty children who were scheduled for laparoscopic (Group L, n=20) or open (Group O, n=20) appendectomy. Hemodynamic variables, right and left regional cerebral oxygen saturation (RrSO2 and LrSO2), fraction of inspired oxygen, end-tidal carbon dioxide pressure (PETCO2), peak inspiratory pressure (Ppeak), respiratory minute volume, inspiratory and end-tidal concentrations of sevoflurane and body temperature were recorded. All parameters were recorded after anesthesia induction and before start of surgery (T0, baseline), 15min after start of surgery (T1), 30min after start of surgery (T2), 45min after start of surgery (T3), 60min after start of surgery (T4) and end of the surgery (T5). There were progressive decreases in both RrSO2 and LrSO2 levels in both groups, which were not statistically significant at T1, T2, T3, T4. The RrSO2 levels of Group L at T5 were significantly lower than that of Group O. One patient in Group L had an rSO2 value <80% of the baseline value. Carbon dioxide insufflation during pneumoperitoneum in pediatric patients may not affect cerebral oxygenation under laparoscopic surgery. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  4. Three Reflections on Assessing Safety Training Needs: A Case Study

    Science.gov (United States)

    Sleezer, Catherine M.; Kelsey, Kathleen D.; Wood, Thomas E.

    2008-01-01

    Needs assessment plays an important role in training and human performance improvement efforts, but the literature contains little research on this topic. This study extended previous research on the Performance Analysis for Training (PAT) model of needs assessment by examining its implementation to determine environmental and occupational health…

  5. The Hip Fracture Surgery in Elderly Patients (HIPELD study: protocol for a randomized, multicenter controlled trial evaluating the effect of xenon on postoperative delirium in older patients undergoing hip fracture surgery

    Directory of Open Access Journals (Sweden)

    Coburn Mark

    2012-09-01

    Full Text Available Abstract Background Strategies to protect the brain from postoperative delirium (POD after hip fracture are urgently needed. The development of delirium often is associated with the loss of independence, poor functional recovery, and increased morbidity, as well as increases in length of hospital stay, discharges to nursing facilities, and healthcare costs. We hypothesize that xenon may reduce the burden of POD, (i by avoiding the need to provide anesthesia with a drug that targets the γ-amino-butyric acid (GABAA receptor and (ii through beneficial anesthetic and organ-protective effects. Methods and design An international, multicenter, phase 2, prospective, randomized, blinded, parallel group and controlled trial to evaluate the incidence of POD, diagnosed with the Confusion Assessment Method (CAM, in older patients undergoing hip fracture surgery under general anesthesia with xenon or sevoflurane, for a period of 4 days post surgery (primary outcome is planned. Secondary objectives are to compare the incidence of POD between xenon and sevoflurane, to evaluate the incidence of POD from day 5 post surgery until discharge from hospital, to determine the time to first POD diagnosis, to evaluate the duration of POD, to evaluate the evolution of the physiological status of the patients in the postoperative period, to evaluate the recovery parameters, to collect preliminary data to evaluate the economical impact of POD in the postoperative period and to collect safety data. Patients are eligible if they are older aged (≥ 75 years and assigned to a planned hip fracture surgery within 48 h after the hip fracture. Furthermore, patients need to be willing and able to complete the requirements of this study including the signature of the written informed consent. A total of 256 randomized patients in the 10 participating centers will be recruited, that is, 128 randomized patients in each of the 2 study groups (receiving either xenon or sevoflurane

  6. Is the routine drainage after surgery for thyroid necessary? - A prospective randomized clinical study [ISRCTN63623153

    Directory of Open Access Journals (Sweden)

    Chintamani

    2005-05-01

    Full Text Available Abstract Background Drains are usually left after thyroid surgery to prevent formation of hematoma and seroma in the thyroid bed. This is done to reduce complications and hospital stay. Objective evaluation of the amount collected in the thyroid bed by ultrasonography (USG can help in assessing the role of drains. Methods A randomized prospective control study was conducted on 94 patients undergoing 102 thyroid surgeries, over a period of fifteen months. Patients included in the study were randomly allocated to drain and non-drain group on the basis of computer generated random number table. The surgeon was informed of the group just before the closure of the wound Postoperatively USG neck was done on first and seventh postoperative day by the same ultrasonologist each time. Any swelling, change in voice, tetany and tingling sensation were also recorded. The data was analyzed using two-sample t-test for calculating unequal variance. Results Both groups were evenly balanced according to age, sex, and size of tumor, type of procedure performed and histopathological diagnosis. There was no significant difference in collection of thyroid bed assessed by USG on D1 & D7 in the two groups (p = 0.313 but the hospital stay was significantly reduced in the non-drain group (p = 0.007. One patient in the drain group required needle aspiration for collection in thyroid bed. No patient in either group required re-operation for bleeding or haematoma. Conclusion Routine drainage of thyroid bed following thyroid surgery may not be necessary. Not draining the wound results in lesser morbidity and decreased hospital stay.

  7. A COMPARA TIVE STUDY OF MANUAL INCISION WITH RADIOSURGERY INCISION INDACRYOCYSTORHYNOSTOMY SURGERY

    Directory of Open Access Journals (Sweden)

    Shailly

    2015-03-01

    Full Text Available MATERIAL & METHODS : This randomized , prospective study was carried out on patient attending out patients department of ophthalmology L . L . R . hospital ( G S V M Medical College Kanpur during the time period of 2 years . Detailed history , general examination & ophthalmic examination done . Then they under went Dacryocystorhinostomy surgery . These patients divided into two groups the Group ‘A’ and Group ‘B’ . Group . A patients underwent the dacryocystorhinostomy surgery with manual scalpel incision and Group B patients underwent the surgery with radiofrequency tools . The subsequent follow up was done at the intervals at one week , 3 weeks , 6 weeks and 6 months . Some w ere followed more frequently whenever needed . RESULTS : The present study was conducted on 118 eyes of 102 patients , o f these 56 eyes ( 48 patients received skin incision with manual scalpel ( Group ‘A’ and 62 eyes ( 54 patients received skin incision with r adiofrequency knife ( Group ‘B’ . The intraoperative bleeding and mean surgical time per case was less with rad i frequency knife that is in group B . There was also faster wound healing with more numbers cases of excellent scar quality on postoperative follo w up in Group B . DISCUSSION : Intraoperative average numbers of gauze pieces used per case was less in Group B because of electrocoagulation action of radiofrequency tools . That is why the mean surgical time per case was less in Group B . Patients was compar ed for scar quality by giving them scores according to Manchester scar scale score and60% patients in Group B achieves excellent scar quality scores in comparison to group A in which only 48% patients achieves excellent scar quality scores . CONCLUSION : There is less intraoperative bleeding and less mean surgical time per case and faster healing with excellent scar quality postoperatively in early and late follow ups with radiofrequency tools than manual scalpel .

