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Sample records for surgery a safety study

  1. Patient safety risk factors in minimally invasive surgery : A validation study

    NARCIS (Netherlands)

    Rodrigues, S.P.; Ter Kuile, M.; Dankelman, J.; Jansen, F.W.

    2012-01-01

    This study was conducted to adapt and validate a patient safety (PS) framework for minimally invasive surgery (MIS) as a first step in understanding the clinical relevance of various PS risk factors in MIS. Eight patient safety risk factor domains were identified using frameworks from a systems

  2. Safety in cardiac surgery

    NARCIS (Netherlands)

    Siregar, S.

    2013-01-01

    The monitoring of safety in cardiac surgery is a complex process, which involves many clinical, practical, methodological and statistical issues. The objective of this thesis was to measure and to compare safety in cardiac surgery in The Netherlands using the Netherlands Association for

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

    Science.gov (United States)

    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.

  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

    of reducing oxidative damage. The aim of this pilot study was to evaluate the safety of various doses of melatonin administered during or after surgery and to monitor the changes in biomarkers of oxidative stress and inflammation during the pre-, intra-, and postoperative period. Six patients undergoing......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......-reactive protein (CRP) were also measured for 4 days after surgery. Melatonin administration did not change hemodynamic parameters (mean arterial pressure or pulse rate) during surgery (P = 0.499 and 0.149, respectively), but oxidative stress parameters (MDA and AA) decreased significantly (P = 0.014 and 0...

  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

    of reducing oxidative damage. The aim of this pilot study was to evaluate the safety of various doses of melatonin administered during or after surgery and to monitor the changes in biomarkers of oxidative stress and inflammation during the pre-, intra- and postoperative period. Six patients undergoing aortic......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......) were also measured for four days after surgery. Melatonin administration did not change hemodynamic parameters (mean arterial pressure or pulse rate) during surgery (P=0.499 and 0.149, respectively), but oxidative stress parameters (MDA and AA) decreased significantly (P=0.014 and 0.001, respectively...

  6. Patient Safety in Spine Surgery: Regarding the Wrong-Site Surgery

    OpenAIRE

    Lee, Seung-Hwan; Kim, Ji-Sup; Jeong, Yoo-Chul; Kwak, Dae-Kyung; Chun, Ja-Hae; Lee, Hwan-Mo

    2013-01-01

    Patient safety regarding wrong site surgery has been one of the priority issues in surgical fields including that of spine care. Since the wrong-side surgery in the DM foot patient was reported on a public mass media in 1996, the wrong-site surgery issue has attracted wide public interest as regarding patient safety. Despite the many wrong-site surgery prevention campaigns in spine care such as the operate through your initial program by the Canadian Orthopaedic Association, the sign your sit...

  7. The Feasibility and Safety of Surgery in Patients Receiving Immune Checkpoint Inhibitors: A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Alexandra W. Elias

    2017-06-01

    Full Text Available Immune checkpoint inhibitors (ICI are revolutionizing care for cancer patients. The list of malignancies for which the Food and Drug Administration is granting approval is rapidly increasing. Furthermore, there is a concomitant increase in clinical trials incorporating ICI. However, the safety of ICI in patients undergoing surgery remains unclear. Herein, we assessed the safety of ICI in the perioperative setting at a single center. We conducted a retrospective review of patients who underwent planned surgery while receiving ICI in the perioperative setting from 2012 to 2016. We collected 30-day postoperative morbidity and mortality utilizing the Clavien–Dindo classification system. We identified 17 patients who received perioperative ICI in 22 operations. Patients were diagnosed with melanoma (n = 14, renal cell carcinoma (n = 2, and urothelial carcinoma (n = 1. Therapies included pembrolizumab (n = 10, ipilimumab (n = 5, atezolizumab (n = 5, and ipilimumab/nivolumab (n = 2. Procedures included cutaneous/subcutaneous resection (n = 6, lymph node resection (n = 5, small bowel resection (n = 5, abdominal wall resection (n = 3, other abdominal surgery (n = 3, orthopedic surgery (n = 1, hepatic resection (n = 1, and neurosurgery (n = 2. There were no Grade III–IV Clavien–Dindo complications. There was one death secondary to ventricular fibrillation in the setting of coronary artery disease. ICI appear safe in the perioperative setting, involving multiple different types of surgery, and likely do not need to be stopped in the perioperative setting. Further studies are warranted to confirm these findings.

  8. Pre-surgery briefings and safety climate in the operating theatre.

    Science.gov (United States)

    Allard, Jon; Bleakley, Alan; Hobbs, Adrian; Coombes, Lee

    2011-08-01

    In 2008, the WHO produced a surgical safety checklist against a background of a poor patient safety record in operating theatres. Formal team briefings are now standard practice in high-risk settings such as the aviation industry and improve safety, but are resisted in surgery. Research evidence is needed to persuade the surgical workforce to adopt safety procedures such as briefings. To investigate whether exposure to pre-surgery briefings is related to perception of safety climate. Three Safety Attitude Questionnaires, completed by operating theatre staff in 2003, 2004 and 2006, were used to evaluate the effects of an educational intervention introducing pre-surgery briefings. Individual practitioners who agree with the statement 'briefings are common in the operating theatre' also report a better 'safety climate' in operating theatres. The study reports a powerful link between briefing practices and attitudes towards safety. Findings build on previous work by reporting on the relationship between briefings and safety climate within a 4-year period. Briefings, however, remain difficult to establish in local contexts without appropriate team-based patient safety education. Success in establishing a safety culture, with associated practices, may depend on first establishing unidirectional, positive change in attitudes to create a safety climate.

  9. The Safety of Aesthetic Labiaplasty: A Plastic Surgery Experience.

    Science.gov (United States)

    Lista, Frank; Mistry, Bhavik D; Singh, Yashoda; Ahmad, Jamil

    2015-08-01

    The demand for female aesthetic labiaplasty surgery continues to rapidly increase. Several questions have been raised regarding the safety and effectiveness of female aesthetic genital surgery. The purpose of this study is to review our experience with aesthetic labiaplasty and describe the type and frequency of complications that have been experienced. A retrospective chart review was performed on all patients who had primary aesthetic labia minora reduction surgery from August 2007 to April 2014. A chart review of the electronic medical record was performed to examine demographic, procedural, and outcome data. In the study period, 113 patients underwent aesthetic labiaplasty. Of these, 29 patients (25.6%) had labiaplasty performed in combination with another procedure. A total of 15 patients (13.3%) reported transient symptoms, including swelling, bruising, and pain. There was one patient (0.8%) that experienced bleeding. Four patients (3.5%) required revision surgery. All revisions were performed to excise further tissue to address persistent redundancy or asymmetry. No major complications were reported. In our experience, aesthetic surgery of the labia minora using an edge excision technique has a very low complication rate and provides satisfactory aesthetic outcomes for our patients. More studies examining the impact of labiaplasty on a woman's self-image and quality of life would add to our understanding of the motivations and expectations of women undergoing this aesthetic surgery. This information will allow us to help our patients make well-informed decisions when considering this aesthetic genital surgery. 4 Risk. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. PVA gel as a potential adhesion barrier: a safety study in a large animal model of intestinal surgery.

    Science.gov (United States)

    Renz, Bernhard W; Leitner, Kurt; Odermatt, Erich; Worthley, Daniel L; Angele, Martin K; Jauch, Karl-Walter; Lang, Reinhold A

    2014-03-01

    Intra-abdominal adhesions following surgery are a major source of morbidity and mortality including abdominal pain and small bowel obstruction. This study evaluated the safety of PVA gel (polyvinyl alcohol and carboxymethylated cellulose gel) on intestinal anastomoses and its potential effectiveness in preventing adhesions in a clinically relevant large animal model. Experiments were performed in a pig model with median laparotomy and intestinal anastomosis following small bowel resection. The primary endpoint was the safety of PVA on small intestinal anastomoses. We also measured the incidence of postoperative adhesions in PVA vs. control groups: group A (eight pigs): stapled anastomosis with PVA gel compared to group B (eight pigs), which had no PVA gel; group C (eight pigs): hand-sewn anastomosis with PVA gel compared to group B (eight pigs), which had no anti-adhesive barrier. Animals were sacrificed 14 days after surgery and analyzed. All anastomoses had a patent lumen without any stenosis. No anastomoses leaked at an intraluminal pressure of 40 cmH2O. Thus, anastomoses healed very well in both groups, regardless of whether PVA was administered. PVA-treated animals, however, had significantly fewer adhesions in the area of stapled anastomoses. The hand-sewn PVA group also had weaker adhesions and trended towards fewer adhesions to adjacent organs. These results suggest that PVA gel does not jeopardize the integrity of intestinal anastomoses. However, larger trials are needed to investigate the potential of PVA gel to prevent adhesions in gastrointestinal surgery.

  12. A Safety and Efficacy Study of Tolvaptan Following Open Heart Surgery in 109 Cases.

    Science.gov (United States)

    Kono, Takanori; Tayama, Eiki; Hori, Hidetsugu; Ueda, Tomohiro; Yamaki, Yuta; Tanaka, Hiroyuki

    2016-07-27

    This study was conducted to evaluate the safety and efficacy of tolvaptan following open heart surgery.We retrospectively reviewed 109 patients who were administered tolvaptan following open heart surgery between August 2011 and July 2014. We divided the patients according to their urine output index (amount of urine output/body surface area) into tertiles as follows: T1 (low responders; n = 36), T2 (intermediate responders; n = 36), and T3 (high responders; n = 37). No fatal adverse events were observed following tolvaptan administration. The factors that showed a significant difference among the 3 groups were body surface area (BSA) and preoperative body weight. Body weight rapidly decreased and a greater increase in the serum sodium level was observed on day 1 in the T3 group than in the other 2 groups. No decrease in blood pressure and no significant differences in the occurrence of atrial fibrillation were observed among the 3 groups during tolvaptan administration.Tolvaptan can be safely and effectively administered to increase the urine output without adversely affecting the cardiovascular system or renal function following open heart surgery. However, careful attention is required regarding the possibility of a rapid increase in the serum sodium level so it is important to monitor changes in serum Na levels.

  13. [Learning from aviation - how to increase patient safety in surgery].

    Science.gov (United States)

    Renz, B; Angele, M K; Jauch, K-W; Kasparek, M S; Kreis, M; Müller, M H

    2012-04-01

    During the last years attempts have been made to draw lessons from aviation to increase patient safety in medicine. In particular similar conditions are present in surgery as pilots and surgeons may have to support high physical and mental pressure. The use of a few safety instruments from aviation is feasible in an attempt to increase safety in surgery. First a "root caused" accident research may be established. This is achievable by morbidity and mortality conferences and critical incident reporting systems (CIRS). Second, standard operating procedures may assure a uniform mental model of team members. Furthermore, crew resource management illustrates a strategy and attitude concept, which is applicable in all situations. Safety instruments from aviation, therefore, seem to have a high potential to increase safety in surgery when properly employed. © Georg Thieme Verlag KG Stuttgart ˙ New York.

  14. The Effect of Product Safety Courses on the Adoption and Outcomes of LESS Surgery

    OpenAIRE

    Toomey, Paul G.; Ross, Sharona B.; Choung, Edward; Donn, Natalie; Vice, Michelle; Luberice, Kenneth; Albrink, Michael; Rosemurgy, Alexander S.

    2015-01-01

    Background and Objectives: As technology in surgery evolves, the medical instrument industry is inevitability involved in promoting the use and appropriate (ie, effective and safe) application of its products. This study was undertaken to evaluate industry-supported product safety courses in laparoendoscopic single-site (LESS) surgery, by using the metrics of surgeons' adoption of the technique, safety of the procedure, and surgeons' perception of the surgery. Methods: LESS surgery courses th...

  15. The use of in-situ simulation to improve safety in the plastic surgery office: a feasibility study.

    Science.gov (United States)

    Shapiro, Fred E; Pawlowski, John B; Rosenberg, Noah M; Liu, Xiaoxia; Feinstein, David M; Urman, Richard D

    2014-01-01

    Simulation-based interventions and education can potentially contribute to safer and more effective systems of care. We utilized in-situ simulation to highlight safety issues, regulatory requirements, and assess perceptions of safety processes by the plastic surgery office staff. A high-fidelity human patient simulator was brought to an office-based plastic surgery setting to enact a half-day full-scale, multidisciplinary medical emergency. Facilitated group debriefings were conducted after each scenario with special consideration of the principles of team training, communication, crisis management, and adherence to evidence-based protocols and regulatory standards. Abbreviated AHRQ Medical Office Safety Culture Survey was completed by the participants before and after the session. The in-situ simulations had a high degree of acceptance and face validity according to the participants. Areas highlighted by the simulation sessions included rapid communication, delegation of tasks, location of emergency materials, scope of practice, and logistics of transport. The participant survey indicated greater awareness of patient safety issues following participation in simulation and debriefing exercises in 3 areas (P issue (100% vs 75%), openness to ideas about improving office processes (100% vs 88%), and the need to discuss ways to prevent errors from recurring (88% vs 62%). Issues of safety and regulatory compliance can be assessed in an office-based setting through the short-term (half-day) use of in-situ simulation with facilitated debriefing and the review of audiovisual recordings by trained facilities inspectors.

  16. Efficacy and safety of bariatric surgery for craniopharyngioma-related hypothalamic obesity: a matched case-control study with 2 years of follow-up.

    Science.gov (United States)

    Wijnen, M; Olsson, D S; van den Heuvel-Eibrink, M M; Wallenius, V; Janssen, J A M J L; Delhanty, P J D; van der Lely, A J; Johannsson, G; Neggers, S J C M M

    2017-02-01

    Hypothalamic obesity is a devastating consequence of craniopharyngioma. Bariatric surgery could be a promising therapeutic option. However, its efficacy and safety in patients with craniopharyngioma-related hypothalamic obesity remain largely unknown. We investigated the efficacy of bariatric surgery for inducing weight loss in patients with craniopharyngioma-related hypothalamic obesity. In addition, we studied the safety of bariatric surgery regarding its effects on hormone replacement therapy for pituitary insufficiency. In this retrospective matched case-control study, we compared weight loss after bariatric surgery (that is, Roux-en-Y gastric bypass and sleeve gastrectomy) between eight patients with craniopharyngioma-related hypothalamic obesity and 75 controls with 'common' obesity during 2 years of follow-up. We validated our results at 1 year of follow-up in a meta-analysis. In addition, we studied alterations in hormone replacement therapy after bariatric surgery in patients with craniopharyngioma. Mean weight loss after bariatric surgery was 19% vs 25% (difference -6%, 95% confidence of interval (CI) -14.1 to 4.6; P=0.091) at 2 years of follow-up in patients with craniopharyngioma-related hypothalamic obesity compared with control subjects with 'common' obesity. Mean weight loss was 25% vs 29% (difference -4%, 95% CI -11.6 to 8.1; P=0.419) after Roux-en-Y gastric bypass and 10% vs 20% (difference -10%, 95% CI -14.1 to -6.2; P=0.003) after sleeve gastrectomy at 2 years of follow-up in patients with craniopharyngioma-related hypothalamic obesity vs control subjects with 'common' obesity. Our meta-analysis demonstrated significant weight loss 1 year after Roux-en-Y gastric bypass, but not after sleeve gastrectomy. Seven patients with craniopharyngioma suffered from pituitary insufficiency; three of them required minor adjustments in hormone replacement therapy after bariatric surgery. Weight loss after Roux-en-Y gastric bypass, but not sleeve gastrectomy

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

    Science.gov (United States)

    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.

  18. Prophylactic intracameral levofloxacin in cataract surgery – an evaluation of safety

    Directory of Open Access Journals (Sweden)

    Espiritu CR

    2017-12-01

    Full Text Available Cesar Ramon G Espiritu,1,2,* Joanne G Bolinao1,* 1American Eye Center, Mandaluyong, 2Department of Ophthalmology, Manila Doctors Hospital, Manila, Philippines *The authors contributed equally to this work Purpose: To evaluate posterior and anterior segment safety of an intracameral injection of levofloxacin 0.5% ophthalmic solution as prophylaxis for patients undergoing cataract extraction and intraocular lens implantation.Setting: This study was conducted at Manila Doctors Hospital, Ermita, Manila, Philippines.Design: This was a prospective interventional study.Methods: Eyes undergoing standard phacoemulsification cataract surgery with intraocular lens implantation were treated with intracameral levofloxacin 0.5% at the conclusion of surgery. Safety parameters, including best-corrected visual acuity (BCVA, endothelial cell counts, anterior chamber cells and flare, and central foveal thickness, were evaluated preoperatively and at 1 day and 1 week postoperatively.Results: A total of 50 eyes of 50 patients were included in the analysis. At 1 week postoperatively, all eyes demonstrated BCVA of 20/30 or better and 19 eyes (38% achieved BCVA of 20/20 or better. On the first postoperative day, no corneal edema was observed, and trace to +2 cells and flare in the anterior chamber were noted in all eyes. After 1 week, all eyes had a quiet anterior chamber and endothelial cell counts decreased by an average of 225 cells/mm2, which was marginally significant (p=0.0525 when compared to other time points. Optical coherence tomography results showed no statistically significant differences between central foveal thickness measurements before and after surgery. There were also no statistically significant differences in preoperative and postoperative pachymetry. No study-related adverse events occurred.Conclusion: There were no safety concerns associated with intracameral injection of levofloxacin 0.5%, prophylactically, following cataract surgery

  19. Assessing the safety and efficacy of combined abdominoplasty and gynecologic surgery.

    Science.gov (United States)

    Sinno, Sammy; Shah, Samir; Kenton, Kimberly; Brubaker, Linda; Angelats, Juan; Vandevender, Darl; Cimino, Victor

    2011-09-01

    Combined surgery is an attractive option for both patients and surgeons. Unfortunately, it remains unclear to patients whether plastic surgery can be combined safely and efficaciously with other surgeries, particularly gynecologic surgery. The goal of this study was to determine the safety and efficacy of combined abdominoplasty and gynecologic surgery. A case-control study of 25 patients undergoing combined abdominoplasty and intra-abdominal gynecologic surgery was performed. These combined patients were compared with control group patients undergoing abdominoplasty alone and gynecologic surgery alone. Demographic data, operative time, estimated blood loss, pre- and postoperative hemoglobin, length of hospitalization, and complications were compared between combined and control groups. Statistically significant reductions were seen in operative time, estimated blood loss, and total days of hospitalization when comparing the combined group to the sum of the control groups. In this study, no major complications, including the need for blood transfusion or pulmonary embolus, were noted in any of the patients. These results demonstrate success in performing abdominoplasty with gynecologic surgery, which may be an acceptable option for patients.

  20. Safety of fast track surgery in pancreaticoduodenectomy: a Meta-analysis

    Directory of Open Access Journals (Sweden)

    LI Weinan

    2017-01-01

    Full Text Available ObjectiveTo investigate the safety and clinical effect of fast track surgery in pancreaticoduodenectomy, one of the most complex surgeries in general surgery. MethodsThe Chinese and foreign databases were searched for articles on the application of fast tract surgery in pancreaticoduodenectomy published from January 1994 to April 2016. Two researchers evaluated the quality of the articles which met the inclusion criteria and extracted related data. Stata 12.0 software was used to analyze the overall incidence rate of complications and the incidence rates of pancreatic leakage and gastrointestinal emptying disorder, and the Begg rank correlation test and Egger linear regression method were used to investigate publication bias. ResultsThe fast track surgery group had a significantly lower overall incidence rate of complications than the conventional group (RR=0.748, 95%CI: 0.680-0.824, P<0.001. There was no significant difference in the incidence rate of pancreatic leakage between the two groups (RR=0.894, 95%CI:0.734-1.089, P=0.266. The fast track surgery group had a significantly lower incidence rate of gastrointestinal emptying disorder than the conventional group (RR=0.520, 95%CI:0.400-0.670, P<0.001. ConclusionFast track surgery is safe and effective in pancreaticoduodenectomy, but the application of some measures in fast track surgery still needs more medical evidence.

  1. The Effect of Product Safety Courses on the Adoption and Outcomes of LESS Surgery.

    Science.gov (United States)

    Toomey, Paul G; Ross, Sharona B; Choung, Edward; Donn, Natalie; Vice, Michelle; Luberice, Kenneth; Albrink, Michael; Rosemurgy, Alexander S

    2015-01-01

    As technology in surgery evolves, the medical instrument industry is inevitability involved in promoting the use and appropriate (ie, effective and safe) application of its products. This study was undertaken to evaluate industry-supported product safety courses in laparoendoscopic single-site (LESS) surgery, by using the metrics of surgeons' adoption of the technique, safety of the procedure, and surgeons' perception of the surgery. LESS surgery courses that involved didactic lectures, operative videos, operation observation, collaborative learning, and simulation, were attended by 226 surgeons. With Florida Hospital Tampa Institutional Review Board approval, the surgeons were queried before and immediately after the course, to assess their attitudes toward LESS surgery. Then, well after the course, the surgeons were contacted, repeatedly if necessary, to complete questionnaires. Before the course, 82% of the surgeons undertook more than 10 laparoscopic operations per month. Immediately after the course, 86% were confident that they were prepared to perform LESS surgery. Months after the course, 77% of the respondents had adopted LESS surgery, primarily cholecystectomy; 59% had added 1 or more trocars in 0-20% of their procedures; and 73% held the opinion that operating room observation was the most helpful learning experience. Complications with LESS surgery were noted 12% of the time. Advantages of the technique were better cosmesis (58%) and patient satisfaction (38%). Disadvantages included risk of complications (37%) and higher technical demand (25%). Seventy-eight percent viewed LESS surgery as an advancement in surgical technique. In multifaceted product safety courses, operating room observation is thought to provide the most helpful instruction for those wanting to undertake LESS surgery. The procedure has been safely adopted by surgeons who frequently perform laparoscopies. The tradeoff is in performing a more difficult technique to obtain better

  2. Safety culture and the 5 steps to safer surgery: an intervention study.

    Science.gov (United States)

    Hill, M R; Roberts, M J; Alderson, M L; Gale, T C E

    2015-06-01

    Improvements in safety culture have been postulated as one of the mechanisms underlying the association between the introduction of the World Health Organisation (WHO) Surgical Safety Checklist with perioperative briefings and debriefings, and enhanced patient outcomes. The 5 Steps to Safer Surgery (5SSS) incorporates pre-list briefings, the three steps of the WHO Surgical Safety Checklist (SSC) and post-list debriefings in one framework. We aimed to identify any changes in safety culture associated with the introduction of the 5SSS in orthopaedic operating theatres. We assessed the safety culture in the elective orthopaedic theatres of a large UK teaching hospital before and after introduction of the 5SSS using a modified version of the Safety Attitude Questionnaire - Operating Room (SAQ-OR). Primary outcome measures were pre-post intervention changes in the six safety culture domains of the SAQ-OR. We also analysed changes in responses to two items regarding perioperative briefings. The SAQ-OR survey response rate was 80% (60/75) at baseline and 74% (53/72) one yr later. There were significant improvements in both the reported frequency (Pculture domain scores (Working Conditions, Perceptions of Management, Job Satisfaction, Safety Climate and Teamwork Climate) of the SAQ-OR (Pculture of elective orthopaedic operating theatres. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  3. A prospective, randomized, multicenter, controlled study of the safety of Seprafilm adhesion barrier in abdominopelvic surgery of the intestine.

    NARCIS (Netherlands)

    Beck, D.E.; Cohen, Z.; Fleshman, J.W.; Kaufman, H.S.; Goor, H. van; Wolff, B.G.

    2003-01-01

    INTRODUCTION: Seprafilm adhesion barrier (Seprafilm) has been proven to prevent adhesion formation after abdominal and pelvic surgery. This article reports safety results, including the postoperative incidence of abdominal and pelvic abscess and pulmonary embolism, from a large, multicenter trial

  4. The Effect of Product Safety Courses on the Adoption and Outcomes of LESS Surgery

    Science.gov (United States)

    Toomey, Paul G.; Ross, Sharona B.; Choung, Edward; Donn, Natalie; Vice, Michelle; Luberice, Kenneth; Albrink, Michael

    2015-01-01

    Background and Objectives: As technology in surgery evolves, the medical instrument industry is inevitability involved in promoting the use and appropriate (ie, effective and safe) application of its products. This study was undertaken to evaluate industry-supported product safety courses in laparoendoscopic single-site (LESS) surgery, by using the metrics of surgeons' adoption of the technique, safety of the procedure, and surgeons' perception of the surgery. Methods: LESS surgery courses that involved didactic lectures, operative videos, operation observation, collaborative learning, and simulation, were attended by 226 surgeons. With Florida Hospital Tampa Institutional Review Board approval, the surgeons were queried before and immediately after the course, to assess their attitudes toward LESS surgery. Then, well after the course, the surgeons were contacted, repeatedly if necessary, to complete questionnaires. Results: Before the course, 82% of the surgeons undertook more than 10 laparoscopic operations per month. Immediately after the course, 86% were confident that they were prepared to perform LESS surgery. Months after the course, 77% of the respondents had adopted LESS surgery, primarily cholecystectomy; 59% had added 1 or more trocars in 0–20% of their procedures; and 73% held the opinion that operating room observation was the most helpful learning experience. Complications with LESS surgery were noted 12% of the time. Advantages of the technique were better cosmesis (58%) and patient satisfaction (38%). Disadvantages included risk of complications (37%) and higher technical demand (25%). Seventy-eight percent viewed LESS surgery as an advancement in surgical technique. Conclusion: In multifaceted product safety courses, operating room observation is thought to provide the most helpful instruction for those wanting to undertake LESS surgery. The procedure has been safely adopted by surgeons who frequently perform laparoscopies. The tradeoff is in

  5. Efficacy, safety, and economics of bracing after spine surgery: a systematic review of the literature.

    Science.gov (United States)

    Zhu, Mary P; Tetreault, Lindsay A; Sorefan-Mangou, Fatimah; Garwood, Philip; Wilson, Jefferson R

    2018-01-31

    Bracing is often used after spinal surgery to immobilize the spine, improve fusion, and relieve pain. However, controversy exists regarding the efficacy, necessity, and safety of various bracing techniques in the postsurgical setting. In this systematic review, we aimed to compare the effectiveness, safety, and cost-effectiveness of postoperative bracing versus no postoperative bracing after spinal surgery in patients with several common operative spinal pathologies. A systematic review was carried out to compare postoperative bracing and no postoperative bracing. A systematic search was conducted of MEDLINE, Embase, and the Cochrane Collaboration Library from 1970 to May 2017, supplemented by manual searching of the reference list of relevant studies and previously published reviews. Studies were included if they compared disability, quality of life, functional impairment, radiographic outcomes, cost-effectiveness, or complications between patients treated with postoperative bracing and patients not receiving any postoperative bracing. Each article was critically appraised independently by two reviewers, and the overall body of evidence was rated using guidelines outlined by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. Of the 858 retrieved citations, 5 studies met the inclusion criteria and were included in this review, consisting of 4 randomized controlled trials and 1 prospective cohort study. Low to moderate evidence suggests that there are no significant differences in most measures of disability, pain, quality of life, functional impairment, radiographic outcomes, and safety between groups. Isolated studies reported statistically significant and inconsistent differences between groups with respect to Neck Disability Index at 6 weeks postoperatively or Short Form-36 Physical Component Score at 1.5, 3, 6, and 12 months postoperatively. Based on limited evidence, postoperative bracing does not result in improved

  6. Transoral endoscopic surgery versus conventional thoracoscopic surgery for thoracic intervention: safety and efficacy in a canine survival model.

    Science.gov (United States)

    Liu, Chien-Ying; Chu, Yen; Wu, Yi-Cheng; Yuan, Hsu-Chia; Ko, Po-Jen; Liu, Yun-Hen; Liu, Hui-Ping

    2013-07-01

    Transoral endoscopic surgery has been shown to be feasible and safe in both humans and animal models. The purpose of this study was to evaluate the safety and efficacy of transoral and conventional thoracoscopy for thoracic exploration, surgical lung biopsy, and pericardial window creation. The animals (n = 20) were randomly assigned to the transoral endoscopic approach group (n = 10) or conventional thoracoscopic approach group (n = 10). Transoral thoracoscopy was performed with a flexible bronchoscope via an incision over the vestibulum oris. In conventional thoracoscopy, access to the thoracic cavity was obtained through a thoracic incision. Surgical outcomes (body weight, operating time, operative complications, and time to resumption of normal diet), physiologic parameters (respiratory rate, body temperature), inflammatory parameters [white blood cell (WBC) counts and C-reactive protein (CRP)], and pulmonary parameters (arterial blood gases) were compared for both procedures. The surgical lung biopsy and pericardial window creation were successfully performed in all animals except one animal in the transoral group. There was no significant difference in operating times between the groups. The increase in WBC in the transoral thoracoscopy group was significantly smaller on postoperative day 1 than in the conventional thoracoscopy group (p = 0.0029). The transoral group had an earlier return to preoperative body temperature (p = 0.041) and respiratory rate (p = 0.045) on day 7. With respect to pulmonary parameters, there was no significant difference in blood pH, pCO2, or PaCO2 between the transoral and transthoracic groups. All animals survived without complications 14 days after surgery. This study demonstrated that the transoral approach was comparable to conventional thoracoscopic surgery for lung biopsy and pericardial window creation in terms of safety and efficacy.

  7. Safety of Laparoscopic Surgery for Colorectal Cancer in Patients with Severe Comorbidities.

    Science.gov (United States)

    Sawazaki, Sho; Numata, Masakatsu; Morita, Junya; Maezawa, Yukio; Amano, Shinya; Aoyama, Toru; Tamagawa, Hiroshi; Sato, Tsutomu; Oshima, Takashi; Mushiake, Hiroyuki; Yukawa, Norio; Shiozawa, Manabu; Rino, Yasushi; Masuda, Munetaka

    2018-06-01

    Previous studies have shown that laparoscopic colorectal cancer surgery is highly safe and effective compared to laparotomy. However, whether laparoscopic colorectal cancer surgery can be safely performed in patients with severe comorbidities remains unclear. The aim of this study was to evaluate the safety of laparoscopic colorectal cancer surgery in patients with severe comorbidities. A total of 82 consecutive patients with colorectal cancer who underwent laparoscopic surgery were retrospectively divided into two groups according to whether they had severe comorbidity (50 patients) or non-severe comorbidity (32 patients). An age-adjusted Charlson comorbidity index of ≥6 was defined as severe comorbidity. Operative time, blood loss, and rate of conversion to laparotomy did not differ between the groups. Postoperative complications and the length of the postoperative hospital stay also did not differ significantly between the groups. Laparoscopic colorectal cancer surgery is feasible and safe, even in patients with severe comorbidities. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  8. 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.

  9. Driving Safety after Spinal Surgery: A Systematic Review.

    Science.gov (United States)

    Alhammoud, Abduljabbar; Alkhalili, Kenan; Hannallah, Jack; Ibeche, Bashar; Bajammal, Sohail; Baco, Abdul Moeen

    2017-04-01

    This study aimed to assess driving reaction times (DRTs) after spinal surgery to establish a timeframe for safe resumption of driving by the patient postoperatively. The MEDLINE and Google Scholar databases were analyzed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) Statement for clinical studies that investigated changes in DRTs following cervical and lumbar spinal surgery. Changes in DRTs and patients' clinical presentation, pathology, anatomical level affected, number of spinal levels involved, type of intervention, pain level, and driving skills were assessed. The literature search identified 12 studies that investigated postoperative DRTs. Six studies met the inclusion criteria; five studies assessed changes in DRT after lumbar spine surgery and two studies after cervical spina surgery. The spinal procedures were selective nerve root block, anterior cervical discectomy and fusion, and lumbar fusion and/ordecompression. DRTs exhibited variable responses to spinal surgery and depended on the patients' clinical presentation, spinal level involved, and type of procedure performed. The evidence regarding the patients' ability to resume safe driving after spinal surgery is scarce. Normalization of DRT or a return of DRT to pre-spinal intervention level is a widely accepted indicator for safe driving, with variable levels of statistical significance owing to multiple confounding factors. Considerations of the type of spinal intervention, pain level, opioid consumption, and cognitive function should be factored in the assessment of a patient's ability to safely resume driving.

  10. 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

    Full Text Available Introduction: Brain arteriovenous malformations (BAVMs are associated with high morbidity and mortality. The treatment of BAVM remains controversial. Microinvasive treatment, including endovascular therapy and gamma knife surgery, has been the first choice in many conditions. However, the overall clinical outcome of microinvasive treatment remains unknown and a prospective trial is needed. Methods: This is a prospective, non-randomized, and multicenter observational registry clinical trial to evaluate the safety and efficacy of microinvasive treatment for BAVMs. The study will require up to 400 patients in approximately 12 or more centers in China, followed for 2 years. Main subjects of this study are BAVM patients underwent endovascular therapy and/or gamma knife surgery. The trial will not affect the choice of treatment modality. The primary outcomes are perioperative complications (safety, and postoperative hemorrhage incidence rate and complete occlusion rate (efficacy. Secondary outcomes are elimination of hemorrhage risk factors (coexisting aneurysms and arteriovenous fistula, volume reduction and remission of symptoms. Safety and efficacy of endovascular therapy, gamma knife surgery, and various combination modes of the two modalities will be compared. Operative complications and outcomes at pretreatment, post-treatment, at discharge and at 3 months, 6 months and 2 years follow-up intervals will be analyzed using the modified Rankin Scale (mRS. 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. Keywords: Brain arteriovenous malformation, Clinical trial, Endovascular therapy, Gamma knife, Safety, Efficacy

  11. 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.

  12. 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

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

    Science.gov (United States)

    Jin, Hengwei; Huo, Xiaochuan; Jiang, Yuhua; Li, Xiaolong; Li, Youxiang

    2017-09-01

    Brain arteriovenous malformations (BAVMs) are associated with high morbidity and mortality. The treatment of BAVM remains controversial. Microinvasive treatment, including endovascular therapy and gamma knife surgery, has been the first choice in many conditions. However, the overall clinical outcome of microinvasive treatment remains unknown and a prospective trial is needed. This is a prospective, non-randomized, and multicenter observational registry clinical trial to evaluate the safety and efficacy of microinvasive treatment for BAVMs. The study will require up to 400 patients in approximately 12 or more centers in China, followed for 2 years. Main subjects of this study are BAVM patients underwent endovascular therapy and/or gamma knife surgery. The trial will not affect the choice of treatment modality. The primary outcomes are perioperative complications (safety), and postoperative hemorrhage incidence rate and complete occlusion rate (efficacy). Secondary outcomes are elimination of hemorrhage risk factors (coexisting aneurysms and arteriovenous fistula), volume reduction and remission of symptoms. Safety and efficacy of endovascular therapy, gamma knife surgery, and various combination modes of the two modalities will be compared. Operative complications and outcomes at pretreatment, post-treatment, at discharge and at 3 months, 6 months and 2 years follow-up intervals will be analyzed using the modified Rankin Scale (mRS). 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.

  14. 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. Copyright 2016, SLACK Incorporated.

  15. Differences in emergency colorectal surgery in Medicaid and uninsured patients by hospital safety net status.

    Science.gov (United States)

    Bradley, Cathy J; Dahman, Bassam; Sabik, Lindsay M

    2015-02-01

    We examined whether safety net hospitals reduce the likelihood of emergency colorectal cancer (CRC) surgery in uninsured and Medicaid-insured patients. If these patients have better access to care through safety net providers, they should be less likely to undergo emergency resection relative to similar patients at non- safety net hospitals. Using population-based data, we estimated the relationship between safety net hospitals, patient insurance status, and emergency CRC surgery. We extracted inpatient admission data from the Virginia Health Information discharge database and matched them to the Virginia Cancer Registry for patients aged 21 to 64 years who underwent a CRC resection between January 1, 1999, and December 31, 2005 (n = 5488). We differentiated between medically defined emergencies and those that originated in the emergency department (ED). For each definition of emergency surgery, we estimated the linear probability models of the effects of being treated at a safety net hospital on the probability of having an emergency resection. Safety net hospitals reduce emergency surgeries among uninsured and Medicaid CRC patients. When defining an emergency resection as those that involved an ED visit, these patients were 15 to 20 percentage points less likely to have an emergency resection when treated in a safety net hospital. Our results suggest that these hospitals provide a benefit, most likely through the access they afford to timely and appropriate care, to uninsured and Medicaid-insured patients relative to hospitals without a safety net mission.

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

    NARCIS (Netherlands)

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

    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

  17. Safety and efficacy of fast-track surgery in perioperative nursing for biliary calculi surgery: a meta-analysis

    Directory of Open Access Journals (Sweden)

    LI Qinan

    2015-10-01

    Full Text Available ObjectiveTo systematically review the efficacy and safety of fast-track surgery (FTS in perioperative nursing for biliary calculi surgery. MethodsOnline databases of PubMed, Cochrane Library, CBM, CNKI, VIP, and Wanfang Data were comprehensively searched for relevant randomized controlled trials (RCTs. Potential bias was evaluated by Cochrane tools and data were analyzed by RevMan 5.3. ResultsA total of 11 RCTs with 1455 patients were included (738 cases in FTS group and 717 cases in control group. The results of meta-analysis showed that FTS significantly reduced the length of postoperative hospital stay (MD=-4.10, 95% CI: -5.68 to -2.52, P<0.000 01 and hospital costs (MD=-0.47, 95%CI: -0.60 to -0.34, P<0.000 01; meanwhile, FTS shortened the time to gastrointestinal recovery (SMD=-2.05, 95%CI: -2.84 to -1.27, P<0.000 01, as well as the time to first defecation (SMD=-1.27, 95% CI: -2.08 to -0.46, P<0.000 01. As for safety, FTS significantly reduced the total complications of choledocholithiasis (RR=0.53, 95%CI: 0.43-0.65, P<0.000 01 and hepatolithiasis (RR=0.52, 95% CI: 0.35-0.77, P=0.001. ConclusionFTS is effective and safe in perioperative nursing for biliary calculi surgery. It can significantly reduce the length of postoperative hospital stay, enhance gastrointestinal recovery, shorten the time to first defecation, and reduce total complications.

  18. Surgery: a risky business.

    Science.gov (United States)

    Vats, Amit; Nagpal, Kamal; Moorthy, Krishna

    2009-10-01

    The advancement of surgical technology has made surgery an increasingly suitable management option for an increasing number of medical conditions. Yet there is also a growing concern about the number of patients coming to harm as a result of surgery. Studies show that this harm can be prevented by better teamwork and communication in operating theatres. This article discusses the extent of adverse events in surgery and how effective teamwork and communication can improve patient safety. It also highlights the role checklists and briefing in improving teamwork and reducing human error in surgery.

  19. Safety syringes and anti-needlestick devices in orthopaedic surgery.

    Science.gov (United States)

    Sibbitt, Wilmer L; Band, Philip A; Kettwich, Lawrence G; Sibbitt, Cristina R; Sibbitt, Lori J; Bankhurst, Arthur D

    2011-09-07

    The American Academy of Orthopaedic Surgery (AAOS), The Joint Commission, the Occupational Safety and Health Administration (OSHA), and the Needlestick Safety and Prevention Act encourage the integration of safety-engineered devices to prevent needlestick injuries to health-care workers and patients. We hypothesized that safety syringes and needles could be used in outpatient orthopaedic injection and aspiration procedures. The study investigated the orthopaedic uses and procedural idiosyncrasies of safety-engineered devices, including (1) four safety needles (Eclipse, SafetyGlide, SurGuard, and Magellan), (2) a mechanical safety syringe (RPD), (3) two automatic retractable syringes (Integra, VanishPoint), (4) three manual retractable syringes (Procedur-SF, Baksnap, Invirosnap), and (5) three shielded syringes (Safety-Lok, Monoject, and Digitally Activated Shielded [DAS] Syringe). The devices were first tested ex vivo, and then 1300 devices were used for 425 subjects undergoing outpatient arthrocentesis, intra-articular injections, local anesthesia, aspiration biopsy, and ultrasound-guided procedures. During the clinical observation, there were no accidental needlesticks (0 needlesticks per 1300 devices). Safety needles could be successfully used on a Luer syringe but were limited to ≤1.5 in (≤3.81 cm) in length and the shield could interfere with sonography. The mechanical safety syringes functioned well in all orthopaedic procedures. Automatic retractable syringes were too small for arthrocentesis of the knee, and the plunger blew out and prematurely collapsed with high-pressure injections. The manual retractable syringes and shielded syringes could be used with conventional needles for most orthopaedic procedures. The most effective and reliable safety devices for orthopaedic syringe procedures are shielded safety needles, mechanical syringes, manual retractable syringes, and shielded syringes, but not automatic retractable syringes. Even when adopting

  20. Safety in surgery: is selection the missing link?

    Science.gov (United States)

    Paice, Alistair G; Aggarwal, Rajesh; Darzi, Ara

    2010-09-01

    Health care providers comprise an example of a "high risk organization." Safety failings within these organizations have the potential to cause significant public harm. Significant safety improvements in other high risk organizations such as the aviation industry have led to the concept of a high reliability organization (HRO)--a high risk organization that has enjoyed a prolonged safety record. A strong organizational culture is common to all successful HROs, encompassing powerful systems of selection and training. Aircrew selection processes provide a good example of this and are examined in detail in this article using the Royal Air Force process as an example. If the lessons of successful HROs are to be applied to health care organizations, candidate selection to specialties such as surgery must become more objective and robust. Other HROs can provide valuable lessons in how this may be approached.

  1. A challenge-response endoscopic sinus surgery specific checklist as an add-on to standard surgical checklist: an evaluation of potential safety and quality improvement issues.

    Science.gov (United States)

    Sommer, Doron D; Arbab-Tafti, Sadaf; Farrokhyar, Forough; Tewfik, Marc; Vescan, Allan; Witterick, Ian J; Rotenberg, Brian; Chandra, Rakesh; Weitzel, Erik K; Wright, Erin; Ramakrishna, Jayant

    2018-02-27

    The goal of this study was to develop and evaluate the impact of an aviation-style challenge and response sinus surgery-specific checklist on potential safety and equipment issues during sinus surgery at a tertiary academic health center. The secondary goal was to assess the potential impact of use of the checklist on surgical times during, before, and after surgery. This initiative is designed to be utilized in conjunction with the "standard" World Health Organization (WHO) surgical checklist. Although endoscopic sinus surgery is generally considered a safe procedure, avoidable complications and potential safety concerns continue to occur. The WHO surgical checklist does not directly address certain surgery-specific issues, which may be of particular relevance for endoscopic sinus surgery. This prospective observational pilot study monitored compliance with and compared the occurrence of safety and equipment issues before and after implementation of the checklist. Forty-seven consecutive endoscopic surgeries were audited; the first 8 without the checklist and the following 39 with the checklist. The checklist was compiled by evaluating the patient journey, utilizing the available literature, expert consensus, and finally reevaluation with audit type cases. The final checklist was developed with all relevant stakeholders involved in a Delphi method. Implementing this specific surgical checklist in 39 cases at our institution, allowed us to identify and rectify 35 separate instances of potentially unsafe, improper or inefficient preoperative setup. These incidents included issues with labeling of topical vasoconstrictor or injectable anesthetics (3, 7.7%) and availability, function and/or position of video monitors (2, 5.1%), endoscope (6, 15.4%), microdebrider (6, 15.4%), bipolar cautery (6, 15.4%), and suctions (12, 30.8%). The design and integration of this checklist for endoscopic sinus surgery, has helped improve efficiency and patient safety in the operating

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

    Science.gov (United States)

    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. Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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

  4. Safety of remifentanil in transsphenoidal surgery: A single-center analysis of 540 patients.

    Science.gov (United States)

    Cote, David J; Burke, William T; Castlen, Joseph P; King, Chih H; Zaidi, Hasan A; Smith, Timothy R; Laws, Edward R; Aglio, Linda S

    2017-04-01

    Although some studies have examined the efficacy and safety of remifentanil in patients undergoing neurosurgical procedures, none has examined its safety in transsphenoidal operations specifically. In this study, all transsphenoidal operations performed by a single author from 2008 to 2015 were retrospectively reviewed to evaluate the safety of remifentanil in a consecutive series of patients. During the study period, 540 transsphenoidal operations were identified. Of these, 443 (82.0%) patients received remifentanil intra-operatively; 97 (18.0%) did not. The two groups were well-matched with regard to demographic categories, comorbidities, and pre-operative medications (p>0.05), except pre-operative tobacco use (p=0.021). Patients were also well-matched with regard to radiographic features and surgical techniques. Patients who received remifentanil were more likely to harbor a macroadenoma (78.1% vs. 67.0%, p=0.025), and had slightly longer anesthesia time on average (269.2minvs. 239.4min, p=0.024). All pathologic diagnoses were well-matched between the two groups, except that patients receiving remifentanil were more likely to harbor a non-functioning adenoma (46.5% vs. 26.8%, ptranssphenoidal surgery, remifentanil was found to be a safe anesthetic adjunct. There were no significant differences in post-operative hospital course or complications in patients who did and did not receive intra-operative remifentanil. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Computer-assisted navigational surgery enhances safety in dental implantology.

    Science.gov (United States)

    Ng, F C; Ho, K H; Wexler, A

    2005-06-01

    Dental implants are increasingly used to restore missing dentition. These titanium implants are surgically installed in the edentulous alveolar ridge and allowed to osteointegrate with the bone during the healing phase. After osseo-integration, the implant is loaded with a prosthesis to replace the missing tooth. Conventional implant treatment planning uses study models, wax-ups and panoramic x-rays to prefabricate surgical stent to guide the preparation of the implant site. The drilling into the alveolar ridge is invariably a "blind" procedure as the part of the drill in bone is not visible. Stereotactic systems were first introduced into neurosurgery in 1986. Since then, computer-assisted navigational technology has brought major advances to neuro-, midface and orthopaedic surgeries, and more recently, to implant placement. This paper illustrates the use of real-time computer-guided navigational technology in enhancing safety in implant surgical procedures. Real-time computer-guided navigational technology enhances accuracy and precision of the surgical procedure, minimises complications and facilitates surgery in challenging anatomical locations.