  8. Delirium in cardiac surgery : a study on risk-assessment and long-term consequenses

    NARCIS (Netherlands)

    Koster, Sandra

    2011-01-01

    BACKGROUND: Delirium or acute confusion is a temporary mental disorder, which occurs frequently among hospitalized elderly patients. Patients who undergo cardiac surgery have an increased risk of developing delirium. Delirium is associated with many negative consequences. Therefore, prevention or ea

  9. Delirium in cardiac surgery. A study on risk-assessment and long-term consequences

    NARCIS (Netherlands)

    Hogen-Koster, S.

    2011-01-01

    BACKGROUND: Delirium or acute confusion is a temporary mental disorder, which occurs frequently among hospitalized elderly patients. Patients who undergo cardiac surgery have an increased risk of developing delirium. Delirium is associated with many negative consequences. Therefore, prevention or

  10. Nanotechnology Safety Self-Study

    Energy Technology Data Exchange (ETDEWEB)

    Grogin, Phillip W. [Los Alamos National Laboratory

    2016-03-29

    Nanoparticles are near-atomic scale structures between 1 and 100 nanometers (one billionth of a meter). Engineered nanoparticles are intentionally created and are used in research and development at Sandia National Laboratories (SNL) and Los Alamos National Laboratory (LANL). This course, Nanotechnology Safety Self-Study, presents an overview of the hazards, controls, and uncertainties associated with the use of unbound engineered nanoscale particles (UNP) in a laboratory environment.

  11. Study on Clinical Application of Nerve Monitor in Parotid Tumor Surgery

    Institute of Scientific and Technical Information of China (English)

    XU Liang-peng; JIA Bao-jun; AO Jian-hua; QU Dan-yang; SHENG Yan-jiao

    2014-01-01

    Objective The purpose of the study is to explore the application value of the nerve monitor adopted to pinpoint facial nerves before anatomization during a parotid tumor surgery. Methods Facial nerves of 36 patients were pinpointed by N800 nerve monitor produced by Shandong Weigao Group Medical Polymer Co. Ltd before being anatomized and exposed in parotid surgeries in order to protect the corresponding facial nerve branch and complete the related surgery. Results All the facial nerves of the 36 patients were located precisely and 108 related facial nerves were suc-cessfully anatomized and protected without any damage. Conclusion Pinpointing the facial nerve branch with a nerve monitor before anatomization pro-motes not only the efficiency of the surgery but also the safety of it and is proved to be more significant in a secondary surgery.

  12. Postoperative antibiotic prophylaxis in clean-contaminated head and neck oncologic surgery: a retrospective cohort study.

    Science.gov (United States)

    Busch, C-J; Knecht, R; Münscher, A; Matern, J; Dalchow, C; Lörincz, B B

    2016-09-01

    Antibiotic prophylaxis is commonly used in head and neck oncologic surgery, due to the clean-contaminated nature of these procedures. There is a wide variety in the use of prophylactic antibiotics regarding the duration of application and the choice of agent. The purpose of this study was to determine whether short-term or long-term antibiotic prophylaxis has an impact on the development of head and neck surgical wound infection (SWI). Retrospective chart review was carried out in 418 clean-contaminated head and neck surgical oncology cases at our department. More than 50 variables including tumour type and stage, type of surgical treatment, co-morbidities, duration and choice of antibiotic prophylaxis, and the incidence of SWI were analysed. Following descriptive data analysis, Chi square test by Pearson and Fisher's exact test were used for statistical evaluation. Fifty-eight of the 418 patients (13.9 %) developed SWI. Patients with advanced disease and tracheotomy showed a significantly higher rate of SWI than those with early stage disease and without tracheotomy (p = 0.012 and p = 0.00017, respectively). However, there was no significant difference between the SWI rates in the short term and long term treatment groups (14.6 and 13.2 %, respectively; p = 0.689). Diabetes and body weight were not found to be risk factors for SWI. Long-term antibiotic prophylaxis was not associated with a decrease in SWI in the entire cohort of patients undergoing clean-contaminated major head and neck oncologic surgery. Our data confirmed the extent of surgery and tracheotomy as being risk factors for postoperative SWI.

  13. Endoscopist-Administered Propofol: A Retrospective Safety Study

    Directory of Open Access Journals (Sweden)

    John WI Morse

    2008-01-01

    Full Text Available BACKGROUND: Propofol is an anesthetic agent that is commonly used for conscious sedation. Propofol has advantages as a sedative agent for endoscopic procedures including rapid onset, short half-life and rapid recovery time. However, concerns exist regarding the potential for respiratory depression, hypotension, perforation due to deep sedation and the need for monitoring by an anesthetist. Propofol has been used under endoscopist supervision at the Stanton Territorial Hospital in Yellowknife, Northwest Territories since 1996 (approximately 7000 cases.

  14. Efficacy and safety of oxaliplatin chemotherapy programs as adjuvant treatment in colorectal cancer after surgery

    Institute of Scientific and Technical Information of China (English)

    杨莉萍

    2013-01-01

    Objective To compare the efficacy and safety of 5-fluorouracil and calcium folinatc combined with oxaliplatin(FOLFOX) program with capecitabine regimen combined oxaliplatin(XELOX) program as adjuvant chemotherapy in advanced colorectal cancer after surgery.

  15. Melatonin versus midazolam premedication in children undergoing surgery: A pilot study.

    Science.gov (United States)

    Gitto, Eloisa; Marseglia, Lucia; D'Angelo, Gabriella; Manti, Sara; Crisafi, Caterina; Montalto, Angela Simona; Impellizzeri, Pietro; Reiter, Russel J; Romeo, Carmelo

    2016-03-01

    Melatonin has been proposed as a premedication alternative to midazolam, preceding anaesthesia induction. However, to our knowledge, data concerning interaction between melatonin and intravenous anaesthetic drugs in children are not available. The aim of this prospective, randomized, double-blind pilot study was to investigate the possible effect of melatonin premedication, in comparison to midazolam, on the required infusion of propofol in children undergoing surgery. As a secondary outcome, the effect of oral melatonin on the preoperative sedation level and on the post anaesthesia recovery score was evaluated. Children between the age of 5 and 14 years, scheduled for elective surgery, were prospectively enrolled between January 2012 and December 2013, and randomly assigned to two groups based on whether they received oral melatonin (0.5 mg/kg) or oral midazolam (0.5 mg/kg) premedication before induction of anaesthesia with propofol. Degree of sedation before and after anaesthesia was also evaluated. Ninety-two patients were studied, 46 for each group. We found that oral administration of melatonin significantly reduced doses of propofol required for induction of anaesthesia in paediatric patients, more than midazolam (P midazolam. These data support the use of melatonin as a premedicant in paediatric surgical patients. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  16. A stepped strategy that aims at the nationwide implementation of the Enhanced Recovery After Surgery programme in major gynaecological surgery: study protocol of a cluster randomised controlled trial.

    Science.gov (United States)

    de Groot, Jeanny Ja; Maessen, José Mc; Slangen, Brigitte Fm; Winkens, Bjorn; Dirksen, Carmen D; van der Weijden, Trudy

    2015-07-30

    Enhanced Recovery After Surgery (ERAS) programmes aim at an early recovery after surgical trauma and consequently at a reduced length of hospitalisation. This paper presents the protocol for a study that focuses on large-scale implementation of the ERAS programme in major gynaecological surgery in the Netherlands. The trial will evaluate effectiveness and costs of a stepped implementation approach that is characterised by tailoring the intensity of implementation activities to the needs of organisations and local barriers for change, in comparison with the generic breakthrough strategy that is usually applied in large-scale improvement projects in the Netherlands. All Dutch hospitals authorised to perform major abdominal surgery in gynaecological oncology patients are eligible for inclusion in this cluster randomised controlled trial. The hospitals that already fully implemented the ERAS programme in their local perioperative management or those who predominantly admit gynaecological surgery patients to an external hospital replacement care facility will be excluded. Cluster randomisation will be applied at the hospital level and will be stratified based on tertiary status. Hospitals will be randomly assigned to the stepped implementation strategy or the breakthrough strategy. The control group will receive the traditional breakthrough strategy with three educational sessions and the use of plan-do-study-act cycles for planning and executing local improvement activities. The intervention group will receive an innovative stepped strategy comprising four levels of intensity of support. Implementation starts with generic low-cost activities and may build up to the highest level of tailored and labour-intensive activities. The decision for a stepwise increase in intensive support will be based on the success of implementation so far. Both implementation strategies will be completed within 1 year and evaluated on effect, process, and cost-effectiveness. The primary

  17. A study on the safety of radioactive waste incineration facilities

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Y. C. [Yonsei Univ., Seoul (Korea, Republic of); Park, W. J.; Lee, B. S.; Lee, S. H. [Korea Institute of Nuclear Safety, Taejon (Korea, Republic of)

    1994-12-15

    The main scope of the project is the selection of some considerable items in design criteria of radioactive waste incineration facilities not only for the protection of workers and residents during operation but also for the safe disposal of ashes after incineration. The technological and regulational status on incineration technologies in domestic and foreign is surveyed and analyzed for providing such basic items which must be contained in the guideline for safe and appropriate design, construction and operation of the facilities. The contents of the project are summarized as follows; surveying the status on incineration technologies for both radioactive and non-radioactive wastes in domestic and foreign, surveying and analysing same related technical standards and regulations in domestic and foreign, picking out main considerable items and proposing a direction of further research.

  18. A study on the safety of radioactive waste incineration facilities

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Y. C. [Yonsei Univ., Seoul (Korea, Republic of); Park, W. J.; Lee, B. S.; Lee, S. H. [Korea Institute of Nuclear Safety, Taejon (Korea, Republic of)

    1994-12-15

    The main scope of the project is the selection of some considerable items in design criteria of radioactive waste incineration facilities not only for the protection of workers and residents during operation but also for the safe disposal of ashes after incineration. The technological and regulational status on incineration technologies in domestic and foreign is surveyed and analyzed for providing such basic items which must be contained in the guideline for safe and appropriate design, construction and operation of the facilities. The contents of the project are summarized as follows; surveying the status on incineration technologies for both radioactive and non-radioactive wastes in domestic and foreign, surveying and analysing same related technical standards and regulations in domestic and foreign, picking out main considerable items and proposing a direction of further research.

  19. Attention Deficit Hyperactivity Disorder Prevalence and Correlates Pre- and Post-Bariatric Surgery: A Comparative Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Friedrich Nielsen

    2017-01-01

    Full Text Available Objective: Previous research shows an association between obesity and attention deficit hyperactivity disorder (ADHD. The present study compares pre- and post-bariatric surgery patients using the internationally used Conners' Adult ADHD Rating Scale (CAARS™ to screen for ADHD. Methods: Matched samples pre- (N = 120 and post-bariatric surgery (N = 128 were compared using self-rating instruments to assess ADHD-relevant symptomatology, depression, eating-related psychopathology, and BMI. Results: Prevalence of probable ADHD did not differ between groups using the CAARS Index Scale T-scores; however, CAARS subscales Inattention/Memory and Self-Concept showed significantly lower scores in post-surgery patients. All CAARS subscales correlated significantly with each other, with depression and eating-related psychopathology. There was no correlation between ADHD and excess BMI loss in post-surgery patients. Conclusion: The findings suggest that a considerable number of patients before and after bariatric surgery screened positive for ADHD. It can be hypothesized that some core ADHD symptoms improve after surgery. Future studies are warranted to investigate the influence of ADHD on long-term surgery outcomes.