  6. Bariatric surgery in adolescents and young adults--safety and effectiveness in a cohort of 345 patients.

    Science.gov (United States)

    Lennerz, B S; Wabitsch, M; Lippert, H; Wolff, S; Knoll, C; Weiner, R; Manger, T; Kiess, W; Stroh, C

    2014-03-01

    To examine the safety and effectiveness of adolescent bariatric surgery and to improve treatment recommendations for this age group. Prospective longitudinal registry. Since January 2005, patients undergoing bariatric surgery in Germany are enlisted in an online registry called 'study for quality assurance in obesity surgeries'. Adolescents and young adults up to the age of 21 years, operated from January 2005 to December 2010. Weight, BMI, comorbidities, complication rates. N=345 primary procedures were recorded by 58 hospitals. N=51 patients were under the age of 18 years. Follow-up information was available for 48% (n=167) of patients, with an average observation period of 544±412 days (median: 388 days). The most common surgical techniques were gastric banding (n=118, 34.2%), gastric bypass (n=116, 33.6%) and sleeve gastrectomy (n=78, 22.6%). Short-term complications (intra-operative; general postoperative; specific postoperative) were slightly lower for gastric banding (0.8%; 2.5%; 0.8%) than for gastric bypass (2.6%; 5.2%; 1.7%) or sleeve gastrectomy (0%; 9.0%; 7.7%). In accordance with published findings, weight and BMI reduction were lower for gastric banding (-28 kg; -9.5 kg m(-2)) compared to gastric bypass (-50 kg; -16.4 kg m(-2)) Pbariatric surgery has low short-term complication rates and results in sustained weight loss in adolescents. However, the missing long-term observations prohibit a final conclusion about lasting effectiveness and safety. Clinical trials with structured follow-up programs and mechanisms to ascertain patient adherences are needed.

  7. A randomized double-masked study to compare the ocular safety, tolerability, and efficacy of bromfenac 0.075% compared with vehicle in cataract surgery subjects

    Science.gov (United States)

    Hosseini, Kamran; Walters, Thomas; DaVanzo, Robert; Lindstrom, Richard L

    2016-01-01

    Purpose The aim of this study was to evaluate the safety, tolerability, and efficacy of a low-dose version of bromfenac 0.075% in DuraSite® (bromfenac 0.075%) compared with DuraSite® vehicle (vehicle) alone for the treatment of postoperative inflammation and ocular pain after cataract surgery. Methods A multicenter, double-masked, vehicle-controlled, parallel-group clinical trial of 240 subjects randomized in a 2:1 ratio to bromfenac 0.075% or vehicle was conducted. Subjects were dosed BID beginning 1 day before the cataract surgery, the day of surgery, and 14 days after surgery. A slit lamp biomicroscopy examination was performed to evaluate the signs of inflammation, including anterior chamber cells (ACC) and anterior chamber flare (ACF). The primary efficacy variable was the proportion of subjects with an ACC grade of 0 at Day 15. Secondary efficacy endpoints included the proportion of subjects who achieved a pain score of 0 at each postsurgical visual analog scale (VAS) assessment and the proportion of subjects with an ACF grade of 0 at Day 15. Results At Day 15, proportionally more subjects in the bromfenac 0.075% group than in the vehicle group had an ACC grade of 0 (57.1% vs 18.8%, respectively; P<0.001). At each of the postsurgical time points (Days 1, 8, 15, and 29), proportionally more bromfenac 0.075%-treated subjects (76.8%, 90.5%, 92.9%, and 85.1%, respectively) had no pain (a VAS score of 0) compared with the vehicle-treated subjects (48.2%, 38.8%, 42.4%, and 47.1%, respectively), and at each time point, these differences in proportions were statistically significant (P<0.001). More subjects in the bromfenac 0.075% group had complete ACF resolution (151/167; 90.4%) compared to those in the vehicle group (54/85; 63.5%). There were no new safety signals reported. Conclusion Bromfenac 0.075% in DuraSite is safe, well tolerated, and effective at reducing inflammation and preventing pain associated with cataract surgery. PMID:27920490

  8. Clinical Effects and Safety of 3% Diquafosol Ophthalmic Solution for Patients With Dry Eye After Cataract Surgery: A Randomized Controlled Trial.

    Science.gov (United States)

    Park, Dae Hyun; Chung, Jin Kwon; Seo, Du Ri; Lee, Sung Jin

    2016-03-01

    To compare the efficacies and safety profiles of 3% diquafosol and 0.1% sodium hyaluronate in patients with dry eye after cataract surgery. Randomized controlled trial. setting: Soonchunhyang University Hospital, Seoul, South Korea. In all, 130 eyes of 86 dry eye patients who had undergone cataract surgery between January 2014 and January 2015 were enrolled and randomly divided into a diquafosol group and a sodium hyaluronate group. The diquafosol group used diquafosol 6 times a day and the hyaluronate group used sodium hyaluronate 6 times a day after cataract surgery. Evaluations of efficacy were conducted based on an Ocular Surface Disease Index questionnaire, tear breakup time (TBUT), Schirmer I test, corneal fluorescein and conjunctival lissamine green staining scores, serial measurement of ocular higher-order aberrations (HOAs), corneal HOAs, and uncorrected distance visual acuity test. Safety evaluations were based on anterior chamber inflammation and discontinuation of the eye drops. Objective signs and subjective symptoms were aggravated at 1 week postoperatively and began to recover significantly 4 weeks after surgery. The diquafosol group showed significantly superior TBUT (P < .001), corneal fluorescein (P = .045), and conjunctival staining (P = .001) compared to the sodium hyaluronate group throughout the study period. TBUT (P < .001) and the change in HOAs (P = .018) recovered significantly more quickly in the diquafosol group. The safety evaluations showed no intergroup differences. Eye drops of 3% diquafosol may be an effective and safe treatment for the management of cataract surgery-induced dry eye aggravation in patients with preexisting dry eye. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Safety in the operating room during orthopedic trauma surgery-incidence of adverse events related to technical equipment and logistics

    NARCIS (Netherlands)

    van Delft, E. A. K.; Schepers, T.; Bonjer, H. J.; Kerkhoffs, G. M. M. J.; Goslings, J. C.; Schep, N. W. L.

    2017-01-01

    Safety in the operating room is widely debated. Adverse events during surgery are potentially dangerous for the patient and staff. The incidence of adverse events during orthopedic trauma surgery is unknown. Therefore, we performed a study to quantify the incidence of these adverse events. Primary

  10. A prospective multicenter study on self-expandable metallic stents as a bridge to surgery for malignant colorectal obstruction in Japan: efficacy and safety in 312 patients.

    Science.gov (United States)

    Saito, Shuji; Yoshida, Shuntaro; Isayama, Hiroyuki; Matsuzawa, Takeaki; Kuwai, Toshio; Maetani, Iruru; Shimada, Mamoru; Yamada, Tomonori; Tomita, Masafumi; Koizumi, Koichi; Hirata, Nobuto; Kanazawa, Hideki; Enomoto, Toshiyuki; Sekido, Hitoshi; Saida, Yoshihisa

    2016-09-01

    Endoscopic stenting with a self-expandable metallic stent (SEMS) is a widely accepted procedure for malignant colonic obstruction. The Colonic Stent Safe Procedure Research Group conducted the present prospective feasibility study. Our objectives were to estimate the safety and feasibility of SEMS placement as a bridge to surgery (BTS) for malignant colorectal obstruction. We conducted a prospective, observational, single-arm, multicenter clinical trial from March 2012 to October 2013. Each patient was treated with an uncovered WallFlex enteral colonic stent. Patients were followed up until discharge after surgery. A total of 518 consecutive patients were enrolled in this study. The cohort intended for BTS consisted of 312 patients (61 %), and the stent could be released in 305 patients. Technical and clinical success rates were 98 and 92 %, respectively. Elective surgery was performed in 297 patients, and emergency surgery was performed in eight patients for the treatment of complications. The overall preoperative complication rate was 7.2 %. Major complications, including perforation, occurred in 1.6 %, persistent colonic obstruction occurred in 1.0 %, and stent migration occurred in 1.3 % patients. The median time from SEMS to surgery was 16 days. Silent perforations were observed in 1.3 %. Open and laparoscopic surgery was performed in 121 and 184 patients, respectively. The tumor could be resected in 297 patients. The primary anastomosis rate was 92 %. The rate of anastomotic leakage was 4 %, and the overall stoma creation rate was 10 %. The median duration of hospitalization following surgery was 12 days. Overall postoperative morbidity and mortality rates were 16 and 0.7 %, respectively. This largest, multicenter, prospective study demonstrates the feasibility of SEMS placement as a BTS for malignant colorectal obstruction. SEMS serves as a safe and effective BTS with acceptable stoma creation and complication rates in patients with acute

  11. The feasibility and safety of thoracoscopic surgery under epidural and/or local anesthesia for spontaneous pneumothorax: a meta-analysis.

    Science.gov (United States)

    Chen, Wei; Zhang, Chenlei; Wang, Gebang; Li, Zhengjun; Wang, Hailong; Liu, Hongxu

    2017-09-01

    The aim of this study was to compare thoracoscopic surgery for spontaneous pneumothorax under epidural and/or local anesthesia (ELA) with that under general anesthesia and prove the feasibility and safety of thoracoscopic surgery under ELA for spontaneous pneumothorax. Relevant studies were searched in five databases from their date of publication to June 2016. We collected and analyzed the data concerning operative time, hospital stay, complications, air leak, recurrence and perioperative mortality. A forest plot was performed to compare the differences between the two groups. There were no significant differences between the ELA group and the general anesthesia (GA) group in operative time, hospital stay, complications, air leak or recurrence. There were 6 deaths reported in two studies. However, patients in the ELA group had significantly shorter global operating room time. Our study demonstrated that ELA, in comparison with GA, is feasible and safe for thoracoscopic surgery of spontaneous pneumothorax.

  12. The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis.

    Science.gov (United States)

    Abbott, T E F; Ahmad, T; Phull, M K; Fowler, A J; Hewson, R; Biccard, B M; Chew, M S; Gillies, M; Pearse, R M

    2018-01-01

    The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32-0.77); P<0.01], but no difference in complication rates [OR 1.02 (0.88-1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62-0.92); P<0.01; I 2 =87%] and reduced complication rates [OR 0.73 (0.61-0.88); P<0.01; I 2 =89%). Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine. Copyright © 2017 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

  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.

    Science.gov (United States)

    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. Efficiency and safety of bipolar vessel and tissue sealing in visceral surgery.

    Science.gov (United States)

    Overhaus, Marcus; Schaefer, Nico; Walgenbach, Klaus; Hirner, Andreas; Szyrach, Mara Natascha; Tolba, René Hany

    2012-11-01

    The aim of this study was to analyze the efficiency and safety of the bipolar tissue/vessel sealing and cutting device EnSeal(™) in comparison to the conventional clamp and ligation technique in visceral surgery. In an acute animal model, a part of the small bowel, a part of the colon and the kidneys were resected either with the conventional clamp and ligation technique or with EnSeal(™). Operation time, blood loss and blood parameters as well as the lateral thermal spread were evaluated. Small bowel, colon and kidney resection time with the EnSeal(™) device was shorter compared to the conventional clamp and ligation technique (small bowel: EnSeal(™): 4.7 ± 1.0 min vs. con: 35.1 ± 2.3 min; colon: EnSeal(™): 7.0 ± 1.4 min vs. con: 16.3 ± 1.5 min, kidney: EnSeal(™): 5.7 ± 1.3 min vs. con: 16.7 ± 3.7 min, p surgery with EnSeal(™) can be performed more efficiently in a shorter time, with significantly less blood loss, minimal thermal damage and without changes of blood parameters, indicating biological safety and integrity.

  15. A randomized double-masked study to compare the ocular safety, tolerability, and efficacy of bromfenac 0.075% compared with vehicle in cataract surgery subjects

    Directory of Open Access Journals (Sweden)

    Hosseini K

    2016-11-01

    Full Text Available Kamran Hosseini,1 Thomas Walters,2 Robert DaVanzo,3 Richard L Lindstrom4 1InSite Vision Inc., Alameda, CA, 2Texan Eye, Austin, TX, 3Cornerstone Health Care, High Point, NC, 4Minnesota Eye Consultants, Bloomington, MN, USA Purpose: The aim of this study was to evaluate the safety, tolerability, and efficacy of a low-dose version of bromfenac 0.075% in DuraSite® (bromfenac 0.075% compared with DuraSite® vehicle (vehicle alone for the treatment of postoperative inflammation and ocular pain after cataract surgery.Methods: A multicenter, double-masked, vehicle-controlled, parallel-group clinical trial of 240 subjects randomized in a 2:1 ratio to bromfenac 0.075% or vehicle was conducted. Subjects were dosed BID beginning 1 day before the cataract surgery, the day of surgery, and 14 days after surgery. A slit lamp biomicroscopy examination was performed to evaluate the signs of inflammation, including anterior chamber cells (ACC and anterior chamber flare (ACF. The primary efficacy variable was the proportion of subjects with an ACC grade of 0 at Day 15. Secondary efficacy endpoints included the proportion of subjects who achieved a pain score of 0 at each postsurgical visual analog scale (VAS assessment and the proportion of subjects with an ACF grade of 0 at Day 15.Results: At Day 15, proportionally more subjects in the bromfenac 0.075% group than in the vehicle group had an ACC grade of 0 (57.1% vs 18.8%, respectively; P<0.001. At each of the postsurgical time points (Days 1, 8, 15, and 29, proportionally more bromfenac 0.075%-treated subjects (76.8%, 90.5%, 92.9%, and 85.1%, respectively had no pain (a VAS score of 0 compared with the vehicle-treated subjects (48.2%, 38.8%, 42.4%, and 47.1%, respectively, and at each time point, these differences in proportions were statistically significant (P<0.001. More subjects in the bromfenac 0.075% group had complete ACF resolution (151/167; 90.4% compared to those in the vehicle group (54/85; 63

  16. A-Part Gel, an adhesion prophylaxis for abdominal surgery: a randomized controlled phase I-II safety study [NCT00646412].

    Science.gov (United States)

    Lang, Reinhold; Baumann, Petra; Schmoor, Claudia; Odermatt, Erich K; Wente, Moritz N; Jauch, Karl-Walter

    2015-01-01

    Intra-abdominal surgical intervention can cause the development of intra-peritoneal adhesions. To reduce this problem, different agents have been tested to minimize abdominal adhesions; however, the optimal adhesion prophylaxis has not been found so far. Therefore, the A-Part(®) Gel was developed as a barrier to diminish postsurgical adhesions; the aim of this randomized controlled study was a first evaluation of its safety and efficacy. In this prospective, controlled, randomized, patient-blinded, monocenter phase I-II study, 62 patients received either the hydrogel A-Part-Gel(®) as an anti-adhesive barrier or were untreated after primary elective median laparotomy. Primary endpoint was the occurrence of peritonitis and/or wound healing impairment 28 ± 10 days postoperatively. As secondary endpoints anastomotic leakage until 28 days after surgery, adverse events and adhesions were assessed until 3 months postoperatively. A lower rate of wound healing impairment and/or peritonitis was observed in the A-Part Gel(®) group compared to the control group: (6.5 vs. 13.8 %). The difference between the two groups was -7.3%, 90 % confidence interval [-20.1, 5.4 %]. Both treatment groups showed similar frequency of anastomotic leakage but incidence of adverse events and serious adverse events were slightly lower in the A-Part Gel(®) group compared to the control. Adhesion rates were comparable in both groups. A-Part Gel(®) is safe as an adhesion prophylaxis after abdominal wall surgery but no reduction of postoperative peritoneal adhesion could be found in comparison to the control group. This may at least in part be due to the small sample size as well as to the incomplete coverage of the incision due to the used application. NCT00646412.

  17. Metabolic Syndrome Prevalence and Associations in a Bariatric Surgery Cohort from the Longitudinal Assessment of Bariatric Surgery-2 Study

    Science.gov (United States)

    Selzer, Faith; Smith, Mark D.; Berk, Paul D.; Courcoulas, Anita P.; Inabnet, William B.; King, Wendy C.; Pender, John; Pomp, Alfons; Raum, William J.; Schrope, Beth; Steffen, Kristine J.; Wolfe, Bruce M.; Patterson, Emma J.

    2014-01-01

    Abstract Background: Metabolic syndrome is associated with higher risk for cardiovascular disease, sleep apnea, and nonalcoholic steatohepatitis, all common conditions in patients referred for bariatric surgery, and it may predict early postoperative complications. The objective of this study was to determine the prevalence of metabolic syndrome, defined using updated National Cholesterol Education Program criteria, in adults undergoing bariatric surgery and compare the prevalence of baseline co-morbid conditions and select operative and 30-day postoperative outcomes by metabolic syndrome status. Methods: Complete metabolic syndrome data were available for 2275 of 2458 participants enrolled in the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), an observational cohort study designed to evaluate long-term safety and efficacy of bariatric surgery in obese adults. Results: The prevalence of metabolic syndrome was 79.9%. Compared to those without metabolic syndrome, those with metabolic syndrome were significantly more likely to be men, to have a higher prevalence of diabetes and prior cardiac events, to have enlarged livers and higher median levels of liver enzymes, a history of sleep apnea, and a longer length of stay after surgery following laparoscopic Roux-en-Y gastric bypass (RYGB) and gastric sleeves but not open RYGB or laparoscopic adjustable gastric banding. Metabolic syndrome status was not significantly related to duration of surgery or rates of composite end points of intraoperative events and 30-day major adverse surgical outcomes. Conclusions: Nearly four in five participants undergoing bariatric surgery presented with metabolic syndrome. Establishing a diagnosis of metabolic syndrome in bariatric surgery patients may identify a high-risk patient profile, but does not in itself confer a higher risk for short-term adverse postsurgery outcomes. PMID:24380645

  18. 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.

  19. Efficacy and Safety of Autologous Fat Transfer in Facial Reconstructive Surgery: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Krastev, Todor K; Beugels, Jip; Hommes, Juliette; Piatkowski, Andrzej; Mathijssen, Irene; van der Hulst, Rene

    2018-03-29

    The use of autologous fat transfer (AFT) or lipofilling for correcting contour deformities is seen as one of the major breakthroughs in reconstructive plastic surgery. Its applications in facial reconstructive surgery have been of particular interest owing to the prospect of achieving autologous reconstruction by a minimally invasive approach. However, its unpredictability and variable degree of resorption have limited its utility and much skepticism still exists regarding its efficacy. Furthermore, more than 2 decades of clinical research have produced a highly fragmented body of evidence that has not been able to provide definite answers. To investigate the safety and efficacy of AFT in facial reconstruction through a systematic review and meta-analysis. A literature search was performed in PubMed, Embase, and the Cochrane Library from inception to October 11, 2017. All published studies investigating the efficacy and safety of AFT in facial reconstructive surgery. Two independent reviewers performed data extraction systematically, adhering to the PRISMA guidelines. Summary measures were pooled in a random-effects model meta-analysis. The patient and surgeon satisfaction, graft survival, number of AFT sessions, and the incidence of AFT-related complications were the main outcomes of interest in this meta-analysis. This systematic review resulted in the inclusion 52 relevant studies consisting of 1568 unique patients. These included 4 randomized clinical trials, 11 cohort studies, and 37 case series. The overall follow-up averaged 1.3 years after AFT. Meta-analysis revealed a very high overall patient satisfaction rate of 91.1% (95% CI, 85.1%-94.8%) and overall surgeon satisfaction rate of 88.6% (95% CI, 83.4%-92.4%). The number of AFT sessions required to achieve the desired result was 1.5 (95% CI, 1.3-1.7) and 50% to 60% of the injected volume was retained at 1 year. Only 4.8% (95% CI, 3.3%-6.9%) of procedures resulted in clinical complications. To our knowledge

  20. Surgical outcomes of robot-assisted rectal cancer surgery using the da Vinci Surgical System: a multi-center pilot Phase II study.

    Science.gov (United States)

    Tsukamoto, Shunsuke; Nishizawa, Yuji; Ochiai, Hiroki; Tsukada, Yuichiro; Sasaki, Takeshi; Shida, Dai; Ito, Masaaki; Kanemitsu, Yukihide

    2017-12-01

    We conducted a multi-center pilot Phase II study to examine the safety of robotic rectal cancer surgery performed using the da Vinci Surgical System during the introduction period of robotic rectal surgery at two institutes based on surgical outcomes. This study was conducted with a prospective, multi-center, single-arm, open-label design to assess the safety and feasibility of robotic surgery for rectal cancer (da Vinci Surgical System). The primary endpoint was the rate of adverse events during and after robotic surgery. The secondary endpoint was the completion rate of robotic surgery. Between April 2014 and July 2016, 50 patients were enrolled in this study. Of these, 10 (20%) had rectosigmoid cancer, 17 (34%) had upper rectal cancer, and 23 (46%) had lower rectal cancer; six underwent high anterior resection, 32 underwent low anterior resection, 11 underwent intersphincteric resection, and one underwent abdominoperineal resection. Pathological stages were Stage 0 in 1 patient, Stage I in 28 patients, Stage II in 7 patients and Stage III in 14 patients. Pathologically complete resection was achieved in all patients. There was no intraoperative organ damage or postoperative mortality. Eight (16%) patients developed complications of all grades, of which 2 (4%) were Grade 3 or higher, including anastomotic leakage (2%) and conversion to open surgery (2%). The present study demonstrates the feasibility and safety of robotic rectal cancer surgery, as reflected by low morbidity and low conversion rates, during the introduction period. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  1. 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.

  2. 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...

  3. Efficacy and safety profile of antibiotic prophylaxis usage in clean and clean-contaminated plastic and reconstructive surgery: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Zhang, Yi; Dong, Jiasheng; Qiao, Yufei; He, Jinguang; Wang, Tao; Ma, Sunxiang

    2014-01-01

    There is no consensus with regard to antibiotic prophylaxis usage in clean and clean-contaminated plastic and reconstructive surgery. This meta-analysis sought to assess the efficacy and safety of antibiotic prophylaxis and to determine appropriate duration of prophylaxis. An English language literature search was conducted using PubMed and the Cochrane Collaboration for randomized controlled trials (RCTs) that evaluate the use of antibiotic prophylaxis to prevent postoperative surgical site infection (SSI) in patients undergoing clean and clean-contaminated plastic and reconstructive surgery. Data from intention-to-treat analyses were used where available. For the dichotomous data, results for each study were odds ratio (OR) with 95% confidence interval (CI) and combined for meta-analysis using the Mantel-Haenszel method or the DerSimonian and Laird method. Study quality was critically appraised by 2 reviewers using established criteria. STATA version 12 was used for meta-analyses. Twelve RCTs involving 2395 patients were included, of which 8 trials were considered to be of high methodological quality. Effect of antibiotic prophylaxis in plastic and reconstructive surgery was found favorable over placebo in SSI prevention (13 studies; 2449 participants; OR, 0.53; 95% CI, 0.4-0.7; P plastic surgeries with high-risk factors and clean-contaminated plastic surgeries. Besides, a short-course administration regimen seemed to be of adequate efficacy and safety. High-quality prospective trials on larger scale are needed to further confirm these findings.

  4. Prospective randomized controlled study on the validity and safety of an absorbable adhesion barrier (Interceed®) made of oxidized regenerated cellulose for laparoscopic colorectal surgery.

    Science.gov (United States)

    Naito, Masanori; Ogura, Naoto; Yamanashi, Takahiro; Sato, Takeo; Nakamura, Takatoshi; Miura, Hirohisa; Tsutsui, Atsuko; Sakamoto, Yasutoshi; Tanaka, Rieko; Kumagai, Yuji; Watanabe, Masahiko

    2017-02-01

    Clinical use of an adhesion barrier made of oxidized, regenerated cellulose, Interceed®, has been reported in the field of obstetrics and gynecology to help prevent adhesions between the peritoneum and the bowel in various types of operations. In gastrointestinal surgery, sodium hyaluronate/carboxymethylcellulose has been reported as an absorbable membrane to reduce postoperative adhesions. The present study was a prospective randomized controlled study to investigate the safety and usefulness of Interceed in laparoscopic colorectal surgery. We analyzed 99 patients who underwent laparoscopic colorectal surgery from 2013 to 2014. The patients were randomly allocated to the group that used Interceed (Interceed group) or the group that did not (Non-Interceed group). Fifty cases used Interceed, and 49 cases did not. The incidence of adverse events was 12.0% in the Interceed group and 16.3% in the Non-Interceed group (P = 0.58). There were no significant differences, and no adhesive bowel obstructions were observed in the Interceed group. We have shown that using Interceed in laparoscopic colorectal surgery is valid and technically safe. © 2016 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  5. Study of the Operational Safety of a Vascular Interventional Surgical Robotic System

    Directory of Open Access Journals (Sweden)

    Jian Guo

    2018-03-01

    Full Text Available This paper proposes an operation safety early warning system based on LabView (2014, National Instruments Corporation, Austin, TX, USA for vascular interventional surgery (VIS robotic system. The system not only provides intuitive visual feedback information for the surgeon, but also has a safety early warning function. It is well known that blood vessels differ in their ability to withstand stress in different age groups, therefore, the operation safety early warning system based on LabView has a vascular safety threshold function that changes in real-time, which can be oriented to different age groups of patients and a broader applicable scope. In addition, the tracing performance of the slave manipulator to the master manipulator is also an important index for operation safety. Therefore, we also transformed the slave manipulator and integrated the displacement error compensation algorithm in order to improve the tracking ability of the slave manipulator to the master manipulator and reduce master–slave tracking errors. We performed experiments “in vitro” to validate the proposed system. According to previous studies, 0.12 N is the maximum force when the blood vessel wall has been penetrated. Experimental results showed that the proposed operation safety early warning system based on LabView combined with operating force feedback can effectively avoid excessive collisions between the surgical catheter and vessel wall to avoid vascular puncture. The force feedback error of the proposed system is maintained between ±20 mN, which is within the allowable safety range and meets our design requirements. Therefore, the proposed system can ensure the safety of surgery.

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

    Science.gov (United States)

    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.

  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 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. 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

  9. 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.

  10. Crude versus case-mix-adjusted control charts for safety monitoring in thyroid surgery.

    Science.gov (United States)

    Duclos, Antoine; Voirin, Nicolas; Touzet, Sandrine; Soardo, Pietro; Schott, Anne-Marie; Colin, Cyrille; Peix, Jean-Louis; Lifante, Jean-Christophe

    2010-12-01

    Patient-safety monitoring based on health-outcome indicators can lead to misinterpretation of changes in case mix. This study aimed to compare the detection of indicator variations between crude and case-mix-adjusted control charts using data from thyroid surgeries. The study population included each patient who underwent thyroid surgery in a teaching hospital from January 2006 to May 2008. Patient safety was monitored according to two indicators, which are immediately recognisable postoperative complications: recurrent laryngeal nerve palsy and hypocalcaemia. Each indicator was plotted monthly on a p-control chart using exact limits. The weighted κ statistic was calculated to measure the agreement between crude and case-mix-adjusted control charts. We evaluated the outcomes of 1405 thyroidectomies. The overall proportions of immediate recurrent laryngeal nerve palsy and hypocalcaemia were 7.4% and 20.5%, respectively. The proportion of agreement in the detection of indicator variations between the crude and case-mix-adjusted p-charts was 95% (95% CI 85% to 99%). The strength of the agreement was κ = 0.76 (95% CI 0.54 to 0.98). The single special cause of variation that occurred was only detected by the case-mix-adjusted p-chart. There was good agreement in the detection of indicator variations between crude and case-mix-adjusted p-charts. The joint use of crude and adjusted charts seems to be a reasonable approach to increase the accuracy of interpretation of variations in outcome indicators.

  11. Surgery and imatinib therapy for liver oligometastasis of GIST: a study of Japanese Study Group on GIST.

    Science.gov (United States)

    Kanda, Tatsuo; Masuzawa, Toru; Hirai, Toshihiro; Ikawa, Osamu; Takagane, Akinori; Hata, Yasuhiro; Ojima, Hitoshi; Sodeyama, Harutsugu; Mochizuki, Izumi; Ishikawa, Takashi; Kagimura, Tatsuo; Nishida, Toshirou

    2017-04-01

    We conducted a multicenter prospective study to clarify the efficacy and safety of surgery and imatinib for liver oligometastasis of gastrointestinal stromal tumors. Eligible gastrointestinal stromal tumor patients were enrolled in the surgery trial or the imatinib trial. Primary endpoints were recurrence-free survival and progression-free survival, respectively. The trials were prematurely terminated due to amendment of guidelines for adjuvant imatinib therapy and low patient accrual. In the surgery trial, all the six patients showed hepatic recurrence: median recurrence-free survival was 145 days (range: 62-1366 days). Of the five patients receiving salvage imatinib therapy, two showed progressive disease although no death was observed. Of the five patients enrolled in the imatinib trial, one died of pneumonia after progressive disease, and four had not shown progressive disease as of last visit. The results suggest that liver oligometastasis of gastrointestinal stromal tumor may not be controllable by surgery alone and require concomitant imatinib therapy. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  12. Safety and effects of two red blood cell transfusion strategies in pediatric cardiac surgery patients: a randomized controlled trial

    NARCIS (Netherlands)

    de Gast-Bakker, D. H.; de Wilde, R. B. P.; Hazekamp, M. G.; Sojak, V.; Zwaginga, J. J.; Wolterbeek, R.; de Jonge, E.; Gesink-van der Veer, B. J.

    2013-01-01

    To investigate the safety and effects of a restrictive red blood cell (RBC) transfusion strategy in pediatric cardiac surgery patients. Randomized controlled trial. Pediatric ICU in an academic tertiary care center, Leiden University Medical Center, Leiden, The Netherlands. One hundred seven

  13. Flexible single-incision surgery: a fusion technique.

    Science.gov (United States)

    Noguera, José F; Dolz, Carlos; Cuadrado, Angel; Olea, José; García, Juan

    2013-06-01

    The development of natural orifice transluminal endoscopic surgery has led to other techniques, such as single-incision surgery. The use of the flexible endoscope for single-incision surgery paves the way for further refinement of both surgical methods. To describe a new, single-incision surgical technique, namely, flexible single-incision surgery. Assessment of the safety and effectiveness of endoscopic cholecystectomy in a series of 30 patients. This technique consists of a single umbilical incision through which a flexible endoscope is introduced and consists of 2 parallel entry ports that provide access to nonarticulated laparoscopic instruments. The technique was applied in all patients for whom it was prescribed. No general or surgical wound complications were noted. Surgical time was no longer than usual for single-port surgery. Flexible single-incision surgery is a new single-site surgical technique offering the same level of patient safety, with additional advantages for the surgeon at minimal cost.

  14. 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...

  15. Utility and safety of the flexible-fiber CO2 laser in endoscopic endonasal transsphenoidal surgery.

    Science.gov (United States)

    Jayarao, Mayur; Devaiah, Anand K; Chin, Lawrence S

    2011-01-01

    This study sought to report on the utility and safety of the flexible-fiber CO2 laser in endoscopic endonasal transsphenoidal surgery. A retrospective chart review identified 16 patients who underwent laser-assisted transsphenoidal surgery. All tumor pathology types were considered. Results were assessed based on hormone status, tumor size, pathology, complications, and resection rates. Sixteen pituitary lesions (pituitary adenomas, 12; Rathke cleft cyst, 2; pituitary cyst and craniopharyngioma, 1 each) with an average size of 22.7 mm were identified by radiographic and pathologic criteria. All patients underwent flexible-fiber CO2 laser-assisted endoscopic endonasal transsphenoidal surgery. Of the adenomas, 8 were nonsecreting and 4 were secreting (3 prolactinomas and 1 ACTH secreting). Gross total resection was achieved in 7 of 16 patients (43.75%) with hormone remission in all patients (100%) after a mean follow-up of 19.3 months. Postoperative complications occurred in 3 patients (18.75%): 2 patients developed transient diabetes insipidus (DI) and 1 developed a CSF leak requiring surgical repair. Five patients (31.25%) underwent postoperative radiation to the residual lesions. We found that CO2-laser-assisted endoscopic endonasal transsphenoidal surgery for sellar tumors is a minimally invasive approach using a tool that is quick and effective at cutting and coagulation. The surgery has a low rate of complication, and no laser-related complications were encountered. The laser fiber allows the surgeon to safely cut and coagulate without the line-of-sight problems encountered with conventional CO2 lasers. Further studies are recommended to further define its role in endoscopic endonasal sellar surgery. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Facilitators and barriers of implementing enhanced recovery in colorectal surgery at a safety net hospital: A provider and patient perspective.

    Science.gov (United States)

    Alawadi, Zeinab M; Leal, Isabel; Phatak, Uma R; Flores-Gonzalez, Juan R; Holihan, Julie L; Karanjawala, Burzeen E; Millas, Stefanos G; Kao, Lillian S

    2016-03-01

    Enhanced Recovery After Surgery (ERAS) pathways are known to decrease complications and duration of stay in colorectal surgery patients. However, it is unclear whether an ERAS pathway would be feasible and effective at a safety-net hospital. The aim of this study was to identify local barriers and facilitators before the adoption of an ERAS pathway for patients undergoing colorectal operations at a safety-net hospital. Semistructured interviews were conducted to assess the perceived barriers and facilitators before ERAS adoption. Stratified purposive sampling was used. Interviews were audiotaped, transcribed verbatim, and analyzed using content analysis. Analytic and investigator triangulation were used to establish credibility. Interviewees included 8 anesthesiologists, 5 surgeons, 6 nurses, and 18 patients. Facilitators identified across the different medical professions were (1) feasibility and alignment with current practice, (2) standardization of care, (3) smallness of community, (4) good teamwork and communication, and (5) caring for patients. The barriers were (1) difficulty in adapting to change, (2) lack of coordination between different departments, (3) special needs of a highly comorbid and socioeconomically disadvantaged patient population, (4) limited resources, and (5) rotating residents. Facilitators identified by the patients were (1) welcoming a speedy recovery, (2) being well-cared for and satisfied with treatment, (3) adequate social support, (4) welcoming early mobilization, and (5) effective pain management. The barriers were (1) lack of quiet and private space, (2) need for more patient education and counseling, and (3) unforeseen complications. Although limited hospital resources are perceived as a barrier to ERAS implementation at a safety-net hospital, there is strong support for such pathways and multiple factors were identified that may facilitate change. Inclusion of patient perspectives is critical to identifying challenges and

  17. Safety and efficacy of sugammadex for the reversal of rocuronium-induced neuromuscular blockade in cardiac patients undergoing noncardiac surgery

    NARCIS (Netherlands)

    Dahl, Vegard; Pendeville, Philippe E.; Hollmann, Markus W.; Heier, Tom; Abels, Esther Am; Blobner, Manfred

    2009-01-01

    Background and objective The present randomized, safety-assessor blinded, placebo-controlled trial was designed to assess safety and efficacy of sugammadex, a novel selective relaxant-binding agent, in patients with underlying cardiovascular disease undergoing noncardiac surgery. Methods Overall,

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

    Science.gov (United States)

    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

  19. Perioperative outcomes of adolescents undergoing bariatric surgery: the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study.

    Science.gov (United States)

    Inge, Thomas H; Zeller, Meg H; Jenkins, Todd M; Helmrath, Michael; Brandt, Mary L; Michalsky, Marc P; Harmon, Carroll M; Courcoulas, Anita; Horlick, Mary; Xanthakos, Stavra A; Dolan, Larry; Mitsnefes, Mark; Barnett, Sean J; Buncher, Ralph

    2014-01-01

    Severe obesity in childhood is a major health problem with few effective treatments. Weight-loss surgery (WLS) is being used to treat severely obese adolescents, although with very limited data regarding surgical safety for currently used, minimally invasive procedures. To assess the preoperative clinical characteristics and perioperative safety outcomes of severely obese adolescents undergoing WLS. This prospective, multisite observational study enrolled patients from February 28, 2007, through December 30, 2011. Consecutive patients aged 19 years or younger who were approved to undergo WLS (n = 277) were offered enrollment into the study at 5 academic referral centers in the United States; 13 declined participation and 22 did not undergo surgery after enrollment, thus the final analysis cohort consisted of 242 individuals. There were no withdrawals. This analysis examined preoperative anthropometrics, comorbid conditions, and major and minor complications occurring within 30 days of operation. All data were collected in a standardized fashion. Reoperations and hospital readmissions were adjudicated by independent reviewers to assess relatedness to the WLS procedure. The mean (SD) age of participants was 17.1 (1.6) years and the median body mass index (calculated as weight in kilograms divided by height in meters squared) was 50.5. Fifty-one percent demonstrated 4 or more major comorbid conditions. Laparoscopic Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and adjustable gastric banding were performed in 66%, 28%, and 6% of patients, respectively. There were no deaths during the initial hospitalization or within 30 days of operation; major complications (eg, reoperation) were seen in 19 patients (8%). Minor complications (eg, readmission for dehydration) were noted in 36 patients (15%). All reoperations and 85% of readmissions were related to WLS. In this series, adolescents with severe obesity presented with abundant comorbid conditions. We observed

  20. Safety and efficacy of bariatric surgery in Mexico: A detailed analysis of 500 surgeries performed at a high-volume center.

    Science.gov (United States)

    Guilbert, L; Joo, P; Ortiz, C; Sepúlveda, E; Alabi, F; León, A; Piña, T; Zerrweck, C

    2018-06-19

    Bariatric surgery is the best method for treating obesity and its comorbidities. Our aim was to provide a detailed analysis of the perioperative outcomes in Mexican patients that underwent surgery at a high-volume hospital center. A retrospective study was conducted on all the patients that underwent bariatric surgery at a single hospital center within a time frame of 4 and one-half years. Demographics, the perioperative variables, complications (early and late), weight loss, failure, and type 2 diabetes mellitus remission were all analyzed. Five hundred patients were included in the study, 83.2% of whom were women. Mean patient age was 38.8 years and BMI was 44.1kg/m 2 . The most common comorbidities were high blood pressure, dyslipidemia, and diabetes. Laparoscopic gastric bypass surgery was performed in 85.8% of the patients, sleeve gastrectomy in 13%, and revision surgeries in 1%. There were 9.8% early complications and 12.2% late ones, with no deaths. Overall weight loss as the excess weight loss percentage at 12 and 24 months was 76.9 and 77.6%. The greatest weight loss at 12 months was seen in the patients that underwent laparoscopic gastric bypass. A total of 11.4% of the patients had treatment failure. In the patients with type 2 diabetes mellitus, 68.7% presented with complete disease remission and 9.3% with partial remission. There was improvement in 21.8% of the cases. In our experience at a high-volume hospital center, bariatric surgery is safe and effective, based on the low number of adverse effects and consequent weight loss and type 2 diabetes mellitus control. Long-term studies with a larger number of patients are needed to determine the final impact of those procedures. Copyright © 2018 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  1. Evaluation and Customization of WHO Safety Checklist for Patient Safety in Otorhinolaryngology.

    Science.gov (United States)

    Dabholkar, Yogesh; Velankar, Haritosh; Suryanarayan, Sneha; Dabholkar, Twinkle Y; Saberwal, Akanksha A; Verma, Bhavika

    2018-03-01

    The WHO has designed a safe surgery checklist to enhance communication and awareness of patient safety during surgery and to minimise complications. WHO recommends that the check-list be evaluated and customised by end users as a tool to promote safe surgery. The aim of present study was to evaluate the impact of WHO safety checklist on patient safety awareness in otorhinolaryngology and to customise it for the speciality. A prospective structured questionnaire based study was done in ENT operating room for duration of 1 month each for cases, before and after implementation of safe surgery checklist. The feedback from respondents (surgeons, nurses and anaesthetists) was used to arrive at a customised checklist for otolaryngology as per WHO guidelines. The checklist significantly improved team member's awareness of patient's identity (from 17 to 86%) and each other's identity and roles (from 46 to 94%) and improved team communication (from 73 to 92%) in operation theatre. There was a significant improvement in preoperative check of equipment and critical events were discussed more frequently. The checklist could be effectively customised to suit otolaryngology needs as per WHO guidelines. The modified checklist needs to be validated by otolaryngology associations. We conclude from our study that the WHO Surgical safety check-list has a favourable impact on patient safety awareness, team-work and communication of operating team and can be customised for otolaryngology setting.

  2. Pre-validation Study of the Brazilian Version of the Disruptions in Surgery Index (DiSI) as a Safety Tool in Cardiothoracic Surgery

    Science.gov (United States)

    Nina, Vinicius José da Silva; Jatene, Fabio B.; Sevdalis, Nick; Mejía, Omar Asdrúbal Vilca; Brandão, Carlos Manuel de Almeida; Monteiro, Rosangela; Caneo, Luiz Fernando; Scudeller, Paula Gobi; Mendes, Augusto Dimitry; Mendes, Vinícius Giuliano; Romano, Bellkiss Wilma

    2017-01-01

    Introduction Most risk stratification scores used in surgery do not include external and non-technical factors as predictors of morbidity and mortality. Objective The present study aimed to translate and adapt transculturally the Brazilian version of the Disruptions in Surgery Index (DiSI) questionnaire, which was developed to capture the self-perception of each member of the surgical team regarding the disruptions that may contribute to error and obstruction of safe surgical flow. Methods A universalist approach was adopted to evaluate the conceptual equivalence of items and semantics, which included the following stages: (1) translation of the questionnaire into Portuguese; (2) back translation into English; (3) panel of experts to draft the preliminary version; and (4) pre-test for evaluation of verbal comprehension by the target population of 43 professionals working in cardiothoracic surgery. Results The questionnaire was translated into Portuguese and its final version with 29 items obtained 89.6% approval from the panel of experts. The target population evaluated all items as easy to understand. The mean overall clarity and verbal comprehension observed in the pre-test reached 4.48 ± 0.16 out of the maximum value of 5 on the psychometric Likert scale. Conclusion Based on the methodology used, the experts' analysis and the results of the pre-test, it is concluded that the essential stages of translation and cross-cultural adaptation of DiSI to the Portuguese language were satisfactorily fulfilled in this study. PMID:29267606

  3. Pre-validation Study of the Brazilian Version of the Disruptions in Surgery Index (DiSI as a Safety Tool in Cardiothoracic Surgery

    Directory of Open Access Journals (Sweden)

    Vinicius José da Silva Nina

    Full Text Available Abstract Introduction: Most risk stratification scores used in surgery do not include external and non-technical factors as predictors of morbidity and mortality. Objective: The present study aimed to translate and adapt transculturally the Brazilian version of the Disruptions in Surgery Index (DiSI questionnaire, which was developed to capture the self-perception of each member of the surgical team regarding the disruptions that may contribute to error and obstruction of safe surgical flow. Methods: A universalist approach was adopted to evaluate the conceptual equivalence of items and semantics, which included the following stages: (1 translation of the questionnaire into Portuguese; (2 back translation into English; (3 panel of experts to draft the preliminary version; and (4 pre-test for evaluation of verbal comprehension by the target population of 43 professionals working in cardiothoracic surgery. Results: The questionnaire was translated into Portuguese and its final version with 29 items obtained 89.6% approval from the panel of experts. The target population evaluated all items as easy to understand. The mean overall clarity and verbal comprehension observed in the pre-test reached 4.48 ± 0.16 out of the maximum value of 5 on the psychometric Likert scale. Conclusion: Based on the methodology used, the experts' analysis and the results of the pre-test, it is concluded that the essential stages of translation and cross-cultural adaptation of DiSI to the Portuguese language were satisfactorily fulfilled in this study.

  4. Efficacy and safety of SOX chemotherapy with or without surgery in AFP-producing advanced gastric cancer

    OpenAIRE

    Li, Zhu; Hou, Xu; Chen, Juan; Sun, Huidong; Mi, Yuetang; Sui, Yongling; Li, Yuhong; Xie, Jiaping; Qiao, Yingli; Lei, Xiaofeng; Che, Xiaoshuang; Liu, Jun

    2017-01-01

    The present study investigated the clinical efficacy of S-1 plus oxaliplatin (SOX) regimen, with or without surgery in ?-fetoprotein-producing gastric cancer (APGC) with liver metastasis. A total of 24 patients with APGC treated at the Liaocheng People's Hospital between January 2011 and December 2013 were retrospectively reviewed. Clinical efficacy and patient safety were compared between the two groups. The median progression-free survival (PFS) and overall survival (OS) in the SOX group we...

  5. [Clinical safety and professional liability claims in Orthopaedic Surgery and Traumatology].

    Science.gov (United States)

    Bori, G; Gómez-Durán, E L; Combalia, A; Trilla, A; Prat, A; Bruguera, M; Arimany-Manso, J

    2016-01-01

    The specialist in orthopaedic and traumatological surgery, like any other doctor, is subject to the current legal provisions while exercising their profession. Mandatory training in the medical-legal aspects of health care is essential. Claims against doctors are a reality, and orthopaedic and traumatological surgery holds first place in terms of frequency of claims according to the data from the General Council of Official Colleges of Doctors of Catalonia. Professionals must be aware of the fundamental aspects of medical professional liability, as well as specific aspects, such as defensive medicine and clinical safety. The understanding of these medical-legal aspects in the routine clinical practice can help to pave the way towards a satisfactory and safe professional career. The aim of this review is to contribute to this training, for the benefit of professionals and patients. Copyright © 2015 SECOT. Published by Elsevier Espana. All rights reserved.

  6. Efficacy and safety of interscalene block combined with general anesthesia for arthroscopic shoulder surgery: A meta-analysis.

    Science.gov (United States)

    Yan, Siyi; Zhao, Yanjun; Zhang, Huan

    2018-06-01

    There is controversy regarding the efficacy and safety of using interscalene block (ISB) combined with general anesthesia (GA) for arthroscopic shoulder surgery. Our meta-analysis was undertaken to evaluate the utility of this approach. We searched the PubMed, Cochrane Library, EMBASE, CNKI, VIP and ClinicalTrials.gov databases for randomized controlled trials. The primary endpoint was extubation time. Secondary endpoints included intraoperative heart rate, pain scores on the day of and 1 day after the operation, intraoperative systolic blood pressure and adverse events. Ten RCTs involving 746 patients undergoing arthroscopic shoulder surgery met inclusion criteria. Compared with GA alone, ISB + GA was associated with a shorter extubation time(WMD = -6.13; 95% CI = -8.68 to -3.57; P shoulder surgery, ISB + GA is associated with a lower heart rate, lower pain scores on the day of and 1 day after the operation, a lower intraoperative systolic blood pressure, a shorter extubation time and a lower incidence of adverse events compared with GA alone. Copyright © 2018 Elsevier Inc. All rights reserved.

  7. The Resident-Run Minor Surgery Clinic: A Pilot Study to Safely Increase Operative Autonomy.

    Science.gov (United States)

    Wojcik, Brandon M; Fong, Zhi Ven; Patel, Madhukar S; Chang, David C; Petrusa, Emil; Mullen, John T; Phitayakorn, Roy

    General surgery training has evolved to align with changes in work hour restrictions, supervision regulations, and reimbursement practices. This has culminated in a lack of operative autonomy, leaving residents feeling inadequately prepared to perform surgery independently when beginning fellowship or practice. A resident-run minor surgery clinic increases junior resident autonomy, but its effects on patient outcomes have not been formally established. This pilot study evaluated the safety of implementing a resident-run minor surgery clinic within a university-based general surgery training program. Single institution case-control pilot study of a resident-run minor surgery clinic from 9/2014 to 6/2015. Rotating third-year residents staffed the clinic once weekly. Residents performed operations independently in their own procedure room. A supervising attending surgeon staffed each case prior to residents performing the procedure and viewed the surgical site before wound closure. Postprocedure patient complications and admissions to the hospital because of a complication were analyzed and compared with an attending control cohort. Massachusetts General Hospital General in Boston, MA; an academic tertiary care general surgery residency program. Ten third-year general surgery residents. Overall, 341 patients underwent a total of 399 procedures (110 in the resident clinic vs. 289 in the attending clinic). Minor surgeries included soft tissue mass excision (n = 275), abscess incision and drainage (n = 66), skin lesion excision (n = 37), skin tag removal (n = 15), and lymph node excision (n = 6). There was no significant difference in the overall rate of patients developing a postprocedure complication within 30 days (3.6% resident vs. 2.8% attending; p = 0.65); which persisted on multivariate analysis. Similar findings were observed for the rate of hospital admission resulting from a complication. Resident evaluations overwhelmingly supported the rotation, citing

  8. 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.

    Science.gov (United States)

    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 pain after 24 hours, with fewer side effects when compared to oral tramadol.

  9. Laparoscopy in major abdominal emergency surgery seems to be a safe procedure

    DEFF Research Database (Denmark)

    Nielsen, Liv Bjerre Juul; Tengberg, Line Toft; Bay-Nielsen, Morten

    2017-01-01

    INTRODUCTION: Laparoscopy is well established in the majority of elective procedures in abdominal surgery. In contrast, it is primarily used in minor surgery such as appendectomy or cholecystectomy in the emergent setting. This study aimed to analyze the safety and effectiveness of a laparoscopic...

  10. Improving patient safety in cardiothoracic surgery: an audit of surgical handover in a tertiary center

    Directory of Open Access Journals (Sweden)

    Bauer NJ

    2016-05-01

    Full Text Available Natasha Johan Bauer Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, UK Background: Novel research has revealed that the relative risk of death increased by 10% and 15% for admissions on a Saturday and Sunday, respectively. With an imminent threat of 7-day services in the National Health Service, including weekend operating lists, handover plays a pivotal role in ensuring patient safety is paramount. This audit evaluated the quality, efficiency, and safety of surgical handover of pre- and postoperative cardiothoracic patients in a tertiary center against guidance on Safe Handover published by the Royal College of Surgeons of ­England and the British Medical Association. Methods: A 16-item questionnaire prospectively audited the nature, time and duration of handover, patient details, operative history and current clinical status, interruptions during handover, and difficulties cross-covering specialties over a month. Results: Just over half (52% of the time, no handover took place. The majority of handovers (64% occurred over the phone; two-thirds of these were uninterrupted. All handovers were less than 10 minutes in duration. About half of the time, the senior house officer had previously met the registrar involved in the handover, but the overwhelming majority felt it would facilitate the handover process if they had prior contact. Patient details handed over 100% of the time included name, ward, and current clinical diagnosis. A third of the time, the patient’s age, responsible consultant, and recent operations or procedures were not handed over, potentially compromising future management due to delays and lack of relevant information. Perhaps the most revealing result was that the overall safety of handover was perceived to be five out of ten, with ten being very safe with no aspects felt to impact negatively on optimal patient care. Conclusion: These findings were presented to the department, and a handover proforma

  11. Foot-controlled robotic-enabled endoscope holder for endoscopic sinus surgery: A cadaveric feasibility study.

    Science.gov (United States)

    Chan, Jason Y K; Leung, Iris; Navarro-Alarcon, David; Lin, Weiyang; Li, Peng; Lee, Dennis L Y; Liu, Yun-hui; Tong, Michael C F

    2016-03-01

    To evaluate the feasibility of a unique prototype foot-controlled robotic-enabled endoscope holder (FREE) in functional endoscopic sinus surgery. Cadaveric study. Using human cadavers, we investigated the feasibility, advantages, and disadvantages of the robotic endoscope holder in performing endoscopic sinus surgery with two hands in five cadaver heads, mimicking a single nostril three-handed technique. The FREE robot is relatively easy to use. Setup was quick, taking less than 3 minutes from docking the robot at the head of the bed to visualizing the middle meatus. The unit is also relatively small, takes up little space, and currently has four degrees of freedom. The learning curve for using the foot control was short. The use of both hands was not hindered by the presence of the endoscope in the nasal cavity. The tremor filtration also aided in the smooth movement of the endoscope, with minimal collisions. The FREE endoscope holder in an ex-vivo cadaver test corroborated the feasibility of the robotic prototype, which allows for a two-handed approach to surgery equal to a single nostril three-handed technique without the holder that may reduce operating time. Further studies will be needed to evaluate its safety profile and use in other areas of endoscopic surgery. NA. Laryngoscope, 126:566-569, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  12. Robotic bariatric surgery: a systematic review.

    Science.gov (United States)

    Fourman, Matthew M; Saber, Alan A

    2012-01-01

    Obesity is a nationwide epidemic, and the only evidence-based, durable treatment of this disease is bariatric surgery. This field has evolved drastically during the past decade. One of the latest advances has been the increased use of robotics within this field. The goal of our study was to perform a systematic review of the recent data to determine the safety and efficacy of robotic bariatric surgery. The setting was the University Hospitals Case Medical Center (Cleveland, OH). A PubMed search was performed for robotic bariatric surgery from 2005 to 2011. The inclusion criteria were English language, original research, human, and bariatric surgical procedures. Perioperative data were then collected from each study and recorded. A total of 18 studies were included in our review. The results of our systematic review showed that bariatric surgery, when performed with the use of robotics, had similar or lower complication rates compared with traditional laparoscopy. Two studies showed shorter operative times using the robot for Roux-en-Y gastric bypass, but 4 studies showed longer operative times in the robotic arm. In addition, the learning curve appears to be shorter when robotic gastric bypass is compared with the traditional laparoscopic approach. Most investigators agreed that robotic laparoscopic surgery provides superior imaging and freedom of movement compared with traditional laparoscopy. The application of robotics appears to be a safe option within the realm of bariatric surgery. Prospective randomized trials comparing robotic and laparoscopic outcomes are needed to further define the role of robotics within the field of bariatric surgery. Longer follow-up times would also help elucidate any long-term outcomes differences with the use of robotics versus traditional laparoscopy. Copyright © 2012 American Society for Metabolic and Bariatric Surgery. All rights reserved.

  13. Aprotinin vs. tranexamic acid in isolated coronary artery bypass surgery: A multicentre observational study.

    Science.gov (United States)

    Deloge, Elsa; Amour, Julien; Provenchère, Sophie; Rozec, Bertrand; Scherrer, Bruno; Ouattara, Alexandre

    2017-05-01

    Aprotinin appears to be more efficacious than lysine analogues to reduce bleeding and transfusion of blood products in high-transfusion-risk cardiac surgical patients. However, in isolated coronary artery bypass graft (CABG) surgery, the results from head-to-head trials remain less conclusive. Our objective was to compare the efficacies and safety of aprotinin and tranexamic acid (TXA) in patients undergoing isolated on-pump CABG. A multicentre before-and-after study pooling individual data from published trials and unpublished data from three other databases. Four tertiary care teaching hospitals (Haut-Lévêque Hospital in Bordeaux, Pitié-Salpêtrière Hospital and Bichat-Claude Bernard Hospital in Paris, and Laennec Hospital in Nantes). We included data of 2496 isolated on-pump CABG surgery patients who received either aprotinin between November 2003 and May 2008 (n = 1267) or TXA between November 2007 and November 2013 (n = 1229). The primary outcome was total blood loss within 24 h after operation. Secondary outcomes were transfusion of blood products, reoperation for bleeding, renal replacement therapy, ICU length of stay and in-hospital mortality. Adjusted mean (SEM) 24-h blood loss after surgery [483 (11) vs. 634 (11) ml, P < 0.0001] and the proportion of patients requiring intraoperative blood product transfusion (32.7 vs. 46.5%, P = 0.01) were lower in aprotinin-treated patients. No difference was observed with regard to reoperations for bleeding, renal replacement therapy and in-hospital mortality. However, patients receiving aprotinin had a significantly shorter adjusted ICU length of stay. In patients undergoing isolated CABG, aprotinin was more effective than TXA in reducing postoperative blood loss, and no safety concerns were identified. The benefits of aprotinin should be considered when evaluating the risk of major blood loss and transfusion in patients scheduled for isolated CABG surgery.

  14. 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

  15. 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

  16. Ambulatory cleft lip surgery: A value analysis.

    Science.gov (United States)

    Arneja, Jugpal S; Mitton, Craig

    2013-01-01

    Socialized health systems face fiscal constraints due to a limited supply of resources and few reliable ways to control patient demand. Some form of prioritization must occur as to what services to offer and which programs to fund. A data-driven approach to decision making that incorporates outcomes, including safety and quality, in the setting of fiscal prudence is required. A value model championed by Michael Porter encompasses these parameters, in which value is defined as outcomes divided by cost. To assess ambulatory cleft lip surgery from a quality and safety perspective, and to assess the costs associated with ambulatory cleft lip surgery in North America. Conclusions will be drawn as to how the overall value of cleft lip surgery may be enhanced. A value analysis of published articles related to ambulatory cleft lip repair over the past 30 years was performed to determine what percentage of patients would be candidates for ambulatory cleft lip repair from a quality and safety perspective. An economic model was constructed based on costs associated with the inpatient stay related to cleft lip repair. On analysis of the published reports in the literature, a minority (28%) of patients are currently discharged in an ambulatory fashion following cleft lip repair. Further analysis suggests that 88.9% of patients would be safe candidates for same-day discharge. From an economic perspective, the mean cost per patient for the overnight admission component of ambulatory cleft surgery to the health care system in the United States was USD$2,390 and $1,800 in Canada. The present analysis reviewed germane publications over a 30-year period, ultimately suggesting that ambulatory cleft lip surgery results in preservation of quality and safety metrics for most patients. The financial model illustrates a potential cost saving through the adoption of such a practice change. For appropriately selected patients, ambulatory cleft surgery enhances overall health care value.

  17. 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.

    Science.gov (United States)

    Wu, Zhihong; Li, Shuning; Wang, Ningli; Liu, Wanshun; Liu, Wen

    2013-01-01

    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. 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. 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 other two groups (maintained 7 days). Significantly lower IOP was observed within the control, blank, and 5-FU groups after surgery on day 14 compared with that before operation, with F-values of 6.567, 11.426, and 13.467, respectively (P < 0.01). The most significant lower IOP was recorded in the MMC group on day 28 postoperation (F-value 26

  18. Assessment of extensive surgery for locally advanced lung cancer. Safety and efficacy of induction therapy

    International Nuclear Information System (INIS)

    Niwa, Hiroshi; Nakamae, Katsumi; Yamada, Takeshi; Kani, Hisanori; Maemoto, Katsutoshi; Mizuno, Takeo

    1999-01-01

    Locally advanced lung cancer has a poor prognosis, despite extensive surgery conducted in an effort to improve survival. We evaluated the safety and efficacy of induction therapy prior to extensive surgery for locally advanced lung cancer. Primary resection for lung cancer was done in 549 consecutive patients divided into three groups; 446 undergoing standard pulmonary resection (no extensive surgery), 87 undergoing extensive surgery without induction therapy, and 16 undergoing surgery after induction therapy. Morbidity was 23.5%, 28.6%, and 43.8%, respectively. The rate was significantly higher in the induction group compared with the no extensive surgery group (P<0.05). Surgical mortality was 0.67%, 3.4%, and 6.3%, respectively. The difference was statistically significant between the no extensive surgery and extensive surgery groups (P<0.02), and between the no extensive surgery and induction groups (P<0.02). Hospital mortality was 2.2%, 9.2%, and 6.3%, respectively. The rates were significantly higher in the extensive surgery (P<0.01) and induction (P<0.05) groups compared to the no extensive surgery group. Five-year survival was 50.3% for the patients who received induction therapy, and 14.7% for the patients who did not receive induction therapy. Survival differences between the induction and non induction groups were not significant, but some patients with T3 or T4 disease may benefit from induction therapy. The high morbidity of induction treatment should be recognized, and strict candidate selection and careful postoperative care used to help prevent increased mortality. (author)

  19. Retroperitoneal laparoscopic pyelolithotomy in renal pelvic stone versus open surgery - a comparative study.

    Science.gov (United States)

    Singal, Rikki; Dhar, Siddharth

    2018-01-01

    The introduction of endourological procedures such as percutaneous nephrolithotomy and ureterorenoscopy have led to a revolution in the the management of urinary stone disease. The indications for open stone surgery have been narrowed significantly, making it a second- or third-line treatment option. To study the safety and efficacy of retroperitoneal laparoscopic pyelolithotomy in retroperitoneal renal stone. We compared the results of laparoscopic and open surgery in terms of easy accessibility, operative period, renal injuries, and early recovery. This prospective study was conducted on renal pelvic stone cases from January 2009 to February 2016 in Suchkhand Hospital, Agra, India. The study included a total of 1700 cases with the diagnosis of solitary renal pelvic stones. In group A - 850 cases - retroperitoneal laparoscopic pyelolithotomy was performed, while group B - 850 cases - underwent open pyelolithotomy. The mean operative time was less in group B than group A (74.83 min vs. 94.43 min) which was significant (p<0.001). The blood loss was less in the laparoscopic group than in the open group (63 mL vs. 103mL). There were statistically significant differences in the post-operative pain scores, and postoperative complications compared to group B (p<0.001). The mean hospital stay was less in group A (p<0.03), which was significant. Laparoscopic surgery reduces analgesic requirements, hospital stay, and blood loss. The disadvantages include the reduced working space, the cost of equipment and the availability of a trained surgeon.

  20. 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.

  1. Robot-Assisted Thoracoscopic Surgery versus Video-Assisted Thoracoscopic Surgery for Lung Lobectomy: Can a Robotic Approach Improve Short-Term Outcomes and Operative Safety?

    Science.gov (United States)

    Mahieu, Julien; Rinieri, Philippe; Bubenheim, Michael; Calenda, Emile; Melki, Jean; Peillon, Christophe; Baste, Jean-Marc

    2016-06-01

    Background Minimally invasive surgery has been recently recommended for treatment of early-stage non-small cell lung cancer. Despite the recent increase of robotic surgery, the place and potential advantages of the robot in thoracic surgery has not been well defined until now. Methods We reviewed our prospective database for retrospective comparison of our first 28 video-assisted thoracoscopic surgery lobectomies (V group) and our first 28 robotic lobectomies (R group). Results No significant difference was shown in median operative time between the two groups (185 vs. 190 minutes, p = 0.56). Median preincision time was significantly longer in the R group (80 vs. 60 minutes, P < 0.0001). The rate of emergency conversion for uncontrolled bleeding was lower in the R group (one vs. four). Median length of stay was comparable (6 days in the R group vs. 7 days in the V group, p = 0.4) with no significant difference in the rate of postoperative complications (eight Grade I in both groups, four Grade III or IV in the V group vs. six in the R group, according to the Clavien-Dindo classification, p = 0.93). No postoperative cardiac morbidity was observed in the R group. Median drainage time was similar (5 days, p = 0.78), with a rate of prolonged air leak slightly higher in the R group (25 vs. 17.8%, p = 0.74). Conclusion Perioperative outcomes are similar even in the learning period but robotic approach seems to offer more operative safety with fewer conversions for uncontrolled bleeding. Georg Thieme Verlag KG Stuttgart · New York.

  2. Efficacy and Safety of Injectable Robenacoxib for the Treatment of Pain Associated With Soft Tissue Surgery in Dogs.

    Science.gov (United States)

    Friton, G; Thompson, C; Karadzovska, D; King, S; King, J N

    2017-05-01

    Nonsteroidal anti-inflammatory drugs (NSAIDs) are used routinely to control pain and inflammation after surgery in dogs. Robenacoxib is a cyclooxygenase-2 selective NSAID. Assess the clinical efficacy and safety of an injectable formulation of robenacoxib in dogs undergoing surgery. Three hundred and seventeen client-owned dogs (N = 159 robenacoxib or N = 158 placebo). In this prospective, multicenter, randomized, masked, placebo-controlled, parallel-group study, dogs received a SC injection of either robenacoxib, at a target dose of 2.0 mg/kg, or placebo once prior to surgery and for 2 additional days postoperatively. Pain assessments were performed using the short form of the Glasgow Composite Measure Pain Scale (CMPS-SF). The primary efficacy variable was treatment success/failure, with failure defined as the need for rescue therapy to control pain or withdrawal of the dog from the study due to an adverse event. Significantly (P = .006) more dogs administered robenacoxib were considered treatment successes (108 of 151, 73.7%) compared to dogs given placebo (85 of 152, 58.1%). Total pain scores (P dogs receiving robenacoxib versus placebo. Robenacoxib administered by SC injection prior to surgery and for 2 additional days postoperatively was effective and well tolerated in the control of postoperative pain and inflammation associated with soft tissue surgery in dogs. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  3. The diagnosis efficacy and safety of video-assisted thoracoscopy surgery (VATS) in undefined interstitial lung diseases: a retrospective study.

    Science.gov (United States)

    Luo, Qun; Han, Qian; Chen, Xiaobo; Xie, Jiaxing; Wu, Lulu; Chen, Rongchang

    2013-06-01

    To evaluate the efficacy and safety of lung biopsies by video-assisted thoracoscopy surgery (VATS) in the diagnosis of undefined interstitial lung disease (ILD). The retrospective analysis was performed in 32 who patients underwent VATS for the diagnosed with ILD from Jan 2007 to Dec 2011. The main reason for VATS for all the patients was due to no specific diagnosis could be obtained after non-invasive methods, transbronchial lung biopsy (TBLB) examination and the consultation with pulmonologist, radiologist and pathologist. The clinical profiles, chest high resolution computerized tomography (HRCT), laboratory profile, TBLB as well as the diagnosis of before and after the VATS were analyzed. The surgery site, biopsy number, duration of the thoracic drain, post-operative complications were also recorded. The 30- and 90-day post-operative mortality rates were calculated. The risk factors associated with the incidence of post-operative complications were assessed. The specific diagnosis could be established in all patients after VATS lung biopsies, with change from previous ones in 27 (84.4%). Among 20 cases (62.5%) diagnosed as unclassified ILD before the surgery, 14 (70.0%) were diagnosed as nonspecific interstitial pneumonia (NSIP), 3 (15.0%) as idiopathic pulmonary fibrosis (IPF) and 3 (15.0%) as connective tissue disease-related ILD (CTD-ILD). Among the 7 cases with complete change of diagnosis after VATS, 4 (57.1%) were cryptogenic organizing pneumonia (COP). The number of site of biopsy had no significant impact on the diagnostic efficacy. There were no significant change of vital sign and lung function after the VATS. 21 (65.6%) patients had post-operative complications, including pulmonary infection (56.3%), pulmonary atelectasis (28.1%) and pneumothorax (25.0%). The 30- and 90-day mortality rates were 0 and 5.2% respectively. Patients were divided into 2 groups based on the incidence of post-operative complications, and no significant difference was found

  4. Surgeon Training in Telerobotic Surgery via a Hardware-in-the-Loop Simulator

    Directory of Open Access Journals (Sweden)

    Xiao Li

    2017-01-01

    Full Text Available This work presents a software and hardware framework for a telerobotic surgery safety and motor skill training simulator. The aims are at providing trainees a comprehensive simulator for acquiring essential skills to perform telerobotic surgery. Existing commercial robotic surgery simulators lack features for safety training and optimal motion planning, which are critical factors in ensuring patient safety and efficiency in operation. In this work, we propose a hardware-in-the-loop simulator directly introducing these two features. The proposed simulator is built upon the Raven-II™ open source surgical robot, integrated with a physics engine and a safety hazard injection engine. Also, a Fast Marching Tree-based motion planning algorithm is used to help trainee learn the optimal instrument motion patterns. The main contributions of this work are (1 reproducing safety hazards events, related to da Vinci™ system, reported to the FDA MAUDE database, with a novel haptic feedback strategy to provide feedback to the operator when the underlying dynamics differ from the real robot’s states so that the operator will be aware and can mitigate the negative impact of the safety-critical events, and (2 using motion planner to generate semioptimal path in an interactive robotic surgery training environment.

  5. Safety and Feasibility of a Ketamine Package to Support Emergency and Essential Surgery in Kenya when No Anesthetist is Available: An Analysis of 1216 Consecutive Operative Procedures.

    Science.gov (United States)

    Burke, Thomas F; Suarez, Sebastian; Sessler, Daniel I; Senay, Ayla; Yusufali, Taha; Masaki, Charles; Guha, Moytrayee; Rogo, Debora; Jani, Pankaj; Nelson, Brett D; Rogo, Khama

    2017-12-01

    Lack of access to emergency and essential surgery is widespread in low- and middle-income countries. Scarce anesthesia services contribute to this unmet need. The aim of this study was to evaluate the safety and feasibility of the Every Second Matters for Emergency and Essential Surgery-Ketamine (ESM-Ketamine) package for emergency and essential procedures when no anesthetist was available. From November 2013 to September 2017, the ESM-Ketamine package was used for patients requiring emergency or life-improving surgeries in fifteen selected facilities across Kenya when no anesthetist was available. A mixed-methods approach was used to assess safety and feasibility of the ESM-Ketamine package, including demand, acceptability, and practicality. The primary outcome was ketamine-related adverse events. Key-informant interviews captured perceptions of providers, hospital administrators, and surgeons/proceduralists. Non-anesthetist mid-level providers used ESM-Ketamine for 1216 surgical procedures across the fifteen study facilities. The median ketamine dose was 2.1 mg/kg. Brief (30 s) oxygen desaturations occurred in seven patients (0.6%). There were 157 (13%) reported cases of hallucinations and agitation which were treated with diazepam. All patients recovered uneventfully, and no ketamine-related deaths were reported. Twenty-seven key-informant interviews showed strong support for the program with four main themes: financial considerations, provision of services, staff impact, and scaling considerations. The ESM-Ketamine package appears safe and feasible and is capable of expanding access to emergency and essential surgeries in rural Kenya when no anesthetist is available.

  6. Safety of prophylactic intracameral moxifloxacin ophthalmic solution after cataract surgery in patients with penetrating keratoplasty

    Directory of Open Access Journals (Sweden)

    Osman Sevki Arslan

    2014-10-01

    Full Text Available AIM:To determine the safety of prophylactic intracameral moxifloxacin after cataract surgery in patients with penetrating keratoplasty (PKP.METHODS:In this retrospective study of consecutive patients who had phacoemulsification cataract surgery after PKP, were treated with intracameral moxifloxacin 0.5% ophthalmic solution (0.5 mg/0.1 mL. The main outcome measures were anterior chamber reaction, best corrected visual acuity (BCVA, corneal endothelial cell count (ECC, and central corneal thickness (CCT.RESULTS:Fifty-five patients were recruited (26 males, 29 females. The mean age was 54.36±4.97y (range 45-64y. All eyes had improved postoperative BCVA. The mean BCVA was 0.25 preoperatively and 0.57 postoperatively, which was statistically significant (P<0.001. One eye had 3+, 7 eyes had 2+, 12 eyes had 1+ and 8 eyes had trace amount of aqueous cells on the first day after surgery. All eyes had no anterior chamber cells at subsequent follow up examinations. Effective phacoemulsification time was 4.33±1.01s. The mean ECC was 2340.20 cells/mm2 preoperatively and 1948.75 cells/mm2 1mo postoperatively (P<0.001. The increase of 21.09 µm in postoperative pachymetry 1mo after surgery was statistically significant (P<0.001.CONCLUSION: No untoward effects were observed after intracameral injection of moxifloxacin (0.5 mg/0.1 mL in terms of anterior chamber reaction, CCT, ECC, and visual rehabilitation at the conclusion of cataract surgery in patients with PKP.

  7. Patient safety in thoracic surgery and European Society of Thoracic Surgeons checklist.

    Science.gov (United States)

    Novoa, Nuria M

    2015-04-01

    Improving patient safety seems to be a new interesting clinical subject but, in fact, it is no new. It has to do with one of the oldest ethical principles of our profession: curing and not harming. The important research that has been done in a short period of time has brought in new insight to this complex area that is fast developing. The creation of safety managing systems will allow coordinating efforts from very different, although complementary, areas to create real safety culture and safety climate in every organization. In the surgical settings, teamwork is basic to provide good quality of care. Safety leaders in every team have an important role in establishing priorities, summarizing proposals, coordinating efforts, launching new initiatives and transmitting that safety efforts are worth taken. Preparedness and anticipation are key points for avoiding most of the diverse types of patient harm that can occur. As has been published, a great number of errors can be avoided simply using crosscheck based on specialized checklist that reviews every important detail of the procedure. This strategy has been demonstrated very useful at other high risk industries such as aviation, nuclear or food management. The Safe Surgery Saves Lives program launched in 2002 by the WHO has taught us that improvement is possible using a simple checklist. More complex and detail checklist can be more adequate for more complex procedures and settings. The proposed ESTS checklist reviews different areas of possible error in deeper detail allowing the finest adjustment of the patient before the skin incision. It has been recently released to the general thoracic community and monitors its use and usefulness has to be warrantied.

  8. Patients for patient safety in China: a cross sectional study.

    Science.gov (United States)

    Zhang, Qiongwen; Li, Yulin; Li, Jing; Mao, Xuanyue; Zhang, Lijuan; Ying, Qinghua; Wei, Xin; Shang, Lili; Zhang, Mingming

    2012-02-01

    To investigate the baseline status of patients' awareness, knowledge, and attitudes to patient safety in China, and to determine the factors that influence patients' involvement in patient safety. We conducted a cross sectional survey using questionnaires adapted from recent studies on patient safety from outside China. The items included medical errors, infection, medication safety, and other aspects of patient safety. The questionnaire included 17 items and 5 domains. The survey was conducted between Jan. 2009 and Dec. 2010 involving 1000 patients from ten grade-A hospitals in seven provinces or cities in China. Most patients from the surgery departments completed the questionnaires voluntarily and anonymously. Five reviewers independently input the data into Microsoft Excel 2003, and the data were double-checked. Data were analyzed using SPSS 15.0 software for differences in the perceptions and attitudes of patients toward patient safety among different genders, ages, and regions. We distributed 1000 questionnaires and collected 959 completed questionnaires (response rate: 96%). Among the respondents, 58% of patients did not know what medical error is. Sixty-five percent of patients wanted disclosure of all medical errors. After errors occurred, 58% of patients wanted explanations of all possible harms that had resulted. Among 187 patients who had experienced medical errors, 83% of patients had sought appropriate legal action. About 52% of patients understood hospital infection, but 28% patients did not know that infections could occur in hospital. Seventy-eight percent of patients thought that medical staff should wash their hands before examining patients. More than half of the patients (68%) were willing to remind the staff of hygiene if they saw unsanitary conditions in a health clinic. Only 14% of patients knew the side effects of medications that they took. The majority of patients surveyed expressed willingness to contribute to patient safety, but their

  9. Ambulatory surgery with chloroprocaine spinal anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Ghisi D

    2015-11-01

    Full Text Available Daniela Ghisi, Stefano Bonarelli Department of Anaesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy Abstract: Spinal anesthesia is a reliable and safe technique for procedures of the lower extremities. Nevertheless, some of its characteristics may limit its use for ambulatory surgery, including delayed ambulation, risk of urinary retention, and pain after block regression. The current availability of short-acting local anesthetics has renewed interest for this technique also in the context of short- and ultra-short procedures. Chloroprocaine (CP is an amino-ester local anesthetic with a very short half-life. It was introduced and has been successfully used for spinal anesthesia since 1952. Sodium bisulfite was then added as a preservative after 1956. The drug was then abandoned in the 1980s for several reports of neurological deficits in patients receiving accidentally high doses of intrathecal CP during epidural labor analgesia. Animal studies have proven the safety of the preservative-free formulation, which has been extensively evaluated in volunteer studies as well as in clinical practice with a favorable profile in terms of both safety and efficacy. In comparison with bupivacaine, 2-chloroprocaine (2-CP showed faster offset times to end of anesthesia, unassisted ambulation, and discharge from hospital. These findings suggests that 2-CP may be a suitable alternative to low doses of long-acting local anesthetics in ambulatory surgery. Its safety profile also suggests that 2-CP could be a valid substitute for intrathecal short- and intermediate-acting local anesthetics, such as lidocaine and mepivacaine – often causes of transient neurological symptoms. In this context, literature suggests a dose ranging between 30 and 60 mg of 2-CP for procedures lasting 60 minutes or less, while 10 mg is considered the no-effect dose. The present review describes recent evidence about 2-CP as an anesthetic agent for

  10. A Time Study of Plastic Surgery Residents.

    Science.gov (United States)

    Lau, Frank H; Sinha, Indranil; Jiang, Wei; Lipsitz, Stuart R; Eriksson, Elof

    2016-05-01

    Resident work hours are under scrutiny and have been subject to multiple restrictions. The studies supporting these changes have not included data on surgical residents. We studied the workday of a team of plastic surgery residents to establish prospective time-study data of plastic surgery (PRS) residents at a single tertiary-care academic medical center. Five trained research assistants observed all residents (n = 8) on a PRS service for 10 weeks and produced minute-by-minute activity logs. Data collection began when the team first met in the morning and continued until the resident being followed completed all non-call activities. We analyzed our data from 3 perspectives: 1) time spent in direct patient care (DPC), indirect patient care, and didactic activities; 2) time spent in high education-value activities (HEAs) versus low education-value activities; and 3) resident efficiency. We defined HEAs as activities that surgeons must master; other activities were LEAs. We quantified resident efficiency in terms of time fragmentation and time spent waiting. A total of 642.4 hours of data across 50 workdays were collected. Excluding call, residents worked an average of 64.2 hours per week. Approximately 50.7% of surgical resident time was allotted to DPC, with surgery accounting for the largest segment of this time (34.8%). Time spent on HEAs demonstrated trended upward with higher resident level (P = 0.086). Time in spent in surgery was significantly associated with higher resident levels (P time study of PRS residents, we found that compared with medicine trainees, surgical residents spent 3.23 times more time on DPC. High education-value activities comprised most of our residents' workdays. Surgery was the leading component of both DPC and HEAs. Our residents were highly efficient and fragmented, with the majority of all activities requiring 4 minutes or less. Residents spent a large portion of their time waiting for other services. In light of these data, we

  11. Efficacy and Safety of Transdermal Buprenorphine versus Oral Tramadol/Acetaminophen in Patients with Persistent Postoperative Pain after Spinal Surgery.

    Science.gov (United States)

    Lee, Jae Hyup; Kim, Jin-Hyok; Kim, Jin-Hwan; Kim, Hak-Sun; Min, Woo-Kie; Park, Ye-Soo; Lee, Kyu-Yeol; Lee, Jung-Hee

    2017-01-01

    Control of persistent pain following spinal surgery is an unmet clinical need. This study compared the efficacy and safety of buprenorphine transdermal system (BTDS) to oral tramadol/acetaminophen (TA) in Korean patients with persistent, moderate pain following spinal surgery. Open-label, interventional, randomized multicenter study. Adults with persistent postoperative pain (Numeric Rating Scale [NRS] ≥ 4 at 14-90 days postsurgery) were enrolled. Patients received once-weekly BTDS ( n = 47; 5  μ g/h titrated to 20  μ g/h) or twice-daily TA ( n = 40; tramadol 37.5 mg/acetaminophen 325 mg, one tablet titrated to 4 tablets) for 6 weeks. The study compared pain reduction with BTDS versus TA at week 6. Quality of life (QoL), treatment satisfaction, medication compliance, and adverse events (AEs) were assessed. At week 6, both groups reported significant pain reduction (mean NRS change: BTDS -2.02; TA -2.76, both P pain following spinal surgery, BTDS is an alternative to TA for reducing pain and supports medication compliance. This trial is registered with Clinicaltrials.gov: NCT01983111.

  12. Safety of continuing aspirin therapy during spinal surgery: A systematic review and meta-analysis.

    Science.gov (United States)

    Zhang, Chenggui; Wang, Guodong; Liu, Xiaoyang; Li, Yang; Sun, Jianmin

    2017-11-01

    Questions whether to continue or discontinue aspirin administration in the perioperative period of spinal surgery has not been systematically evaluated. The present systematic review is carried out to assess the impact of continuing aspirin administration on the bleeding and cardiovascular events in perispinal surgery period. Studies were retrieved through MEDLINE, EMBASE, and Springer Link Databases (search terms, aspirin, continue or discontinue, and spinal fusion), bibliographies of the articles retrieved, and the authors' reference files. We included studies that enrolled patients who underwent spinal surgery who were anticoagulated with aspirin alone and that reported bleeding or cardiovascular events as an outcome. Study quality was assessed using a validated form. 95% confidence interval (95% CI) was pooled to give summary estimates of bleeding and cardiovascular risk. We identified 4 studies assessing bleeding risk associated with aspirin continuation or cardiovascular risk with aspirin discontinuation during spinal surgery. The continuation of aspirin will not increase the risk of blood loss during the spinal surgery (95% CI, -111.72 to -0.59; P = .05). Also, there was no observed increase in the operative time (95% CI, -33.29 to -3.89; P = .01) and postoperative blood transfusion (95% CI, 0.00-0.27; P = .05). But as for the cardiovascular risk without aspirin continuation and mean hospital length of stay with aspirin continuation, we did not get enough samples to make an accurate decision about their relations with aspirin. Patients undergoing spinal surgery with continued aspirin administration do not have an increased risk for bleeding. In addition, there is no observed increase in the operation time and postoperative blood transfusion.

  13. New Refractive Surgery Procedures and Their Implications for Aviation Safety

    National Research Council Canada - National Science Library

    Nakagawara, Van B; Wood, Kathryn J; Montgomery, Ron W

    2006-01-01

    ...., myopia, hyperopia, astigmatism) with corrective surgery. Prior Federal Aviation Administration research studies have shown that the number of civil airmen with refractive surgery continues to increase...

  14. 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.

  15. 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. © The Author(s) 2014.

  16. [Present situation and prospect of enhanced recovery after surgery in pancreatic surgery].

    Science.gov (United States)

    Feng, Mengyu; Zhang, Taiping; Zhao, Yupei

    2017-05-25

    Enhanced recovery after surgery is a multimodal perioperative strategy according to the evidence-based medicine and multidisciplinary collaboration, aiming to improve the restoration of functional capacity after surgery by reducing surgical stress, optimal control of pain, early oral diet and early mobilization. Compared with other sub-specialty in general surgery, pancreatic surgery is characterized by complex disease, highly difficult procedure and more postoperative complications. Accordingly, pancreatic surgery shares a slow development in enhanced recovery after surgery. In this review, the feasibility, safety, application progress, prospect and controversy of enhanced recovery after surgery in pancreatic surgery are discussed.

  17. A comparison of salvage surgery following CRT and following BRT for advanced hypopharyngeal cancer

    International Nuclear Information System (INIS)

    Kamijo, Tomoyuki; Onitsuka, Tetsuro; Yokota, Tomoya

    2016-01-01

    There are still few comparison reports regarding the safety of salvage surgery for recurrence and persistence following platinum-based chemoradiotherapy (CRT) and cetuximab-based bioradiotherapy (BRT), which are frequently used as non-surgical therapies for advanced head and neck carcinomas. This study compared the safety of salvage surgery following CRT against that following BRT for advanced hypopharyngeal cancer. The study examined 34 cases who underwent salvage surgery following CRT and 7 cases who underwent salvage surgery following BRT from September 2002 to December 2015. The number of cases that were able to undergo salvage surgery was 34 among 67 recurrence and persistence cases following CRT and 7 of 8 cases following BRT. In terms of the surgical procedure, salvage neck dissection was conducted for 22 cases in the CRT group and 5 cases in the BRT group, with no significant differences observed between both including the surgical time and amount of bleeding, and with no major complications in either group. Total hypopharynx or total laryngectomy resection for salvage was conducted for 19 cases in the CRT group and 3 cases in the BRT group, upon which we observed anastomotic leakage in 3 cases in the CRT group and 1 case in the BRT group; however, there was no significant difference in the onset frequency. There was no clear difference regarding safety between salvage surgery following CRT and following BRT for locally advanced hypopharyngeal cancer. However, regarding the adaptation of salvage surgery, the possibility of limitations in the CRT group was suggested in comparison with the BRT group. (author)

  18. 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

    Directory of Open Access Journals (Sweden)

    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

  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. Laparoendoscopic single-site surgery in gynaecology: A new frontier in minimally invasive surgery

    Directory of Open Access Journals (Sweden)

    Fader Amanda

    2011-01-01

    Full Text Available Review Objective: To review the recent developments and published literature on laparoendoscopic single-site (LESS surgery in gynaecology. Recent Findings: Minimally invasive surgery has become a standard of care for the treatment of many benign and malignant gynaecological conditions. Recent advances in conventional laparoscopy and robotic-assisted surgery have favorably impacted the entire spectrum of gynaecological surgery. With the goal of improving morbidity and cosmesis, continued efforts towards refinement of laparoscopic techniques have lead to minimization of size and number of ports required for these procedures. LESS surgery is a recently proposed surgical term used to describe various techniques that aim at performing laparoscopic surgery through a single, small-skin incision concealed within the umbilicus. In the last 5 years, there has been a surge in the developments in surgical technology and techniques for LESS surgery, which have resulted in a significant increase in utilisation of LESS across many surgical subspecialties. Recently published outcomes data demonstrate feasibility, safety and reproducibility for LESS in gynaecology. The contemporary LESS literature, extent of gynaecological procedures utilising these techniques and limitations of current technology will be reviewed in this manuscript. Conclusions: LESS surgery represents the newest frontier in minimally invasive surgery. Comparative data and prospective trials are necessary in order to determine the clinical impact of LESS in treatment of gynaecological conditions.

  1. Recent Development of Augmented Reality in Surgery: A Review

    Science.gov (United States)

    Vávra, P.; Zonča, P.; Ihnát, P.; El-Gendi, A.

    2017-01-01

    Introduction The development augmented reality devices allow physicians to incorporate data visualization into diagnostic and treatment procedures to improve work efficiency, safety, and cost and to enhance surgical training. However, the awareness of possibilities of augmented reality is generally low. This review evaluates whether augmented reality can presently improve the results of surgical procedures. Methods We performed a review of available literature dating from 2010 to November 2016 by searching PubMed and Scopus using the terms “augmented reality” and “surgery.” Results. The initial search yielded 808 studies. After removing duplicates and including only journal articles, a total of 417 studies were identified. By reading of abstracts, 91 relevant studies were chosen to be included. 11 references were gathered by cross-referencing. A total of 102 studies were included in this review. Conclusions The present literature suggest an increasing interest of surgeons regarding employing augmented reality into surgery leading to improved safety and efficacy of surgical procedures. Many studies showed that the performance of newly devised augmented reality systems is comparable to traditional techniques. However, several problems need to be addressed before augmented reality is implemented into the routine practice. PMID:29065604

  2. Recent Development of Augmented Reality in Surgery: A Review

    Directory of Open Access Journals (Sweden)

    P. Vávra

    2017-01-01

    Full Text Available Introduction. The development augmented reality devices allow physicians to incorporate data visualization into diagnostic and treatment procedures to improve work efficiency, safety, and cost and to enhance surgical training. However, the awareness of possibilities of augmented reality is generally low. This review evaluates whether augmented reality can presently improve the results of surgical procedures. Methods. We performed a review of available literature dating from 2010 to November 2016 by searching PubMed and Scopus using the terms “augmented reality” and “surgery.” Results. The initial search yielded 808 studies. After removing duplicates and including only journal articles, a total of 417 studies were identified. By reading of abstracts, 91 relevant studies were chosen to be included. 11 references were gathered by cross-referencing. A total of 102 studies were included in this review. Conclusions. The present literature suggest an increasing interest of surgeons regarding employing augmented reality into surgery leading to improved safety and efficacy of surgical procedures. Many studies showed that the performance of newly devised augmented reality systems is comparable to traditional techniques. However, several problems need to be addressed before augmented reality is implemented into the routine practice.

  3. Enhanced Recovery After Surgery (ERAS) - The Evidence in Geriatric Emergency Surgery

    DEFF Research Database (Denmark)

    Paduraru, Mihai; Ponchietti, Luca; Casas, Isidro Martinez

    2017-01-01

    Background: Geriatric surgery is rising and projected to continue at a greater rate. There is already concern about the poor outcomes for the emergency surgery in elderly. How to manage the available resources to improve outcomes in this group of patients is an important object of debate...... to conventional care. Emergency surgical patients also had fewer postoperative complications with ERAS compared to conventional care. Hospital stay was reduced in 2 out of 3 studies for emergency surgery.Conclusions:ERAS can be safely applied to elderly and emergency patients with a reduction in postoperative....... OBJECTIVES: We aimed to determine the feasibility and safety of applying ERAS pathways to emergency elderly surgical patients. METHOD: Two searches were undertaken for ERAS protocols in elderly patients and emergency surgery, in order to gather evidence in relation to ERAS in geriatric emergency patients...

  4. Adolescent bariatric surgery program characteristics: the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study experience.

    Science.gov (United States)

    Michalsky, Marc P; Inge, Thomas H; Teich, Steven; Eneli, Ihuoma; Miller, Rosemary; Brandt, Mary L; Helmrath, Michael; Harmon, Carroll M; Zeller, Meg H; Jenkins, Todd M; Courcoulas, Anita; Buncher, Ralph C

    2014-02-01

    The number of adolescents undergoing weight loss surgery (WLS) has increased in response to the increasing prevalence of severe childhood obesity. Adolescents undergoing WLS require unique support, which may differ from adult programs. The aim of this study was to describe institutional and programmatic characteristics of centers participating in Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS), a prospective study investigating safety and efficacy of adolescent WLS. Data were obtained from the Teen-LABS database, and site survey completed by Teen-LABS investigators. The survey queried (1) institutional characteristics, (2) multidisciplinary team composition, (3) clinical program characteristics, and (4) clinical research infrastructure. All centers had extensive multidisciplinary involvement in the assessment, pre-operative education, and post-operative management of adolescents undergoing WLS. Eligibility criteria and pre-operative clinical and diagnostic evaluations were similar between programs. All programs have well-developed clinical research infrastructure, use adolescent-specific educational resources, and maintain specialty equipment, including high weight capacity diagnostic imaging equipment. The composition of clinical team and institutional resources is consistent with current clinical practice guidelines. These characteristics, coupled with dedicated research staff, have facilitated enrollment of 242 participants into Teen-LABS. © 2013 Published by Elsevier Inc.