  20. Comprehension of workplace safety signs: A case study in an industrial company in Shiraz

    Directory of Open Access Journals (Sweden)

    2012-01-01

    Full Text Available Introduction: Safety signs provide information as well as instructions concerning the hazard or dangers in the workplace. The correct comprehension of these signs is very important for doing the necessary feedback in the specific situation which they are described. . Method and Materials: In this cross sectional study, the comprehension of 10 selected safety signs were investigated in 53 randomly selected employees of an industrial company in Shiraz. The comprehension test was carried out by aid a standard questionnaire obtained from ISO 9186-1:2007. .Results: In this study the mean comprehension scores of the tested signs was 65.95 percent with standard deviation if 28.7. The highest and lowest comprehension scores were for “use hearing protectors” and “biological hazard” respectively. The comprehension of 40 percent of tested safety signs was lower than the minimum acceptable values of ISO 3864 and ANSI Z535.3 standards.. Conclusion: This study showed that there is a significant difference in comprehensions of tested safety signs. For full comprehension of safety signs it is necessary to train the employees or adding supplementary text to the symbols in some cases.

  1. Measuring patient safety culture in maternal and child health institutions in China: a qualitative study.

    Science.gov (United States)

    Wang, Yuanyuan; Liu, Weiwei; Shi, Huifeng; Liu, Chaojie; Wang, Yan

    2017-07-12

    Patient safety culture (PSC) plays a critical role in ensuring safe and quality care. Extensive PSC studies have been undertaken in hospitals. However, little is known about PSC in maternal and child health (MCH) institutions in China, which provide both population-based preventive services as well as individual care for patients. This study aimed to develop a theoretical framework for conceptualising PSC in MCH institutions in China. The study was undertaken in six MCH institutions (three in Hebei and three in Beijing). Participants (n=118) were recruited through stratified purposive sampling: 20 managers/administrators, 59 care providers and 39 patients. In-depth interviews were conducted with the participants. The interview data were coded using both inductive (based on the existing PSC theory developed by the Agency for Healthcare Research and Quality) and deductive (open coding arising from data) approaches. A PSC framework was formulated through axial coding that connected initial codes and selective coding that extracted a small number of themes. The interviewees considered patient safety in relation to six aspects: safety and security in public spaces, safety of medical services, privacy and information security, financial security, psychological safety and gap in services. A 12-dimensional PSC framework was developed, containing 69 items. While the existing PSC theory was confirmed by this study, some new themes emerged from the data. Patients expressed particular concerns about psychological safety and financial security. Defensive medical practices emerged as a PSC dimension that is associated with not only medical safety but also financial security and psychological safety. Patient engagement was also valued by the interviewees, especially the patients, as part of PSC. Although there are some common features in PSC across different healthcare delivery systems, PSC can also be context specific. In MCH settings in China, the meaning of 'patient safety

  2. The use of a surgical incision management system on vascular surgery incisions: a pilot study.

    Science.gov (United States)

    Weir, Gregory

    2014-06-01

    Health care-associated infections in hospitals, including surgical site infections, contribute significantly to morbidity as well as mortality. Surgical incision management (SIM) using negative pressure wound therapy (Prevena™ Incision Management System, Kinetic Concepts, Inc., San Antonio, TX, USA) is designed to cover and protect closed surgical incisions from external factors including infectious sources and local trauma, while negative pressure removes fluid and infectious material from the surgical incision. A prospective case-control study assessed wound complications in patients undergoing vascular bypass procedures, where both femoral areas were incised to gain access to the femoral arteries. SIM was placed on one femoral area while a standard postoperative wound dressing was placed on the contralateral femoral area. Eight patients were included in this pilot study. All of them required bilateral femoral artery access. During the follow-up period patients were monitored for wound complications. All wound complications requiring surgical intervention were considered significant. No significant wound complications occurred in wounds treated with SIM, compared with three significant complications in control wounds. These preliminary data would suggest a potential reduction in wound complications and no observed increase in haemorrhage in high-risk patients with severe co-morbidities undergoing vascular surgery.

  3. Preliminary planning study for safety relief valve experiments in a Mark III BWR pressure suppression system

    Energy Technology Data Exchange (ETDEWEB)

    McCauley, E.W.; Holman, G.S.

    1980-04-21

    In response to a request from the Water Reactor Safety Research Division of the US NRC, a preliminary study is provided which identifies key features and consideration involved in planning a comprehensive in-plant Safety Relief Valve experimental program for a Mark III containment design. The report provides identification of program objectives, measurement system requirements, and some details quantifying expected system response. In addition, a preliminary test matrix is outlined which involves a supporting philosophy intended to enhance the usefulness of the experimental results for all members of the program team: experimentalists, analysts, and plant operator.

  4. Safety Management. An Introduction to a Frame of Reference Exemplified with Case Studies from Non-Nuclear Contexts

    Energy Technology Data Exchange (ETDEWEB)

    Svensson, Ola (Risk Analysis, Social and Decision Research Unit, Dept. of Psychology, Stockholm Univ., Stockholm (Sweden)); Salo, Ilkka (Dept. of Psychology, Lund Univ., Lund (Sweden))

    2004-11-15

    A systems perspective on safety management is introduced followed by two briefly presented case studies of safety management in non-nuclear contexts. The first study concerns a car manufacturer and the second study a road traffic tunnel system. The risks of a car accident in the first case study are evident. The great exposure generates many incidents and accidents. In the second study, the rather low traffic intensity through the tunnel produces few incidents and accidents and only a few fatal accidents over the years. Yet, the risk of the individual traveler is much greater in the tunnel than on the average road. The case studies are presented in a systems perspective with emphasis on information feedback about the risks of the systems. The first case study illustrates high quality safety management, while the second case study shows many weaknesses of the safety management in the tunnel system. Some differences in safety management between the case studies are noted. The last part of the study presents an organizational perspective on safety management and offers alternative theoretical perspectives on the concept of safety management. The report shows that further studies are needed both (1) to develop a frame of reference for describing safety management across industries and activities and (2) to collect data illustrating of good and poor safety management. Then, the results can be used to strengthen and/or improving safety management in the nuclear power industry and its regulators

  5. Efficacy and safety of intravenous lidocaine for postoperative analgesia and recovery after surgery

    DEFF Research Database (Denmark)

    Weibel, S; Jokinen, J; Pace, N L

    2016-01-01

    % CI -0.47 to 0.03). Subgroup analysis and trial sequential analysis suggested pain reduction for patients undergoing laparoscopic abdominal surgery or open abdominal surgery, but not for patients undergoing other surgeries. There was limited evidence of positive effects of lidocaine on postoperative...... infusion. RESULTS: Forty-five trials (2802 participants) were included. Meta-analysis suggested that lidocaine reduced postoperative pain (visual analogue scale, 0 to 10 cm) at 1-4 h (MD -0.84, 95% CI -1.10 to -0.59) and at 24 h (MD -0.34, 95% CI -0.57 to -0.11) after surgery, but not at 48 h (MD -0.22, 95......) and indirectness (small studies). CONCLUSIONS: There is limited evidence suggesting that i.v. lidocaine may be a useful adjuvant during general anaesthesia because of its beneficial impact on several outcomes after surgery....