  5. A prospective, randomised, controlled, double-blind phase I-II clinical trial on the safety of A-Part® Gel as adhesion prophylaxis after major abdominal surgery versus non-treated group

    Directory of Open Access Journals (Sweden)

    Weis Christine

    2010-07-01

    Full Text Available Abstract Background Postoperative adhesions occur when fibrous strands of internal scar tissue bind anatomical structures to one another. The most common cause of intra-abdominal adhesions is previous intra-abdominal surgical intervention. Up to 74% of intestinal obstructions are caused by post surgical adhesions. Although a variety of methods and agents have been investigated to prevent post surgical adhesions, the problem of peritoneal adhesions remains largely unsolved. Materials serving as an adhesion barrier are much needed. Methods/Design This is a prospective, randomised, controlled, patient blinded and observer blinded, single centre phase I-II trial, which evaluates the safety of A-Part® Gel as an adhesion prophylaxis after major abdominal wall surgery, in comparison to an untreated control group. 60 patients undergoing an elective median laparotomy without prior abdominal surgery are randomly allocated into two groups of a 1:1- ratio. Safety parameter and primary endpoint of the study is the occurrence of wound healing impairment or peritonitis within 28 (+10 days after surgery. The frequency of anastomotic leakage within 28 days after operation, occurrence of adverse and serious adverse events during hospital stay up to 3 months and the rate of adhesions along the scar within 3 months are defined as secondary endpoints. After hospital discharge the investigator will examine the enrolled patients at 28 (+10 days and 3 months (±14 days after surgery. Discussion This trial aims to assess, whether the intra-peritoneal application of A-Part® Gel is safe and efficacious in the prevention of post-surgical adhesions after median laparotomy, in comparison to untreated controls. Trial registration NCT00646412

  6. Improving safety culture through the health and safety organization: a case study.

    Science.gov (United States)

    Nielsen, Kent J

    2014-02-01

    International research indicates that internal health and safety organizations (HSO) and health and safety committees (HSC) do not have the intended impact on companies' safety performance. The aim of this case study at an industrial plant was to test whether the HSO can improve company safety culture by creating more and better safety-related interactions both within the HSO and between HSO members and the shop-floor. A quasi-experimental single case study design based on action research with both quantitative and qualitative measures was used. Based on baseline mapping of safety culture and the efficiency of the HSO three developmental processes were started aimed at the HSC, the whole HSO, and the safety representatives, respectively. Results at follow-up indicated a marked improvement in HSO performance, interaction patterns concerning safety, safety culture indicators, and a changed trend in injury rates. These improvements are interpreted as cultural change because an organizational double-loop learning process leading to modification of the basic assumptions could be identified. The study provides evidence that the HSO can improve company safety culture by focusing on safety-related interactions. © 2013. Published by Elsevier Ltd and National Safety Council.

  7. Sexual satisfaction following bariatric surgery: A prospective exploratory study.

    Science.gov (United States)

    Ferrer-Márquez, Manuel; Pomares-Callejón, María Ángeles; Fernández-Agis, Inmaculada; Belda-Lozano, Ricardo; Vidaña-Márquez, Elisabet; Soriano-Maldonado, Alberto

    2017-11-01

    Bariatric surgery improves sexual function in obese individuals, although the extent to which sexual satisfaction is improved following surgery is unknown. The aims of this study were 1) to describe sexual satisfaction in severely/morbidly obese men and women candidates for bariatric surgery; 2) to assess the effects of bariatric surgery on sexual satisfaction at 12-months follow-up; and 3) to assess whether weight changes at follow-up following bariatric surgery are associated with changes in sexual satisfaction. We conducted a prospective observational study from February 2011 to June 2014. A total of 44 patients with severe/morbid obesity participated in the study. Sexual satisfaction was assessed (at baseline and 12-months follow-up) through the Index of Sexual Satisfaction (ISS) questionnaire. Of 44 patients who completed the ISS at baseline (mean age 40.3 [SD=9.4] years and BMI 46.9 [SD=6.2] kg/m 2 ), 17 were lost to follow-up. The baseline ISS total scores were 32.0 (SD=20.1) in women and 24.4 (SD=16.0) in men (P>0.05). The proportion of sexually satisfied men and women at baseline was 62.5% and 46.4%, respectively (P=0.360). At follow-up, sexual satisfaction improved significantly in women (average difference 13.7 units; P=0.032) but not in men (average difference 3.6 units; P=0.717). The percentage of women with sexual satisfaction problems was reduced by 33% at follow-up (P=0.038). A relatively large percentage of severely/morbidly obese women and men present clinically significant sexual satisfaction problems before undergoing bariatric surgery. Sexual satisfaction improves significantly 12 months following bariatric surgery, particularly in women. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Laparoscopic surgery for rectal cancer: a single-centre experience of 120 cases.

    LENUS (Irish Health Repository)

    Good, Daniel W

    2011-10-01

    For colorectal surgeons, laparoscopic rectal cancer surgery poses a new challenge. The defence of the questionable oncological safety tempered by the impracticality of the long learning curve is rapidly fading. As a unit specialising in minimally invasive surgery, we have routinely undertaken rectal cancer surgery laparoscopically since 2005.

  9. Important Non-Technical Skills in Video-Assisted Thoracoscopic Surgery Lobectomy

    DEFF Research Database (Denmark)

    Gjeraa, Kirsten; Mundt, Anna S.; Spanager, Lene

    2017-01-01

    Background Safety in the operating room is dependent on the team's non-technical skills. The importance of non-technical skills appears to be different for minimally invasive surgery as compared with open surgery. The aim of this study was to identify which non-technical skills are perceived...... with complementary and overlapping scopes of practice between surgical and anesthesia subteams. Conclusions This study identified six non-technical skills that serve as the foundation for shared mental models of the patient, the current situation, and team resources. These findings contribute three important...... by team members to be most important for patient safety, in the setting of video-assisted thoracoscopic surgery (VATS) lobectomy. Methods This was an explorative, semistructured interview-based study with 21 participants from all four thoracic surgery centers in Denmark that perform VATS lobectomy. Data...

  10. Robot-assisted pancreatic surgery: a systematic review of the literature

    Science.gov (United States)

    Strijker, Marin; van Santvoort, Hjalmar C; Besselink, Marc G; van Hillegersberg, Richard; Borel Rinkes, Inne HM; Vriens, Menno R; Molenaar, I Quintus

    2013-01-01

    Background To potentially improve outcomes in pancreatic resection, robot-assisted pancreatic surgery has been introduced. This technique has possible advantages over laparoscopic surgery, such as its affordance of three-dimensional vision and increased freedom of movement of instruments. A systematic review was performed to assess the safety and feasibility of robot-assisted pancreatic surgery. Methods The literature published up to 30 September 2011 was systematically reviewed, with no restrictions on publication date. Studies reporting on over five patients were included. Animal studies, studies not reporting morbidity and mortality, review articles and conference abstracts were excluded. Data were extracted and weighted means were calculated. Results A total of 499 studies were screened, after which eight cohort studies reporting on a total of 251 patients undergoing robot-assisted pancreatic surgery were retained for analysis. Weighted mean operation time was 404 ± 102 min (510 ± 107 min for pancreatoduodenectomy only). The rate of conversion was 11.0% (16.4% for pancreatoduodenectomy only). Overall morbidity was 30.7% (n = 77), most frequently involving pancreatic fistulae (n = 46). Mortality was 1.6%. Negative surgical margins were obtained in 92.9% of patients. The rate of spleen preservation in distal pancreatectomy was 87.1%. Conclusions Robot-assisted pancreatic surgery seems to be safe and feasible in selected patients and, in left-sided resections, may increase the rate of spleen preservation. Randomized studies should compare the respective outcomes of robot-assisted, laparoscopic and open pancreatic surgery. PMID:23216773

  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. 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.

  13. Safety and effectiveness of a polyvinyl alcohol barrier in reducing risks of vascular tissue damage during anterior spinal revision surgery.

    Science.gov (United States)

    Jeffords, Paul; Li, Jinsheng; Panchal, Deepal; Denoziere, Guilhem; Fetterolf, Donald

    2012-05-01

    This study was conducted as a controlled, prospective investigation to show the safety and efficacy of a polyvinyl alcohol (PVA) device in a sheep model. To evaluate the ability of a permanent PVA hydrogel barrier to reduce the risk of potential vessel damage during anterior vertebral revision surgery, to provide a nonadhesive barrier at the surgical site, and to create a surgical revision plane of dissection. The development of scar tissue and adhesions presents a significant postoperative problem in spine surgery, where adhesion involvement of overlying structures can cause pain, neurovascular complications, and present a difficult surgical environment during revisions. The devices were implanted onto the ventral surface of exposed lumbar intervertebral discs using an anterolateral approach. One disc separated from the study site was also exposed to serve as a control. Three sheep each were then evaluated with an explant procedure at 30 and 90 days. Extensive sampling was undertaken to evaluate gross anatomic, micropathologic, and biochemical environments and properties of the device. The structural properties and appearance of the device remained intact at both 30 and 90 days. The material remained flexible, hydrophilic, and soft, without visible resorption or decomposition. The material was well tolerated by the animal, with minimal histologic signs of inflammation or rejection. Tissue planes were easily able to be localized by the surgeon attempting to locate the prior surgical site at the time of resection. The PVA vessel shield effectively protected the structures overlying the sheep spine during revision, providing a clear dissection plane for resection at repeat surgery. The overlying structures separated from the previous surgical site with no adhesion, and allowed safe separation of adjacent tissues without the use of sharp dissection.

  14. Echocardiography-based hemodynamic management of left ventricular diastolic dysfunction: a feasibility and safety study.

    Science.gov (United States)

    Shillcutt, Sasha K; Montzingo, Candice R; Agrawal, Ankit; Khaleel, Maseeha S; Therrien, Stacey L; Thomas, Walker R; Porter, Thomas R; Brakke, Tara R

    2014-11-01

    Patients with left ventricular diastolic dysfunction (LVDD) are at increased risk of postoperative adverse events. The primary aim of this study was to evaluate the safety and feasibility of using echocardiography-guided hemodynamic management (EGHEM) during surgery in subjects with LVDD compared to conventional management. The feasibility of using echocardiography to direct a treatment algorithm and clinical outcomes were compared for safety between groups. Subjects were screened for LVDD by preoperative transthoracic echocardiography (TTE) and randomized to the conventional or EGHEM group. Subjects in EGHEM received hemodynamic management based on left ventricular filling patterns on transesophageal echocardiography (TEE). Primary outcomes measured were the feasibility to obtain TEE images and follow a TEE-based treatment algorithm. Safety outcomes also compared the following clinical differences between groups: length of hospitalization, incidence of atrial fibrillation, congestive heart failure (CHF), myocardial infarction, cerebrovascular accident, transient ischemic attack and renal failure measured 30 days postoperatively. Population consisted of 28 surgical subjects (14 in conventional group and 14 in EGHEM group). Mean subject age was 73.4 ± 6.7 years (36% male) in conventional group and 65.9 ± 14.4 years (36% male) in EGHEM group. Procedures included orthopedic (conventional = 29%, EGHEM 36%), general (conventional = 50%, EGHEM = 36%), vascular (conventional = 7%, EGHEM = 21%), and thoracic (conventional = 14%, EGHEM = 7%). There was no statistically significant difference in adverse clinical events between the 2 groups. The EGHEM group had less CHF, atrial fibrillation, and shorter length of stay. Echocardiography-guided hemodynamic management of patients with LVDD during surgery is feasible and may be a safe alternative to conventional management. © 2014, Wiley Periodicals, Inc.

  15. 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.

  16. 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.

  17. Intraoperative Death During Cervical Spinal Surgery: A Retrospective Multicenter Study.

    Science.gov (United States)

    Wang, Jeffrey C; Buser, Zorica; Fish, David E; Lord, Elizabeth L; Roe, Allison K; Chatterjee, Dhananjay; Gee, Erica L; Mayer, Erik N; Yanez, Marisa Y; McBride, Owen J; Cha, Peter I; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    A retrospective multicenter study. Routine cervical spine surgeries are typically associated with low complication rates, but serious complications can occur. Intraoperative death is a very rare complication and there is no literature on its incidence. The purpose of this study was to determine the intraoperative mortality rates and associated risk factors in patients undergoing cervical spine surgery. Twenty-one surgical centers from the AOSpine North America Clinical Research Network participated in the study. Medical records of patients who received cervical spine surgery from January 1, 2005, to December 31, 2011, were reviewed to identify occurrence of intraoperative death. A total of 258 patients across 21 centers met the inclusion criteria. Most of the surgeries were done using the anterior approach (53.9%), followed by posterior (39.1%) and circumferential (7%). Average patient age was 57.1 ± 13.2 years, and there were more male patients (54.7% male and 45.3% female). There was no case of intraoperative death. Death during cervical spine surgery is a very rare complication. In our multicenter study, there was a 0% mortality rate. Using an adequate surgical approach for patient diagnosis and comorbidities may be the reason how the occurrence of this catastrophic adverse event was prevented in our patient population.

  18. Nonelective surgery at night and in-hospital mortality Prospective observational data from the European Surgical Outcomes Study

    NARCIS (Netherlands)

    van Zaane, Bas; van Klei, Wilton A.; Buhre, Wolfgang F.; Bauer, Peter; Boerma, E. Christiaan; Hoeft, Andreas; Metnitz, Philipp; Moreno, Rui P.; Pearse, Rupert; Pelosi, Paolo; Sander, Michael; Vallet, Benoit; Pettilä, Ville; Vincent, Jean-Louis; Rhodes, Andrew; Moreno, Rui; Spies, Claudia; Hoste, Eric; Huyghens, Luc; Jacobs, Rita; van Mossevelde, Veerle; Opdenacker, Godelieve; Poelaert, Jan; Spapen, Herbert; Leleu, Kris; Rijckaert, Dirk; de Decker, Koen; Foubert, Luc; de Neve, Nikolaas; Biston, Patrick; Piagnerelli, Michael; Collin, Vincent; den Blauwen, Nadia; Clauwaert, Charlotte; de Crop, Luc; Verbeke, An; Derumeaux, Pieter; Gardin, Christophe; Kindt, Sebastiaan; Louage, Sofie; Verhamme, Bruno; Druwé, Patrick; Lahaye, Ingrid; Rosseel, Francis; Rutsaert, Robert; Vanlinthout, Luc; de Kock, Marc; Forget, Patrice; Georges, Pascal; Grosu, Irina; Kahn, David; Lois, Fernande; Momeni, Mona; Yemnga, Audrey Pospiech Bernadette; Jadoul, Jean-Luc; Malbrain, Manu; Bosinceanu, Dana; Collard, Edith; Jorens, Philippe; Reyntiens, Dirk; Smitz, Carine; Vercauteren, Marcel; Fagnoul, David; van Obbergh, Luc; Goranović, Tatjana; Mazul-Sunko, Branka; Toplice, Krapinske; Oremuš, Krešimir; Bešlić, Gabrijela; Duzel, Viktor; Hauptman, Ada; Peremin, Sanja; Šribar, Andrej; Župčić, Miroslav; Benčević, Josip; Brod, Slavonski; Mirković, Ivan; Šarić Bauer, Zlata; Belavić, Matija; Blažanin, Božidar; Lončarić Katušin, Mirjana; Brozović Krijan, Antonija; Mišković, Petar; Šimić-Korać, Nataša; Topić, Jasna; Žilić, Antonio; Žunić, Josip; Acan, Ivana; Adanić, Mirta; Ivanov, Nikola; Pavičić Šarić, Jadranka; Tomulić, Katarina; Visković, Nataša; Bošnjak, Silvana; Haršanji Drenjančevic, Ivana; Kristek, Gordana; Kvolik, Slavica; Markić, Stela; Stojanovic Rakipovic, Andreja; Tot, Ozana Katarina; Venzera-Azenic, Darija; Fabris, Lada Kalagac; Bačak-Kocman, Iva; Balenović, Igor; Bandić, Daniela; Deutsch, Patricia Adrianne Judith; Divjak, Loredana; Grčić Filipović, Ina; Gužvinec, Zvonka; Krznarić, Zrinka; Lončarić, Yvonne; Magaš, Jelena Vadlja; Mitrović, Marek; Okić, Marija; Pavlek, Mario; Ramov, Elza; Rezek, Karolina; Sekulić, Ante; Tomasevic, Boris; Mirić, Mirjana; Tomašević, Anita; Tomić Mahečić, Tina; Vrbanović, Vilena; Bobinac, Mirna; Božić, Alfred; Debelic, Danijela; Frkovic, Vedran; Mladić Batinica, Inga; Baranović, Senka; Gavranović, Željka; Kikec, Mirna; Maldini, Branka; Marić, Stela; Agnić, Ivan; Delić, Nikola; Dropulić, Nataša; Kljaković Gašpić, Toni; Ilić, Darko; Ivančev, Božena; Karanović, Nenad; Kuščević, Dorjan; Marović, Zlatko; Milić, Matija; Nevešćanin, Ana; Petković, Tatjana; Smoje, Mario; Brozović, Gordana; Jelisavac, Milana; Matolić, Martina; Oberhofer, Dagmar; Pavičić, Ana Marija; Šakić, Kata; Bozovic, Margarita Delija; Krecek, Zvjezdana Kotorac; Krobot, Renata; Andabaka, Tatjana; Bratanić, Mislav; Dzepina, Orjana; Kraljev, Martina; Šeric, Julija; Šimurina, Tatjana; Grujić, Rosa; Nacevski-Bulaja, Biljana; Barižon, Mirna; Danira, Vrančić; Dražen, Bulaja; Dušanka, Kimer; Bašić Halužan, Marijana; Joško, Žaja; Katica, Roca; Labor, Magda; Grgurević Marinković, Tea; Mihovilčević, Danči; Marija, Bego; Srečko, Marinković; Vranković, Srđan; Kyprianou, Theodoros; Neophytou, Kyriakos; Cerny, Vladimir; Cvachovec, Karel; Belikova, Barbora; Drab, Michal; Hudacek, Kamil; Krikava, Ivo; Stourac, Petr; Zadrazilova, Katarina; Bicek, Vladimír; Brabcová, Milena; Klozová, Radka; Vajter, Jaromír; Vymazal, Tomáš; Toft, Palle; Blichfeldt, Louise; Hansen, Bo Dilling; Moller, Kirsten; Nielsen, Jeppe Sylvest; Frederiksen, Joachim; Dohn Andersen, Johnny; Kühne, Jan Peter; Leivdal, Siv; Stendell, Line; Simonsen, Martin; Zoltowski, Marcin Konrad; Ali, Zahida Salman; Freundlich, Morten; Pilypaite, Jurgita; Clausen, Nicola Groes; Thorup, Line; Hansen, Frank; Bestle, Morten; Hansen, Christian Steen; Afshari, Arash; Bastholm Bille, Anders; Lefort, Michele; Secher, Erik L.; Liboriussen, Lisbeth; Herodes, Veiko; Marvet, Kadri; Pool, Kristiina; Kallas, Pille; Mägi, Triinu-Kreete; Sütt, Jaan; Vijar, Kerli; Visk, Evelin; Vinnal, Mare; Ellermaa, Jaanus; Liibusk, Liia; Tikkerberi, Artur; Falk, Ilme; Mällo, Esta; Talving, Jaak; Pettila, Ville; Hovilehto, Seppo; Kirsi, Anne; Mustola, Seppo; Tiainen, Pekka; Toivonen, Juhani; Dabnell, Sandra; Kaminski, Tadeusz; Kaukonen, Maija; Silvasti, Päivi; Vainio, Kaisa; Lund, Vesa; Sjövall, Sari; Saarinen, Kari; Viitanen, Matti; Ahonen, Tommi; Alaspää, Ari; Zittling, Ritva; Aarne, Saarikoski; Annette, Moisander; Bodo, Wagner; Laru-Sompa, Raili; Elomaa, Esa; Lavonen, Leena; Nevantaus, Juha; Geier, Klaus; Kavasmaa, Tomi; Koorits, Ursula; Kubjas, Mari; Lauritsalo, Seppo; Ottelin, Lauri; Palve, Markki; Pynnönen, Jari; Raabis, Inga; Saarelainen, Minna; Heikkilä, Tapani; Kontula, Timo; Lehtimäki, Markku; Liimatainen, Jari; Moilanen-Oikarinen, Mari; Pakarinen, Marika; Palanne, Riku; Seppänen, Hanna; Pulkkinen, Anni; Vääräniemi, Heikki; Kainuun Keskussairaala, Kajaani; Paananen, Sami; Koskenkari, Juha; Sälkiö, Sinikka; Vakkala, Merja; Koskue, Talvikki; Loisa, Pekka; Ruut, Laitio; Hautamäki, Raku; Koivisto, Simo-Pekka; Futier, Emmanuel; Lefrant, Jean-Yves; Leon, Alain; Bonnet, Francis; Marret, Emmanuel; Spielvogel, Catherine; Papageorgiou, Chryssa; Szymkiewicz, Olga; Tounou-Akue, Felix; Aubrun, Frederic; Bonnet, Aurélie; Gazon, Mathieu; Guiraud, Michel; Laurent, Virginie; Béclère, Antoine; Tachon, Guillaume; Demars, Nadège; Dumenil, Anne-Sylvie; Mercier, Frederic J.; Landais, Alain; Mentec, Herve; Bazin, Marie; Gonnu, Sophie; Petit, Antoine; Albaladejo, Pierre; Almeras, Luc; Bataillard, Amélie; Rossi-Blancher, Marine; Lefrant, Jean Yves; Barthel, Florian; Hallel, Dan; Sbai, Hicham; Khalifeh, Pamela; Lidzborski, Lionel; Jully, Marion; Platon, Ecaterina; Pottecher, Julien; Baumgarten, Romain; Schultz, Christel; ElMiloudi, Fayçal; Lefebvre, Julie; Waton, Karen; Sprunck, Adrien; Steib, Annick; Thibaud, Adrien; Thuet, Vincent; Kieffer, Vianney; Dubois-Vallaud, Delphine; Jacob, Laurent; Becanne, Xavier; Cherfaoui, Salim; Gauzit, Remy; Godier, Anne; Lakhdari, Mourad; Samma, Charles Marc; Bigeon, Jean Yves; Burtin, Philippe; Halchini, Constantin; Lacroix, Magali; Pinna, Frederic; Barbes, Aurélie; Just, Bernard; Mateu, Philippe; Benayoun, Laurent; Berger, Philippe; Granier, Nathalie; Perrigault, Pierre Francois; Libert, Nicolas; de Rudnicki, Stephan; Merat, Stéphane; Bourdet, Benoit; Ferré, Fabrice; Minville, Vincent; Piriou, Vincent; Rague, Philippe; Wallet, Florent; Lebuffe, Gilles; Desbordes, Jacques; Robin, Emmanuel; Ichai, Carole; Orban, Jean-Christophe; Marx, Gernot; Gottschalk, André; Piontek, André; Unterberg, Matthias; Hilpert, Justus; Kees, Martin; Triltsch, Andreas; Wiegand-Löhnert, Carola; Glöckner, Christiane; Hohn, Andreas; Rose, Elmar; Schröder, Stefan; Wiese, Oliver; Awlakpui, Eli; Scheidemann, Mona; Wittmann, Maria; Ramminger, Axel; Gama de Abreu, Marcelo; Heller, Axel R.; Marx, Christine; Neidel, Julia; Goldmann, Anton; von Heymann, Christian; Laetsch, Beatrix; Maahs, Esther; Scholz, Lars; Frenzel, Dirk; Massarat, Kyros; Lenhart, Franz-Peter; Reichle, Florian; Rudlof, Kristina; Borchers, Friedrich; Buettner, Christoph; Schmutzler, Martin; Burgard, Gerald; Lucht, Alexander; Wagner, Jan; Pilge, Stefanie; Schneider, Gerhard; Untergehrer, Gisela; Bis, Beata; Krassler, Jens; Dittmann, Jan; Haberkorn, Jörg; Eberitsch, Jürgen; Eberitsch, Karola; Nippraschk, Thomas; Wepler, Ulrich; Engelen, Wolf-Christian; Nau, Carla; Scholler, Axel; Schüttler, Jürgen; Wintzheimer, Simone; Bloos, Frank; Braune, Anke; Fergen, Daniela; Ludewig, Katrin; Paxian, Markus; Reinhart, Konrad; Graf, Nikolaus; Schwarzkopf, Konrad; Berger, Katharina; Habicher, Marit; Kasperiunaite, Ruta; Savelsberg, Sabine; Krep, Henning; Reindl, Michael; Weber, Matthias; Bauer, Wolfgang; Bingold, Florian; Christ, Saskia; Friederich, Patrick; Kaviani, Reza; Auer, Patrick; Bonnländer, Georg; Drescher, Jürgen; Braun, Roland; Eichenauer, Tim; Kerner, John; Bierbaum, Kathrin; Brünner, Horst; Grond, Stefan; Perez-Platz, Ursula; Andresen, Bent; Linstedt, Ulf; Stegmann, Nils; Erkens, Uwe; Kopcke, Jens; Meyer, Andreas; Brestrich, Hartmut; Ernst, Sandra; Merkel, Stella; Krieger, Lena; Luers, Frank; Weyland, Andreas; Noeldge-Schomburg, Gabriele; Menckie, Thomas; Wasmund, Christina; Bredtmann, Ralph-Dieter; Erler, Ines; Haumann, Christine; Möllemann, Angela; Oehmichen, Uwe; Sergejewa, Olga; Lehning, Brigitte; Czeslick, Elke; Geyer, Michaela; Malcharek, Michael; Sablotzki, Armin; Stier, Marina; Feld, Florian; Rossaint, Rolf; Simon, Verena; Armaganidis, Apostolos; Koulenti, Despoina; Kotanidou, Anastasia; Nanas, Serafim; Papastylianou, Androula; Psevdi, Aikaterini; Stathopoulos, Anastasios; Voulas, Asklepieion; Kanna, Efthymia; Koutsikou, Anastasia; Moustaka, Alexandra; Chovas, Achilleas; Komnos, Apostolos; Zafiridis, Tilemachos; Franses, Josef; Lavrentieva, Athena; Koraki, Eleni; Katsenos, Chrysostomos; Kasianidou, Maria Flora; Nasopoulou, Pantelia; Spyropoulou, Eleni; Gousia, Chrysoula; Katsanoulas, Constantine; Lathyris, Dimitrios; Kyriazopoulos, George; Sfyras, Dimitrios; Tsirogianni, Athanasia; Kostopanagiotou, Georgia; Lignos, Mihail; Matsota, Paraskevi; Christopoulos, Christos; Mouratidou, Alexandra; Vrettou, Efstratia; Boufidis, Spyros; Moka, Eleni; Arnaoutoglou, Eleni; Koulouras, Vasileios; Nakos, George; Papathanakos, Georgios; Anthopoulos, Georgios; Choutas, Georgios; Karapanos, Dimitrios; Tzani, Vaso; Gkiokas, Georgios; Nastos, Konstantinos; Nikolakopoulos, Fotios; Dragoumanis, Christos; Nikitidis, Nikos; Pneumatikos, Ioannis; Theodorou, Vassiliki; Zacharouli, Danai; Kandi, Stella; Tasopoulos, Konstantinos; Arvaniti, Kostoula; Matamis, Dimitrios; Mplougoura, Eva; Petropoulou, Polixeni; Soumpasis, Ioannis; Amaniti, Ekaterini; Giannakou-Peftoulidou, Maria; Gkeka, Eleni; Soultati, Ioanna; Kokinou, Maria; Papatheodorou, Lambrini; Stafylaraki, Maria; Giasnetsova, Tatiana; Gritsi-Gerogianni, Nikoleta; Kydona, Christina; Kiskira, Olga; Koulentis, Ioannis; Apsokardos, Alexandros; Dimitropoulos, Konstantinos; Soldatou, Ourania; Nathanail, Christodoulos; Papazotos, Alexios; Kolotoura, Athina; Sartzi, Monika; Papanikolaou, Spiros; Polakis, Pavlos; Karatzas, Stylianos; Kyparissi, Aikaterini; Papavasilopoulou, Theonymfi; Koukoubani, Triantafillia; Mastora, Evangelia; Spyropoulou, Kyriaki; Papaioannou, Alexandra; Maragkou, Elisavet; Spring, Anna; Ioakeimidou, Stavros Evagelatos Aikaterini; Noulas, Nikos; Molnár, Zsolt; Csüllög, Emese; Elekes, Enikő; Katona, Zsuzsana; Kremer, Ildiko; Miko, Angela; Csomos, Akos; Galambos, Zsuzsanna; Szucs, Akos; Nyikos, Gyorgy; Szekeres, Gabor; Szabo, Ervin; Kranitz, Katalin; Simon, Melinda; Szigeti, Janos; Gaál, Emánuel; Havas, Attila; Ille, Alexandru; Bráz, Krisztina; Nagy, Geza; Sigurdsson, Gisli; Sigurbjörnsson, Fridrik T.; Sigurdsson, Gisli H.; Sigurdardottir, Elin Edda; Gunnarsson, Björn; Westbrook, Andrew; Broderick, Alan; Hafeez, Parvaiz; Hanumanthaiah, Deepak; Brohan, Janette; O'Chroinin, Donal; Bailey, Kevin; Ramamoorthy, Karthik G.; Doyle, Yvonne; Freir, Noelle; O'Rourke, James; Jonson, Philip; Saeed, Sabir; Hayes, Ivan; Loughrey, John; Frohlich, Stephen; McCauley, Nuala; Ryan, Donal; Fitzpatrick, Gerry; Kevin, Leo; Thomas, Jubil; Warde, Barry; Woolhead, Alan; Duggan, Michelle; Egan, Cara; Crowley, Seamus; Lebese, Soloman; Bergin, Anne; Page, Rory; Collins, Daniel; McKenny, Michael; Della Rocca, Giorgio; Grasso, Salvatore; Bresciani, Anna; Carmino, Livio; Ghelfi, Silvia; Lorenzelli, Laura; Novelli, Maria Teresa; Pescarmona, Chiara; Roasio, Agostino; Gatta, Alessandro; Nastasi, Mauro; Sanseverino, Manlio; Tinti, Carla; Bianchin, Andrea; Tormena, Maria Paola; Franco, Antonio; Marini, Federica; Rapido, Francesca; Bellotti, Ferdinando; Boninsegna, Daniele; Castellani, Gianluca; Sances, Daniele; Spano, Gianluca; Tredici, Stefano; Vezzoli, Dario; Fucecchio, Igneo; Bacci, Alessandro; Coppini, Roberta; Dell'unto, Sandro; Mori, Emanuele; Stanzani, Maria Rosa; Tosi, Monica; Collareta, Michele; Forfori, Francesco; Franchi, Matteo; Mancino, Giuseppe; Battistella, Massimo; Baricocchi, Elisa; Bona, Francesco; Debernardi, Felicino; Giacoletto, Gianmarco; Iacobellis, Antonio; Massucco, Paolo; Moselli, Nora; Muratore, Andrea; Palomba, Graziella; Sardo, Elena; de Simone, Michele; Suita, Luisa; Zocca, Edoardo; Bucci, Barbara; Corte, Francesco Della; Piciucco, Tiziana; Viarengo, Valeria; Pugliese, Francesco; Ruberto, Franco; Bettelli, Gabriella; Cantarini, Eugenia; Giampieri, Marina; Tanfani, Alessandra; Recchia, Eugenio; Milano, S. Raffaele; Bignami, Elena; Bruno, Giovanna; Costagliola, Roberto; Gandolfi, Azzurra; Greco, Massimiliano; Lembo, Rosalba; Monti, Giacomo; Nicelli, Elisa; Pasculli, Nicola; Turi, Stefano; Baroselli, Antonio; Brazzoni, Marcella; Buttazzoni, Mattia; Buttera, Stefania; Centonze, Carlo; Serena, Giovanni; Spagnesi, Lorenzo; Toretti, Ilaria; Vilardi, Anna; Zearo, Ester; Arpino, Ines; Baraldi, Sara; Guarnerio, Chiara; Molene, Vincenzo; Monea, Maria Concetta; Vaccarisi, Enrico; Vicari, Luigi; Albante, Alida; Aversano, Marco; Loiacono, Cinzia; Marandola, Maurizio; Fusari, Maurizio; Petrucci, Nicola; Galla, Amerigo; Mascia, Antonio; Primieri, Paolo; Di Noto, Anna; Gratarola, Angelo; Molin, Alessandro; Spagnolo, Luigi; Spena, Claudio; Bussolengo, Orlandi; Calligaro, Plinio; Marchiotto, Simonetta; Merlini, Alberto; Pedrazzoli, Eleonora; Perina, Giulia; Visentin, Renea; Fumagalli, Roberto; Garbagnati, Andrea; Manetti, Bruna; Snaier, Chiara; Somaini, Marta; Farnia, Antonio; Nani, Roberto; Pierantonio, Novello; de Michele, Michele; Gazzanelli, Sergio; Bergamini, Elena; Tassinati, Tania; Capuzzo, Maurizia; Cirillo, Vera; Tufano, Rosalba; Oggioni, Roberto; Parrini, Vieri; Brunori, Emanuela; Capone, Micaela; Carbone, Luigi; Corradetti, Francesco; Elisei, Daniele; Fiorentino, Stefano; Francesconi, Maurizio; Gattari, Diego; Gorgoglione, Maria; Iacobone, Emanuele; Minnucci, Francesco; Montironi, Claudio; Riccioni, Gianrenato; Tappata, Giuseppe; Zompanti, Valeria; Verdenelli, Paola; Cerutti, Elisabetta; Ranieri, Vito Marco; Golubovska, Iveta; Grigorjevs, Sergejs; Rikmane, Maija; Rozkalne, Daina; Stepanovs, Jevgenijs; Suba, Olegs; Kazune, Sigita; Miscuk, Aleksej; Nemme, Janis; Oss, Peteris; Sipylaite, Jurate; Macas, Andrius; Ragaisis, Vytautas; Kontrimaviciute, Egle; Tomkute, Gabija; Kramer, Irene Fleur; Poeze, Martijn; Ziekenhuis, Antonius; Maria, John; Pelzer, Gerardus; Winsser, Lex J. A.; Nijsten, Maarten; Schoorl, Michiel; Spanjersberg, Rob; Dieleman, Stefan; Koopman-van Gemert, A. W. M. M.; Bouw, Martijn; Pickkers, Peter; van der A, Marieke; Capelle, Ziekenhuis; Schreiner, Frodo; van den Berg, Roy; de Wit, Esther; Keijzer, Christaan; Hollmann, Markus W.; Preckel, Benedikt; van Acker, Gijs J. D.; Dennesen, Paul J. W.; Kuijpers-Visser, Agnes Gerda; Inan, T.; Ponssen, Huibert Hendrik; Brouwer, Tammo; Koopmans, Matty; van Bommel, Jasper; van Duijn, Ditty; van der Hoven, Ben; Ormskerk, Patricia; Beck, Oliver; Schiere, Sjouke; Reidinga, C.; Venema, Allart; Olthof, Kees; Flaatten, Hans; Jammer, Ib; Dokka, Vegard; Monsen, Svein Arne; Ytrebo, Lars Marius; Noursadeghi, Mostafa; Shahzad, Ahmed; Boksasp, Dagfinn; Roiss, Christoph; Strietzel, Hans Frank; Berntsen, Anne Gina Schie; Haugland, Helge; Vingsnes, Svein Ove; Axelsson, Patric; Risom Olsen, Thomas C.; Katre, Sanjay; Aakeroey, Kristin; Mikstacki, Adam; Tamowicz, Barbara; Bożiłow, Dominika; Goch, Robert; Grabowski, Piotr; Kupisiak, Jacek; Małłek, Małgorzata; Szyca, Robert; Jankowski, Grzegorz; Kościelniak, Władysław; Pietraszek, Paweł; Szarowar, Bartosz; Matos, Ricardo; França, Carlos; Lacerda, António Pais; Ormonde, Lucindo; Rosa, Rosário; Pereira, Inês; Vitor, Paula; Valente, Pulido; Lopes Marques Carvalho, Maria Raquel; Faria, Manuela; Almeida, Eduardo; Mealha, Rui; Vicente, Rachel; Monte, Raquel; Rua, Fernando; Barros, Nelson; Esteves, Francisco; Gouveia Pinheiro, Célia Maria; Oliveira, Vítor Miguel; Oliveira, Maria Fátima; Martins, Isabel; Saraiva, José Pedro; Assunção, José Pedro; Bártolo, Anabela; Carvalho, Anabela; Correia, Carlos; Martins, Salomé; Milheiro, Ruth; Diaz, Alejandro; Gonçalves, Maria Imelda; Ribeiro, Rosa; Estilita, Joana; Glória, Carlos; de Almeida, José; Barros, Filipa; Ramos, Armindo; Camara, Margarida; Maul, Edward Richard; Nobrega, Julio; Langner, Anuscka; Maia, Dionísio Faria; Afonso, Ofélia; Faria, Filomena; Cabral, Curry; Botelho, Maria Manuela; Ferreira, Pedro; Mourão, Luís; Oliveira, Ana Vintém; Resende, Margarida; Aleman, Miguel; Fonseca, Jorge; Isidoro, Marta; de Meneses, Helena; Pêgas, António; Pereira, José; Pereira, Luis; Ramos, Bárbara; Matos, Francisco; Martins, Ana; Ramos, Cristina; de Sousa, Manuel; Bento, Luís; Botas, Conceição; Lopes, Vitor; Mendes, Rosa; Grigoras, Ioana; Blaj, Mihaela; Damian, Mihaela; Lupusoru, Andreea; Ristescu, Irina; Codreanu, Monica; Diaconescu, Ciresica; Nistor, Alina; Stanescu Stelian, Dorin; Streanga, Livia; Berneanu, Maria; Bordeianu, Cristina; Florenta, Calarasu; Iacob, Alina; Lupu, Mary Nicoleta; Mocanu, Iulian; Moraru, Coca; Meran, Carleta; Nicolae, Bacalbasa; Sandu, Madalina; Turcanu, Roxana; Grigore, Monica; Hotaranu, Cristina; Popescu, Nicoleta; Baban, Oleg; Baciu, Manuela; Ciobanu, Aurica; Denciu, Catalin Ioan; Gurau, Vitalie; Maftei, Ion; Ungureanu, Liviu; Bogdan, Prodan; Corneci, Dan; Dinu, Melania; Madalina, Dutu; Silvius, Negoita; Tomescu, Dana; Gabriela, Droc; Dinescu, Stelian Adrian; Calin, Mitre; Ionescu, Daniela; Margarit, Simona; Vasian, Horatiu; Albu, Corina; Balasa, Carmen; Cadrigati, Alina; Dragulescu, Dorian; Gavra, Loredana; Hentia, Ciprian; Macarie, Claudiu; Manescu, Mihaela; Nediglea, Ioan; Ocica, Dana; Ovidiu, Bedreag; Papurica, Marius; Plavat, Cosmin; Popa, Claudia; Ramneantu, Mihaela; Sandici, Zoran; Sarandan, Mihaela; Belciu, Ioana; Tincu, Eugen; Ursu, Irina; Aignatoaie, Mariana; Huzuneanu, Mariana; Cocu, Simona; Hagau, Natalia; Ciubotaru, Roxana; Copotoiu, Ruxandra; Ioana, Ghitescu; Kovacs, Judit; Leonard, Azamfirei; Szederjesi, Ianos; Genoveva, Vanvu; Mosnegutu, Simona; Surbatovic, Maja; Djordjevic, Dragan; Djordjevic, Biljana; Grujic, Krasimirka; Jovanovic, Dusko; Krstic, Ivana; Zeba, Snjezana; Jevdjic, Jasna; Miletic, Milos; Zunic, Filip; Bulasevic, Aleksandra; Brko, Radoslava; Gazibegovic, Narcisa; Kendrisic, Mirjana; Vojinovic, Radisa; Firment, Jozef; Capková, Judita; Grochova, Monika; Trenkler, Stefan; Griger, Martin; Bakosova, Erika; Kvasnica, Martin; Saniova, Beata; Sulaj, Miroslav; Zacharovska, Andrea; Simkova, Alexandra; Číková, Andrea; Gebhardtova, Andrea; Hanuljaková, Slávka; Koutun, Juraj; Martonová, Andrea; Žilinčárová, Veronika; Galkova, Katarína; Krbila, Stefan; Sobona, Viliam; Ocenasova, Marieta; Novak-Jankovic, Vesna; Grynyuk, Andriy; Damjanovska, Marija; Kostadinov, Ivan; Knezevic, Mile; Malivojevic, Marko; Borovsak, Zvonko; Kamenik, Mirt; Mekiš, Dušan; Osojnik, Irena; Kosec, Lučka; Kapš, Silva Ostojič; Aleksic, Dragoslav; Gerjevič, Božena; Kalan, Katja; Ursic, Tomaz; Aldecoa, Cesar; Montejo González, Juan C.; Artigas, Anna; Garcia, Andres; Lisi, Alberto; Perez, Isabel; Perez, Gisela; Poch, Nuria; Vaquer, Sergi; Balciscueta, Goiatz; Barrasa, Helena; Cabanes, Sara; Maynar, Javier; Poveda, Yolanda; Rodero, Amaia Quintano; Garcia-Bunger, Beatriz; Elvira, Maria Adoracion; Lajara, Ana María; Palencia, María; Ramos, Rafael; Fernandez, Ana Saez; Tirapu León, Juan Pedro; López, Jaione Iza; Yoldi Murillo, Francisco Javier; Ramirez, Eva Turumbay; Rico, Patricia Unzué; Patricia, Marta; Vizcaíno, Martín; Bernat Álvarez, Maria José; Real, Kenneth Planas; Aracil, Norma; Menendez Bodega, Begoña; Fernández García, Raquel; Álvarez García, Marivi; Gordon, Quintana; Gutiérrez Jodrá, Alicia; de Santos López, Angela; Ros, Juan José Llavador; Soto, Rocío Ayala; Sepúlveda, Isabel; Díez, Esperanza Pascual; Fernández Fernández, Luisa; Gulina, Carlos Soria; Pérez Arviza, Laura; Mouriz Fernandez, Lorena; Gómez, Antía Río; Alonso Martínez, Concepción; Mouriz Rodríguez, Ana Belén; Lopez Soto, Carmen; Garcia, Clara; Lorenzo, Mario; Pinilla, Elena; Rico, Jesus; Ruperez, Irene; Alonso, Eduardo; Leira, Fernando; Maseda, David Pestaña Emilio; Royo, Concepcion; Villagran, Jose; Murillo Candi, Giralt; Esteva, Garcia Eduardo; Folgado, Raquel Mansilla; Fornaguera, Nadal Joan; Calonge Montse, Pijoan; Prat, Anna Sape; Sintes, Dolores; Arteta, Donaldo Arteta; García Delgado, Horacio; López-Cuervo, Juan Fajardo; López, Mikel Celaya; Ramírez, Alejandro; Saldaña, Francisco José; Aliste, Pilar; Anchuelo, Ana Hermira; García Campos, Ascensión; Catalán, Mercedes; García Gómez, Mónica; Gonzalez Gonzalaez, Olga; López López, Eloísa; Arlanzón de Quevedo, Sara; Gonzalez Serrano, Matilde; Perez-Cerdá Silvestre, Francisco; Martinez Torrente, Francisco; Arocas, Blanca; Soro, Marina; Maroto, Fernando; Robledo Algarra, Ruth; Aleixandre, Inés Silla; Rodriguez Argente, Gemma; Broseta Lleó, Ana; Rubio, Antonio Vela; Vicente Sánchez, José Luis; Enríquez Valcárcel, Irene; Balust, Clara; Balust, Jaume; Borrat, Xavier; Carretero, Maria Jose; Gracia, Isabel; Matute, Purificacion; Mercadal, Jordi; Pujol, Roger; Tena, Beatriz; Ubre, Marta; Albalad, Dolores Dorda; Muñoz Alcaide, Concepción; Caballero, Jesus; Montferrer Estruch, Nuria; Ferrer, Mercè Ballvé; Lacasta Fornells, Albert; Terrer Galera, Eduard; Garcia Martinez, Irene; Manrique Muñoz, Susana; Pelavski, Andres; Perez, Pilar Tormos; Gonzalez Posada, Miguel Angel; Chocron de Prat, Ivette; Rello, Jordi; Garcia Serrano, Llum; Naya Sieiro, José Manuel; Silva, Lorena; Colomina Sole, Maria Jose; Biarnes Suñé, Alfons; Rochera Villach, Isabel; Gómez Herreras, José Ignacio; Poves, Rodrigo; Martinez Rafael, Beatriz; Martinez Almeida, Icier; Fernandez Collates, Angel; Bartolomé, Maria Jose; Cimadevilla, Bonifacio; González González, Antonio Manuel; Rabanal Llevot, Jose Manuel; de Terán Mira, Juan Carlos Diaz; González Molina, Begoña; Pardo, Sara; Sánchez, Carlos López; Williams, Monica; Muñoz Corsini, Lourdes; Rodríguez Fraile, José Ramón; de la Lastra, Maria; Sacramento, Monir Kabiri; López Saña, Francisco Javier; Trenado Ålvarez, Josep; Cantón Bulnes, Maria Luisa; Carrasco, Violeta Gándara; Cubillos, Diana Narváez; Seisdedos, Ángel Arenzana; Torres, Bartolomé Fernández; Ampuero, Marian Santos; Llano, Marta Chicot; Munoz, Manuel; Orts, Mar; Planas, Antonio; Ramasco, Fernando; Roman, Carlos; Durán, Marina Varela; del Río Fernandez, Sabela; Sanduende Otero, Yolanda; Lopez Pineiro, Susana; Barreiro Pardal, Cristina; Fernández Alcantud, Jesús; Antolinos, Mercedes Ayuso; Barrios, Francisco; Casanova, Ana Collantes; Castro, Manuel Ruiz; Crespo, Beatriz Infantes; Felipe, Uzuri Lancha; Fuster, Marta Liceras; García, Máximo Sanz; Garrote, Begoña Herrero; Gonzalez, Ricardo Moreno; Granero, Maria José Montes; Lloreda de la Guia, Carlos; López, Raquel Chaves; de Frutos López, Santiago; Martinez, Jose Javier Marco; Mostaza, Angel Garcia; Moreno, Antonio Jiménez; Osado, Irene Riquelme; Pastor, Ana Bardina; Peña, Rosa; Pérez, Mónica Rustarazo; Piña, María Aliaño; Romero, Carlos Aranda; Rodríguez, Elena Rodríguez; Sáez, Vicente Pedroviejo; Safatle, Fernando; Salvan, Javier Hernández; Sampedro, Mar Galán; de la Torre, Patricia Alfaro; Toro, Jonatan Pérez; Unzúe, Crsitina Lasa; Vargas, Maria José; Bernal, David Garcia; Echevarria, Mercedes; Iglesias, Alejandro Ubeda; Loza, Ana; Rodriguez Morillo, Araceli; Serrano, Pedro Diaz; Barrientos Sevilla, Fernando Caba; Cacho, Elena; Calderón, Ricardo; Dufur, Mercedes; Marginet, Carolina; Monedero, Pablo; Yepes, Maria José; Alvarez, Luzdivina Rellán; Carballal, Francisca Fernández; Castiñeiras, Alberto Pensado; García, Paula Dieguez; López, Lorena Ramos; Maceiras, Pablo Rama; Puente, María Socorro Martínez; Rilo, Maria Teresa Rey; Alonso, Esther Trujillo; Fernández, Sonia Rodríguez; García, Rafael Omaña; García, Aníbal Pérez; Puentes, Rafael Bello; Aguado, Domingo Nunez; Carballo, Carlos Lopez; Fernandez, Ricardo Fernandez; Presedo, Amadeo Toledo; de Rabago, Ricardo Bermejo Diaz; Velasco, Ana Rodriguez; Capel, Yolanda Jiménez; Cortés, Ana Fernández; García, Esther Martínez; Gimeno, Laura Martinez; Klamburg, Jordi; Omedas, Rosa Castillo; Núñez, Miriam González; Maristany, Clara Llubià; Ruiz, Enrique Moret; Artigas, Xavier; Castrillón, Sebastian; Espinosa, Nieves; Gomez-Caro, Ana Maria; Illa, Susana; Martín-Huerta, Beatriz; Moreno, Marisa; Fernández, Cristina Iglesias; García, Violeta Fernández; Hernández, Pedro Picatto; Checa, Alberto Honrubia; Diaz, David Salvatierra; Noguera, Manuel Linero; Varela, Ignacio Pujol; Gallego, Miguel A. González; García, Oscar Martínez; Irujo, José Javier Ariño; Perrino, Carlos González; Picazo, Julio Rey; Timoneda, Francisco López; Arroyo, María Manzanero; Blanco, Isabel Albalá; Borja, Marcos Martínez; Burcio, Sara Martín; Castro, Nilda Martinez; Cerdeiriña, Aránzazu Puente; Cristina, Medrano Viñas; Dorado Díaz, Trinidad; Esteruelas, Juan Avellanosa; Ingelmo, Ildefonso Ingelmo; Insuga, Paco Duran; Llamas, Elisabeth Claros; Lopez, Jose Juan Martín; Martín, María Beltran; Martín, Elena Elías; Mesa, Eva Ureta; Monterde, Manuela Loren; Montoiro, Paloma Alonso; Móstoles, Maria Luisa Gonzalez; Olarte, Eva Velasco; Pérez, Adolfo Martínez; Perez, Fernando Domínguez; Romero, Ana Serrano; Rous, Diego Parise; Ruiz, Nuria Mané; Ruiz, Jose Angel Palomo; Saiz, Alvaro Ruigomez; Toha, Angel Candela; Utrera, Fernando Alvarez; Alberdi, Fermín; Elósegui, Itxaso; García, Javier; Garde, Pilar Marco; Mintegui, Escudero Itziar; Sáez, Iker García; Salas, Estibaliz; Camil, Sant; Diaz-Boladeras, Rosa-Maria; Mora-Guevara, Emilio; Zamora, Julia Ferreras; Bonet, Alfons; Salo, Lidia; Salinas, Unai; Zaballos, Juan M.; Alvarez, Ana Abella; Garrido, Carlos Jimenez; Roa, Juan Ramón Hita; Vidal, Federico Gordo; Garcia-Egea, Jorge; Elson, Monica Zamora; Asensio, Miguel Angel Mendiola; Simeón, Rosa Gastaldo; Alameda, Luis Enrique Muñoz; Angulo, Guillermo Oeding; Aranzubia, Monserrat; Arcas, Jose Juan; Arevalo, Julian; Belvert, Belén Quesada; Calvo, César Pérez; Cremades, Marta; Crespo, Pascual; Cuarental, Ana; Fernández, Pablo Turrión; Herrera, Elena; Llorente, Miguel Angel Alcala; Rabes, Cecilia Martin; de Maeyer, Ana Gamo; Marquez, Manuel Pérez; Mendoza, Diego López; Muñoz, José María Milicua; Martínez, Natividad Arias; Ferrandiz, Sergi Tormo; Sanchez-Morcillo, Silvia; Sánchez, Matilde Lafuente; Parra, Asunción Marqués; Vidal, Sonia Gomar; Allué, Raquel Montoiro; Etayo, Begoña Zalba; Rodriguez, Raquel Bustamante; Villen, Luis Martin; Jimenez, Cristina Molla; de Zayas, Ricardo Salas; Moreno, Cristina Dolera; Pacheco, Fernando SanJose; Pascual, Jose Luis Anton; Parla, Infanta Cristina; Gude, Fernando Tejera; Riestra, Eva Manteiga; Delgado, Francisco Cota; de Vilanova, Arnau; Barrios, Javier; García-Sanz, Mercedes; García, Vicente; Sanmiguel, Guillermo; Álvaro, Julian López; Barrachima, Beatriz Bornay; Bermejo, Francisco Jose Romero; Garcia, Alberto Garcia Fernandez Pilar Martinez; Ramírez, Carolina Navarro; Ramos, Jorge Gómez; Samaniego, Luis Angel; Belenguer-Muncharaz, Alberto; Mateu-Campos, Maria-Lidon; Domínguez, David; Espinosa, Elena; León, Teresa; Betancor, Nazario Ojeda; Cortes, Javier Garcia; Díaz, Juan José Díaz; Canalechevarria, Ana Manzano; Novales, Beatriz Fores; Peña, Jose Manuel Garcia; Delgado, Tomas Rodriguez; Roquerio, Beatriz Santamaria; Sainz, Juan Jose Gomez; Soto, Teresa Tebar; Chew, Michelle; Dahm, Peter; Odenstedt Hergès, Helena; Lundborg, Christoffer; Söndergaard, Sören; Rylander, Christian; Sari, Ferenc; Oscarsson Tibblin, Anna; Adolfsson, Anne; Klarin, Bengt; Schrey, Susann; Chew, Michelle S.; Merisson, Edyta; Ryde, Jörgen; Divander, Mona Britt; Hedin, Annika; Hedlund, Daniel; Jawad, Monir; Layous, Lona; Brattström, Olof; Olheden, Staffan; Oldner, Anders; Sellden, Eva; Walder, Bernhard; Wickboldt, Nadine; Rossi, Ariane; Steiner, Luzius; Djurdjevic, Mirjana; Lussmann, Roger; Geisen, Martin; Hofer, Christoph; Turina, Matthias; Grocott, Mike; Goldhill, David; Everett, Lynn; Harris, Katy; Wright, Maggie; Adams, David; Alderson, Lorraine; Baker, Julie; Christie, Iain; Ferguson, Colin; Hill, Matthew; Holmes, Kate; Hutton, Andrew; Minto, Gary; Moor, Paul; Porter, Andrew; Struthers, Richard; Akotia, Niven; Belhaj, Alaa; Chang, Serene; Collantes, Enrique; Eigener, Katrin; Husband, Michael; Khan, Ahsun; McAlees, Eleanor Jane; MacDonald, Neil; Niebrzegowska, Edyta; Parnell, Wendy; Smith, Amanda; Chhatwal, Ally; Jhingan, Smriti; Muswell, Richard; Poon, Yoyo; Singh, Nidhita; Stephens, Robert; Vasan, Robin; Waife, Nicola; Weda, Tahmina; Clarke, Adrian; Szakmany, Tamas; Fletcher, Simon; Rosbergen, Melissa; Prince, Liz; Wong, Kate; Kumar, Ram; Stilwell, Sarah; Couper, Keith; Crooks, Neil; Gao-Smith, Fang; Melody, Teresa; Snaith, Catherine; Patel, Jaimin; Parekh, Dhruv; Yeung, Joyce; Loughnan, Bernadette; Rope, Tamsin; Dawson, Julie; Hadfield, Daniel; Hopkins, Phil; McDonald, Lisa; Willars, Chris; Campbell, Gillian; Craig, Jayne; Smith, Andrew; Ladipo, Karleen; Lockwood, Geoff; Moreno, Juan; Ballington, Ruth; Hamandishe, Sibongilele; Rogerson, David; Cowman, Sarah; Hayden, Paul; Pinto, Nuno; Arawwawala, Dilshan; Brotherston, Lauren; Mitchell-Inwang, Christine; Walsh, Helena; Alagarsamy, Famila; Goon, Serena; Karcheva, Sylvia; Krepska, Amy; McKinney, Brian; Patil, Vishal; Devon, Royal; Batchelor, Nicholas; Finch, Louise; Gibson, Charlie; Grayling, Matthew; Hubble, Sheena; Key, William; Knight, Thomas; Loosley, Alexander; Margetts, Paul; Stewart, Hannah; Bewley, Jeremy; Hurley, Katrina; Murphy, Ruth; Philpott, Catherine; Pollock, Kathryn; Sweet, Katie; Thomas, Matthew; Tucker, Katy; Windsor, David; Conway, Daniel; Gold, Steve; Quraishi, Tanviha; Cupitt, Jason; Baddeley, Sally; Brown, John David; Mantle, Damien; Carvalho, Peter; Huddart, Sam; Kirk-Bayley, Justin; Smith, Rebecca-Lea; Milligan, Lisa; Poulose, Sonia; Sarkar, Som; Nolan, Jerry; Pedley, Emma; Padkin, Andrew; Pesian, Siamak; Rajamanickam, Satish; Ramkumar, Konnur; Thomas, Jerry; Crayford, Alison; Turner, Angus; Bottrill, Fiona; Webb, Stephen; Jhanji, Shaman; MacCallum, Niall; Wessels, Kate; Wigmore, Tim; Meikle, Alistair; Wilson, Stephen; White, Stuart; Bonnett, Andrew; Rushton, Andrew; Williams, Colin; Zuzan, Oliver; Hall, Andrew; Montgomery, Jane; Piggot, Ailie; Read, Richard; Stocker, Mary; Tamm, Tiina; Agarwal, Banwari; Ward, Stephen; Brown, Lucy; Joy, Manju; Venkatesh, Suresh; Hughes, Thomas; Zsisku, Lajos; Roy, Alistair; Hooper, Victoria; Mouland, Johanna; Nightingale, Jeremy; Rose, Steve; Chiam, Patrick; Chohan, Harnita; Dickson, Chris; Gibb, Sarah; Higham, Charley; Harvey, Caroline; Janarthanan, Chandra; Jones, Laura; Kapoor, Avinash; Moll, Mark; Roberts, Louise; Saunders, David; Arnold, Glenn; Gibbs, Claire; Jhurgursing, Mhairi; Pritchard, Frances; Doyle, Patrick; Templeton, Maie; Wilson, Robert; Zantua, Kim; Collyer, Thomas; Featherstone, James; Worton, Rachael; Bruce, Jean; McGuigan, Kate; Moreton, Sarah; Pulletz, Mark; Anderson, Helen; Baxter, Ian; Beckingsale, Alex; Callaghan, Mark; Datta, Ansu; Dawson, Jo; Gollogly, Jackit; Izod, Chris; Lobaz, Steve; MacFie, Caroline; Patel, Manju; Payne, Heather; Singh, Raj; Timms, Gemma; McLeod, Shaun; O'Brian, Peter; Horner, Elspeth; Joshi, Vivekananda; Stuart-Smith, Karen; Seale, Tania; Bolger, Clare; Collins, Hannah; Ekins, Emma; Golder, Kim; Hawkins, Lesley; Jonas, Max; Linford, Karen; Wadams, Beverley; Vizcaychipi, Marcela; Jewsbury, William; Davies, Simon; Kangaraj, Muthuraj; Pissay, Nagesh; Smith, Neil; Gopalakrishnan, Senthilkumar; MacKinnon, John; Strandvik, Gustav; Francis, Ruth; Jennings, Adrian; Keating, Matthew; Kumar, Sajith; Leese, Sarah; Magee, Cliona; Pilsbury, Jane; Ralph, James; Riddington, David; Sachdeva, Rajneesh; Snelson, Catherine; Vasanth, Suresh; Wilde, Judith; Lavender, Beth; Lyons, Rachel; Watters, Malcolm; Adams, Tim; Dyer, Simon; Tindall, Lucy; Claxton, Andrew; Netke, Meenu; Princess, Diana; Akouds, Esam; Bates, Debrah; Gallagher, Heather; Hatton, Jonathan; Holroyd, William; Mitra, Atideb; Nurse, Trudy; Reed, Deborah; Barber, Russell; Childs, Sophie; O'Carroll-Kuehn, Britta; Wyldbore, Mark; Al-Abdaly, Ayad; Amatya, Suman; Bhaskaran, Sherly; Chandan, Garud; Chaudhry, Suman; Chikungwa, Moses; Earnshaw, Greg; Grewal, Moni; Haque, Shamimul; Hawkins, John; Javaid, Ahmed; Jackson, Clare; Kamel, Miriam; Marla, Ruchira; Mculloch, Dori-Ann; Parker, Tom; Salib, Yussof; Saravanmuthu, Ramesh; Secker, Chris; Sockalingam, Siva; Taylor, Anne; Austine, Pauline; Kanade, Vrushali; Paal, Dora; Mok, Sam; Burtenshaw, Andrew; Davis, Laura; Ellahee, Parvez; Freeman, David; Pierson, Richard; Wollaston, Julie; Karmarkar, Amara; Ball, Clare; Calton, Emily; Maxwell, Louise; Walker, Rachel; Bland, Martin; Bullock, Lynne; Harrison-Briggs, Donna; Hodge, Paul; Krige, Anton; Dempsey, Ged; Hammell, Claire; Loveridge, Robert; Parker, Robert; Snell, Jane; Wright, Carl; Baker, Andy; Barr, Katharine; Belcher, Alex; Bonnington, Sam; Bougeard, Anne-Marie; Fitzgerald, Emma; Ford, Rachael; Gillard, Chantal; Griffiths, Liz; Greenberg, Lizzie; Huber, Jonathan; Mathieu, Steve; Richardson, Neil; Tompsett, Laura; White, Nigel; Patel, Santosh; Thomas, Richard; Wilson, Jennifer; Copley, Ed; Flutter, Laura; Hulme, Jonathan; Susarla, Jay; Thwaites, Alison; Infirmary, Albert Edward; Jayasundera, Suraj; McAfee, Sean; Chantler, Jonathan; McKechnie, Stuart; Neely, Julia; Mouton, Ronelle; Scarth, Edward; Buss, Joanne; Currie, Vicki; Sange, Mansoor; Kuttler, Anja; Power, Fiona; Alexander, David; Dunne, Kevin; Shinner, Guy; Black, Euan; Haldane, Grant; Kerr, Jennie; Saran, Taj; Ward, Geraldine; Jefferies, Fiona; Alexander, Peter; Royle, Alison; Nahla, Farid; Bowles, Tim; Gregory, Maggie; Ahern, Rebecca; Cartlidge, David; Craker, Lloyd; Thompson, Christopher; Bidd, Heena; Giles, Julian; Manser, Amanda; Parry, Gareth; Chan, Peter; Das, Dinesh; Fahmy, Nisreen; Higgins, David; Khader, Ahamed Abdul; Stone, Alex; Leonardi, Silvia; Rose, Oliver; Ercole, Ari; Rafi, Muhammed Amir; Ramasamy, Radhika; Sheshgiri, Bengeri; Merrill, Colin; Page, Valerie; Walker, Elaine; Harris, Stephen; Hughes, Sarah; Morrison, Alan; Razouk, Khaled; Ayman, Mustafa; al-Subaie, Nawaf; Arif, Fuhazia; Cashman, Jeremy; Cecconi, Maurizio; Edsell, Mark; Fossati, Nicoletta; Hammond, Sarah Jane; Hamilton, Mark; Lonsdale, Dagan; Moran, Carl; Siegmueller, Claas; Velzeboer, Freya; Wong, Patrick; Jakeman, Alicia; Mowatt, Chris; Tsakas, Pirros; Clouva-Molyvdas, Phyllis-Maria; Nyktari, Vasileia; Malliotakis, Polychronis; Bekos, Vasileios; Molnar, Tamas; Karason, Sigurbergur; Blondal, Asbjorn; Di Mauro, Piero; Tommasino, Concezione; Zandvliet, Ria; in't Veld, Bas A.; Reidinga, Auke C.; Dagfinn Boksasp, Ola; Kostryka, Wlodzimierz; Choma, Robert; de Sousa Pereira de Freitas, Ana Claudia; de la Quintana Gordon, Borja; Serra, Sofia; Goncalves Castro, Maria de Lurdes; Botas, Concecao; Maldovan, Ion; Rely, Manolescu; Sandesc, Dorel; Copotoiu, Sanda-Maria; Obradovic, Jovana; Zahorec, Roman; Stecher, Adela; Stivan, Feri; Vallejo, Ana; Mas Serra, Arantxa; Real Navacerrada, Isabel; Pastor Martinez, Ernesto; Camps Cervantes, Angel; de Nadal Clanchet, Miriam; Zaldibar, Estibaliz; Miguez Crespo, Maria del Rocio; Laza Laza, Enrique; Heredia Perez, Maria del Pino; India, Inmaculada; Moral, Victoria; Concostrina, Maria de la Torre; de la Vega Terol, Alvaro; Zabarte, Mercedes; Seron-Arbeloa, Carlos; del Olmo, Mercedes; Franqueza Garcia Isabel Garcia Vega, Jose Luis; Santos Oveido, Arnoldo; Inigo, Jose Alonso; de la Torre Prados, Maria Victoria; Ferrandiz-Selles, Amparo; Seeman-Lodding, Helene; Ryde'n, Jorgen; Wernerman, Jan; Bjorne, Hakan; Kong, Ming-Li; Blunt, Mark; Moosajee, Vas; Edger, Lliam; Sandhar, Taj; Day, Christopher; Foo, Irwin; Pierro, Dena; Price, Grant; Desikan, Somi; Mok, May Un Sam; Trodd, Dawn; Soar, Jasmeet; Bright, Elizabeth