  6. Correlates of non-technical skills in surgery: a prospective study

    Science.gov (United States)

    Gillespie, Brigid M; Harbeck, Emma; Steel, Catherine; Fairweather, Nicole; Chaboyer, Wendy

    2017-01-01

    Background Communication and teamwork failures have frequently been identified as the root cause of adverse events and complications in surgery. Few studies have examined contextual factors that influence teams’ non-technical skills (NTS) in surgery. The purpose of this prospective study was to identify and describe correlates of NTS. Methods We assessed NTS of teams and professional role at 2 hospitals using the revised 23-item Non-TECHnical Skills (NOTECHS) and its subscales (communication, situational awareness, team skills, leadership and decision-making). Over 6 months, 2 trained observers evaluated teams’ NTS using a structured form. Interobserver agreement across hospitals ranged from 86% to 95%. Multiple regression models were developed to describe associations between operative time, team membership, miscommunications, interruptions, and total NOTECHS and subscale scores. Results We observed 161 surgical procedures across 8 teams. The total amount of explained variance in NOTECHS and its 5 subscales ranged from 14% (adjusted R2 0.12, p<0.001) to 24% (adjusted R2 0.22, p<0.001). In all models, inverse relationships between the total number of miscommunications and total number of interruptions and teams’ NTS were observed. Conclusions Miscommunications and interruptions impact on team NTS performance. PMID:28137931

  7. A Case Study of Dynamic Response Analysis and Safety Assessment for a Suspended Monorail System.

    Science.gov (United States)

    Bao, Yulong; Li, Yongle; Ding, Jiajie

    2016-11-10

    A suspended monorail transit system is a category of urban rail transit, which is effective in alleviating traffic pressure and injury prevention. Meanwhile, with the advantages of low cost and short construction time, suspended monorail transit systems show vast potential for future development. However, the suspended monorail has not been systematically studied in China, and there is a lack of relevant knowledge and analytical methods. To ensure the health and reliability of a suspended monorail transit system, the driving safety of vehicles and structure dynamic behaviors when vehicles are running on the bridge should be analyzed and evaluated. Based on the method of vehicle-bridge coupling vibration theory, the finite element method (FEM) software ANSYS and multi-body dynamics software SIMPACK are adopted respectively to establish the finite element model for bridge and the multi-body vehicle. A co-simulation method is employed to investigate the vehicle-bridge coupling vibration for the transit system. The traffic operation factors, including train formation, track irregularity and tire stiffness, are incorporated into the models separately to analyze the bridge and vehicle responses. The results show that the coupling of dynamic effects of the suspended monorail system between vehicle and bridge are significant in the case studied, and it is strongly suggested to take necessary measures for vibration suppression. The simulation of track irregularity is a critical factor for its vibration safety, and the track irregularity of A-level road roughness negatively influences the system vibration safety.

  8. A multi-centric prospective study: Anxiety and associated factors among parents of children undergoing mild surgery in ENT

    Directory of Open Access Journals (Sweden)

    Mehmet Akdağ

    2014-06-01

    Full Text Available Objective: The aim of this study to evaluate the anxiety and expectancy among parents of children undergoing surgery in the multi-centric surgery units. Methods: Following approval from the ethics committee, a questionnaire was given to the parents of 123 children who were undergoing surgery in the multi-centric surgery units. The parents were informed that their answers would not affect the care given to their children. The questionnaire was evaluated using the State-Trait Anxiety Inventory (STAI-I and STAI-II. Results: The STAI results indicated that the parents’ anxiety level increased before their children underwent surgery. In addition, there was a negative correlation between STAI-II scores and high levels of wealth (p= 0.004. Also, those with steady employment and higher levels of education had lower anxiety levels and difference was significant (p=0.001. The state anxiety levels were unaffected by family income and education, but the trait anxiety levels decreased with increasing income and education. Mothers were less anxious if their child had undergone surgery in the past, while this result was not significant statistically (p>0.05. Parents were most commonly concerned with possible complications from the surgery and/or anesthesia. Conclusion: Results of our study indicate that parents of children undergoing surgery that have steady employment, to be informed, previously has been administered anesthesia or surgery, high level of wealth and education was observed less anxiety than others. J Clin Exp Invest 2014; 5 (2: 206-210

  9. Effects on incident reporting after educating residents in patient safety: a controlled study

    Directory of Open Access Journals (Sweden)

    Jansma José D

    2011-12-01

    Full Text Available Abstract Background Medical residents are key figures in delivering health care and an important target group for patient safety education. Reporting incidents is an important patient safety domain, as awareness of vulnerabilities could be a starting point for improvements. This study examined effects of patient safety education for residents on knowledge, skills, attitudes, intentions and behavior concerning incident reporting. Methods A controlled study with follow-up measurements was conducted. In 2007 and 2008 two patient safety courses for residents were organized. Residents from a comparable hospital acted as external controls. Data were collected in three ways: 1] questionnaires distributed before, immediately after and three months after the course, 2] incident reporting cards filled out by course participants during the course, and 3] residents' reporting data gathered from hospital incident reporting systems. Results Forty-four residents attended the course and 32 were external controls. Positive changes in knowledge, skills and attitudes were found after the course. Residents' intentions to report incidents were positive at all measurements. Participants filled out 165 incident reporting cards, demonstrating the skills to notice incidents. Residents who had reported incidents before, reported more incidents after the course. However, the number of residents reporting incidents did not increase. An increase in reported incidents was registered by the reporting system of the intervention hospital. Conclusions Patient safety education can have immediate and long-term positive effects on knowledge, skills and attitudes, and modestly influence the reporting behavior of residents.