    2015-01-01

    BACKGROUND Evidence suggests that sleep deprivation associated with night-time working may adversely affect performance resulting in a reduction in the safety of surgery and anaesthesia. OBJECTIVE Our primary objective was to evaluate an association between nonelective night-time surgery and

  19. Minimal invasive gastric surgery: A systematic review

    Directory of Open Access Journals (Sweden)

    Kirti Bushan

    2015-01-01

    Full Text Available Background: As an alternate to open surgery, laparoscopic gastrectomy (LG is currently being performed in many centers, and has gained a wide clinical acceptance. The aim of this review article is to compare oncologic adequacy and safety of LG with open surgery for gastric adenocarcinomas with respect to lymphadenectomy, short-term outcomes (postoperative morbidity and mortality and long-term outcome (5 years overall survival and disease-free survival. Materials and Methods: PubMed was searched using query “LG” for literature published in English from January 2000 to April 2014. A total of 875 entries were retrieved. These articles were screened and 59 manuscripts ultimately formed the basis of current review. Results: There is high-quality evidence to support short-term efficacy, safety and feasibility of LG for gastric adenocarcinomas, although accounts on long-term survivals are still infrequent.

  20. Improving operating room safety

    Directory of Open Access Journals (Sweden)

    Garrett Jill

    2009-11-01

    Full Text Available Abstract Despite the introduction of the Universal Protocol, patient safety in surgery remains a daily challenge in the operating room. This present study describes one community health system's efforts to improve operating room safety through human factors training and ultimately the development of a surgical checklist. Using a combination of formal training, local studies documenting operating room safety issues and peer to peer mentoring we were able to substantially change the culture of our operating room. Our efforts have prepared us for successfully implementing a standardized checklist to improve operating room safety throughout our entire system. Based on these findings we recommend a multimodal approach to improving operating room safety.

  1. A multicentre, randomised, controlled trial to assess the safety, ease of use, and reliability of hyaluronic acid/carboxymethylcellulose powder adhesion barrier versus no barrier in colorectal laparoscopic surgery.

    Science.gov (United States)

    Berdah, Stéphane V; Mariette, Christophe; Denet, Christine; Panis, Yves; Laurent, Christophe; Cotte, Eddy; Huten, Nöel; Le Peillet Feuillet, Eliane; Duron, Jean-Jacques

    2014-10-27

    Intra-peritoneal adhesions are frequent following abdominal surgery and are the most common cause of small bowel obstructions. A hyaluronic acid/carboxymethylcellulose (HA/CMC) film adhesion barrier has been shown to reduce adhesion formation in abdominal surgery. An HA/CMC powder formulation was developed for application during laparoscopic procedures. This was an exploratory, prospective, randomised, single-blind, parallel-group, Phase IIIb, multicentre study conducted at 15 hospitals in France to assess the safety of HA/CMC powder versus no adhesion barrier following laparoscopic colorectal surgery. Subjects ≥18 years of age who were scheduled for colorectal laparoscopy (Mangram contamination class I‒III) within 8 weeks of selection were eligible, regardless of aetiology. Participants were randomised 1:1 to the HA/CMC powder or no adhesion barrier group using a centralised randomisation list. Patients assigned to HA/CMC powder received a single application of 1 to 10 g on adhesion-prone areas. In the no adhesion barrier group, no adhesion barrier or placebo was applied. The primary safety assessments were the incidence of adverse events, serious adverse events, and surgical site infections (SSIs) for 30 days following surgery. Between-group comparisons were made using Fisher's exact test. Of those randomised to the HA/CMC powder (n = 105) or no adhesion barrier (n = 104) groups, one patient in each group discontinued prior to the study end (one death in each group). Adverse events were more frequent in the HA/CMC powder group versus the no adhesion barrier group (63% vs. 39%; P barrier group in SSIs (21% vs. 14%; P = 0.216) and serious SSIs (12% vs. 9%; P = 0.38), or in the most frequent serious SSIs of pelvic abscess (5% and 2%; significance not tested), anastomotic fistula (3% and 4%), and peritonitis (2% and 3%). This exploratory study found significantly higher rates of adverse events and serious adverse events in the HA/CMC powder group compared with

  2. Weight loss in orthognathic surgery: a clinical study.

    Science.gov (United States)

    Hammond, Douglas; Williams, Rhodri W; Juj, Kiranjit; O'Connell, Susan; Isherwood, Grant; Hammond, Nichola

    2015-09-01

    To analyse weight change, body composition change and Body Mass Index change in patients undergoing orthognathic surgery. A service evaluation was undertaken in orthognathic patients pre-operatively and at 4 weeks post-surgery. Queen Elizabeth Hospital Birmingham outpatient department. Thirty-one patients scheduled for single- or two-jaw orthognathic surgery and rigid internal fixation. Immediately pre-operatively and at 4 weeks post-surgery the following information was gathered: (1) patient height; (2) patient weight (kg); (3) Patient Body Mass Index; and (4) patient body fat percentage. In the 4-week post-operative period, the average weight loss was -4·96 kg (range: -9·6 to +3·0 kg), with a body fat reduction of -3·07% (range: -5·80% to +2·30%) and an average reduction in Body Mass Index of -1·63 (range: -3·4 to +0·8). There was no statistically significant difference in weight loss (P = 0·1562) or body fat composition change (P = 0·2391) between single- or two-jaw surgery. There was no statistically significant difference in weight loss (P = 0·4858) or body fat composition change (P = 0·5321) between male and female patients. Weight loss observed was similar to that reported in studies using inter-maxillary fixation. Closer psychological and dietetic support is needed for patients who have a low normal or underweight Body Mass Index. Better and more bespoke tailored Oral Nutritional Supplementation must be provided for all orthognathic surgery patients to potentially reduce this significant weight loss.

  3. Evaluation of the safety and efficacy of therapeutic bandage contact lenses on post-cataract surgery patients.

    Science.gov (United States)

    Shi, Dan-Na; Song, Hang; Ding, Tong; Qiu, Wei-Qiang; Wang, Wei

    2018-01-01

    To evaluate the safety of therapeutic bandage contact lens for post-cataract surgery patients and to illustrate its efficacy on post-operative comfort and tear-film stability. A total of 40 participants were recruited and randomly divided into two groups. Group one was instructed to wear bandage contact lenses for a week and use antibiotic eye drops for a month since the first day after surgery. Group two received sub-conjunctival injection of tobramycin and was asked to wear eye pads on the first day after surgery and then were instructed to use antibiotic eye drops as the first group did. Ocular surface disease index (OSDI) questionnaire, slit-lamp microscope examination of tear break-up time (TBUT), corneal fluorescein score (CFS), tear meniscus height (TMH) together with anterior segment optical coherence tomography (AS-OCT) and corneal topography were evaluated preoperatively and postoperatively. The subjective feeling ( P =0.004), TBUT ( P <0.001) and TMH ( P =0.02) post-surgery had improved in patients who used bandage contact lenses compared with those who did not at 1wk post-surgery. Until three month postoperatively, the comfort degree ( P =0.004) and TMH ( P =0.01) of group two were still worse than group one. Moreover, TBUT ( P <0.001) and CFS ( P =0.004) of the group with eye pads got worse than the results before, whereas the group with bandage contact lenses recovered to normal. None of these patients had infections or other complications. Wearing therapeutic bandage contact lens after cataract surgery, compared with traditional eye-pads, is a safe method to improve tear-film stability and reduce post-operative discomfort without hindering corneal incision recovery.

  4. [Comparison of validity and safety between holmium: YAG laser and traditional surgery in partial nephrectomy].

    Science.gov (United States)

    Bi, Sheng; Xia, Ming

    2015-08-11

    To compare the validity and safety between holmium: YAG laser and traditional surgery in partial nephrectomy. A total of 28 patients were divided into two groups (holmium: YAG laser group without renal artery clamping and traditional surgery group with renal artery clamping). The intraoperative blood loss, total operative time, renal artery clamping time, postoperative hospital stay, separated renal function, postoperative complications and depth of tissue injury were recorded. The intraoperative blood loss, total operative time, renal artery clamping time, postoperative hospital stay, separated renal function, postoperative complications and depth of tissue injury were 80 ml, 77 min, 0 min, 7.4 days, 35 ml/min, 0, 0.9 cm, respectively, in holmium: YAG laser group. And in traditional surgery group were 69 ml, 111 min, 25.5 min, 7.3 days, 34 ml/min, 0, 2.0 cm, respectively. The differences of total operative time, renal artery clamping time and depth of tissue injury between two groups were statistically significant. The others were not statistically significant. Holmium: YAG laser is effective and safe in partial nephrectomy. It can decrease the total operative time, minimize the warm ischemia time and enlarge the extent of surgical excision.

  5. The McGill simulator for endoscopic sinus surgery (MSESS): a validation study.

    Science.gov (United States)

    Varshney, Rickul; Frenkiel, Saul; Nguyen, Lily H P; Young, Meredith; Del Maestro, Rolando; Zeitouni, Anthony; Saad, Elias; Funnell, W Robert J; Tewfik, Marc A

    2014-10-24

    Endoscopic sinus surgery (ESS) is a technically challenging procedure, associated with a significant risk of complications. Virtual reality simulation has demonstrated benefit in many disciplines as an important educational tool for surgical training. Within the field of rhinology, there is a lack of ESS simulators with appropriate validity evidence supporting their integration into residency education. The objectives of this study are to evaluate the acceptability, perceived realism and benefit of the McGill Simulator for Endoscopic Sinus Surgery (MSESS) among medical students, otolaryngology residents and faculty, and to present evidence supporting its ability to differentiate users based on their level of training through the performance metrics. 10 medical students, 10 junior residents, 10 senior residents and 3 expert sinus surgeons performed anterior ethmoidectomies, posterior ethmoidectomies and wide sphenoidotomies on the MSESS. Performance metrics related to quality (e.g. percentage of tissue removed), efficiency (e.g. time, path length, bimanual dexterity, etc.) and safety (e.g. contact with no-go zones, maximum applied force, etc.) were calculated. All users completed a post-simulation questionnaire related to realism, usefulness and perceived benefits of training on the MSESS. The MSESS was found to be realistic and useful for training surgical skills with scores of 7.97 ± 0.29 and 8.57 ± 0.69, respectively on a 10-point rating scale. Most students and residents (29/30) believed that it should be incorporated into their curriculum. There were significant differences between novice surgeons (10 medical students and 10 junior residents) and senior surgeons (10 senior residents and 3 sinus surgeons) in performance metrics related to quality (p education. This simulator may be a potential resource to help fill the void in endoscopic sinus surgery training.

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

    Science.gov (United States)

    Kim, Jong Wan; Kim, Jeong Yeon; Kang, Byung Mo; Lee, Bong Hwa; Kim, Byung Chun; Park, Jun Ho

    2016-01-01

    The purpose of the present study was to compare the perioperative and oncologic outcomes between laparoscopic surgery and open surgery for transverse colon cancer. 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. 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, Pstudy showed that laparoscopic surgery is associated with several perioperative benefits and similar oncologic outcomes to open surgery for the resection of transverse colon cancer. Therefore, laparoscopic surgery offers a safe alternative to open surgery in patients with transverse colon cancer.

  7. High-power diode laser in the circumvestibular incision for Le Fort I osteotomy in orthognathic surgery: a prospective case series study.

    Science.gov (United States)

    Jaeger, Filipe; Chiavaioli, Gustavo Marques; de Toledo, Guilherme Lacerda; Freire-Maia, Belini; Amaral, Marcio Bruno Figueiredo; Mesquita, Ricardo Alves

    2018-01-01

    The incisions during orthognathic surgery are classically performed with conventional scalpel or electrocautery. Considering that the high-power diode laser surgery may provide advantages when compared to conventional incision techniques, the current study aimed to present a prospective case series of patients submitted to circumvestibular incision for Le Fort I osteotomy. Ten patients with dentofacial deformities who underwent to rapid assisted maxillary expansion or bimaxillary orthognathic surgery were enrolled in the study. All incisions were performed by a single surgeon using an 808-nm diode laser, with an optical fiber of 600 μm, at a power of 2.5 W, in a continuous-wave mode. The performance of the incision was evaluated by incision velocity, bleeding, edema, secondary infection, clinical healing, and pain. The velocity of the incision ranged from 0.10 to 0.20 mm/s (mean 0.13 ± 0.03 mm/s). Considering bleeding during the soft tissue incision, all surgeries were classified as absent bleeding. All patients presented a clinical healing of the surgical wound in a period that range from 3 to 5 weeks and experienced swelling during the follow-up period. On average, approximately 50% of the swelling had resolved after the third postoperative week, and 28.8% of swelling remained after 2 months after the surgery. The pain decreased after 2 and 3 days, and 90.0% of the patients reported no pain after 7 postoperative days. High-power diode laser is effective and safety during circumvestibular incisions for Le Fort I osteotomy in orthognathic surgery decreasing bleeding, surgery time, pain, and edema after orthognathic surgery.

  8. Safety and efficacy of loteprednol etabonate ophthalmic ointment 0.5% for the treatment of inflammation and pain following cataract surgery.

    Science.gov (United States)

    Comstock, Timothy L; Paterno, Michael R; Singh, Angele; Erb, Tara; Davis, Elizabeth

    2011-01-01

    To compare the safety and efficacy of loteprednol etabonate ophthalmic ointment 0.5% (LE ointment), a new topical ointment formulation, with vehicle for the treatment of inflammation and pain following cataract surgery. Two randomized, multicenter, double-masked, parallel-group, vehicle-controlled studies were conducted. Patients aged ≥18 years with a combined postoperative anterior chamber cells and flare (ACI) ≥ Grade 3 following uncomplicated cataract surgery participated in seven study visits. Patients self-administered either topical LE ointment or vehicle four times daily for 14 days. Efficacy outcomes included the proportion of patients with complete resolution of ACI and the proportion of patients with no (Grade 0) pain at postoperative day 8. Safety outcomes included the incidence of adverse events, ocular symptoms, changes in intraocular pressure and visual acuity, and biomicroscopy and funduscopy findings. Data from the two studies were combined. The integrated intent-to-treat population consisted of 805 patients (mean [standard deviation] age 69.0 [9.2] years; 58.0% female and 89.7% white). Significantly more LE ointment-treated patients than vehicle-treated patients had complete resolution of ACI (27.7% versus 12.5%) and no pain (75.5% versus 43.1%) at day 8 (P < 0.0001 for both). Fewer LE ointment-treated patients required rescue medication (27.7% versus 63.8%), and fewer had an ocular adverse event (47.2% versus 78.0%, P < 0.0001) while on study treatment. The most common ocular adverse events with LE ointment were anterior chamber inflammation, photophobia, corneal edema, conjunctival hyperemia, eye pain, and iritis. Mean intraocular pressure decreased in both treatment groups. Four patients had increased intraocular pressure ≥10 mmHg (three LE ointment and one vehicle) prior to rescue medication. Visual acuity and dilated funduscopy results were similar between the treatment groups, with the exception of visual acuity at visits 5 and 6, which

  9. 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.

  10. The natural lifespan of a safety policy: violations and system migration in anaesthesia.

    Science.gov (United States)

    de Saint Maurice, Guillaume; Auroy, Yves; Vincent, Charles; Amalberti, René

    2010-08-01

    Safety rules continue growing rapidly, as if constraining human behaviour was the unique avenue for reaching ultimate safety. Safety rules are essential for a safe system, but their multiplication can have counterproductive effects. To monitor, in an anaesthesia ward, compliance with a process-oriented safety rule, and understand barriers and facilitators which help and hinder physicians from following guidelines. The rule stipulated that the day before surgery anaesthetists had to record in the patient's file the drugs to be used for the anaesthesia (induction, maintenance, airway control). Compliance was assessed before introduction of the rule, immediately after, at 6 months and at 12 months. All medical staff were blinded to the protocol. 717 patient records were included. The results showed an initial compliance with policy, reaching 86% for some items (never 100%). Reduction began within 6 months and returned almost to initial levels within a year. One individual showed poor compliance throughout the study but even initially compliant doctors experienced a reduction. Compliance was higher for complex surgery but lower for unscheduled surgery and when job pressure was greater. Compliance eroded over time. A major trigger of erosion seemed to be lack of continued compliance by a senior member of staff. Rules and procedures constitute fragile safety barriers, and it may be better to forego introducing a new safety rule if it is not considered as a priority by staff and is therefore vulnerable to sacrifice in case of conflict with competitive demands.

  11. Safety, efficacy, and intraoperative characteristics of DisCoVisc and Healon ophthalmic viscosurgical devices for cataract surgery

    Directory of Open Access Journals (Sweden)

    Modi SS

    2011-09-01

    Full Text Available Satish S Modi1, James A Davison2, Tom Walters3 1Seeta Eye Centers, Poughkeepsie, NY, USA; 2Wolfe Clinic, Marshalltown, IA, USA; 3Texas Eye Care, Austin, TX, USA Purpose: To evaluate the safety and efficacy of DisCoVisc ophthalmic viscosurgical device (OVD, Alcon Laboratories, Inc with respect to a comparator, Healon OVD (Advanced Medical Optics, Inc. Patients and methods: In this prospective study, patients with cataracts were randomized to an OVD, and then received phacoemulsification and injection of an intraocular lens. After each surgery, unmasked investigators completed subjective questionnaires about OVD characteristics during each stage of the procedure. Masked technicians evaluated objective safety parameters of intraocular pressure (IOP and endothelial cell density, with 90 days of follow-up. Results: The DisCoVisc OVD group (128 eyes and the Healon OVD group (121 eyes had statistically similar outcomes for IOP and for endothelial cell loss. Subjectively assessed viscosity was statistically different (P < 0.0001, with Healon OVD most often rated “cohesive” and DisCoVisc OVD most often rated “both dispersive and cohesive”. Workspace maintenance differed between groups (P < 0.0001, with workspace most frequently rated “full chamber maintained” when using DisCoVisc OVD and most frequently rated “workspace maintained” when using Healon OVD. “Flat” or “shallow” workspace ratings occurred only in the Healon OVD group. Conclusion: DisCoVisc OVD had both cohesive and dispersive properties, and was safe and effective for every stage of cataract surgery. Keywords: cataract, endothelial cell density, viscoelastic, phacoemulsification

  12. Air Travel Safety in Postoperative Breast Cancer Patients: A Systematic Review.

    Science.gov (United States)

    Co, Michael; Ng, Judy; Kwong, Ava

    2018-05-17

    Air travel has long been a dilemma in post-breast cancer surgery patients. Anecdotal reports have described adverse outcomes on surgical wound, implants, and lymphedema during air travel. This review aims to evaluate the best evidence from the literature concerning the air travel safety in breast cancer patients. A comprehensive review was performed of the Medline, Embase, CINAHL, and Cochrane databases using a predefined strategy. Retrieved studies were independently screened and rated for relevance. Data were extracted by 2 researchers. We reviewed the best evidence on air travel safety in postoperative breast cancer patients. Evidence was limited in the current literature to suggest adverse effects on postoperative mastectomy wounds and drains by high-altitude travel. Similarly, adverse effects on breast implants were limited to case reports and ex vivo experiments. A systematic review of 12 studies concluded that air travel is not associated with upper limb lymphedema after breast cancer surgery. Deep-vein thrombosis (DVT) is a known complication after air travel; in addition, malignancy itself is a known risk factor for DVT. Evidence of safety to continue tamoxifen during the period of air travel is lacking in the literature. Evidence to support the use of systemic DVT prophylaxis in general postoperative breast cancer patients is also limited. Best evidence from a large retrospective study suggested that mechanical antiembolism devices and early mobilization are the only measures required. Air travel is generally safe in patients after breast cancer surgery. Copyright © 2018. Published by Elsevier Inc.

  13. PATIENT SAFETY IN SURGERY: THE QUALITY OF IMPLEMENTATION OF PATIENT SAFETY CHECKLISTS IN A REGIONAL HOSPITAL

    Directory of Open Access Journals (Sweden)

    V. Karyadinata

    2012-09-01

    Full Text Available Introduction. Patient safety and the avoidance of inhospital adverse events is a key focus of clinical practice and medical audit. A large of proportion of medical errors affect surgical patients in the peri-operative setting. Safety checklists have been adopted by the medical profession from the aviation industry as a cheap and reliable method of avoiding errors which arise from complex or stressful situations. Current evidence suggests that the use of periooperative checklists has led to a decrease in surgical morbidity and hospital costs. Aim. To assess the quality of implementation of a modified patient safety checklist in a UK district general hospital. Methods. An observational tool was designed to assess in real time the peri-operative performance of the surgical safety checklist in patients undergoing general surgical, urological or orthopaedic procedures. Initiation of the checklist, duration of performance and staff participation were audited in real time. Results. 338 cases were monitored. Nurses were most active in initiating the safety checklist. The checklist was performed successfully in less than a minute in most cases. 11-24% of staff (according to professional group present in the operating room did not participate in the checklist. Critical safety checks (patient identity and procedure name were performed in all cases across all specialties. Variations were noted in checking other categories, such as deep vein thrombosis (DVT prophylaxis or patient warming. Conclusions. There is still a potential for improving the practice and culture of surgical patient safety activities. Staff training and designation of patient safety leadership roles is needed in increasing compliance and implementation of patient safety mechanism, such as peri-operative checklists. There is significant data to advocate the need to implement patient safety surgical checklists internationally

  14. A comparative study of efficacy and safety of flupirtine versus piroxicam in postoperative pain in patients undergoing lower limb surgery

    Directory of Open Access Journals (Sweden)

    Chinnaiyan S

    2017-10-01

    Full Text Available Sowmya Chinnaiyan,1 Narayana Sarala,1 Heddur Shanthappa Arun2 1Department of Pharmacology, 2Department of Orthopaedics, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India Background: Effective control of pain postoperatively is essential in providing enhanced patient care and a cost-effective hospital stay. Though many treatment modalities exist for postoperative pain management in orthopedic surgeries they are often accompanied by adverse effects. This study was carried out to assess the efficacy of flupirtine and piroxicam in postoperative pain reduction using visual analog scale (VAS score. Materials and methods: An open-label, parallel group, comparative study was conducted on patients undergoing lower limb orthopedic surgery, randomized into two groups of 38 patients each. They received either flupirtine 100 mg or piroxicam 20 mg 6 hours after surgery and then twice daily orally for 5 days. Pain was measured using VAS score, total pain relief score (TOTPAR24, and patient satisfaction score (PSS; the other scales used were behavioral pain assessment scale (BPAS and functional activity score (FAS. Rescue medication used was tramadol 100 mg intravenously. WHO causality scale was used for assessing adverse effects. Descriptive and inferential statistics were used for assessment of various parameters. Results: A total of 76 patients with mean ± standard deviation age of 35.08±10.3 years were recruited; 34 in the flupirtine and 37 in the piroxicam groups completed the study. Patients in both groups were comparable in baseline characteristics. Flupirtine and piroxicam reduced VAS score 48 hours postoperatively compared to baseline (p=0.006 and 0.001 and piroxicam produced significant reduction in pain at 8, 12, and 120 hours compared to flupirtine (p=0.028, 0.032, 0.021. TOTPAR24 and PSS at 24 hours were comparable between the treatments. BPAS scores at 24 hours were reduced

  15. Safety of intravenous tranexamic acid in patients undergoing majororthopaedic surgery: a meta-analysis of randomised controlled trials

    Science.gov (United States)

    Franchini, Massimo; Mengoli, Carlo; Marietta, Marco; Marano, Giuseppe; Vaglio, Stefania; Pupella, Simonetta; Mannucci, Pier Mannuccio; Liumbruno, Giancarlo M.

    2018-01-01

    Among the various pharmacological options to decrease peri-operative bleeding, tranexamic acid appears to be one of the most interesting. Several trials have consistently documented the efficacy of this synthetic drug in reducing the risk of blood loss and the need for allogeneic blood transfusion in patients undergoing total hip and knee arthroplasty. The safety of intravenous tranexamic acid in major orthopaedic surgery, particularly regarding the risk of venous thromboembolism, was systematically analysed in this review. A systematic search of the literature identified 73 randomised controlled trials involving 4,174 patients and 2,779 controls. The raw overall incidence of venous thromboembolism was 2.1% in patients who received intravenous tranexamic acid and 2.0% in controls. A meta-analytic pooling showed that the risk of venous thromboembolism in tranexamic acid-treated patients was not significantly different from that of controls (risk difference: 0.01%, 95% confidence interval [CI]: −0.05%, 0.07%; risk ratio: 1.067, 95% CI: 0.760–1.496). Other severe drug-related adverse events occurred very rarely (0.1%). In conclusion, the results of this systematic review and meta-analysis show that intravenous tranexamic acid is a safe pharmacological treatment to reduce blood loss and transfusion requirements in patients undergoing major orthopaedic surgery. PMID:29337665

  16. Mitral valve surgery using right anterolateral thoracotomy: is the aortic cannulation a safety procedure?

    Science.gov (United States)

    Guedes, Marco Antonio Vieira; Pomerantzeff, Pablo Maria Alberto; Brandão, Carlos Manuel de Almeida; Vieira, Marcelo Luiz Campos; Grinberg, Max; Stolf, Noedir Antonio Groppo

    2010-01-01

    The right anterolateral thoracotomy is an alternative technique for surgical approach of mitral valve. In these cases, femoral-femoral bypass still has been used, rising occurrence of complications related to femoral cannulation. Describe the technique and results of mitral valve treatment by right anterolateral thoracotomy using aortic cannulation for cardiac pulmonary bypass (CPB). From 1983 e 2008, 100 consecutive female patients, with average age 35 ±13 years, 96 (96%) underwent mitral valve surgical treatment in the Heart Institute of São Paulo. A right anterolateral thoracotomy approach associated with aortic cannulation was used for CPB. Eighty (80%) patients had rheumatic disease and 84 (84%) patients presented functional class III or IV. Were performed 45 (45%) comissurotomies, 38 (38%) valve repairs, 7(7%) mitral valve replacements, seven (7%) recomissurotomies and three (3%) prosthesis replacement. Sparing surgery was performed in 90 (90%) patients. The average CPB and clamp time were 57 ± 27 min e 39 ± 19 min, respectively. There were no in-hospital death, reoperation due to bleeding and convertion to sternotomy. Introperative complications were related to heart harvest (5%), especially in reoperations (3%). The most important complications in postoperative period were related to pulmonary system (11%), followed by atrial fibrilation (10%) but without major systemic repercussions. The mean inhospital length of stay was 8 ± 3 days. Follow-up was 6.038 patients/month. Actuarial survival was 98.0 ± 1.9% and freedom from reoperation was 81.4 ± 7.8% in 180 months. The right anterolateral thoracotomy associated with aortic cannulation in mitral valve surgery is a simple technique, reproducible and safety.

  17. 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

  18. Safety of Running Two Rooms: A Systematic Review and Meta-Analysis of Overlapping Neurosurgical Procedures.

    Science.gov (United States)

    Self, D Mitchell; Ilyas, Adeel; Stetler, William R

    2018-04-27

    Overlapping surgery, a long-standing practice within academic neurosurgery centers nationwide, has recently come under scrutiny from the government and media as potentially harmful to patients. Therefore, the objective of this systematic review and meta-analysis is to determine the safety of overlapping neurosurgical procedures. The authors performed a systematic review and meta-analysis in accordance with PRISMA guidelines. A review of PubMed and Medline databases was undertaken with the search phrase "overlapping surgery AND neurosurgery AND outcomes." Data regarding patient demographics, type of neurosurgical procedure, and outcomes and complications were extracted from each study. The principle summary measure was odds ratio (OR) of the association of overlapping versus non-overlapping surgery with outcomes. The literature search yielded a total of 36 studies, of which 5 studies met inclusion criteria and were included in this study. These studies included a total of 25,764 patients undergoing neurosurgical procedures. Overlapping surgery was associated with an increased likelihood of being discharged home (OR = 1.32; 95% CI 1.20 to 1.44; P < 0.001) and a reduced 30-day unexpected return to the operating room (OR = 0.79; 95% CI 0.72 to 0.87; P < 0.001). Overlapping surgery did not significantly affect OR of length of surgery, 30-day mortality, or 30-day readmission. Overlapping neurosurgical procedures were not associated with worse patient outcomes. Additional, prospective studies are needed to further assess the safety overlapping procedures. Copyright © 2018. Published by Elsevier Inc.