  10. Micro-economic impact of congenital heart surgery: results of a prospective study from a limited-resource setting.

    Directory of Open Access Journals (Sweden)

    Manu Raj

    Full Text Available The microeconomic impact of surgery for congenital heart disease is unexplored, particularly in resource limited environments. We sought to understand the direct and indirect costs related to congenital heart surgery and its impact on Indian households from a family perspective.Baseline and first follow-up data of 644 consecutive children admitted for surgery for congenital heart disease (March 2013 - July 2014 in a tertiary referral hospital in Central Kerala, South India was collected prospectivelyfrom parents through questionnaires using a semi-structured interview schedule.The median age was 8.2 months (IQR: 3.0- 36.0 months. Most families belonged to upper middle (43.0% and lower middle (35.7% socioeconomic class. Only 3.9% of families had some form of health insurance. The median expense for the admission and surgery was INR 201898 (IQR: 163287-266139 [I$ 11989 (IQR: 9696-15804], which was 0.93 (IQR: 0.52-1.49 times the annual family income of affected patients. Median loss of man-days was 35 (IQR: 24-50 and job-days was 15 (IQR: 11-24. Surgical risk category and hospital stay duration significantly predicted higher costs. One in two families reported overwhelming to high financial stress during admission period for surgery. Approximately half of the families borrowed money during the follow up period after surgery.Surgery for congenital heart disease results in significant financial burden for majority of families studied. Efforts should be directed at further reductions in treatment costs without compromising the quality of care together with generating financial support for affected families.

  11. Micro-economic impact of congenital heart surgery: results of a prospective study from a limited-resource setting.

    Science.gov (United States)

    Raj, Manu; Paul, Mary; Sudhakar, Abish; Varghese, Anu Alphonse; Haridas, Aareesh Chittulliparamb; Kabali, Conrad; Kumar, Raman Krishna

    2015-01-01

    The microeconomic impact of surgery for congenital heart disease is unexplored, particularly in resource limited environments. We sought to understand the direct and indirect costs related to congenital heart surgery and its impact on Indian households from a family perspective. Baseline and first follow-up data of 644 consecutive children admitted for surgery for congenital heart disease (March 2013 - July 2014) in a tertiary referral hospital in Central Kerala, South India was collected prospectivelyfrom parents through questionnaires using a semi-structured interview schedule. The median age was 8.2 months (IQR: 3.0- 36.0 months). Most families belonged to upper middle (43.0%) and lower middle (35.7%) socioeconomic class. Only 3.9% of families had some form of health insurance. The median expense for the admission and surgery was INR 201898 (IQR: 163287-266139) [I$ 11989 (IQR: 9696-15804)], which was 0.93 (IQR: 0.52-1.49) times the annual family income of affected patients. Median loss of man-days was 35 (IQR: 24-50) and job-days was 15 (IQR: 11-24). Surgical risk category and hospital stay duration significantly predicted higher costs. One in two families reported overwhelming to high financial stress during admission period for surgery. Approximately half of the families borrowed money during the follow up period after surgery. Surgery for congenital heart disease results in significant financial burden for majority of families studied. Efforts should be directed at further reductions in treatment costs without compromising the quality of care together with generating financial support for affected families.

  12. Obesity Slows Recovery for Heart Surgery Patients: Study

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_167721.html Obesity Slows Recovery for Heart Surgery Patients: Study They' ... Aug. 10 in The Annals of Thoracic Surgery . "Obesity is a growing problem for society that has ...

  13. Behavioral risk factors associated with listeriosis in the home: a review of consumer food safety studies.

    Science.gov (United States)

    Evans, Ellen W; Redmond, Elizabeth C

    2014-03-01

    Listeria monocytogenes causes human listeriosis, which is associated with the highest hospitalization and mortality rates of all foodborne illnesses. In recent years, the incidence of listeriosis has doubled in Europe, almost exclusively among older adults (≥ 60 years of age). Food safety factors associated with increased risk of listeriosis include lack of adherence to "use by" dates and ineffective refrigerated storage of foods. Consequently, older adult consumers' implementation of safe food practices should be evaluated. This article is a review of consumer food safety cognitive and behavioral data relating to risk factors associated with listeriosis in the home as reported in 165 consumer food safety studies. Overall, only 41% of studies included assessment of consumer cognitive or behavioral data associated with listeriosis; of these studies 59% included data on safe refrigeration, 54% included data on storage time for opened ready-to-eat foods, and 49% included data on adherence to use-by dates. In most (83%) of the studies, survey-based data collection methods (questionnaires/interviews) were used; thus, the majority of findings were based on self-report (74%) and knowledge (44%). Observation (31%) and focus groups (12%) were less commonly used, resulting in a lack of actual behaviors and attitudinal data relating to listeriosis risk factors. Only 7% of studies included food safety data for older adults. Although older adults may fail to implement recommended practices, this review reveals a need for in-depth research to determine food safety attitudes and actual behaviors of older adults in conjunction with knowledge and selfreport of practices linked to increased risks of listeriosis. Such data combined with review findings would inform targeted food safety education to reduce risks associated with listeriosis in the home.