  19.  Patient safety in orthopedic surgery: prioritizing key areas of iatrogenic harm through an analysis of 48,095 incidents reported to a national database of errors

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    Panesar SS

    2013-03-01

    harm in the specialty, and make suggestions on the way forward.Conclusion and level of evidence: Despite the limitations of such analyses, it is clear that there are many proven interventions which can improve patient safety and need to be implemented. Avoidable errors must be prevented, lest we be accused of contravening our fundamental duty of primum non nocere. This is a level III evidence-based study.Keywords: orthopedic surgery, patient safety incident, iatrogenic harm, error

  20. Evaluation of the safety and efficacy of therapeutic bandage contact lenses on post-cataract surgery patients

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    Dan-Na Shi

    2018-02-01

    Full Text Available AIM: To evaluate the safety of therapeutic bandage contact lens for post-cataract surgery patients and to illustrate its efficacy on post-operative comfort and tear-film stability. METHODS: A total of 40 participants were recruited and randomly divided into two groups. Group one was instructed to wear bandage contact lenses for a week and use antibiotic eye drops for a month since the first day after surgery. Group two received sub-conjunctival injection of tobramycin and was asked to wear eye pads on the first day after surgery and then were instructed to use antibiotic eye drops as the first group did. Ocular surface disease index (OSDI questionnaire, slit-lamp microscope examination of tear break-up time (TBUT, corneal fluorescein score (CFS, tear meniscus height (TMH together with anterior segment optical coherence tomography (AS-OCT and corneal topography were evaluated preoperatively and postoperatively. RESULTS: The subjective feeling (P=0.004, TBUT (P<0.001 and TMH (P=0.02 post-surgery had improved in patients who used bandage contact lenses compared with those who did not at 1wk post-surgery. Until three month postoperatively, the comfort degree (P=0.004 and TMH (P=0.01 of group two were still worse than group one. Moreover, TBUT (P<0.001 and CFS (P=0.004 of the group with eye pads got worse than the results before, whereas the group with bandage contact lenses recovered to normal. None of these patients had infections or other complications. CONCLUSION: Wearing therapeutic bandage contact lens after cataract surgery, compared with traditional eye-pads, is a safe method to improve tear-film stability and reduce post-operative discomfort without hindering corneal incision recovery.

  1. Can we improve patient safety?

    Science.gov (United States)

    Corbally, Martin Thomas

    2014-01-01

    Despite greater awareness of patient safety issues especially in the operating room and the widespread implementation of surgical time out World Health Organization (WHO), errors, especially wrong site surgery, continue. Most such errors are due to lapses in communication where decision makers fail to consult or confirm operative findings but worryingly where parental concerns over the planned procedure are ignored or not followed through. The WHO Surgical Pause/Time Out aims to capture these errors and prevent them, but the combination of human error and complex hospital environments can overwhelm even robust safety structures and simple common sense. Parents are the ultimate repository of information on their child's condition and planned surgery but are traditionally excluded from the process of Surgical Pause and Time Out, perhaps to avoid additional stress. In addition, surgeons, like pilots, are subject to the phenomenon of "plan-continue-fail" with potentially disastrous outcomes. If we wish to improve patient safety during surgery and avoid wrong site errors then we must include parents in the Surgical Pause/Time Out. A recent pilot study has shown that neither staff nor parents found it added to their stress, but, moreover, 100% of parents considered that it should be a mandatory component of the Surgical Pause nor does it add to the stress of surgery. Surgeons should be required to confirm that the planned procedure is in keeping with the operative findings especially in extirpative surgery and this "step back" should be incorporated into the standard Surgical Pause. It is clear that we must improve patient safety further and these simple measures should add to that potential.

  2. Long-term effectiveness and safety of stereotactic gamma knife surgery as a primary sole treatment in the management of glomus jagulare tumor.

    Science.gov (United States)

    Hafez, Raef F A; Morgan, Magad S; Fahmy, Osama M; Hassan, Hamdy T

    2018-05-01

    This study aims to report and confirm long-term effectiveness and safety of stereotactic Gamma Knife Surgery as a primary sole treatment in the management of 40 glomus jagulare tumors patients. Retrospective analysis of clinical and radiological outcomes of 40 GJTs consecutive patients treated with GKS as primary sole treatment at International Medical Center (IMC), Cairo-Egypt from the beginning of 2005 till the end of 2014,with mean follow-up period of 84 months (range 36-156 months), mean tumor volume was 6.5 cc, and mean peripheral radiation dose of 15 Gy, to mean isodose curve of 38%. The most common neurological deficit at initial evaluation was bulbar symptoms in 24 patients, followed by pulsatile tinnitus in 22, deterioration of hearing in 20 patients. The overall clinical control achieved in 92.5% of patients, while actuarial tumor size control rate post- GKS was 97.5% at 3 years, 97% at 5 years and 92% at 10 years of follow-up period. Gamma knife surgery could be used effectively and safely as a primary sole treatment tool in the management of glomus jugulare tumors. Copyright © 2018 Elsevier B.V. All rights reserved.

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

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    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.

  4. Endoscopic versus microscopic trans-sphenoidal pituitary surgery: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Goudakos, J. K.; Markou, K. D.; Georgalas, C.

    2011-01-01

    Endoscopic trans-sphenoidal surgery has been increasingly replacing microscopic surgery as the state of the art trans-sphenoidal approach. To assess the efficacy and safety of pure endoscopic approach in comparison with microscopic approach in pituitary surgery. Literature review and meta-analysis.

  5. Predicting surgical site infection after spine surgery: a validated model using a prospective surgical registry.

    Science.gov (United States)

    Lee, Michael J; Cizik, Amy M; Hamilton, Deven; Chapman, Jens R

    2014-09-01

    The impact of surgical site infection (SSI) is substantial. Although previous study has determined relative risk and odds ratio (OR) values to quantify risk factors, these values may be difficult to translate to the patient during counseling of surgical options. Ideally, a model that predicts absolute risk of SSI, rather than relative risk or OR values, would greatly enhance the discussion of safety of spine surgery. To date, there is no risk stratification model that specifically predicts the risk of medical complication. The purpose of this study was to create and validate a predictive model for the risk of SSI after spine surgery. This study performs a multivariate analysis of SSI after spine surgery using a large prospective surgical registry. Using the results of this analysis, this study will then create and validate a predictive model for SSI after spine surgery. The patient sample is from a high-quality surgical registry from our two institutions with prospectively collected, detailed demographic, comorbidity, and complication data. An SSI that required return to the operating room for surgical debridement. Using a prospectively collected surgical registry of more than 1,532 patients with extensive demographic, comorbidity, surgical, and complication details recorded for 2 years after the surgery, we identified several risk factors for SSI after multivariate analysis. Using the beta coefficients from those regression analyses, we created a model to predict the occurrence of SSI after spine surgery. We split our data into two subsets for internal and cross-validation of our model. We created a predictive model based on our beta coefficients from our multivariate analysis. The final predictive model for SSI had a receiver-operator curve characteristic of 0.72, considered to be a fair measure. The final model has been uploaded for use on SpineSage.com. We present a validated model for predicting SSI after spine surgery. The value in this model is that it gives

  6. Robotic, laparoscopic and open surgery for gastric cancer compared on surgical, clinical and oncological outcomes: a multi-institutional chart review. A study protocol of the International study group on Minimally Invasive surgery for GASTRIc Cancer—IMIGASTRIC

    Science.gov (United States)

    Desiderio, Jacopo; Jiang, Zhi-Wei; Nguyen, Ninh T; Zhang, Shu; Reim, Daniel; Alimoglu, Orhan; Azagra, Juan-Santiago; Yu, Pei-Wu; Coburn, Natalie G; Qi, Feng; Jackson, Patrick G; Zang, Lu; Brower, Steven T; Kurokawa, Yukinori; Facy, Olivier; Tsujimoto, Hironori; Coratti, Andrea; Annecchiarico, Mario; Bazzocchi, Francesca; Avanzolini, Andrea; Gagniere, Johan; Pezet, Denis; Cianchi, Fabio; Badii, Benedetta; Novotny, Alexander; Eren, Tunc; Leblebici, Metin; Goergen, Martine; Zhang, Ben; Zhao, Yong-Liang; Liu, Tong; Al-Refaie, Waddah; Ma, Junjun; Takiguchi, Shuji; Lequeu, Jean-Baptiste; Trastulli, Stefano; Parisi, Amilcare

    2015-01-01

    Introduction Gastric cancer represents a great challenge for healthcare providers and requires a multidisciplinary treatment approach in which surgery plays a major role. Minimally invasive surgery has been progressively developed, first with the advent of laparoscopy and recently with the spread of robotic surgery, but a number of issues are currently being debated, including the limitations in performing an effective extended lymph node dissection, the real advantages of robotic systems, the role of laparoscopy for Advanced Gastric Cancer, the reproducibility of a total intracorporeal technique and the oncological results achievable during long-term follow-up. Methods and analysis A multi-institutional international database will be established to evaluate the role of robotic, laparoscopic and open approaches in gastric cancer, comprising of information regarding surgical, clinical and oncological features. A chart review will be conducted to enter data of participants with gastric cancer, previously treated at the participating institutions. The database is the first of its kind, through an international electronic submission system and a HIPPA protected real time data repository from high volume gastric cancer centres. Ethics and dissemination This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevant laws/regulations. A multicentre study with a large number of patients will permit further investigation of the safety and efficacy as well as the long-term outcomes of robotic, laparoscopic and open approaches for the management of gastric cancer. Trial registration number NCT02325453; Pre-results. PMID:26482769

  7. Evaluation of aesthetic and functional outcomes in rhinoplasty surgery: a prospective study.

    Science.gov (United States)

    Sena Esteves, Sara; Gonçalves Ferreira, Miguel; Carvalho Almeida, João; Abrunhosa, José; Almeida E Sousa, Cecília

    Evaluation of surgery outcome measured by patient satisfaction or quality of life is very important, especially in plastic surgery. There is increasing interest in self-reporting outcomes evaluation in plastic surgery. The aim of our study was to determine patient satisfaction in regard to nose appearance and function with the use of a validated questionnaire, before and after rhinoplasty surgery. A prospective study was realized at a tertiary centre. All rhinoplasty surgeries performed in adults between February 2013 and August 2014 were included. Many patients underwent additional nasal surgery such as septoplasty or turbinoplasty. The surgical procedures and patients' characteristics were also recorded. Among 113 patients, 107 completed the questionnaires and the follow-up period. Analysis of pre-operative and post-operative Rhinoplasty Evaluation Outcome showed a significant improvement after 3 and 6 months in functional and aesthetic questions (pprocedures, primary or revision surgery and open versus closed approach. We found that patients with lower literacy degree were more satisfied with the procedure. Rhinoplasty surgery significantly improved patient quality of life regarding nose function and appearance. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

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

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    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

  9. A prospective qualitative study on patients' perceptions of endoscopic endonasal transsphenoidal surgery.

    Science.gov (United States)

    Edem, Idara J; Banton, Beverly; Bernstein, Mark; Lwu, Shelly; Vescan, Allan; Gentilli, Fred; Zadeh, Gelareh

    2013-02-01

    Endoscopic transsphenoidal surgery has been shown to be a safe and effective treatment option for patients with pituitary tumours, but no study has explored patients' perceptions before and after this surgery. The authors in this study aim to explore patients' perceptions on endoscopic transsphenoidal surgery. Using qualitative research methodology, two semi-structured interviews were conducted with 30 participants who were adults aged > 18 undergoing endoscopic transsphenoidal surgery for the resection of a pituitary tumour between December 2008 and June 2011. The interviews were audiotaped and transcribed. The resulting data was analyzed using a modified thematic analysis. Seven overarching themes were identified: (1) Patients had a positive surgical experience; (2) patients were satisfied with the results of the procedure; (3) patients were initially surprised that neurosurgery could be performed endonasally; (4) patients expected a cure and to feel better after the surgery; (5) many patients feared that something might go wrong during the surgery; (6) patients were psychologically prepared for the surgery; (7) most patients reported receiving adequate pre-op and post-op information. This is the first qualitative study reporting on patients' perceptions before and after an endoscopic endonasal transsphenoidal pituitary surgery, which is increasingly used as a standard surgical approach for patients with pituitary tumours. Patients report a positive perception and general satisfaction with the endoscopic transsphenoidal surgical experience. However, there is still room for improvement in post-surgical care. Overall, patients' perceptions can help improve the delivery of comprehensive care to future patients undergoing pituitary tumour surgery.

  10. Early audit of renal complications in a new cardiac surgery service in Australia.

    Science.gov (United States)

    Bolsin, Stephen N; Stow, Peter; Bucknell, Sarah

    2004-09-01

    To assess the incidence of renal failure in a cardiac surgery service commencing in Australia. Prospective data collection and retrospective database analysis. A tertiary referral, university teaching hospital in the state of Victoria, Australia. The first 502 patients undergoing cardiac surgery in this institution from commencement of the service. The overall rate of renal failure was low in comparison to other studies at 0.2% (95% CI 0.04-1.3%). The rate of postoperative renal dysfunction was also low at 4.2% (95% CI 2.7-6.5%). The safety of the new service with respect to this complication of cardiac surgery was good when compared with published data. However the lack of uniform definitions of renal failure following cardiac surgery make comparisons between studies difficult. Uniform reporting of this complication would facilitate comparisons between units and quality assurance activities in this field.

  11. Pre- or postoperative interscalene block and/or general anesthesia for arthroscopic shoulder surgery: a retrospective observational study.

    Science.gov (United States)

    Bosco, Laura; Zhou, Cheng; Murdoch, John A C; Bicknell, Ryan; Hopman, Wilma M; Phelan, Rachel; Shyam, Vidur

    2017-10-01

    Arthroscopic shoulder surgery can be performed with an interscalene brachial plexus block (ISBPB) alone, ISBPB combined with general anesthesia (GA), or GA alone. Postoperative pain is typically managed with opioids; however, both GA and opioids have adverse effects which can delay discharge. This retrospective study compares the efficacy of four methods of anesthesia management for arthroscopic shoulder surgery. Charts of all patients who underwent shoulder surgery by a single surgeon from 2012-2015 were categorized by analgesic regimen: GA only (n = 177), single-shot ISBPB only (n = 124), or pre- vs postoperative ISBPB combined with GA (ISBPB + GA [n = 72] vs GA + ISBPB [n = 52], respectively). The primary outcome measure was the time to discharge from the postanesthesia care unit (PACU). Mean (SD) time in the PACU ranged from 70.5 (39.9) min for ISBPB only to 111.2 (56.9) min for GA only. Use of ISBPB in any combination and regardless of timing resulted in significantly reduced PACU time, with a mean drop of 27.2 min (95% confidence interval [CI], 17.3 to 37.2; P shoulder surgery are confirmed. Postoperative ISBPBs may also be beneficial for reducing pain and opioid requirements and could be targeted for patients in severe pain upon emergence. A sufficiently powered randomized-controlled trial could determine the relative efficacy, safety, and associated financial implications associated with each method.

  12. Locating Errors Through Networked Surveillance: A Multimethod Approach to Peer Assessment, Hazard Identification, and Prioritization of Patient Safety Efforts in Cardiac Surgery.

    Science.gov (United States)

    Thompson, David A; Marsteller, Jill A; Pronovost, Peter J; Gurses, Ayse; Lubomski, Lisa H; Goeschel, Christine A; Gosbee, John W; Wahr, Joyce; Martinez, Elizabeth A

    2015-09-01

    The objectives were to develop a scientifically sound and feasible peer-to-peer assessment model that allows health-care organizations to evaluate patient safety in cardiovascular operating rooms and to establish safety priorities for improvement. The locating errors through networked surveillance study was conducted to identify hazards in cardiac surgical care. A multidisciplinary team, composed of organizational sociology, organizational psychology, applied social psychology, clinical medicine, human factors engineering, and health services researchers, conducted the study. We used a transdisciplinary approach, which integrated the theories, concepts, and methods from each discipline, to develop comprehensive research methods. Multiple data collection was involved: focused literature review of cardiac surgery-related adverse events, retrospective analysis of cardiovascular events from a national database in the United Kingdom, and prospective peer assessment at 5 sites, involving survey assessments, structured interviews, direct observations, and contextual inquiries. A nominal group methodology, where one single group acts to problem solve and make decisions was used to review the data and develop a list of the top priority hazards. The top 6 priority hazard themes were as follows: safety culture, teamwork and communication, infection prevention, transitions of care, failure to adhere to practices or policies, and operating room layout and equipment. We integrated the theories and methods of a diverse group of researchers to identify a broad range of hazards and good clinical practices within the cardiovascular surgical operating room. Our findings were the basis for a plan to prioritize improvements in cardiac surgical care. These study methods allowed for the comprehensive assessment of a high-risk clinical setting that may translate to other clinical settings.

  13. Telemedicine and Plastic Surgery: A Pilot Study

    Directory of Open Access Journals (Sweden)

    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.

  14. Efficacy and Safety of Adjuvant Proton Therapy Combined With Surgery for Chondrosarcoma of the Skull Base: A Retrospective, Population-Based Study.

    Science.gov (United States)

    Feuvret, Loïc; Bracci, Stefano; Calugaru, Valentin; Bolle, Stéphanie; Mammar, Hamid; De Marzi, Ludovic; Bresson, Damien; Habrand, Jean-Louis; Mazeron, Jean-Jacques; Dendale, Rémi; Noël, Georges

    2016-05-01

    Chondrosarcoma is a rare malignant tumor of the cartilage affecting young adults. Surgery, followed by charged-particle irradiation, is considered the reference standard for the treatment of patients with grade I to II skull base chondrosarcoma. The present study was conducted to assess the effect of the quality of surgery and radiation therapy parameters on local control (LC) and overall survival (OS). From 1996 to 2013, 159 patients (median age 40 years, range 12-83) were treated with either protons alone or a combination of protons and photons. The median total dose delivered was 70.2 Gy (relative biologic effectiveness [RBE]; range 67-71). Debulking and biopsy were performed in 133 and 13 patients, respectively. With a median follow-up of 77 months (range 2-214), 5 tumors relapsed based on the initial gross tumor volume. The 5- and 10-year LC rates were 96.4% and 93.5%, respectively, and the 5- and 10-year OS rates were 94.9% and 87%, respectively. A total of 16 patients died (13 of intercurrent disease, 3 of disease progression). On multivariate analysis, age chondrosarcoma can achieve a high LC rate with a low toxicity profile. Maximal safe surgery, followed by high-dose conformal proton therapy, is therefore recommended. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Efficacy and Safety of Adjuvant Proton Therapy Combined With Surgery for Chondrosarcoma of the Skull Base: A Retrospective, Population-Based Study

    Energy Technology Data Exchange (ETDEWEB)

    Feuvret, Loïc, E-mail: loic.feuvret@psl.aphp.fr [Department of Radiation Oncology, Groupe Hospitalier La Pitié-Salpêtrière–Charles Foix (Assistance Publique–Hôpitaux de Paris), Paris (France); Department of Radiation Oncology, Institut Curie–Centre de protonthérapie d' Orsay (CPO), Orsay (France); Bracci, Stefano [Institute of Radiation Oncology, Sapienza University, Sant' Andrea Hospital, Rome (Italy); Calugaru, Valentin [Department of Radiation Oncology, Institut Curie–Centre de protonthérapie d' Orsay (CPO), Orsay (France); Bolle, Stéphanie [Department of Radiation Oncology, Gustave Roussy, Villejuif (France); Mammar, Hamid; De Marzi, Ludovic [Department of Radiation Oncology, Institut Curie–Centre de protonthérapie d' Orsay (CPO), Orsay (France); Bresson, Damien [Department of Neurosurgery, Hôpital Lariboisière (Assistance Publique–Hôpitaux de Paris), Paris (France); Habrand, Jean-Louis [Department of Radiation Oncology, Centre François Baclesse, Caen (France); Mazeron, Jean-Jacques [Department of Radiation Oncology, Groupe Hospitalier La Pitié-Salpêtrière–Charles Foix (Assistance Publique–Hôpitaux de Paris), Paris (France); Dendale, Rémi [Department of Radiation Oncology, Institut Curie–Centre de protonthérapie d' Orsay (CPO), Orsay (France); and others

    2016-05-01

    Purpose: Chondrosarcoma is a rare malignant tumor of the cartilage affecting young adults. Surgery, followed by charged-particle irradiation, is considered the reference standard for the treatment of patients with grade I to II skull base chondrosarcoma. The present study was conducted to assess the effect of the quality of surgery and radiation therapy parameters on local control (LC) and overall survival (OS). Methods and Materials: From 1996 to 2013, 159 patients (median age 40 years, range 12-83) were treated with either protons alone or a combination of protons and photons. The median total dose delivered was 70.2 Gy (relative biologic effectiveness [RBE]; range 67-71). Debulking and biopsy were performed in 133 and 13 patients, respectively. Results: With a median follow-up of 77 months (range 2-214), 5 tumors relapsed based on the initial gross tumor volume. The 5- and 10-year LC rates were 96.4% and 93.5%, respectively, and the 5- and 10-year OS rates were 94.9% and 87%, respectively. A total of 16 patients died (13 of intercurrent disease, 3 of disease progression). On multivariate analysis, age <40 years and primary disease status were independent favorable prognostic factors for progression-free survival and OS, and local tumor control was an independent favorable predictor of OS. In contrast, the extent of surgery, dosimetric parameters, and adjacent organs at risk were not prognostic factors for LC or OS. Conclusions: Systematic high-dose postoperative proton therapy for skull base chondrosarcoma can achieve a high LC rate with a low toxicity profile. Maximal safe surgery, followed by high-dose conformal proton therapy, is therefore recommended.

  16. New trends in minimally invasive urological surgery

    Directory of Open Access Journals (Sweden)

    Prabhakar Rajan

    2009-10-01

    Full Text Available Purpose: The perceived benefits of minimally-invasive surgery include less postoperative pain, shorter hospitalization, reduced morbidity and better cosmesis while maintaining diagnostic accuracy and therapeutic outcome. We review the new trends in minimally-invasive urological surgery. Materials and method: We reviewed the English language literature using the National Library of Medicine database to identify the latest technological advances in minimally-invasive surgery with particular reference to urology. Results: Amongst other advances, studies incorporating needlescopic surgery, laparoendoscopic single-site surgery , magnetic anchoring and guidance systems, natural orifice transluminal endoscopic surgery and flexible robots were considered of interest. The results from initial animal and human studies are also outlined. Conclusion: Minimally-invasive surgery continues to evolve to meet the demands of the operators and patients. Many novel technologies are still in the testing phase, whilst others have entered clinical practice. Further evaluation is required to confirm the safety and efficacy of these techniques and validate the published reports.

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

    Directory of Open Access Journals (Sweden)

    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. Single-port laparoscopic rectal surgery - a systematic review

    DEFF Research Database (Denmark)

    Lolle, Ida; Rosenstock, Steffen; Bulut, Orhan

    2014-01-01

    INTRODUCTION: Single-port laparoscopic surgery (SPLS) for colonic disease has been widely described, whereas data for SPLS rectal resection are sparse. This review aimed to evaluate the feasibility, safety and complication profile of SPLS for rectal diseases. METHODS: A systematic literature search...

  19. A randomized study comparing outcomes of stapled and hand-sutured anastomoses in patients undergoing open gastrointestinal surgery.

    Science.gov (United States)

    Chandramohan, S M; Gajbhiye, Raj Narenda; Agwarwal, Anil; Creedon, Erin; Schwiers, Michael L; Waggoner, Jason R; Tatla, Daljit

    2013-08-01

    Although stapling is an alternative to hand-suturing in gastrointestinal surgery, recent trials specifically designed to evaluate differences between the two in surgery time, anastomosis time, and return to bowel activity are lacking. This trial compared the outcomes of the two in subjects undergoing open gastrointestinal surgery. Adult subjects undergoing emergency or elective surgery requiring a single gastric, small, or large bowel anastomosis were enrolled into this open-label, prospective, randomized, interventional, parallel, multicenter, controlled trial. Randomization was assigned in a 1:1 ratio between the hand-sutured group (n = 138) and the stapled group (n = 142). Anastomosis time, surgery time, and time to bowel activity were collected and compared as primary endpoints. A total of 280 subjects were enrolled from April 2009 to September 2010. Only the time of anastomosis was significantly different between the two arms: 17.6 ± 1.90 min (stapled) and 20.6 ± 1.90 min (hand-sutured). This difference was deemed not clinically or economically meaningful. Safety outcomes and other secondary endpoints were similar between the two arms. Mechanical stapling is faster than hand-suturing for the construction of gastrointestinal anastomoses. Apart from this, stapling and hand-suturing are similar with respect to the outcomes measured in this trial.

  20. Resolution of neurosensory deficit after mandibular orthognathic surgery: A prospective longitudinal study.

    Science.gov (United States)

    Alolayan, Albraa Badr; Leung, Yiu Yan

    2017-05-01

    To investigate the longitudinal resolution of neurosensory deficit (NSD) and the possible risk factors that might contribute to NSD following mandibular orthognathic procedures. A prospective longitudinal observational study on patients who had mandibular orthognathic procedures was performed. Standardized neurosensory assessments were performed. The 2 years longitudinal resolution and risk factors of NSD including patients' age and gender, specific mandibular procedures and surgeons' experience were analyzed. 66 patients (44 females) with 132 sides of mandibular procedures were enrolled in the study. Surgical procedures included mandibular ramus surgery, anterior mandibular surgery, or the combination of the two. The overall occurrences of subjective NSD improved from 78.8% at postoperative 2 weeks to 13.8% at post-operative 2 years. Combinations of ramus surgery and anterior mandibular surgery increased the risk of NSD at the first three post-operative months (p orthognathic surgery. The occurrence of NSD after mandibular orthognathic procedures reduced progressively within the post-operative 2 years. Combination of mandibular ramus surgery and anterior mandibular surgery increased the risk of NSD in the early post-operative period. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  1. A comparative study on the short-term clinicopathologic outcomes of laparoscopic surgery versus conventional open surgery for transverse colon cancer.

    Science.gov (United States)

    Kim, H J; Lee, I K; Lee, Y S; Kang, W K; Park, J K; Oh, S T; Kim, J G; Kim, Y H

    2009-08-01

    The long-term oncologic stability of laparoscopic surgery for colon cancer was established, and laparoscopic surgery was accepted as an alternative to conventional open surgery for colon cancer. However, transverse colon cancer was excluded from the majority of the previous prospective studies. As a result, debate on laparoscopic surgery for transverse colon cancer continues. This study aimed to compare the clinicopathologic outcome of laparoscopic surgery with that of conventional open surgery for transverse colon cancer. From August 2004 to December 2007, 106 cases of transverse colon cancer were managed by resection at our institution, and 89 of these cases were included in this study. Age, sex, body mass index (BMI), operation time, blood loss, time to first flatus, time to start of diet, hospital stay, complications, tumor size, distal resection margin, proximal resection margin, and number of nodes harvested were compared between the two groups. No significant differences were found between the laparoscopic and conventional groups in terms of age, sex, BMI, operation time, or hospital stay. The mean blood loss during the operations was significantly less in the laparoscopic group (113.8 +/- 128.9 ml) than in the conventional group (278.8 +/- 268.7 ml; p transverse colon cancer, and the oncologic quality of laparoscopic surgery was found to be acceptable compared with conventional open surgery.

  2. Medical Ethics in Plastic Surgery: A Mini Review.

    Science.gov (United States)

    Nejadsarvari, Nasrin; Ebrahimi, Ali; Ebrahimi, Azin; Hashem-Zade, Haleh

    2016-09-01

    Currently, cosmetic surgery is spread around the world. Several factors are involved in this rapidly evolving field such as socio-economic development, changes in cultural norms, globalization and the effects of Western culture, advertising, media, and mental disorders. Nowadays the cosmetic surgery is becoming a profitable business, which deals exclusively with human appearance and less from the perspective of beauty based on physical protests and considering factors such as sex, age, and race. The morality of plastic surgery subspecialty has undergone many moral dilemmas in the past few years. The role of the patient regardless of his unrealistic dreams has questionable ethical dimension. The problem is the loss of human values and replacing them with false values, of pride and glory to a charismatic person of higher status, that may underlie some of the posed ethical dilemmas. Cosmetic surgery has huge difference with the general principle of legal liability in professional orientation, because the objective for cosmetic surgeries is different from common therapeutic purposes. To observe excellence in the medical profession, we should always keep in mind that these service providers, often as a therapist (healer) must maintain a commitment and priority for patient safety and prior to any action, a real apply for this service recipient should be present. Also, patient-physician confidentiality is the cornerstone of medical ethics. In this review, we study the issues addressed and the ways that they can be resolved.

  3. Prevalence of acute neuropathic pain after cancer surgery: A prospective study

    Directory of Open Access Journals (Sweden)

    P N Jain

    2014-01-01

    Full Text Available Background and Aims: Acute neuropathic pain (ANP is an under-recognised and under-diagnosed condition and often difficult to treat. If left untreated, it may further transform into persistent post-operative chronic pain leading to a disability. Aims: This prospective study was undertaken on 300 patients to identify the prevalence of ANP in the post-operative period by using a neuropathic pain detection questionnaire tool. Methods: This is an open-label study in which patients with six different types of cancer surgeries (Thoracic, gastro-intestinal, gynae/urology, bone/soft-tissue, head and neck and breast subgroups-50 each were included for painDETECT questionnaire tool on the 2 nd and 7 th day surgery. Results: This study found a 10% point prevalence of ANP. Analysis showed that 25 patients had ′possible′ ANP, the maximum from urological cancer surgery (6 followed by thoracic surgery (5. Five patients were found to have ′positive′ ANP including 2 groin node dissection, 2 hemipelvectomy and 1 oesophagectomy. Conclusion: Significant relationship between severity of post-operative pain was found with the occurrence of ANP in the post-operative period requiring a special attention to neuropathic pain assessment. Larger studies are required with longer follow-up to identify accurately the true prevalence and causative factors of ANP after surgery.

  4. Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines.

    Science.gov (United States)

    van Det, M J; Meijerink, W J H J; Hoff, C; Totté, E R; Pierie, J P E N

    2009-06-01

    With minimally invasive surgery (MIS), a man-machine environment was brought into the operating room, which created mental and physical challenges for the operating team. The science of ergonomics analyzes these challenges and formulates guidelines for creating a work environment that is safe and comfortable for its operators while effectiveness and efficiency of the process are maintained. This review aimed to formulate the ergonomic challenges related to monitor positioning in MIS. Background and guidelines are formulated for optimal ergonomic monitor positioning within the possibilities of the modern MIS suite, using multiple monitors suspended from the ceiling. All evidence-based experimental ergonomic studies conducted in the fields of laparoscopic surgery and applied ergonomics for other professions working with a display were identified by PubMed searches and selected for quality and applicability. Data from ergonomic studies were evaluated in terms of effectiveness and efficiency as well as comfort and safety aspects. Recommendations for individual monitor positioning are formulated to create a personal balance between these two ergonomic aspects. Misalignment in the eye-hand-target axis because of limited freedom in monitor positioning is recognized as an important ergonomic drawback during MIS. Realignment of the eye-hand-target axis improves personal values of comfort and safety as well as procedural values of effectiveness and efficiency. Monitor position is an important ergonomic factor during MIS. In the horizontal plain, the monitor should be straight in front of each person and aligned with the forearm-instrument motor axis to avoid axial rotation of the spine. In the sagittal plain, the monitor should be positioned lower than eye level to avoid neck extension.

  5. Oral Anticoagulant Use After Bariatric Surgery: A Literature Review and Clinical Guidance.

    Science.gov (United States)

    Martin, Karlyn A; Lee, Craig R; Farrell, Timothy M; Moll, Stephan

    2017-05-01

    Bariatric surgery may alter the absorption, distribution, metabolism, or elimination (disposition) of orally administered drugs via changes to the gastrointestinal tract anatomy, body weight, and adipose tissue composition. As some patients who have undergone bariatric surgery will need therapeutic anticoagulation for various indications, appropriate knowledge is needed regarding anticoagulant drug disposition and resulting efficacy and safety in this population. We review general considerations about oral drug disposition in patients after bariatric surgery, as well as existing literature on oral anticoagulation after bariatric surgery. Overall, available evidence on therapeutic anticoagulation is very limited, and individual drug studies are necessary to learn how to safely and effectively use the direct oral anticoagulants. Given the sparsity of currently available data, it appears most prudent to use warfarin with international normalized ratio monitoring, and not direct oral anticoagulants, when full-dose anticoagulation is needed after bariatric surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. The efficacy and safety of topical administration of tranexamic acid in spine surgery: a meta-analysis.

    Science.gov (United States)

    Luo, Wei; Sun, Ru-Xin; Jiang, Han; Ma, Xin-Long

    2018-04-24

    We conducted a meta-analysis from randomized controlled trials (RCTs) and non-RCTs to assess the efficacy and safety of tranexamic acid (TXA) in spine surgery. Potentially relevant academic articles were identified from the Cochrane Library, MEDLINE (1966-2017.11), PubMed (1966-2017.11), Embase (1980-2017.11), and ScienceDirect (1985-2017.11). Secondary sources were identified from the references of the included literature. The pooled data were analyzed using RevMan 5.1. Three RCTs and one non-RCT met the inclusion criteria. There were significant differences in total blood loss (MD = - 267.53, 95% CI - 373.04 to - 106.02, P < 0.00001), drainage volume (MD = - 157.00, 95% CI - 191.17 to - 122.84, P < 0.00001), postoperative hemoglobin level (MD = 0.95, 95% CI 0.44 to 1.47, P = 0.0003), and length of hospital stay (MD = - 1.42, 95% CI - 1.92 to - 0.93, P < 0.00001). No significant differences were found regarding transfusion requirement, deep vein thrombosis (DVT), pulmonary embolism (PE), wound hematoma, and infection between the two groups. The present meta-analysis indicated that the topical application of TXA in spinal surgery decreases the total blood loss and drainage volume and preserves higher postoperative hemoglobin level without increasing the risk of DVT infection, hematoma, DVT, and PE.

  7. The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

    NARCIS (Netherlands)

    Abbott, T. E. F.; Ahmad, T.; Phull, M. K.; Fowler, A. J.; Hewson, R.; Biccard, B. M.; Chew, M. S.; Gillies, M.; Pearse, R. M.; Pearse, Rupert M.; Beattie, Scott; Clavien, Pierre-Alain; Demartines, Nicolas; Fleisher, Lee A.; Grocott, Mike; Haddow, James; Hoeft, Andreas; Holt, Peter; Moreno, Rui; Pritchard, Naomi; Rhodes, Andrew; Wijeysundera, Duminda; Wilson, Matt; Ahmed, Tahania; Everingham, Kirsty; Hewson, Russell; Januszewska, Marta; Phull, Mandeep-Kaur; Halliwell, Richard; Shulman, Mark; Myles, Paul; Schmid, Werner; Hiesmayr, Michael; Wouters, Patrick; de Hert, Stefan; Lobo, Suzana; Fang, Xiangming; Rasmussen, Lars; Futier, Emmanuel; Biais, Matthieu; Venara, Aurélien; Slim, Karem; Sander, Michael; Koulenti, Despoina; Arvaniti, Kostoula; Chan, Mathew; Kulkarni, Atul; Chandra, Susilo; Tantri, Aida; Geddoa, Emad; Abbas, Muntadhar; Della Rocca, Giorgio; Sivasakthi, Datin; Mansor, Marzida; Luna, Pastor; Bouwman, Arthur; Buhre, Wolfgang; Beavis, Vanessa; Campbell, Douglas; Short, Tim; Osinaike, Tunde; Matos, Ricardo; Grigoras, Ioana; Kirov, Mikhail; Protsenko, Denis; Biccard, Bruce; Aldecoa, Cesar; Chew, Michelle; Hofer, Christoph; Hubner, Martin; Ditai, James; Szakmany, Tamas; Fleisher, Lee; Ferguson, Marissa; MacMahon, Michael; Cherian, Ritchie; Currow, Helen; Kanathiban, Kathirgamanathan; Gillespie, David; Pathmanathan, Edward; Phillips, Katherine; Reynolds, Jenifer; Rowley, Joanne; Douglas, Jeanene; Kerridge, Ross; Garg, Sameer; Bennett, Michael; Jain, Megha; Alcock, David; Terblanche, Nico; Cotter, Rochelle; Leslie, Kate; Stewart, Marcelle; Zingerle, Nicolette; Clyde, Antony; Hambidge, Oliver; Rehak, Adam; Cotterell, Sharon; Huynh, Wilson Binh Quan; McCulloch, Timothy; Ben-Menachem, Erez; Egan, Thomas; Cope, Jennifer; Fellinger, Paul; Haisjackl, Markus; Haselberger, Simone; Holaubek, Caroline; Lichtenegger, Paul; Scherz, Florian; Hoffer, Franz; Cakova, Veronika; Eichwalder, Andreas; Fischbach, Norbert; Klug, Reinhold; Schneider, Elisabeth; Vesely, Martin; Wickenhauser, Reinhart; Grubmueller, Karl Gernot; Leitgeb, Marion; Lang, Friedrich; Toro, Nancy; Bauer, Marlene; Laengle, Friedrich; Haberl, Claudia; Mayrhofer, Thomas; Trybus, Christoph; Buerkle, Christian; Forstner, Karin; Germann, Reinhard; Rinoesl, Harald; Schindler, Elke; Trampitsch, Ernst; Bogner, Gerhard; Dankl, Daniel; Duenser, Martin; Fritsch, Gerhard; Gradwohl-Matis, Ilse; Hartmann, Andreas; Hoelzenbein, Thomas; Jaeger, Tarkan; Landauer, Franz; Lindl, Gregor; Lux, Michael; Steindl, Johannes; Stundner, Ottokar; Szabo, Christian; Bidgoli, Jawad; Verdoodt, Hans; Forget, Patrice; Kahn, David; Lois, Fernande; Momeni, Mona; Prégardien, Caroline; Pospiech, Audrey; Steyaert, Arnaud; Veevaete, Laurent; de Kegel, Dirk; de Jongh, Karen; Foubert, Luc; Smitz, Carine; Vercauteren, Marcel; Poelaert, Jan; van Mossevelde, Veerle; Abeloos, Jacques; Bouchez, Stefaan; Coppens, Marc; de Baerdemaeker, Luc; Deblaere, Isabel; de Bruyne, Ann; Fonck, Kristine; Heyse, Bjorn; Jacobs, Tom; Lapage, Koen; Moerman, Anneliese; Neckebroek, Martine; Parashchanka, Aliaksandra; Roels, Nathalie; van den Eynde, Nancy; Vandenheuvel, Michael; Limmen, JurgenVan; Vanluchene, Ann; Vanpeteghem, Caroline; Wyffels, Piet; Huygens, Christel; Vandenbempt, Punitha; van de Velde, Marc; Dylst, Dimitri; Janssen, Bruno; Schreurs, Evelien; Aleixo, Fábia Berganton; Candido, Keulle; Batista, Hugo Dias; Guimarães, Mario; Guizeline, Jaqueline; Hoffmann, João; Lobo, Francisco Ricardo Marques; Nascimento, Vinícius; Nishiyama, Katia; Pazetto, Lucas; Souza, Daniela; Rodrigues, Rodrigo Souza; Vilela Dos Santos, Ana Maria; Jardim, Jaquelline; Sá Malbouisson, Luiz Marcelo; Silva, Joao; Nascimento Junior, Paulo do; Baio, Thalissa Hermínia; Pereira de Castro, Gabriel Isaac; Watanabe Oliveira, Henri Roger; Amendola, Cristina Prata; Cardoso, Gutemberg; Ortega, Daniela; Brotto, Ana Flavia; de Oliveira, Mirella Cristine; Réa-Neto, Álvaro; Dias, Fernando; Travi, Maria Eduarda; Zerman, Luiza; Azambuja, Pedro; Knibel, Marcos Freitas; Martins, Antonio; Almeida, William; Neto, Calim Neder; Tardelli, Maria Angela; Caser, Eliana; Machado, Marcio; Aguzzoli, Crisitiano; Baldisserotto, Sérgio; Tabajara, Fernanda Beck; Bettega, Fernanda; Rodrigues Júnior, La Hore Correa; de Gasperi, Julia; Faina, Lais; Nolasco, Marcos Farias; Ferreira da Costa Fischer, Bruna; Fosch de Campos Ferreira, Mariana; Hartmann, Cristina; Kliemann, Marta; Hubert Ribeiro, Gustavo Luis; Fraga, Julia Merladete; Netto, Thiago Motta; Pozza, Laura Valduga; Wendling, Paulo Rafael; Azevedo, Caroline; Garcia, Juliana; Lopes, Marcel; Maia, Bernardo; Maselli, Paula; Melo, Ralph; Mendes, Weslley; Neves, Matheus; Ney, Jacqueline; Piras, Claudio; Applewhaite, Christopher; Carr, Adrienne; Chow, Lorraine; Duttchen, Kaylene; Foglia, Julena; Greene, Michael; Hinther, Ashley; Houston, Kendra; McCormick, Thomas Jared; Mikhayel, Jennifer; Montasser, Sam; Ragan, Alex; Suen, Andrew; Woolsey, Adrianna; Yu, Hai Chuan; Funk, Duane; Kowalski, Stephen; Legaspi, Regina; McDonald, Heather; Siddiqui, Faisal; Pridham, Jeremy; Rowe, Bernadette; Sampson, Sonia; Thiessen, Barton; Zbitnew, Geoff; Bernard, Andre; George, Ronald; Jones, Philip; Moor, Rita; Siddiqui, Naveed; Wolfer, Alexandra; Tran, Diem; Winch, Denyse; Dobson, Gary; McCormick, Thomas; Montasser, Osama; Hall, Richard; Baghirzada, Leyla; Curley, Gerard; Dai, Si Yuan; Hare, Gregory; Lee, Esther; Shastri, Uma; Tsui, Albert; Yagnik, Anmol; Alvares, Danielle; Choi, Stephen; Dwyer, Heather; Flores, Kathrina; McCartney, Colin; Somascanthan, Priya; Carroll, Jo; Pazmino-Canizares, Janneth; Ami, Noam; Chan, Vincent; Perlas, Anahi; Argue, Ruth; Huang, Yang; Lavis, Katie; Mayson, Kelly; Cao, Ying; Gao, Hong; Hu, Tingju; Lv, Jie; Yang, Jian; Yang, Yang; Zhong, Yi; Zhou, Jing; Zou, Xiaohua; He, Miao; Li, Xiaoying; Luo, Dihuan; Wang, Haiying; Yu, Tian; Chen, Liyong; Wang, Lijun; Cai, Yunfei; Cao, Zhongming; Li, Yanling; Lian, Jiaxin; Sun, Haiyun; Wang, Sheng; Wang, Zhipeng; Wang, Kenru; Zhu, Yi; Du, Xindan; Fan, Hao; Fu, Yunbin; Huang, Lixia; Huang, Yanming; Hwan, Haifang; Luo, Hong; Qu, Pi-Sheng; Tao, Fan; Wang, Zhen; Wang, Guoxiang; Wang, Shun; Zhang, Yan; Zhang, Xiaolin; Chen, Chao; Wang, Weixing; Liu, Zhengyuan; Fan, Lihua; Tang, Jing; Chen, Yijun; Chen, Yongjie; Han, Yangyang; Huang, Changshun; Liang, Guojin; Shen, Jing; Wang, Jun; Yang, Qiuhong; Zhen, Jungang; Zhou, Haidong; Chen, Junping; Chen, Zhang; Li, Xiaoyu; Meng, Bo; Ye, Haiwang; Zhang, Xiaoyan; Bi, Yanbing; Cao, Jianqiao; Guo, Fengying; Lin, Hong; Liu, Yang; Lv, Meng; Shi, Pengcai; Song, Xiumei; Sun, Chuanyu; Sun, Yongtao; Wang, Yuelan; Wang, Shenhui; Zhang, Min; Chen, Rong; Hou, Jiabao; Leng, Yan; Meng, Qing-Tao; Qian, Li; Shen, Zi-Ying; Xia, Zhong-Yuan; Xue, Rui; Zhang, Yuan; Zhao, Bo; Zhou, Xian-Jin; Chen, Qiang; Guo, Huinan; Guo, Yongqing; Qi, Yuehong; Wang, Zhi; Wei, Jianfeng; Zhang, Weiwei; Zheng, Lina; Bao, Qi; Chen, Yaqiu; Chen, Yijiao; Fei, Yue; Hu, Nianqiang; Hu, Xuming; Lei, Min; Li, Xiaoqin; Lv, Xiaocui; Miao, Fangfang; Ouyang, Lingling; Qian, Lu; Shen, Conyu; Sun, Yu; Wang, Yuting; Wang, Dong; Wu, Chao; Xu, Liyuan; Yuan, Jiaqi; Zhang, Lina; Zhang, Huan; Zhang, Yapping; Zhao, Jinning; Zhao, Chong; Zhao, Lei; Zheng, Tianzhao; Zhou, Dachun; Zhou, Haiyan; Zhou, Ce; Lu, Kaizhi; Zhao, Ting; He, Changlin; Chen, Hong; Chen, Shasha; Cheng, Baoli; He, Jie; Jin, Lin; Li, Caixia; Li, Hui; Pan, Yuanming; Shi, Yugang; Wen, Xiao Hong; Wu, Shuijing; Xie, Guohao; Zhang, Kai; Zhao, Bing; Lu, Xianfu; Chen, Feifei; Liang, Qisheng; Lin, Xuewu; Ling, Yunzhi; Liu, Gang; Tao, Jing; Yang, Lu; Zhou, Jialong; Chen, Fumei; Cheng, Zhonggui; Dai, Hanying; Feng, Yunlin; Hou, Benchao; Gong, Haixia; Hu, Chun Hua; Huang, Haijin; Huang, Jian; Jiang, Zhangjie; Li, Mengyuan; Lin, Jiamei; Liu, Mei; Liu, Weicheng; Liu, Zhen; Liu, Zhiyi; Luo, Foquan; Ma, Longxian; Min, Jia; Shi, Xiaoyun; Song, Zhiping; Wan, Xianwen; Xiong, Yingfen; Xu, Lin; Yang, Shuangjia; Zhang, Qin; Zhang, Hongyan; Zhang, Huaigen; Zhang, Xuekang; Zhao, Lili; Zhao, Weihong; Zhao, Weilu; Zhu, Xiaoping; Bai, Yun; Chen, Linbi; Chen, Sijia; Dai, Qinxue; Geng, Wujun; Han, Kunyuan; He, Xin; Huang, Luping; Ji, Binbin; Jia, Danyun; Jin, Shenhui; Li, Qianjun; Liang, Dongdong; Luo, Shan; Lwang, Lulu; Mo, Yunchang; Pan, Yuanyuan; Qi, Xinyu; Qian, Meizi; Qin, Jinling; Ren, Yelong; Shi, Yiyi; Wang, Junlu; Wang, Junkai; Wang, Leilei; Xie, Junjie; Yan, Yixiu; Yao, Yurui; Zhang, Mingxiao; Zhao, Jiashi; Zhuang, Xiuxiu; Ai, Yanqiu; Du, Fang; He, Long; Huang, Ledan; Li, Zhisong; Li, Huijuan; Li, Yetong; Li, Liwei; Meng, Su; Yuan, Yazhuo; Zhang, Enman; Zhang, Jie; Zhao, Shuna; Ji, Zhenrong; Pei, Ling; Wang, Li; Chen, Chen; Dong, Beibei; Li, Jing; Miao, Ziqiang; Mu, Hongying; Qin, Chao; Su, Lin; Wen, Zhiting; Xie, Keliang; Yu, Yonghao; Yuan, Fang; Hu, Xianwen; Zhang, Ye; Xiao, Wangpin; Zhu, Zhipeng; Dai, Qingqing; Fu, Kaiwen; Hu, Rong; Hu, Xiaolan; Huang, Song; Li, Yaqi; Liang, Yingping; Yu, Shuchun; Guo, Zheng; Jing, Yan; Tang, Na; Wu, Jie; Yuan, Dajiang; Zhang, Ruilin; Zhao, Xiaoying; Li, Yuhong; Bai, Hui-Ping; Liu, Chun-Xiao; Liu, Fei-Fei; Ren, Wei; Wang, Xiu-Li; Xu, Guan-Jie; Hu, Na; Li, Bo; Ou, Yangwen; Tang, Yongzhong; Yao, Shanglong; Zhang, Shihai; Kong, Cui-Cui; Liu, Bei; Wang, Tianlong; Xiao, Wei; Lu, Bo; Xia, Yanfei; Zhou, Jiali; Cai, Fang; Chen, Pushan; Hu, Shuangfei; Wang, Hongfa; Xu, Qiong; Hu, Liu; Jing, Liang; Li, Bin; Liu, Qiang; Liu, Yuejiang; Lu, Xinjian; Peng, Zhen Dan; Qiu, Xiaodong; Ren, Quan; Tong, Youliang; Wang, Jin; Wen, Yazhou; Wu, Qiong; Xia, Jiangyan; Xie, Jue; Xiong, Xiapei; Xu, Shixia; Yang, Tianqin; Ye, Hui; Yin, Ning; Yuan, Jing; Zeng, Qiuting; Zhang, Baoling; Zheng, Kang; Cang, Jing; Chen, Shiyu; Fan, Yu; Fu, Shuying; Ge, Xiaodong; Guo, Baolei; Huang, Wenhui; Jiang, Linghui; Jiang, Xinmei; Liu, Yi; Pan, Yan; Ren, Yun; Shan, Qi; Wang, Jiaxing; Wang, Fei; Wu, Chi; Zhang, Xiaoguang; Christiansen, Ida Cecilie; Granum, Simon Nørgaard; Rasmussen, Bodil Steen; Daugaard, Morten; Gambhir, Rajiv; Brandsborg, Birgitte; Steingrímsdóttir, Guðný Erla; Jensen-Gadegaard, Peter; Olsen, Karsten Skovgaard; Siegel, Hanna; Eskildsen, Katrine Zwicky; Gätke, Mona Ring; Wibrandt, Ida; Heintzelmann, Simon Bisgaard; Wiborg Lange, Kai Henrik; Lundsgaard, Rune Sarauw; Amstrup-Hansen, Louise; Hovendal, Claus; Larsen, Michael; Lenstrup, Mette; Kobborg, Tina; Larsen, Jens Rolighed; Pedersen, Anette Barbre; Smith, Søren Hübertz; Oestervig, Rebecca Monett; Afshari, Arash; Andersen, Cheme; Ekelund, Kim; Secher, Erik Lilja; Beloeil, Helene; Lasocki, Sigismond; Ouattara, Alexandre; Sineus, Marlene; Molliex, Serge; Legouge, Marie Lim; Wallet, Florent; Tesniere, Antoine; Gaudin, Christophe; Lehur, Paul; Forsans, Emma; de Rudnicki, Stéphane; Maudet, Valerie Serra; Mutter, Didier; Sojod, Ghassan; Ouaissi, Mehdi; Regimbeau, Jean-Marc; Desbordes, Jacques; Comptaer, Nicolas; Manser, Diae El; Ethgen, Sabine; Lebuffe, Gilles; Auer, Patrick; Härtl, Christine; Deja, Maria; Legashov, Kirill; Sonnemann, Susanne; Wiegand-Loehnert, Carola; Falk, Elke; Habicher, Marit; Angermair, Stefan; Laetsch, Beatrix; Schmidt, Katrin; von Heymann, Christian; Ramminger, Axel; Jelschen, Florian; Pabel, Svenja; Weyland, Andreas; Czeslick, Elke; Gille, Jochen; Malcharek, Michael; Sablotzki, Armin; Lueke, Katharina; Wetzel, Peter; Weimann, Joerg; Lenhart, Franz-Peter; Reichle, Florian; Schirmer, Frederike; Hüppe, Michael; Klotz, Karl; Nau, Carla; Schön, Julika; Mencke, Thomas; Wasmund, Christina; Bankewitz, Carla; Baumgarten, Georg; Fleischer, Andreas; Guttenthaler, Vera; Hack, Yvonne; Kirchgaessner, Katharina; Männer, Olja; Schurig-Urbaniak, Marlen; Struck, Rafael; van Zyl, Rebekka; Wittmann, Maria; Goebel, Ulrich; Harris, Sarah; Veit, Siegfried; Andreadaki, Evangelia; Souri, Flora; Katsiadramis, Ioannis; Skoufi, Anthi; Vasileiou, Maria; Aimoniotou-Georgiou, Eleni; Katsourakis, Anastasios; Veroniki, Fotini; Vlachogianni, Glyceria; Petra, Konstantina; Chlorou, Dimitra; Oloktsidou, Eirini; Ourailoglou, Vasileios; Papapostolou, Konstantinos; Tsaousi, Georgia; Daikou, Panagoula; Dedemadi, Georgia; Kalaitzopoulos, Ioannis; Loumpias, Christos; Bristogiannis, Sotirios; Dafnios, Nikolaos; Gkiokas, Georgios; Kontis, Elissaios; Kozompoli, Dimitra; Papailia, Aspasia; Theodosopoulos, Theodosios; Bizios, Christol; Koutsikou, Anastasia; Moustaka, Aleaxandra; Plaitakis, Ioannis; Armaganidis, Apostolos; Christodoulopoulou, Theodora; Lignos, Mihail; Theodorakopoulou, Maria; Asimakos, Andreas; Ischaki, Eleni; Tsagkaraki, Angeliki; Zakynthinos, Spyros; Antoniadou, Eleni; Koutelidakis, Ioannis; Lathyris, Dimitrios; Pozidou, Irene; Voloudakis, Nikolaos; Dalamagka, Maria; Elena, Gkonezou; Chronis, Christos; Manolakaki, Dimitra; Mosxogiannidis, Dimitris; Slepova, Tatiana; Tsakiridou, Isaia-Sissy; Lampiri, Claire; Vachlioti, Anastasia; Panagiotakis, Christos; Sfyras, Dimitrios; Tsimpoukas, Fotios; Tsirogianni, Athanasia; Axioti, Elena; Filippopoulos, Andreas; Kalliafa, Elli; Kassavetis, George; Katralis, Petros; Komnos, Ioannis; Pilichos, Georgios; Ravani, Ifigenia; Totis, Antonis; Apagaki, Eymorfia; Efthymiadi, Andromachi; Kampagiannis, Nikolaos; Paraforou, Theoniki; Tsioka, Agoritsa; Georgiou, Georgios; Vakalos, Aristeidis; Bairaktari, Aggeliki; Charitos, Efthimios; Markou, George; Niforopoulou, Panagiota; Papakonstantinou, Nikolaos; Tsigou, Evdoxia; Xifara, Archontoula; Zoulamoglou, Menelaos; Gkioni, Panagiota; Karatzas, Stylianos; Kyparissi, Aikaterini; Mainas, Efstratios; Papapanagiotou, Ioannis; Papavasilopoulou, Theonymfi; Fragandreas, George; Georgopoulou, Eleni; Katsika, Eleni; Psarras, Kyriakos; Synekidou, Eirini; Verroiotou, Maria; Vetsiou, Evangelia; Zaimi, Donika; Anagnou, Athina; Apostolou, Konstantinos; Melissopoulou, Theodora; Rozenberg, Theophilos; Tsigris, Christos; Boutsikos, Georgios; Kalles, Vasileios; Kotsalas, Nikolaos; Lavdaiou, Christina; Paikou, Fotini; Panagou, Georgia-Laura; Spring, Anna; Botis, Ioannis; Drimala, Maria; Georgakakis, Georgios; Kiourtzieva, Ellada; Ntouma, Panagiota; Prionas, Apostolos; Xouplidis, Kyriakos; Dalampini, Eleftheria; Giannaki, Chrysavgi; Iasonidou, Christina; Ioannidis, Orestis; Lavrentieva, Athina; Lavrentieva, Athena; Papageorgiou, George; Kokkinoy, Maria; Stafylaraki, Maria; Gaitanakis, Stylianos; Karydakis, Periclis; Paltoglou, Josef; Ponireas, Panagiotis; Chaloulis, Panagiotis; Provatidis, Athanasios; Sousana, Anisoglou; Gardikou, Varvara Vanessa; Konstantivelli, Maria; Lataniotou, Olga; Lisari, Elisavet; Margaroni, Maria; Stamatiou, Konstantinos; Nikolaidis, Edouardos; Pnevmatikos, Ioannis; Sertaridou, Eleni; Andreou, Alexandros; Arkalaki, Eleni; Athanasakis, Elias; Chaniotaki, Fotini; Chatzimichali, Chatzimichali Aikaterini; Christofaki, Maria; Dermitzaki, Despina; Fiorentza, Klara; Frantzeskos, Georgios; Geromarkaki, Elisavet; Kafkalaki, Kalliopi; Kalogridaki, Marina; Karydi, Konstyllia; Kokkini, Sofia; Kougentakis, Georgios; Lefaki, Tatiana; Lilitsis, Emmanouhl; Makatounaki, Aikaterini; Malliotakis, Polychronis; Michelakis, Dimosthenis; Neonaki, Maria; Nyktari, Vasileia; Palikyra, Iliana; Papadakis, Eleftherios; Papaioannou, Alexandra; Sfakianakis, Konstantinos; Sgouraki, Maria; Souvatzis, Xenia; Spartinou, Anastasia; Stefanidou, Nefeli; Syrogianni, Paulina; Tsagkaraki, Georgia; Arnaoutoglou, Elena; Arnaoutoglou, Christina; Bali, Christina; Bouris, Vasilios; Doumos, Rodamanthos; Gkini, Konstantia-Paraskevi; Kapaktsi, Clio; Koulouras, Vasilios; Lena, Arian; Lepida, Dimitra; Michos, Evangelos; Papadopoulos, Dimitrios; Paschopoulos, Minas; Rompou, Vaia Aliki; Siouti, Ioanna; Tsampalas, Stavros; Ververidou, Ourania; Zilis, Georgios; Charlalampidoy, Alexandra; Christodoulidis, Gregory; Flossos, Andreas; Stamoulis, Konstantinos; Chan, Matthew; Tsang, Man Shing Caleb; Tsang, Man Shing; Lai, Man Ling; Yip, Chi Pang; Heymans Chan, Hey Man; Law, Bassanio; Li, Wing Sze; Chu, Hiu Man; Koo, Emily Gar Yee; Lam, Chi Cheong Joe; Cheng, Ka Ho; Lam, Tracy; Chu, Susanna; Lam, Wing Yan; Wong, Kin Wai Kevin; Kwok, Dilys; Hung, Ching Yue Janice; Chan, Wai Kit Jacky; Wong, Wing Lam; Chung, Chun Kwong Eric; Ma, Shu Kai; Kaushik, Shuchi; Shah, Bhagyesh; Shah, Dhiren; Shah, Sanjay; Ar, Praburaj; Muthuchellappan, Radhakrishnan; Agarwal, Vandana; Divatia, Jigeeshu; Mishra, Sanghamitra; Nimje, Ganesh; Pande, Swati; Savarkar, Sukhada; Shrivastava, Aditi; Thomas, Martin; Yegnaram, Shashikant; Hidayatullah, Rahmat; Puar, Nasman; Niman, Sumara; Indra, Imai; Hamzah, Zulkarnain; Yuliana, Annika; Abidin, Ucu Nurhadiat; Dursin, Ade Nurkacan; Kurnia, Andri; Susanti, Ade; Handayani, Dini; Alit, Mahaalit Aribawa; Arya, Aryabiantara; Senapathi, Tjokorda Gde Agung; Utara, Utara Hartawan; Wid, Widnyana Made; Wima, Semarawima; Wir, Wiryana Made; Jehosua, Brillyan; Kaunang, Jonathan; Lantang, Eka Yudha; Najoan, Rini; Waworuntu, Neil; Awad, Hadi; Fuad, Akram; Geddoa, Burair; Khalaf, Abdel Razzaq; Al Hussaini, Sabah; Albaj, Safauldeensalem; Kenber, Maithem; Bettinelli, Alessandra; Spadaro, Savino; AlbertoVolta, Carlo; Giancarlo, Luigi; Sottosanti, Vicari; Copetti, Elisa; Spagnesi, Lorenzo; Toretti, Ilaria; Alloj, Chiara; Cardellino, Silvano; Carmino, Livio; Costanzo, Eleonora; Fanfani, Lucia Caterina; Novelli, Maria Teresa; Roasio, Agostino; Bellandi, Mattia; Beretta, Luigi; Bignami, Elena; Bocchino, Speranza; Cabrini, Luca; Corti, Daniele; Landoni, Giovanni; Meroni, Roberta; Moizo, Elena; Monti, Giacomo; Pintaudi, Margherita; Plumari, Valentina Paola; Taddeo, Daiana; Testa, Valentina; Winterton, Dario; Zangrillo, Alberto; Cloro, Luigi Maria; Colangelo, Chiara; Colangelo, Antonio; Rotunno, Giuseppe; Paludi, Miguel Angel; Maria, Cloro Paolo; Pata, Antonio; Parrini, Vieri; Gatta, Alessandro; Nastasi, Mauro; Tinti, Carla; Baroselli, Antonio; Arrigo, Mario; Benevento, Angelo; Bottini, Corrado; Cannavo', Maurizio; Gastaldi, Christian; Marchesi, Alessandro; Pascazio, Angelantonio; Pata, Francesco; Pozzi, Emilio; Premoli, Alberto; Tessera, Gaetano; Boschi, Luca; D'Andrea, Rocco; Ghignone, Federico; Poggioli, Gilberto; Sibilio, Andrea; Taffurelli, Mario; Ugolini, Giampaolo; Ab Majid, Mohd Azuan; Ab Rahman, Rusnah; Joseph, James; Pathan, Furquan; Sybil Shah, Mohammad Hafizshah; Yap, Huey Ling; Cheah, Seleen; Chin, Im Im; Looi, Ji Keon; Tan, Siew Ching; Visvalingam, Sheshendrasurian; Kwok, Fan Yin; Lee, Chew Kiok; Tan, Tse Siang; Wong, Sze Meng; Abdullah, Noor Hairiza; Liew, Chiat Fong; Luxuman, Lovenia; Mohd Zin, Nor Hafizah; Norddin, Muhamad Faiz; Raja Alias, Raja Liza; Wong, Juan Yong; Yong, Johnny; Bin Mustapha, Mohd Tarmimi; Chan, Weng Ken; Dzulkipli, Norizawati; Kuan, Pei Xuan; Lee, Yew Ching; Alias, Anita; Guok, Eng Ching; Jee, Chiun Chen; Ramon, Brian Rhadamantyne; Wong, Cheng Weng; Abd Ghafar, Fara Nur Idayu; Aziz, Faizal Zuhri; Hussain, Nabilah; Lee, Hooi Sean; Sukawi, Ismawaty; Woon, Yuan Liang; Abd Hadi, Husni Zaeem; Ahmad Azam, Ummi Azmira; Alias, Abdul Hafiz; Kesut, Saiful Aizar; Lee, Jun May; Ooi, Dar Vin; Sulaiman, Hetty Ayuni; Lih, Tengku Alini Tengku; Veerakumaran, Jeyaganesh; Rojas, Eder; Resendiz, Gerardo Esteban Alvarez; Zapata, Darcy Danitza Mari; López, Julio Cesar Jesús Aguilar; Flores, Armando Adolfo Alvarez; Amador, Juan Carlos Bravo; Avila, Erendira Jocelin Dominguez; Aquino, Laura Patricia González; Rodriguez, Ricardo Lopez; Landa, Mariana Torres; Urias, Emma; Hollmann, Markus; Hulst, Abraham; Preckel, Benedikt; Koopman-van Gemert, Ankie; Buise, Marc; Tolenaar, Noortje; Weber, Eric; de Fretes, Jennifer; Houweling, Peter; Ormskerk, Patricia; van Bommel, Jasper; Lance, Marcus; Smit-Fun, Valerie; van Zundert, Tom; Baas, Peter; Donald de Boer, Hans; Sprakel, Joost; Elferink-Vonk, Renske; Noordzij, Peter; van Zeggeren, Laura; Brand, Bastiaan; Spanjersberg, Rob; ten Bokkel-Andela, Janneke; Numan, Sandra; van Klei, Wilton; van Zaane, Bas; Boer, Christa; van Duivenvoorde, Yoni; Hering, Jens Peter; van Rossum, Sylvia; Zonneveldt, Harry; Campbell, Doug; Hoare, Siobhan; Santa, Sahayam; Ali, Marlynn; Allen, Sara Jane; Bell, Rachel; Choi, Hyun-Min David; Drake, Matthew; Farrell, Helen; Hayes, Katia; Higgie, Kushlin; Holmes, Kerry; Jenkins, Nicole; Kim, Chang Joon; Kim, Steven; Law, Kiew Chai; McAllister, Davina; Park, Karen; Pedersen, Karen; Pfeifer, Leesa; Pozaroszczyk, Anna; Salmond, Timothy; Steynor, Martin; Tan, Michael; Waymouth, Ellen; Ab Rahman, Ahmad Sufian; Armstrong, John; Dudson, Rosie; Jenkins, Nia; Nilakant, Jayashree; Richard, Seigne; Virdi, Pardeep; Dixon, Liane; Donohue, Roana; Farrow, Mehreen; Kennedy, Ross; Marissa, Henderson; McKellow, Margie; Nicola, Delany; Pascoe, Rebecca; Roberts, Stephen John; Rowell, George; Sumner, Matthew; Templer, Paul; Chandrasekharan, Shardha; Fulton, Graham; Jammer, Ib; More, Richard; Wilson, Leona; Chang, Yuan Hsuan; Foley, Julia; Fowler, Carolyn; Panckhurst, Jonathan; Sara, Rachel; Stapelberg, Francois; Cherrett, Veronica; Ganter, Donna Louise; McCann, Lloyd; Gilmour, Fiona; Lumsden, Rachelle; Moores, Mark; Olliff, Sue; Sardareva, Elitza; Tai, Joyce; Wikner, Matthew; Wong, Christopher; Chaddock, Mark; Czepanski, Carolyn; McKendry, Patrick; Polakovic, Daniel; Polakovich, Daniel; Robert, Axe; Belda, Margarita Tormo; Norton, Tracy; Alherz, Fadhel; Barneto, Lisa; Ramirez, Alberto; Sayeed, Ahmed; Smith, Nicola; Bennett, Cambell; McQuoid, Shane; Jansen, Tracy-Lee; Nico, Zin; Scott, John; Freschini, David; Freschini, Angela; Hopkins, Brian; Manson, Lara; Stoltz, Deon; Bates, Alexander; Davis, Simon; Freeman, Victoria; McGaughran, Lynette; Williams, Maya; Sharma, Swarna Baskar; Burrows, Tom; Byrne, Kelly; English, Duane; Johnson, Robert; Manikkam, Brendon; Naidoo, Shaun; Rumball, Margot; Whittle, Nicola; Franks, Romilla; Gibson-Lapsley, Hannah; Salter, Ryan; Walsh, Dean; Cooper, Richard; Perry, Katherine; Obobolo, Amos; Sule, Umar Musa; Ahmad, Abdurrahman; Atiku, Mamuda; Mohammed, Alhassan Datti; Sarki, Adamu Muhammad; Adekola, Oyebola; Akanmu, Olanrewaju; Durodola, Adekunle; Olukoju, Olusegun; Raji, Victor; Olajumoke, Tokunbo; Oyebamiji, Emmanuel; Adenekan, Anthony; Adetoye, Adedapo; Faponle, Folayemi; Olateju, Simeon; Owojuyigbe, Afolabi; Talabi, Ademola; Adenike, Odewabi; Adewale, Badru; Collins, Nwokoro; Ezekiel, Emmanuel; Fatungase, Oluwabunmi Motunrayo; Grace, Anuforo; Sola, Sotannde; Stella, Ogunmuyiwa; Ademola, Adeyinka; Adeolu, Augustine A.; Adigun, Tinuola; Akinwale, Mukaila; Fasina, Oluyemi; Gbolahan, Olalere; Idowu, Olusola; Olonisakin, Rotimi Peter; Osinaike, Babatunde Babasola; Asudo, Felicia; Mshelia, Danladi; Abdur-Rahman, Lukman; Agodirin, Olayide; Bello, Jibril; Bolaji, Benjamin; Oyedepo, Olanrewaju Olubukola; Ezike, Humphrey; Iloabachie, Ikechukwu; Okonkwo, Ikemefuna; Onuora, Elias; Onyeka, Tonia; Ugwu, Innocent; Umeh, Friday; Alagbe-Briggs, Olubusola; Dodiyi-Manuel, Amabra; Echem, Richard; Obasuyi, Bright; Onajin-Obembe, Bisola; Bandeira, Maria Expedito; Martins, Alda; Tomé, Miguel; Costa, Ana Cristina Miranda Martins; Krystopchuk, Andriy; Branco, Teresa; Esteves, Simao; Melo, Marco António; Monte, Júlia; Rua, Fernando; Martins, Isabel; Pinho-Oliveira, Vítor Miguel; Rodrigues, Carla Maria; Cabral, Raquel; Marques, Sofia; Rêgo, Sara; Jesus, Joana Sofia Teixeira; Marques, Maria Conceição; Romao, Cristina; Dias, Sandra; Santos, Ana Margarida; Alves, Maria Joao; Salta, Cristina; Cruz, Salome; Duarte, Célia; Paiva, António Armando Furtado; Cabral, Tiago do Nascimento; Faria E Maia, Dionisio; Correia da Silva, Rui Freitas Mendonça; Langner, Anuschka; Resendes, Hernâni Oliveira; Soares, Maria da Conceição; Abrunhosa, Alexandra; Faria, Filomena; Miranda, Lina; Pereira, Helena; Serra, Sofia; Ionescu, Daniela; Margarit, Simona; Mitre, Calin; Vasian, Horatiu; Manga, Gratiela; Stefan, Andreea; Tomescu, Dana; Filipescu, Daniela; Paunescu, Marilena-Alina; Stefan, Mihai; Stoica, Radu; Gavril, Laura; Pătrășcanu, Emilia; Ristescu, Irina; Rusu, Daniel; Diaconescu, Ciresica; Iosep, Gabriel Florin; Pulbere, Dorin; Ursu, Irina; Balanescu, Andreea; Grintescu, Ioana; Mirea, Liliana; Rentea, Irina; Vartic, Mihaela; Lupu, Mary-Nicoleta; Stanescu, Dorin; Streanga, Lavinea; Antal, Oana; Hagau, Natalia; Patras, Dumitru; Petrisor, Cristina; Tosa, Flaviu; Tranca, Sebastian; Copotoiu, Sanda Maria; Ungureanu, Liviu Lucian; Harsan, Cristian Remus; Papurica, Marius; Cernea, Daniela Denisa; Dragoescu, Nicoleta Alice; CarmenVaida, Laura Aflori; Ciobotaru, Oana Roxana; Aignatoaie, Mariana; Carp, Cristina Paula; Cobzaru, Isabelle; Mardare, Oana; Purcarin, Bianca; Tutunaru, Valentin; Ionita, Victor; Arustei, Mirela; Codita, Anisoara; Busuioc, Mihai; Chilinciuc, Ion; Ciobanu, Cristina; Belciu, Ioana; Tincu, Eugen; Blaj, Mihaela; Grosu, Ramona-Mihaela; Sandu, Gigel; Bruma, Dana; Corneci, Dan; Dutu, Madalina; Krepil, Adriana; Copaciu, Elena; Dumitrascu, Clementina Oana; Jemna, Ramona; Mihaescu, Florentina; Petre, Raluca; Tudor, Cristina; Ursache, Elena; Kulikov, Alexander; Lubnin, Andrey; Grigoryev, Evgeny; Pugachev, Stanislav; Tolmasov, Alexander; Hussain, Ayyaz; Ilyina, Yana; Roshchina, Anna; Iurin, Aleksandr; Chazova, Elena; Dunay, Artem; Karelov, Alexey; Khvedelidze, Irina; Voldaeva, Olga; Belskiy, Vladislav; Dzhamullaev, Parvin; Grishkowez, Elena; Kretov, Vladimir; Levin, Valeriy; Molkov, Aleksandr; Puzanov, Sergey; Samoilenko, Aleksandr; Tchekulaev, Aleksandr; Tulupova, Valentina; Utkin, Ivan; Allorto, Nikki Leigh; Bishop, David Gray; Builu, Pierre Monji; Cairns, Carel; Dasrath, Ashish; de Wet, Jacques; Hoedt, Marielle den; Grey, Ben; Hayes, Morgan Philip; Küsel, Belinda Senta; Shangase, Nomcebo; Wise, Robert; Cacala, Sharon; Farina, Zane; Govindasamy, Vishendran; Kruse, Carl-Heinz; Lee, Carolyn; Marais, Leonard; Naidoo, Thinagrin Dhasarthun; Rajah, Chantal; Rodseth, Reitze Nils; Ryan, Lisa; von Rhaden, Richard; Adam, Suwayba; Alphonsus, Christella; Ameer, Yusuf; Anderson, Frank; Basanth, Sujith; Bechan, Sudha; Bhula, Chettan; Biccard, Bruce M.; Biyase, Thuli; Buccimazza, Ines; Cardosa, Jorge; Chen, James; Daya, Bhavika; Drummond, Leanne; Elabib, Ali; Abdel Goad, Ehab Helmy; Goga, Ismail E.; Goga, Riaz; Harrichandparsad, R.; Hodgson, Richard E.; Jordaan, J.; Kalafatis, Nicky; Kampik, Christian; Landers, A. T.; Loots, Emil; Madansein, Rajhmum; Madaree, Anil; Madiba, Thandinkosi E.; Manzini, Vukani T.; Mbuyisa, Mbali; Moodley, Rajan; Msomi, Mduduzi; Mukama, Innocent; Naidoo, Desigan; Naidoo, Rubeshan; Naidu, Tesuven K.; Ntloko, Sindiswa; Padayachee, Eneshia; Padayachee, Lucelle; Phaff, Martijn; Pillay, Bala; Pillay, Desigan; Pillay, Lutchmee; Ramnarain, Anupa; Ramphal, Suren R.; Ryan, Paul; Saloojee, Ahmed; Sebitloane, Motshedisi; Sigcu, Noluyolo; Taylor, Jenna L.; Torborg, Alexandra; Visser, Linda; Anderson, Philip; Conradie, Alae; de Swardt, Mathew; de Villiers, Martin; Eikman, Johan; Liebenberg, Riaan; Mouton, Johan; Paton, Abbey; van der Merwe, Louwrence; Wilscott-Davids, Candice; Barrett, Wendy Joan; Bester, Marlet; de Beer, Johan; Geldenhuys, Jacques; Gouws, Hanni; Potgieter, Jan-Hendrik; Strydom, Magdel; WilberforceTurton, Edwin; Chetty, Rubendraj R.; Chirkut, Subash; Cronje, Larissa; de Vasconcellos, Kim; Dube, Nokukhanya Z.; Gama, N. Sibusiso; Green, Garyth M.; Green-Thompson, Randolph; Kinoo, Suman Mewa; Kistnasami, Prenolin; Maharaj, Kapil; Moodley, Manogaran S.; Mothae, Sibongile J.; Naidoo, Ruvashni; Aslam F Noorbhai, M.; Rughubar, Vivesh; Reddy, Jenendhiran; Singh, Avesh; Skinner, David L.; Smith, Murray J.; Singh, Bhagwan; Misra, Ravi; Naidoo, Maheshwar; Ramdharee, Pireshin; Selibea, Yvonne; Sewpersad, Selina; Sham, Shailendra; Wessels, Joseph D.; Africander, Cucu; Bejia, Tarek; Blakemore, Stephen P.; Botes, Marisa; Bunwarie, Bimalshakth; Hernandez, Carlos B.; Jeeraz, Mohammud A.; Legutko, Dagmara A.; Lopez, Acela G.; de Meyer, Jenine N.; Muzenda, Tanaka; Naidoo, Noel; Patel, Maryam; Pentela, Rao; Junge, Marina; Mansoor, Naj; Rademan, Lana; Scislowski, Pawel; Seedat, Ismail; van den Berg, Bianca; van der Merwe, Doreen; van Wyk, Steyn; Govender, Komalan; Naicker, Darshan; Ramjee, Rajesh; Saley, Mueen; Kuhn, Warren Paul; Matos-Puig, Roel; Alberto Lisi, Zaheer Moolla; Perez, Gisela; Beltran, Anna Valle; Lozano, Angels; Navarro, Carlos Delgado; Duca, Alejandro; Ernesto, Ernesto Pastor Martinez; Ferrando, Carlos; Fuentes, Isabel; García-Pérez, Maria Luisa; Gracia, Estefania; Palomares, Ana Izquierdo; Katime, Antonio; Miñana, Amanda; Incertis, Raul Raul; Romero, Esther; Romero Garcia, Carolina Soledad; Rubio, Concepcion; Artiles, Tania Socorro; Soro, Marina; Valls, Paola; Laguarda, Gisela Alaman; Benavent, Pau; Cuenca, Vicente Chisbert; Cueva, Andreu; Lafuente, Matilde; Parra, Asuncion Marques; Rodrigo, Alejandra Romero; Sanchez-Morcillo, Silvia; Tormo, Sergi; Redondo, Francisco Javier; de Andrés Ibanez, José Antonio; Diago, Lorena Gómez; José Hernández Cádiz, Maria; Manuel, Granell Gil; Peris, Raquel; Saiz, Cristina; Vivo, Jose Tatay; Soto, Maria Teresa Tebar; Brunete, Tamara; Cancho, David; Delgado García, David R.; Zamudio, Diana; del Valle, Santiago Garcia; Serrano, M. Luz; Alonso, Eduardo; Anillo, Victor; Maseda, Emilio; Salgado, Patricia; Suarez, Luis; Suarez-de-la-Rica, Alejandro; Villagrán, María José; Alonso, José Ignacio; Cabezuelo, Estefania; Garcia-Saiz, Irene; Lopez del Moral, Olga; Martín, Silvia; Gonzalez, Alba Perez; Doncel, Ma Sherezade Tovar; Vera, Martin Agüero; José Ávila Sánchez, Francisco; Castaño, Beatriz; Moreira, Beatriz Castaño; Risco, Sahely Flores; Martín, Daniel Paz; Martín, Fernando Pérez; Poza, Paloma; Ruiz, Adela; Serna Martínez, Wilson Fabio; Vicente, Bárbara Vázquez; Dominguez, Saul Velaz; Fernández, Salvador; Munoz-López, Alfonso; Bernat, Maria Jose; Mas, Arantxa; Planas, Kenneth; Jawad, Monir; Saeed, Yousif; Hedin, Annika; Levander, Helena; Holmström, Sandra; Lönn, David; Zoerner, Frank; Åkring, Irene; Widmark, Carl; Zettergren, Jan; Liljequist, Victor Aspelund; Nystrom, Lena; Odeberg-Wernerman, Suzanne; Oldner, Anders; Fagerlund, Malin Jonsson; Reje, Patrik; Lyckner, Sara; Sperber, Jesper; Adolfsson, Anne; Klarin, Bengt; Ögren, Katrin; Barras, Jean-Pierre; Bührer, Thomas; Despotidis, Vasileios; Helmy, Naeder; Holliger, Stephan; Raptis, Dimitri Aristotle; Schmid, Roger; Meyer, Antoine; Jaquet, Yves; Kessler, Ulf; Muradbegovic, Mirza; Nahum, Solange R.; Rotunno, Teresa; Schiltz, Boris; Voruz, François; Worreth, Marc; Christoforidis, Dimitri; Popeskou, Sotirios Georgios; Furrer, Markus; Prevost, Gian Andrea; Stocker, Andrea; Lang, Klaus; Breitenstein, Stefan; Ganter, Michael T.; Geisen, Martin; Soll, Christopher; Korkmaz, Michelle; Lubach, Iris; Schmitz, Michael; Meyer Zu Schwabedissen, Moritz; Moritz, Meyer Zu Schwabedissen; Zingg, Urs; Hillermann, Thomas; Wildi, Stefan; Pinto, Bernardo Bollen; Walder, Bernhard; Mariotti, Giustina; Slankamenac, Ksenija; Namuyuga, Mirioce; Kyomugisha, Edward; Kituuka, Olivia; Shikanda, Anne Wesonga; Kakembo, Nasser; Tom, Charles Otim; Antonina, Webombesa; Bua, Emmanuel; Ssettabi, Eden Michael; Epodoi, Joseph; Kabagenyi, Fiona; Kirya, Fred; Dempsey, Ged; Seasman, Colette; Nawaz Khan, Raja Basit; Kurasz, Claire; Macgregor, Mark; Shawki, Burhan; Francis, Daren; Hariharan, Vimal; Chau, Simon; Ellis, Kate; Butt, Georgina; Chicken, Dennis-Wayne; Christmas, Natasha; Allen, Samantha; Daniel, Gayatri Daniel; Dempster, Angie; Kemp, Juliette; Matthews, Lewis; Mcglone, Philip; Tambellini, Joanne; Trodd, Dawn; Freitas, Katie; Garg, Atul; Gupta, Janesh Kumar; Karpate, Shilpaja; Kulkarni, Aditi; O'Hara, Chloe; Troko, Jtroko; Angus, Kirsty; Bradley, Jacqueline; Brennan, Emma; Brooks, Carolyn; Brown, Janette; Brown, Gemma; Finch, Amanda; Gratrix, Karen; Hesketh, Sue; Hill, Gillian; Jeffs, Carol; Morgan, Maureen; Pemberton, Chris; Slawson, Nicola; Spickett, Helen; Swarbrick, Gemma; Thomas, Megan; van Duyvenvoorde, Greta; Brennan, Andrew; Briscoe, Richard; Cooper, Sarah; Lawton, Tom; Northey, Martin; Senaratne, Rashmi; Stanworth, Helen; Burrows, Lorna; Cain, Helen; Craven, Rachael; Davies, Keith; Jonas, Attila; Pachucki, Marcin; Walkden, Graham; Davies, Helen; Gudaca, Mariethel; Hobrok, Maria; Arawwawala, Dilshan; Fergey, Lauren; Gardiner, Matthew; Gunn, Jacqueline; Johnson, Lyndsay; Lofting, Amanda; Lyle, Amanda; Neela, Fiona Mc; Smolen, Susan; Topliffe, Joanne; Williams, Sarah; Bland, Martin; Balaji, Packianathaswamy; Kaura, Vikas; Lanka, Prasad; Smith, Neil; Ahmed, Ahmed; Myatt, John; Shenoy, Ravikiran; Soon, Wai Cheong; Tan, Jessica; Karadia, Sunny; Self, James; Durant, Emma; Tripathi, Shiva; Bullock, Clare; Campbell, Debbie; Ghosh, Alison; Hughes, Thomas; Zsisku, Lajos; Bengeri, Sheshagiri; Cowton, Amanda; Khalid, Mohammed Shazad; Limb, James; McAdam, Colin; Porritt, Mandy; Rafi, M. Amir; Shekar, Priya; Adams, David; Harden, Catherine; Hollands, Heidi; King, Angela; March, Linda; Minto, Gary; Patrick, Abigail; Squire, Rosalyn; Waugh, Darren; Kumara, Paramesh; Simeson, Karen; Yarwood, Jamie; Browning, Julie; Hatton, Jonathan; Julian, Howes; Mitra, Atideb; Newton, Maria; Pernu, Pawan Kootelu; Wilson, Alison; Commey, Thelma; Foot, Helen; Glover, Lyn; Gupta, Ajay; Lancaster, Nicola; Levin, Jill; Mackenzie, Felicity; Mestanza, Claire; Nofal, Emma; Pout, Lauren; Varden, Rosanna; Wild, Jonathan; Jones, Stephanie; Moreton, Sarah; Pulletz, Mark; Davies, Charlotte; Martin, Matthew; Thomas, Sian; Burns, Karen; McArthur, Carol; Patel, Panna; Lau, Gary; Rich, Natalie; Davis, Fiona; Lyons, Rachel; Port, Beth; Prout, Rachel; Smith, Christopher; Adelaja, Yemi; Bennett, Victoria; Bidd, Heena; Dumitrescu, Alexandra; Murphy, Jacqui Fox; Keen, Abigail; Mguni, Nhlanhla; Ong, Cheng; Adams, George; Boshier, Piers; Brown, Richard; Butryn, Izabella; Chatterjee, Jayanta; Freethy, Alexander; Lockwood, Geoffrey; Tsakok, Maria; Tsiligiannis, Sophia; Peat, William; Stephenson, Lorraine; Bradburn, Mike; Pick, Sara; Cunha, Pedro; Olagbaiye, Olufemi; Tayeh, Salim; Packianathaswamy, Balaji; Abernethy, Caroline; Balasubramaniam, Madhu; Bennett, Rachael; Bolton, David; Martinson, Victoria; Naylor, Charde; Bell, Stephanie; Heather, Blaylock; Kushakovsky, Vlad; Alcock, Liam; Alexander, Hazel; Anderson, Colette; Baker, Paul; Brookes, Morag; Cawthorn, Louise; Cirstea, Emanuel; Clarkson, Rachel; Colling, Kerry; Coulter, Ian; Das, Suparna; Haigh, Kathryn; Hamdan, Alhafidz; Hugill, Keith; Kottam, Lucksy; Lisseter, Emily; Mawdsley, Matthew; McGivern, Julie; Padala, Krishnaveni; Phelps, Victoria; Ramesh Kumar, Vineshykaa; Stewart, Kirsten; Towse, Kayley; Tregonning, Julie; Vahedi, Ali; Walker, Alycon; Baines, Duncan; Bilolikar, Anjali; Chande, Shiv; Copley, Edward; Dunk, Nigel; Kulkarni, Raghavendra; Kumar, Pawan; Metodiev, Yavor; Ncomanzi, Dumisani; Raithatha, Bhavesh; Raymode, Parizade; Szafranski, Jan; Twohey, Linda; Watt, Philip; Weatherall, Lucie; Weatherill, J.; Whitman, Zoe; Wighton, Elinor; Abayasinghe, Chamika; Chan, Alexander; Darwish, Sharif; Gill, James; Glasgow, Emma; Hadfield, Daniel; Harris, Clair; Hopkins, Phil; Kochhar, Arun; Kunst, Gudrun; Mellis, Clare; Pool, Andrew; Riozzi, Paul; Selman, Andrew; Smith, Emma-Jane; Vele, Liana; Gercek, Yuksel; Guy, Kramer; Holden, Douglas; Watson, Nicholas; Whysall, Karen; Andreou, Prematie; Hales, Dawn; Thompson, Jonathan; Bowrey, Sarah; McDonald, Shara; Gilmore, Jemma; Hills, Vicky; Kelly, Chan; Kelly, Sinead; Lloyd, Geraint; Abbott, Tom; Gall, Lewis; Torrance, Hew; Vivian, Mark; Berntsen, Emer; Nolan, Tracey; Turner, Angus; Vohra, Akbar; Brown, Andrew; Clark, Richard; Coughlan, Elaine; Daniel, Conway; Patvardhan, Chinmay; Pearson, Rachel; Predeep, Sheba; Saad, Hesham; Shanmugam, Mohanakrishnan; Varley, Simon; Wylie, Katharine; Cooper, Lucy; Makowski, Arystarch; Misztal, Beata; Moldovan, Eliza; Pegg, Claire; Donovan, Andrew; Foot, Jayne; Large, Simon; Claxton, Andrew; Netke, Bhagyashree; Armstrong, Richard; Calderwood, Claire; Kwok, Andy; Mohr, Otto; Oyeniyi, Peter; Patnaik, Lisa; Post, Benjamin; Ali, Sarah; Arshad, Homa; Baker, Gerard; Brenner, Laura; Brincat, Maximilian; Brunswicker, Annemarie; Cox, Hannah; Cozar, Octavian Ionut; Cheong, Edward; Durst, Alexander; Fengas, Lior; Flatt, Jim; Glister, Georgina; Narwani, Vishal; Photi, Evangelos; Rankin, Adeline; Rosbergen, Melissa; Tan, Mark; Beaton, Ceri; Horn, Rachel; Hunt, Jane; Rousseau, Guy; Stancombe, Lucia; Absar, Mohammed; Allsop, Joanne; Drinkwater, Zoe; Hodgkiss, Tracey; Smith, Kirsty; Brown, Jamie; Alexander-Sefre, Farhad; Campey, Lorraine; Dudgeon, Lucy; Hall, Kathryn; Hitchcock, Rachael; James, Lynne; Smith, Kate; Winstone, Ulrika; Ahmad, Norfaizan; Bauchmuller, Kris; Harrison, Jonathan; Jeffery, Holly; Miller, Duncan; Pinder, Angela; Pothuneedi, Sailaja; Rosser, Jonathan; Sanghera, Sumayer; Swift, Diane; Walker, Rachel; Bester, Delia; Cavanagh, Sarah; Cripps, Heather; Daniel, Harvey; Lynch, Julie; Paton, Alison; Pyke, Shirley; Scholefield, John; Whitworth, Helen; Bottrill, Fiona; Ramalingam, Ganesh; Webb, Stephen; Akerman, Nik; Antill, Philip; Bourner, Lynsey; Buckley, Sarah; Castle, Gail; Charles, Rob; Eggleston, Christopher; Foster, Rebecca; Gill, Satwant; Lindley, Kate; Lklouk, Mohamed; Lowery, Tracey; Martin, Oliver; Milne, David; O'Connor, Patrick; Ratcliffe, Andrew; Rose, Alastair; Smith, Annie; Varma, Sandeep; Ward, Jackie; Barcraft-Barnes, Helena; Camsooksai, Julie; Colvin, Carolyn; Reschreiter, Henrik; Tbaily, Lee; Venner, Nicola; Hamilton, Caroline; Kelly, Lewis; Toth-Tarsoly, Piroska; Dodsworth, Kerry; Foord, Denise; Gordon, Paul; Hawes, Elizabeth; Lamb, Nikki; Mouland, Johanna; Nightingale, Jeremy; Rose, Steve; Schrieber, Joe; Al'Amri, Khalid; Aladin, Hafiz; Arshad, Mohammed Asif; Barraclough, James; Bentley, Conor; Bergin, Colin; Carrera, Ronald; Clarkson, Aisling; Collins, Michelle; Cooper, Lauren; Denham, Samuel; Griffiths, Ewen; Ip, Peter; Jeyanthan, Somasundaram; Joory, Kavita; Kaur, Satwant; Marriott, Paul; Mitchell, Natalie; Nagaiah, Sukumar; Nilsson, Annette; Parekh, Nilesh; Pope, Martin; Seager, Joseph; Serag, Hosam; Tameem, Alifia; Thomas, Anna; Thunder, Joanne; Torrance, Andrew; Vohra, Ravinder; Whitehouse, Arlo; Wong, Tony; Blunt, Mark; Wong, Kate; Giles, Julian; Reed, Isabelle; Weller, Debbie; Bell, Gillian; Birch, Julie; Damant, Rose; Maiden, Jane; Mewies, Clare; Prince, Claire; Radford, Jane; Reynolds, Tim; Balain, Birender; Banerjee, Robin; Barnett, Andrew; Burston, Ben; Davies, Kirsty; Edwards, Jayne; Evans, Chris; Ford, David; Gallacher, Pete; Hill, Simon; Jaffray, David; Karlakki, Sudheer; Kelly, Cormac; Kennedy, Julia; Kiely, Nigel; Lewthwaite, Simon; Marquis, Chris; Ockendon, Matthew; Phillips, Stephen; Pickard, Simon; Richardson, James; Roach, Richard; Smith, Tony; Spencer-Jones, Richard; Steele, Niall; Steen, Julie; van Liefland, Marck; White, Steve; Faulds, Matthew; Harris, Meredyth; Kelly, Carrie; Nicol, Scott; Pearson, Sally Anne; Chukkambotla, Srikanth; Andrew, Alyson; Attrill, Elizabeth; Campbell, Graham; Datson, Amanda; Fouracres, Anna; Graterol, Juan; Graves, Lynne; Hong, Bosun; Ishimaru, Alexander; Karthikeyan, Arvind; King, Helen; Lawson, Tom; Lee, Gregory; Lyons, Saoirse; Hall, Andrew Macalister; Mathoulin, Sophie; Mcintyre, Eilidh; Mclaughlin, Danny; Mulcahy, Kathleen; Paddle, Jonathan; Ratcliffe, Anna; Robbins, James; Sung, Weilin; Tayo, Adeoluwa; Trembath, Lisa; Venugopal, Suneetha; Walker, Robert; Wigmore, Geoffrey; Boereboom, Catherine; Downes, Charlotte; Humphries, Ryan; Melbourne, Susan; Smith, Coral; Tou, Samson; Ullah, Shafa; Batchelor, Nick; Boxall, Leigh; Broomby, Rupert; Deen, Tariq; Hellewell, Alistair; Helliwell, Laurence; Hutchings, Melanie; Hutchins, David; Keenan, Samantha; Mackie, Donna; Potter, Alison; Smith, Frances; Stone, Lucy; Thorpe, Kevin; Wassall, Richard; Woodgate, Andrew; Baillie, Shelley; Campbell, Tara; James, Sarah; King, Chris; Marques de Araujo, Daniela; Martin, Daniel; Morkane, Clare; Neely, Julia; Rajendram, Rajkumar; Burton, Megan; James, Kathryn; Keevil, Edward; Minik, Orsolya; Morgan, Jenna; Musgrave, Anna; Rajanna, Harish; Roberts, Tracey; Adamson, Michael; Jumbe, Sandra; Kendall, Jennie; Muthuswamy, Mohan Babu; Anderson, Charlotte; Cruikshanks, Andrew; Wrench, Ian; Zeidan, Lisa; Ardern, Diane; Harris, Benjamin; Hellstrom, Johanna; Martin, Jane; Thomas, Richard; Varsani, Nimu; Brown, Caroline Wrey; Docherty, Philip; Gillies, Michael; McGregor, Euan; Usher, Helen; Craig, Jayne; Smith, Andrew; Ahmad, Tahania; Bodger, Phoebe; Creary, Thais; Fowler, Alexander; Hewson, Russ; Ijuo, Eke; Jones, Timothy; Kantsedikas, Ilya; Lahiri, Sumitra; McLean, Aaron Lawson; Niebrzegowska, Edyta; Phull, Mandeep; Wang, Difei; Wickboldt, Nadine; Baldwin, Jacqueline; Doyle, Donna; Mcmullan, Sean; Oladapo, Michelle; Owen, Thomas; Williams, Alexandra; Daniel, Hull; Gregory, Peter; Husain, Tauqeer; Kirk-Bayley, Justin; Mathers, Edward; Montague, Laura; Harper, Mark; White, Stuart; Jack, James; Ridley, Carrie; Avis, Joanne; Cook, Tim; Dali-Kemmery, Lola; Kerslake, Ian; Lambourne, Victoria; Pearson, Annabel; Boyd, Christine; Callaghan, Mark; Lawson, Cathy; McCrossan, Roopa; Nesbitt, Vanessa; O'connor, Laura; Scott, Julia; Sinclair, Rhona; Farid, Nahla; Morgese, Ciro; Bhatia, Kailash; Karmarkar, Swati; Ahmed, Jamil; Branagan, Graham; Hutton, Monica; Swain, Andrew; Brookes, Jamie; Cornell, Jonathan; Dolan, Rachael; Hulme, Jonathan; Jansen van Vuuren, Amanda; Jowitt, Tom; Kalashetty, Gunasheela; Lloyd, Fran; Patel, Kiran; Sherwood, Nicholas; Brown, Lynne; Chandler, Ben; Deighton, Kerry; Emma, Temlett; Haunch, Kirsty; Cheeseman, Michelle; Dent, Kathy; Garg, Sanjeev; Gray, Carol; Hood, Marion; Jones, Dawn; Juj, Joanne; Rao, Roshan; Walker, Tara; Al Anizi, Mashel; Cheah, Clarissa; Cheing, Yushio; Coutinho, Francisco; Gondo, Prisca; Hadebe, Bernard; Hove, Mazvangu Onie; Khader, Ahamed; Krishnachetty, Bobby; Rhodes, Karen; Sokhi, Jagdish; Baker, Katie-Anne; Bertram, Wendy; Looseley, Alex; Mouton, Ronelle; Hanna, George; Arnold, Glenn; Arya, Shobhit; Balfoussia, Danai; Baxter, Linden; Harris, James; Jones, Craig; Knaggs, Alison; Markar, Sheraz; Perera, Anisha; Scott, Alasdair; Shida, Asako; Sirha, Ravneet; Wright, Sally; Frost, Victoria; Gray, Catherine; Andrews, Emma; Arrandale, Lindsay; Barrett, Stephen; Cifra, Elna; Cooper, Mariese; Dragnea, Dragos; Elna, Cifra; Maclean, Jennifer; Meier, Sonja; Milliken, Donald; Munns, Christopher; Ratanshi, Nadir; Ramessur, Suneil; Salvana, Abegail; Watson, Anthony; Ali, Hani; Campbell, Gill; Critchley, Rebecca; Endersby, Simon; Hicks, Catherine; Liddle, Alison; Pass, Marc; Ritchie, Charlotte; Thomas, Charlotte; Too, Lingxi; Welsh, Sarah; Gill, Talvinder; Johnson, Joanne; Reed, Joanne; Davis, Edward; Papadopoullos, Sam; Attwood, Clare; Biffen, Andrew; Boulton, Kerenza; Gray, Sophie; Hay, David; Mills, Sarah; Montgomery, Jane; Riddell, Rory; Simpson, James; Bhardwaj, Neeraj; Paul, Elaine; Uwubamwen, Nosakhare; Alexander, Maini; Arrich, James; Arumugam, Swarna; Blackwood, Douglas; Boggiano, Victoria; Brown, Robyn; Chan, Yik Lam; Chatterjee, Devnandan; Chhabra, Ashok; Christian, Rachel; Costelloe, Hannah; Matthewman, Madeline Coxwell; Dalton, Emma; Darko, Julia; Davari, Maria; Dave, Tejal; Deacon, Matthew; Deepak, Shantal; Edmond, Holly; Ellis, Jessica; El-Sayed, Ahmed; Eneje, Philip; English, Rose; Ewe, Renee; Foers, William; Franklin, John; Gallego, Laura; Garrett, Emily; Goldberg, Olivia; Goss, Harry; Greaves, Rosanna; Harris, Rudy; Hennings, Charles; Jones, Eleanor; Kamali, Nelson; Kokkinos, Naomi; Lewis, Carys; Lignos, Leda; Malgapo, Evaleen Victoria; Malik, Rizwana; Milne, Andrew; Mulligan, John-Patrick; Nicklin, Philippa; Palipane, Natasha; Parsons, Thomas; Piper, Rebecca; Prakash, Rohan; Ramesh, Byron; Rasip, Sarah; Reading, Jacob; Rela, Mariam; Reyes, Anna; Stephens, Robert; Rooms, Martin; Shah, Karishma; Simons, Henry; Solanki, Shalil; Spowart, Emma; Stevens, Amy; Thomas, Christopher; Waggett, Helena; Yassaee, Arrash; Kennedy, Anthony; Scott, Sara; Somanath, Sameer; Berg, Andrew; Hernandez, Miguel; Nanda, Rajesh; Tank, Ghanshyambhai; Wilson, Natalie; Wilson, Debbie; Al-Soudaine, Yassr; Baldwin, Matthew; Cornish, Julie; Davies, Zoe; Davies, Leigh; Edwards, Marc; Frewer, Natasha; Gallard, Sian; Glasbey, James; Harries, Rhiannon; Hopkins, Luke; Kim, Taeyang; Koompirochana, Vilavan; Lawson, Simon; Lewis, Megan; Makzal, Zaid; Scourfield, Sarah; Ahmad, Yousra; Bates, Sarah; Blackwell, Clare; Bryant, Helen; Collins, Hannah; Coulter, Suzanne; Cruickshank, Ross; Daniel, Sonya; Daubeny, Thomas; Edwards, Mark; Golder, Kim; Hawkins, Lesley; Helen, Bryant; Hinxman, Honor; Levett, Denny; Salmon, Karen; Seaward, Leanne; Skinner, Ben; Tyrell, Bryony; Wadams, Beverley; Walsgrove, Joseph; Dickson, Jane; Constantin, Kathryn; Karen, Markwell; O'Brien, Peter; O'Donohoe, Lynn; Payne, Hannah; Sundayi, Saul; Walker, Elaine; Brooke, Jenny; Cardy, Jon; Humphreys, Sally; Kessack, Laura; Kubitzek, Christiane; Kumar, Suhas; Cotterill, Donna; Hodzovic, Emil; Hosdurga, Gurunath; Miles, Edward; Saunders, Glenn; Campbell, Marta; Chan, Peter; Jemmett, Kim; Raj, Ashok; Naik, Aditi; Oshowo, Ayo; Ramamoorthy, Rajarajan; Shah, Nimesh; Sylvan, Axel; Blyth, Katharine; Burtenshaw, Andrew; Freeman, David; Johnson, Emily; Lo, Philip; Martin, Terry; Plunkett, Emma; Wollaston, Julie; Allison, Joanna; Carroll, Christine; Craw, Nicholas; Craw, Sarah; Pitt-Kerby, Tressy; Rowland-Axe, Rebecca; Spurdle, Katie; McDonald, Andrew; Simon, Davies; Sinha, Vivek; Smith, Thomas; Banner-Goodspeed, Valerie; Boone, Myles; Campbell, Kathleen; Lu, Fengxin; Scannell, Joseph; Sobol, Julia; Balajonda, Naraida; Clemmons, Karen; Conde, Carlos; Elgasim, Magdi; Funk, Bonita; Hall, Roger; Hopkins, Thomas; Olaleye, Omowunmi; Omer, Omer; Pender, Michelle; Porto, Angelo; Stevens, Alice; Waweru, Peter; Yeh, Erlinda; Bodansky, Daniella; Evans, Adam; Kleopoulos, Steven; Maril, Robert; Mathney, Edward; Sanchez, Angela; Tinuoye, Elizabeth; Bateman, Brian; Eng, Kristen; Jiang, Ning; Ladha, Karim; Needleman, Joseph; Chen, Lee-Lynn; Lane, Rondall; Robinowitz, David; Ghushe, Neil; Irshad, Mariam; O'Connor, John; Patel, Samir; Takemoto, Steven; Wallace, Art; Mazzeffi, Michael; Rock, Peter; Wallace, Karin; Zhu, Xiaomao; Chua, Pandora; Mattera, Matthew; Sharar, Rebecca; Thilen, Stephan; Treggiari, Miriam; Morgan, Angela; Sofjan, Iwan; Subramaniam, Kathirvel; Avidan, Michael; Maybrier, Hannah; Muench, Maxwell; Wildes, Troy