  14. Patient safety attitudes of pharmacy students in an Ethiopian university: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Tegegn HG

    2017-05-01

    Full Text Available Henok Getachew Tegegn, Tamrat Befekadu Abebe, Mohammed Biset Ayalew, Akshaya Srikanth Bhagavathula Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia Introduction: Patient safety is a major health care concern and is being included in an undergraduate curriculum as it plays a major role in lessening harm. Therefore, we aim to assess the attitude of pharmacy students toward patient safety.Methods: A cross-sectional study using a self-administered questionnaire containing 21 items was conducted at the University of Gondar among fourth and fifth year students. Data analysis was performed to calculate mean, standard deviation, percentages, and logistic regressions using SPSS software version 22 (IBM Corporation, Armonk, NY, USA. Statistical significance was set at P<0.05.Results: A total of 83 pharmacy students (fourth year groups=50, fifth year groups=33 participated in the study with response rate of 92%. Majority of the students 70/83 (84.33% had the overall positive attitude of patient safety. Most of the respondents (80.7% agree or strongly agree that after an error occurs, an effective strategy is to work hard to be more careful. Most of them (79.6% believe that pharmacists should routinely spend part of their professional time working to improve patient care. About half (48.2% of pharmacy students disagree or strongly disagree that pharmacists should discuss and report errors to an affected patient and their family even if the patient is not harmed. No significant association between the attitude of pharmacy students toward patient safety and their age, sex and year of study was found.Conclusion: Pharmacy students have the overall good attitude to patient safety. However, they claimed the culture and attitude within the pharmacy workplace lacked for patient safety. Moreover, standardized patient safety course should be considered in the curriculum for junior

  15. A comparative effectiveness trial of postoperative management for lumbar spine surgery: changing behavior through physical therapy (CBPT) study protocol.

    Science.gov (United States)

    Archer, Kristin R; Coronado, Rogelio A; Haug, Christine M; Vanston, Susan W; Devin, Clinton J; Fonnesbeck, Christopher J; Aaronson, Oran S; Cheng, Joseph S; Skolasky, Richard L; Riley, Lee H; Wegener, Stephen T

    2014-10-01

    The United States has the highest rate of lumbar spine surgery in the world, with rates increasing over 200% since 1990. Medicare spends over $1 billion annually on lumbar spine surgery. Despite surgical advances, up to 40% of patients report chronic pain and disability following surgery. Our work has demonstrated that fear of movement is a risk factor for increased pain and disability and decreased physical function in patients following lumbar spine surgery for degenerative conditions. Cognitive-behavioral therapy and self-management treatments have the potential to address psychosocial risk factors and improve outcomes after spine surgery, but are unavailable or insufficiently adapted for postoperative care. Our research team developed a cognitive-behavioral based self-management approach to postoperative rehabilitation (Changing Behavior through Physical Therapy (CBPT)). Pilot testing of the CBPT program demonstrated greater improvement in pain, disability, physical and mental health, and physical performance compared to education. The current study compares which of two treatments provided by telephone - a CBPT Program or an Education Program about postoperative recovery - are more effective for improving patient-centered outcomes in adults following lumbar spine surgery for degenerative conditions. A multi-center, comparative effectiveness trial will be conducted. Two hundred and sixty patients undergoing lumbar spine surgery for degenerative conditions will be recruited from two medical centers and community surgical practices. Participants will be randomly assigned to CBPT or Education at 6 weeks following surgery. Treatments consist of six weekly telephone sessions with a trained physical therapist. The primary outcome will be disability and secondary outcomes include pain, general health, and physical activity. Outcomes will be assessed preoperatively and at 6 weeks, 6 months and 12 months after surgery by an assessor masked to group allocation

  16. Driver characteristics associated with child safety seat usage in Malaysia: a cross-sectional study.

    Science.gov (United States)

    Kulanthayan, S; Razak, Ahmad; Schenk, Ellen

    2010-03-01

    The rapidly motorizing environment in Malaysia has made child occupant safety a current public health concern. The usage of child safety seats (CSS) is a widely regarded intervention to enhance child occupant safety, yet no study has been conducted on CSS in Malaysia. This study aims to determine the CSS usage rates in Malaysia and to assess driver characteristics that are associated with CSS usage. Nine variables - urban versus rural study location, age, gender, marital status, educational status, monthly family income, number of children present in the vehicle, distance traveled to the study location, and attitude - were examined through a cross-sectional study of interviewing drivers of 230 vehicles transporting at least one child Melaka. 27.4% of the drivers were found to be using at least one CSS at the time of the survey. Among the nine variables studied, three of the driver characteristics showed statistical significance (p<0.05) with CSS usage: age (p=0.047), educational status (p=0.009), and attitude (p=0.009). This study begins to create knowledge on child occupant safety in Malaysia. The results indicate that interventional efforts should focus on educational programs geared toward drivers that are less educated or extended family members who inconsistently transport young children. Furthermore, any educational efforts could be strongly enhanced by legislation mandating the use of CSS. Every effort should be made to thoroughly assess the effectiveness of any educational or legislative activities that are implemented. Copyright 2009 Elsevier Ltd. All rights reserved.

  17. USE AND SAFETY OF A SHORTENED HISTAMINE CHALLENGE TEST IN AN OCCUPATIONAL STUDY

    NARCIS (Netherlands)

    KREMER, AM; PAL, TM; OLDENZIEL, M; KERKHOF, M; DEMONCHY, JGR; RIJCKEN, B

    1995-01-01

    A shortened histamine challenge test was used in a study of occupational airway disease. We evaluated the safety, defined as the absence of a decrease in forced expiratory volume in one second (FEV1) of greater than 40%. The occurrence of complaints, the repeatability of test results, and the averag

  18. Management of postoperative pain in abdominal surgery in Spain. A multicentre drug utilization study

    Science.gov (United States)

    Vallano, Antonio; Aguilera, Cristina; Arnau, Josep Maria; Baños, Josep-Eladi; Laporte, Joan-Ramon

    1999-01-01

    Participating centres: Hospital Universitario San Juan, Alicante: Maria Jesús Olaso, Javier Agulló, Clara Faura. Hospital Torrecárdenas, Almería: Carmen Fernández Sánchez, Miguel Lorenzo Campos, Juan Manuel Rodríguez Alonso. Hospital Quirúrgic Adriano, Barcelona: Carmen Alerany Pardo, Paquita Alvarez González, Teresa Martín Benito. Hospital Universitari del Mar-IMIM, Barcelona: Magí Farré, Maite Terán. Corporació Sanitària Parc Taulí, Sabadell: Montserrat Cañellas, Sergio Zavala, Josep Planell. Hospital Universitari de la Santa Creu i Sant Pau: Gonzalo Calvo, Rosa Morros, Silvia Mateo. Hospital General Vall d’Hebron, Barcelona: Carmen Bosch, María José Martínez. Hospital Universitario Virgen de la Victoria, Málaga: Maribel Lucena, José Antonio González, Gabriel Carranque. Hospital Clínico Universitario San Carlos, Madrid: Emilio Vargas, Amparo Gil López-Oliva, Míriam García Mateos. Hospital Universitario Marqués de Valdecilla, Santander: Mario González, Antonio Cuadrado. Hospital Universitario Virgen de la Macarena, Sevilla: Juan Antonio Durán, Pilar Máyquez, María Isabel Serrano. Hospital Universitario Virgen del Rocío, Sevilla: Jaume Torelló, Juan Ramón Castillo, María de las Nieves Merino. Aims Postoperative pain is common in hospital-admitted patients. Its management is determined by different therapeutic traditions and by the attitudes of health professionals in each hospital. The aim of this study was to describe the patterns of prescription and administration of analgesic drugs used for postoperative pain after abdominal surgery in Spanish hospitals, to know the prevalence and the severity of postoperative pain, and to determine the extent of variability in the management of postoperative pain among the participating centres. Methods The study was a multicentre descriptive cross-sectional drug utilization study in 12 Spanish hospitals. The subjects were an unselected sample of consecutive patients undergoing abdominal

  19. A post cardiac surgery intervention to manage delirium involving families: a randomized pilot study.

    Science.gov (United States)

    Mailhot, Tanya; Cossette, Sylvie; Côté, José; Bourbonnais, Anne; Côté, Marie-Claude; Lamarche, Yoan; Denault, André

    2017-07-01

    As many delirium manifestations (e.g., hallucinations or fears) are linked to patients' experiences and personality traits, it is suggested that interventions should be tailored to optimize its management. The inclusion of family members, as part of an intervention, has recently emerged as a solution to developing individualised patient care, but has never been assessed in post-cardiac surgery intensive care unit where almost half of patients will present with delirium. To assess the feasibility, acceptability and preliminary efficacy of an nursing intervention involving family caregivers (FC) in delirium management following cardiac surgery. A randomized pilot study. A total of 30 patient/FC dyads were recruited and randomized to usual care (n = 14) or intervention (n = 16). The intervention was based on the Human Caring Theory, a mentoring model, and sources informing self-efficacy. It comprised seven planned encounters spread over 3 days between an intervention nurse and the FC, each including a 30-min visit at the patient's bedside. During this bedside visit, the FC used delirium management strategies, e.g. reorient the person with delirium. The primary indicator of acceptability was to obtain consent from 75% of approached FCs. The preliminary effect of the intervention on patient outcomes was assessed on (1) delirium severity using the Delirium Index, (2) occurrence of complications, such as falls, (3) length of postoperative hospital stay and (4) psycho-functional recovery using the Sickness Impact Profile. The preliminary effect on FC outcomes was assessed on FC anxiety and self-efficacy. Data were analysed using descriptive statistics, ANCOVAs and logistic regressions. The primary indicator of obtaining consent from FC was achieved (77%). Of the 14 dyads, thirteen (93%) dyads received all seven encounters planned in the experimental intervention. Intervention group patients presented better psycho-functional recovery scores when compared with

  20. Assessment of radiation safety awareness among nuclear medicine nurses: a pilot study

    Science.gov (United States)

    Yunus, N. A.; Abdullah, M. H. R. O.; Said, M. A.; Ch'ng, P. E.

    2014-11-01

    All nuclear medicine nurses need to have some knowledge and awareness on radiation safety. At present, there is no study to address this issue in Malaysia. The aims of this study were (1) to determine the level of knowledge and awareness on radiation safety among nuclear medicine nurses at Putrajaya Hospital in Malaysia and (2) to assess the effectiveness of a training program provided by the hospital to increase the knowledge and awareness of the nuclear medicine nurses. A total of 27 respondents attending a training program on radiation safety were asked to complete a questionnaire. The questionnaire consists 16 items and were categorized into two main areas, namely general radiation knowledge and radiation safety. Survey data were collected before and after the training and were analyzed using descriptive statistics and paired sample t-test. Respondents were scored out of a total of 16 marks with 8 marks for each area. The findings showed that the range of total scores obtained by the nuclear medicine nurses before and after the training were 6-14 (with a mean score of 11.19) and 13-16 marks (with a mean score of 14.85), respectively. Findings also revealed that the mean score for the area of general radiation knowledge (7.59) was higher than that of the radiation safety (7.26). Currently, the knowledge and awareness on radiation safety among the nuclear medicine nurses are at the moderate level. It is recommended that a national study be conducted to assess and increase the level of knowledge and awareness among all nuclear medicine nurses in Malaysia.

  1. A feasibility study to investigate the use of a bupivacaine-collagen implant (XaraColl for postoperative analgesia following laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Hemsen L

    2013-02-01

    Full Text Available Lisa Hemsen,1 Susan L Cusack,2 Harold S Minkowitz,3 Michael E Kuss41Innocoll Technologies, Athlone, Ireland; 2Cusack Pharmaceutical Consulting, Burlington, NJ, USA; 3Memorial Hermann Memorial City Medical Center, Houston, TX, USA; 4Premier Research Group, Austin, TX, USABackground: XaraColl, a collagen-based implant that delivers bupivacaine to sites of surgical trauma, has been shown to reduce postoperative pain and use of opioid analgesia in patients undergoing open surgery. We therefore designed and conducted a preliminary feasibility study to investigate its application and ease of use for laparoscopic surgery.Methods: We implanted four XaraColl implants each containing 50 mg of bupivacaine hydrochloride (200 mg total dose in ten men undergoing laparoscopic inguinal or umbilical hernioplasty. Postoperative pain intensity and use of opioid analgesia were recorded through 72 hours for comparison with previously reported data from efficacy studies performed in men undergoing open inguinal hernioplasty. Safety was assessed for 30 days.Results: XaraColl was easily and safely implanted via a laparoscope. The summed pain intensity and total use of opioid analgesia through the first 24 hours were similar to the values observed in previously reported studies for XaraColl-treated patients after open surgery, but were lower through 48 and 72 hours.Conclusion: XaraColl is suitable for use in laparoscopic surgery and may provide postoperative analgesia in laparoscopic patients who often experience considerable postoperative pain in the first 24–48 hours following hospital discharge. Randomized controlled trials specifically to evaluate its efficacy in this application are warranted.Keywords: laparoscopic, hernioplasty, hernia repair