    2018-01-01

    The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of

  8. [Technology: training centers--a new method for learning surgery in visceral surgery].

    Science.gov (United States)

    Troidl, H

    1996-01-01

    The importance of training centers can be best described after first answering a few questions like: 1. What kind of surgery will we deal with in the future? 2. What kind of surgeon do we need for this surgery, if it is basically different? 3. How will this surgeon have to be educated/trained for this different surgery? Although I am aware of the fact, that statements about future prospects are usually doomed to fail, I maintain that endoscopic surgery will be an essential part of general surgery. If this is so, surgery will be dominated by extremely complicated technology, new techniques and new instruments. It will be a "different" surgery. It will offer more comfort at the same safety. The surgeon of the future will still need a certain personality; he will still need intuition and creativity. To survive in our society, he will have to be an organiser and even a businessman. Additionally, something new has to be added: he will have to understand modern, complicated technology and will have to use totally different instruments for curing surgical illness. This makes it clear that we will need a different education/training and may be even a different selection of surgeons. We should learn from other professions sharing common interests with surgery, for example, sports where the common interest is achieving most complicated motions and necessarily highly differentiated coordination. Common interest with airline pilots is the target of achieving absolute security. They have a highly differentiated selection and training concept. Training centers may be-under certain prerequisites-a true alternative for this necessary form of training. They must have a concept, i.e. contents and aims have to be defined, structured and oriented on the requirements of surgery for the patient. Responsibility for the concept, performance and control can only be in the hands of Surgical Societies and Universities. These prerequisites correspond most likely to training centers being

  9. 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.

  10. Gynecomastia Surgery-Impact on Life Quality: A Prospective Case-Control Study.

    Science.gov (United States)

    Kasielska-Trojan, Anna; Antoszewski, Bogusław

    2017-03-01

    To evaluate the results of surgical treatment of gynecomastia in the context of quality of life and satisfaction after the surgery. Fifty male patients (mean age, 25.1 years [SD = 8 years]) who underwent surgery for gynecomastia and completed both (preoperative and postoperative) stages of the study were included in the analysis. The quality-of-life evaluation instrument was The Short Form-36 Health Survey Questionnaire. Additionally, we used a short questionnaire including 2 questions about patient satisfaction with gynecomastia surgery. The overall change in life satisfaction after gynecomastia surgery was 1 point on Likert scale (sign test, P gynecomastia surgery scored significantly higher than before the procedure in all Short Form-36 Health Survey Questionnaire domains as well as in 2 main scales Psychical and Physical Health. The changes were especially visible for the domain social functioning and a scale Psychical Health (P Gynecomastia surgery significantly improved men's life quality in all aspects and especially in the social aspect and psychical health. This indicates that adult men with gynecomastia are a specific group of patients, in which surgery may result in life quality improvement even over the average scores.

  11. Impact of workflow on the use of the Surgical Safety Checklist: a qualitative study.

    Science.gov (United States)

    Gillespie, Brigid M; Marshall, Andrea P; Gardiner, Therese; Lavin, Joanne; Withers, Teresa K

    2016-11-01

    Regardless of the benefits associated of the Surgical Safety Checklist, adherence across its three phases remains inconsistent. The aim of this study was to systematically identify issues around workflow that impact on surgical teams' ability to use the Surgical Safety Checklist in a large tertiary facility in Queensland, Australia. Observational audit of 10 surgical teams and 33 semi-structured interviews with 70 participants from nursing, medicine and the community were conducted. Data were collected during 2014-2015. Inductive and deductive approaches were used to analyse field observations and interview transcripts. The domain, impact of workflow on checklist utilization, was identified. Within this domain, seven categories illustrated the causal conditions which determined the ways in which workflow influenced checklist use. These categories included: 'busy doing the task'; 'clashing task priorities'; 'being pressured, running out of time'; 'adapting processes to work patterns'; 'doubling up on work'; 'a domino effect, leading to delays' and 'reality of the workflow'. One of the greatest systemic challenges to checklist use in surgery is workflow. Process changes in the way that surgical safety checklists are used need to incorporate the temporal demands of the workflow. Any changes made must ensure the process is reliable, is easily embedded into existing work routines and is not disruptive. © 2016 Royal Australasian College of Surgeons.

  12. Safety of laparoscopic resection for colorectal cancer in patients with liver cirrhosis: A retrospective cohort study.

    Science.gov (United States)

    Zhou, Senjun; Zhu, Hepan; Li, Zhenjun; Ying, Xiaojiang; Xu, Miaojun

    2018-05-26

    Patients with liver cirrhosis represent a high risk group for colorectal surgery. The safety and effectiveness of laparoscopy in colorectal surgery for cirrhotic patients is not clear. The aim of this study was to compare the outcomes of laparoscopic colorectal surgery with those of open procedure for colorectal cancer in patients with liver cirrhosis. A total of 62 patients with cirrhosis who underwent radical resections for colorectal cancer from 2005 to 2014 were identified retrospectively from a prospective database according to the technique adopted (laparoscopic or open). Short- and long-term outcomes were compared between the two groups. Comparison of laparoscopic group and open group revealed no significant differences at baseline. In the laparoscopic group, the laparoscopic surgery was associated with reduced estimated blood loss (136 vs. 266 ml, p = 0.015), faster first flatus (3 vs. 4 days, p = 0.002) and shorter days to first oral intake (4 vs. 5 days, p = 0.033), but similar operative times (p = 0.856), number of retrieved lymph nodes (p = 0.400) or postoperative hospital stays (p = 0.170). Despite the similar incidence of overall complications between the two groups (50.0% vs. 68.8%, p = 0.133), we observed lower morbidities in laparoscopic group in terms of the rate of Grade II complication (20.0% vs. 50.0%, p = 0.014). Long-term of overall and Disease-free survival rates did not differ between the two groups. Laparoscopic colorectal surgery appears to be a safe and less invasive alternative to open surgery in some elective cirrhotic patients in terms of less blood loss or early recovery and does not result in additional harm in terms of the postoperative complications or long-term oncological outcomes. Copyright © 2018. Published by Elsevier Ltd.

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

    Science.gov (United States)

    Al-Otaibi, Faisal; Baz, Salah; Althubaiti, Ibrahim; Aldhalaan, Hisham; MacDonald, David; Abalkhail, Tareq; Fiol, Miguel E.; Alyamani, Suad; Chedrawi, Aziza; Leblanc, Frank; Parrent, Andrew; Maclean, Donald; Girvin, John

    2014-01-01

    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. PMID:24627805

  14. Awakening: a qualitative study on maintaining weight loss after bariatric surgery.

    Science.gov (United States)

    Liebl, Lori; Barnason, Susan; Brage Hudson, Diane

    2016-04-01

    To describe the experiences of adults who were successful in maintaining weight loss after bariatric surgery. The majority of studies examine a homogenous demographic group of postbariatric surgical patients who have gone through initial weight loss, which occurs within the first 12-24 months post surgery. Maintenance of weight loss begins 24 months after bariatric surgery; however, there is a paucity of research examining experiences during this period. The lack of conclusive research related to interactions between intrapersonal, behavioural and environmental influences suggests a need to develop a better understanding of patients' experiences related to weight loss maintenance post bariatric surgery. Bandura's Social Cognitive Theory provided the framework for the semi-structured interviews for this qualitative descriptive study. In-person interviews with n = 14 participants who were able to maintain weight loss at least 24 months after a bariatric surgery. Participants experienced an awakening and gained a new perspective on their life. They identified negative attitudes, influences and behaviours and modified their environment to support their desired healthy behaviour. To maintain weight loss, an individual must seek out and be surrounded by positive family and peer support influences. Positive support may provide the opportunity for an individual to place personal health needs as a priority. Therapeutic education and counselling for individuals, couples and families should occur during all phases of bariatric surgery. Communication techniques may empower clients to deflect negative comments and influences in a constructive manner. Support groups should accommodate the various phases of bariatric surgery. Clients should be prepared for how to work through emotions associated with weight fluctuations. © 2016 John Wiley & Sons Ltd.

  15. The safety of dipyridamole in patients undergoing myocardial perfusion scintigraphy prior to lung volume reduction surgery

    International Nuclear Information System (INIS)

    Roman, M.R.; Angelides, S.; Parker, M.K.; Silva, I. da; Freeman, A.P.

    2001-01-01

    Patients with end-stage chronic obstructive pulmonary disease (COPD) undergoing lung volume reduction surgery (LVRS) are at high risk of peri-operative cardiac complications, and myocardial perfusion scintigraphy (MPS) is commonly used for risk stratification. This study prospectively assessed the safety of dipyridamole in these patients and compared the incidence of side-effects (particularly dyspnoea) with that in patients undergoing dipyridamole MPS prior to elective non-cardiothoracic surgery. Fifty patients were enrolled: 25 in the LVRS cohort (13 males, 12 females), with a mean age of 65 years and a mean FEV 1 of 0.79 l, and 25 (with no history of asthma or COPD) in the control cohort (14 males, 11 females), with a mean age of 66 years. Fourteen patients (56%) in each group developed side-effects. Dyspnoea was reported by five patients (20%) in the LVRS and two patients (8%) in the control cohort (P=NS). One patient in each cohort developed severe hypotension and bradycardia. Eight (32%) other patients developed minor side-effects in the LVRS cohort compared with 11 (44%) in the control group. All side-effects responded promptly to intravenous aminophylline. In summary, there was a statistically non-significant increase in the incidence of dyspnoea in patients with end-stage COPD and all side-effects responded to aminophylline. Thus, dipyridamole can be used safely in these patients. (orig.)

  16. Patients' perceptions of waiting for bariatric surgery: a qualitative study.

    Science.gov (United States)

    Gregory, Deborah M; Temple Newhook, Julia; Twells, Laurie K

    2013-10-18

    In Canada waiting lists for bariatric surgery are common, with wait times on average > 5 years. The meaning of waiting for bariatric surgery from the patients' perspective must be understood if health care providers are to act as facilitators in promoting satisfaction with care and quality care outcomes. The aims of this study were to explore patients' perceptions of waiting for bariatric surgery, the meaning and experience of waiting, the psychosocial and behavioral impact of waiting for treatment and identify health care provider and health system supportive measures that could potentially improve the waiting experience. Twenty-one women and six men engaged in in-depth interviews that were digitally recorded, transcribed verbatim and analysed using a grounded theory approach to data collection and analysis between June 2011 and April 2012. The data were subjected to re-analysis to identify perceived health care provider and health system barriers to accessing bariatric surgery. Thematic analysis identified inequity as a barrier to accessing bariatric surgery. Three areas of perceived inequity were identified from participants' accounts: socioeconomic inequity, regional inequity, and inequity related to waitlist prioritization. Although excited about their acceptance as candidates for surgery, the waiting period was described as stressful, anxiety provoking, and frustrating. Anger was expressed towards the health care system for the long waiting times. Participants identified the importance of health care provider and health system supports during the waiting period. Recommendations on how to improve the waiting experience included periodic updates from the surgeon's office about their position on the wait list; a counselor who specializes in helping people going through this surgery, dietitian support and further information on what to expect after surgery, among others. Patients' perceptions of accessing and waiting for bariatric surgery are shaped by perceived

  17. Current Trends in and Indications for Endoscopy-Assisted Breast Surgery for Breast Cancer: Results from a Six-Year Study Conducted by the Taiwan Endoscopic Breast Surgery Cooperative Group

    Science.gov (United States)

    Lai, Hung-Wen; Chen, Shou-Tung; Chen, Dar-Ren; Chen, Shu-Ling; Chang, Tsai-Wang; Kuo, Shou-Jen; Kuo, Yao-Lung; Hung, Chin-Sheng

    2016-01-01

    Background Endoscopy-assisted breast surgery (EABS) performed through minimal axillary and/or periareolar incisions is a possible alternative to open surgery for certain patients with breast cancer. In this study, we report the early results of an EABS program in Taiwan. Methods The medical records of patients who underwent EABS for breast cancer during the period May 2009 to December 2014 were collected from the Taiwan Endoscopic Breast Surgery Cooperative Group database. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, complications and recurrence were analyzed to determine the effectiveness and oncologic safety of EABS in Taiwan. Results A total of 315 EABS procedures were performed in 292 patients with breast cancer, including 23 (7.8%) patients with bilateral disease. The number of breast cancer patients who underwent EABS increased initially from 2009 to 2012 and then stabilized during the period 2012–2014. The most commonly performed EABS was endoscopy-assisted total mastectomy (EATM) (85.4%) followed by endoscopy-assisted partial mastectomy (EAPM) (14.6%). Approximately 74% of the EATM procedures involved breast reconstruction, with the most common types of reconstruction being implant insertion and autologous pedicled TRAM flap surgery. During the six-year study period, there was an increasing trend in the performance of EABS for the management of breast cancer when total mastectomy was indicated. The positive surgical margin rate was 1.9%. Overall, the rate of complications associated with EABS was 15.2% and all were minor and wound-related. During a median follow-up of 26.8 (3.3–68.6) months, there were 3 (1%) cases of local recurrence, 1 (0.3%) case of distant metastasis and 1 (0.3%) death. Conclusion The preliminary results from the EABS program in Taiwan show that EABS is a safe procedure and results in acceptable cosmetic outcome. These findings could help to promote this under-used surgical technique

  18. Early illness experiences related to unexpected heart surgery: A qualitative descriptive study.

    Science.gov (United States)

    Chang, Yu-Ling; Tsai, Yun-Fang

    2017-09-01

    Most studies on patients' experiences following emergency cardiac surgery focus on evaluation of patients after their discharge. Few studies have evaluated patients' experiences after being transferred from intensive care and before being discharged. This study aimed to describe patients' experiences in the early stages of recovery following emergency heart surgery. For this exploratory qualitative descriptive study, 13 patients were recruited from a medical centre in northern Taiwan. Participants had undergone emergency heart surgery and had resided in the cardiothoracic surgical ward for ≥6 days following transfer from the ICU; all expected to be discharged from the hospital within 3 days. Semi-structured, face-to-face interviews were conducted in private after the patients had been transferred to the cardiothoracic surgical wards. Audiotaped interviews were transcribed and analysed using content analysis. Data analysis identified four themes, which represented different recovery stages: sudden and serious symptoms, nightmares and vivid dreams, physical and emotional disturbances, and establishing a new life after emergency surgery. A fifth theme, support for a new lifestyle, occurred between the four stages. Participants experienced symptoms of physical and psychological stress during the early recovery stages following emergency heart surgery. A lack of understanding of the process of recovery increased these difficulties; participants wanted and needed multidisciplinary care and education. Emergency heart surgery does not allow healthcare professionals to inform patients of what to expect post-surgery. Our findings suggest that rather than waiting until discharge to offer disease information and treatment plans, multidisciplinary care should be initiated as soon as possible to facilitate recovery. Copyright © 2017 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  19. Global outbreak of severe Mycobacterium chimaera disease after cardiac surgery: a molecular epidemiological study.

    Science.gov (United States)

    van Ingen, Jakko; Kohl, Thomas A; Kranzer, Katharina; Hasse, Barbara; Keller, Peter M; Katarzyna Szafrańska, Anna; Hillemann, Doris; Chand, Meera; Schreiber, Peter Werner; Sommerstein, Rami; Berger, Christoph; Genoni, Michele; Rüegg, Christian; Troillet, Nicolas; Widmer, Andreas F; Becker, Sören L; Herrmann, Mathias; Eckmanns, Tim; Haller, Sebastian; Höller, Christiane; Debast, Sylvia B; Wolfhagen, Maurice J; Hopman, Joost; Kluytmans, Jan; Langelaar, Merel; Notermans, Daan W; Ten Oever, Jaap; van den Barselaar, Peter; Vonk, Alexander B A; Vos, Margreet C; Ahmed, Nada; Brown, Timothy; Crook, Derrick; Lamagni, Theresa; Phin, Nick; Smith, E Grace; Zambon, Maria; Serr, Annerose; Götting, Tim; Ebner, Winfried; Thürmer, Alexander; Utpatel, Christian; Spröer, Cathrin; Bunk, Boyke; Nübel, Ulrich; Bloemberg, Guido V; Böttger, Erik C; Niemann, Stefan; Wagner, Dirk; Sax, Hugo

    2017-10-01

    Since 2013, over 100 cases of Mycobacterium chimaera prosthetic valve endocarditis and disseminated disease were notified in Europe and the USA, linked to contaminated heater-cooler units (HCUs) used during cardiac surgery. We did a molecular epidemiological investigation to establish the source of these patients' disease. We included 24 M chimaera isolates from 21 cardiac surgery-related patients in Switzerland, Germany, the Netherlands, and the UK, 218 M chimaera isolates from various types of HCUs in hospitals, from LivaNova (formerly Sorin; London, UK) and Maquet (Rastatt, Germany) brand HCU production sites, and unrelated environmental sources and patients, as well as eight Mycobacterium intracellulare isolates. Isolates were analysed by next-generation whole-genome sequencing using Illumina and Pacific Biosciences technologies, and compared with published M chimaera genomes. Phylogenetic analysis based on whole-genome sequencing of 250 isolates revealed two major M chimaera groups. Cardiac surgery-related patient isolates were all classified into group 1, in which all, except one, formed a distinct subgroup. This subgroup also comprised isolates from 11 cardiac surgery-related patients reported from the USA, most isolates from LivaNova HCUs, and one from their production site. Isolates from other HCUs and unrelated patients were more widely distributed in the phylogenetic tree. HCU contamination with M chimaera at the LivaNova factory seems a likely source for cardiothoracic surgery-related severe M chimaera infections diagnosed in Switzerland, Germany, the Netherlands, the UK, the USA, and Australia. Protective measures and heightened clinician awareness are essential to guarantee patient safety. Partly funded by the EU Horizon 2020 programme, its FP7 programme, the German Center for Infection Research (DZIF), the Swiss National Science Foundation, the Swiss Federal Office of Public Health, and National Institute of Health Research Oxford Health Protection

  20. PIEZOELECTRIC BONE SURGERY: A REVIEW OF THE LITERATURE AND POTENTIAL APPLICATIONS IN VETERINARY OROMAXILLOFACIAL SURGERY

    Directory of Open Access Journals (Sweden)

    Philippe eHENNET

    2015-05-01

    Full Text Available Piezoelectric bone surgery is a recent and innovative technology permitting a selective cut of mineralized tissue while sparing soft tissue. Similar to a dental scaler, a high frequency vibration, in the range of 25-35kHz, is transmitted to a metallic tip. However, the power of the piezosurgical instrument is 3 to 6 times higher than that of a dental scaler. The major advantages of this technology include high precision, a design that increases ease of curvilinear osteotomy, less trauma to soft tissue, preservation of neurological and vascular structures, reduced hemorrhage, minimal thermal damage to the bone as well as overall improvement of healing. The handpiece of the instrument is equipped with a sterile irrigation system and light-emitting diode (LED light, which improves visibility and overall safety. Piezoelectric surgery is particularly useful when performing delicate bone procedures such as periodontal or endodontic surgery. It is also indicated when performing more invasive bone surgery such as maxillectomy, mandibulectomy, and condylectomy, where preservation of neurovascular structures is important. Piezoelectric instruments are different from rotary instrumentation or oscillating saws, they require light pressure with constant motion of the tip. Training is required to master the technique.

  1. 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.

  2. Criticality safety basics, a study guide

    International Nuclear Information System (INIS)

    Putman, V.L.

    1999-01-01

    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

  3. Fundamental principles of conducting a surgery economic analysis study.

    Science.gov (United States)

    Kotsis, Sandra V; Chung, Kevin C

    2010-02-01

    The use of economic evaluation in surgery is scarce. Economic evaluation is used even less so in plastic surgery, in which health-related quality of life is of particular importance. This article, part of a tutorial series on evidence-based medicine, focuses on the fundamental principles of conducting a surgery economic analysis. The authors include the essential aspects of conducting a surgical cost-utility analysis by considering perspectives, costs, outcomes, and utilities. The authors also describe and give examples of how to conduct the analyses (including calculating quality-adjusted life-years and discounting), how to interpret the results, and how to report the results. Although economic analyses are not simple to conduct, a well-conducted one provides many rewards, such as recommending the adoption of a more effective treatment. For comparing and interpreting economic analysis publications, it is important that all studies use consistent methodology and report the results in a similar manner.

  4. 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...

  5. TMJ surgery following orthognathic surgery: A case series

    Directory of Open Access Journals (Sweden)

    C. Politis

    2018-06-01

    Full Text Available Orthognathic surgery may affect or cause temporomandibular joint (TMJ complaints. This study evaluated the need for TMJ surgery after orthognathic surgery.A retrospective cohort study was carried out on 630 consecutive patients undergoing at least a Le Fort I or bilateral sagittal split osteotomy (BSSO. The mean follow-up time was 2,3 years. Clinical, surgical and radiographic findings were collected.Ten of the 630 patients (1.6% had additional arthroscopic TMJ-surgery in one (9 or in both (1 joints because of internal derangement, resistant to conventional therapy. Only 4/10 patients had successful outcomes following arthroscopic surgery. One patient with unsuccessful outcome required multiple additional open TMJ-surgeries, all remaining ineffective to relieve pain and restricted mouth opening. If arthroscopy failed to relieve symptoms (5/10 patients, further conservative management was opted. Arthroscopy seemed effective mainly in patients without pre-existing TMJ complaints.A further five of the 630 patients (0.8% required more treatment because of bilateral postoperative condylar resorption, but none of them required TMJ-surgery.In contrast to patients with bilateral condylar resorption where the skeletal relapse remained the issue of concern, patients with internal derangement/osteoarthrosis exhibited major occlusal changes in one patient only (1/10, leaving the TMJ complaints as the main concern. Keywords: Sagittal split osteotomy, Le Fort I osteotomy, Orthognathic surgery, Condylar remodelling, Condylar resorption, Osteoarthrosis, Internal derangement, Relapse, Arthroscopy

  6. A Randomized Controlled Trial on the Efficacy and Safety of a New Crosslinked Hyaluronan Gel in Reducing Adhesions after Gynecologic Laparoscopic Surgeries.

    Science.gov (United States)

    Liu, Chongdong; Lu, Qi; Zhang, Zhiqiang; Xue, Min; Zhang, Youzhong; Zhang, Yi; Wang, Huilan; Li, Huajun; Zhou, Yingfang; Zhang, Zhenyu; Li, Wei

    2015-01-01

    To evaluate the safety and efficacy of a new crosslinked hyaluronan (NCH) gel in reducing postoperative adhesions. Randomized controlled trial (Canadian Task Force classification I). Seven departments of obstetrics and gynecology in China. A total of 216 women scheduled for gynecologic laparoscopic surgery for primary removal of adhesions, myomas, ovarian cysts, or endometriotic cysts. Patients were randomized to receive either NCH gel or saline with 1:1 allocation. All patients were evaluated using a modified American Fertility Society (mAFS) scoring system for the incidence, extent, and severity of pre-existing and postoperative adhesions at the 10 anatomic sites of ovaries/tubes and at the expanded 23 or 24 anatomic sites throughout the abdominopelvic cavity by laparoscopy. A total of 215 randomized patients were treated with either saline solution (108 of 108) or NCH gel (107 of 108), composing the full analysis set (FAS), and 196 patients (94 of 108 in the saline control group and 102 of 108 in the NCH gel group) completed the entire study, composing the per protocol set (PPS). The postoperative incidence of moderate or severe adhesions evaluated at the 10 sites (the primary endpoint for efficacy) was 27.7% in the control group and 9.8% in the NCH gel group, a difference of 14.4% (95% confidence interval [CI], 2.6%-20.6%) in the PPS, and 37.0% in the control group and 14.0% in the NCH gel group, a difference of 20.0% (95% CI, 8.9%-26.8%) in the FAS. The postoperative incidence of moderate or severe adhesions evaluated at the 24 sites was also significantly lower in the NCH gel group compared with the control group (5.9% vs 14.9%; p = .036) in the PPS. Also in the PPS, the NCH gel group had significantly lower postoperative adhesion scores of severity, extent, and mAFS: 60.0%, 50.8%, and 76.9%, respectively (median scores of the 10 sites; p = .002) and 48.5%, 50.0%, and 72.2% (median scores of the 24 sites; p = .001) lower than those recorded in the control

  7. Safe pediatric surgery: development and validation of preoperative interventions checklist

    Directory of Open Access Journals (Sweden)

    Maria Paula de Oliveira Pires

    2013-09-01

    Full Text Available OBJECTIVES: this study was aimed at developing and validating a checklist of preoperative pediatric interventions related to the safety of surgical patients. METHOD: methodological study concerning the construction and validation of an instrument with safe preoperative care indicators. The checklist was subject to validation through the Delphi technique, establishing a consensus level of 80%. RESULTS: five professional specialists in the area conducted the validation and a consensus on the content and the construct was reached after two applications of the Delphi technique. CONCLUSION: the "Safe Pediatric Surgery Checklist", simulating the preoperative trajectory of children, is an instrument capable of contributing to the preparation and promotion of safe surgery, as it identifies the presence or absence of measures required to promote patient safety.

  8. Low anastomotic leak rate after colorectal surgery: a single-centre study.

    Science.gov (United States)

    Jones, O M; John, S K P; Horseman, N; Lawrance, R J; Fozard, J B J

    2007-10-01

    Anastomotic leak after colorectal surgery is a serious event associated with significant morbidity and mortality. There is little consensus regarding 'acceptable' rates of leakage, however. This study describes the experience of anastomotic leakage after both elective and emergency colorectal surgery in a district general hospital. A prospectively collected database of all patients with a diagnosis of colorectal cancer in a single hospital formed the basis of the study. Leak was defined as breakdown of the anastomosis contributing to death or requiring reoperation or reintervention. A total of 949 patients underwent surgery with an anastomosis between 1996 and 2004, including 331 patients treated with anterior resection. Anastomotic leaks requiring reoperation occurred in eight patients (0.8%). Thirty-day and in-hospital mortality was 4%. A very low rate of anastomotic leakage after colorectal surgery is possible in a district general hospital setting. Given the impact of anastomotic leakage on function, tumour recurrence and long-term survival, it should be considered as a marker of surgical quality when evaluating surgical performance.

  9. Suprascapular and Interscalene Nerve Block for Shoulder Surgery: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Hussain, Nasir; Goldar, Ghazaleh; Ragina, Neli; Banfield, Laura; Laffey, John G; Abdallah, Faraj W

    2017-12-01

    Interscalene block provides optimal shoulder surgery analgesia, but concerns over its associated risks have prompted the search for alternatives. Suprascapular block was recently proposed as an interscalene block alternative, but evidence of its comparative analgesic effect is conflicting. This meta-analysis compares the analgesic effect and safety of suprascapular block versus interscalene block for shoulder surgery. Databases were searched for randomized trials comparing interscalene block with suprascapular block for shoulder surgery. Postoperative 24-h cumulative oral morphine consumption and the difference in the area under curve for pooled rest pain scores were designated as primary outcomes. Analgesic and safety outcomes, particularly block-related and respiratory complications, were evaluated as secondary outcomes. Results were pooled using random-effects modeling. Data from 16 studies (1,152 patients) were analyzed. Interscalene block and suprascapular block were not different in 24-h morphine consumption. The difference in area under the curve of pain scores for the 24-h interval favored interscalene block by 1.1 cm/h, but this difference was not clinically important. Compared with suprascapular block, interscalene block reduced postoperative pain but not opioid consumption during recovery room stay by a weighted mean difference (95% CI) of 1.5 cm (0.6 to 2.5 cm; P shoulder surgery.

  10. 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.

  11. Feasibility and safety of robot-assisted thoracic surgery for lung lobectomy in patients with non-small cell lung cancer: a systematic review and meta-analysis.

    Science.gov (United States)

    Wei, Shiyou; Chen, Minghao; Chen, Nan; Liu, Lunxu

    2017-05-08

    The aim of this study is to evaluate the feasibility and safety of robot-assisted thoracic surgery (RATS) lobectomy versus video-assisted thoracic surgery (VATS) for lobectomy in patients with non-small cell lung cancer (NSCLC). An electronic search of six electronic databases was performed to identify relevant comparative studies. Meta-analysis was performed by pooling the results of reported incidence of overall morbidity, mortality, prolonged air leak, arrhythmia, and pneumonia between RATS and VATS lobectomy. Subgroup analysis was also conducted based on matched and unmatched cohort studies, if possible. Relative risks (RR) with their 95% confidence intervals (CI) were calculated by means of Revman version 5.3. Twelve retrospective cohort studies were included, with a total of 60,959 patients. RATS lobectomy significantly reduced the mortality rate when compared with VATS lobectomy (RR = 0.54, 95% CI 0.38-0.77; P = 0.0006), but this was not consistent with the pooled result of six matched studies (RR = 0.12, 95% CI 0.01-1.07; P = 0.06). There was no significant difference in morbidity between the two approaches (RR = 0.97, 95% CI 0.85-1.12; P = 0.70). RATS lobectomy is a feasible and safe technique and can achieve an equivalent short-term surgical efficacy when compared with VATS, but its cost effectiveness also should be taken into consideration.

  12. Health Technology Assessment of laparoscopic compared to conventional surgery with and without mesh for incisional hernia repair regarding safety, efficacy and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Willich, Stefan

    2008-03-01

    Medical Documentation and Information (DIMDI as well as by a manual search. The former included the following electronic resources: SOMED (SM78, Cochrane Library – Central (CCTR93, MEDLINE Alert (ME0A, MEDLINE (ME95, CATFILEplus (CATLINE (CA66, ETHMED (ED93, GeroLit (GE79, HECLINET (HN69, AMED (CB85, CAB Abstracts (CV72, GLOBAL Health (AZ72, IPA (IA70, Elsevier BIOBASE (EB94, BIOSIS Previews (BA93, EMBASE (EM95, EMBASE Alert (EA08, SciSearch (IS90, Cochrane Library – CDSR (CDSR93, NHS-CRD-DARE (CDAR94, NHS-CRD-HTA (INAHTA as well as NHSEED (NHSEED. The present report includes German and English literature published until 31.08.2005. The search parameters can be found in the appendix. No limits were placed on the target population. The methodological quality of the included clinical studies was assessed using the criteria recommended by the “Scottish Intercollegiate Guidelines Network Grading Review Group“. Economic studies were evaluated by the criteria of the German Scientific Working Group Technology Assessment for Health Care. Results: The literature search identified 17 relevant medical publications. One of these studies compared laparoscopic and conventional surgery with and without mesh for incisional hernia repair, while 16 studies compared laparoscopic and conventional surgery with mesh for incisional hernia repair. Among these studies were 14 primary studies (one randomised controlled trial (RCT, two systematic reviews and one HTA-Report. The only study comparing laparoscopic and conventional surgery without mesh found substantial differences in terms of baseline characteristics between treatment groups. The outcome parameters showed decreased recurrence rates for the laparoscopic repair and similar safety of the procedures. Studies comparing laparoscopic and conventional surgery with mesh found similar outcome in terms of medical efficacy and safety. However, there was a trend towards lower recurrence rates, length of hospital stay, and postoperative

  13. 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.

  14. Safety study application guide

    International Nuclear Information System (INIS)

    1993-07-01

    Martin Marietta Energy Systems, Inc., (Energy Systems) is committed to performing and documenting safety analyses for facilities it manages for the Department of Energy (DOE). Included are analyses of existing facilities done under the aegis of the Safety Analysis Report Upgrade Program, and analyses of new and modified facilities. A graded approach is used wherein the level of analysis and documentation for each facility is commensurate with the magnitude of the hazard(s), the complexity of the facility and the stage of the facility life cycle. Safety analysis reports (SARs) for hazard Category 1 and 2 facilities are usually detailed and extensive because these categories are associated with public health and safety risk. SARs for Category 3 are normally much less extensive because the risk to public health and safety is slight. At Energy Systems, safety studies are the name given to SARs for Category 3 (formerly open-quotes lowclose quotes) facilities. Safety studies are the appropriate instrument when on-site risks are limited to irreversible consequences to a few people, and off-site consequences are limited to reversible consequences to a few people. This application guide provides detailed instructions for performing safety studies that meet the requirements of DOE Orders 5480.22, open-quotes Technical Safety Requirements,close quotes and 5480.23, open-quotes Nuclear Safety Analysis Reports.close quotes A seven-chapter format has been adopted for safety studies. This format allows for discussion of all the items required by DOE Order 5480.23 and for the discussions to be readily traceable to the listing in the order. The chapter titles are: (1) Introduction and Summary, (2) Site, (3) Facility Description, (4) Safety Basis, (5) Hazardous Material Management, (6) Management, Organization, and Institutional Safety Provisions, and (7) Accident Analysis

  15. 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

  16. Enhanced Recovery after Emergency Surgery: A Systematic Review.

    Science.gov (United States)

    Paduraru, Mihai; Ponchietti, Luca; Casas, Isidro Martinez; Svenningsen, Peter; Zago, Mauro

    2017-04-01

    To evaluate the current scientific evidence for the applicability, safety and effectiveness of pathways of enhanced recovery after emergency surgery (ERAS). We undertook a search using PubMed and Cochrane databases for ERAS protocols in emergency cases. The search generated 65 titles; after eliminating the papers not meeting search criteria, we selected 4 cohort studies and 1 randomized clinical trial (RCT). Data extracted for analysis consisted of: patient age, type of surgery performed, ERAS elements implemented, surgical outcomes in terms of postoperative complications, mortality, length of stay (LOS) and readmission rate. The number of ERAS items applied was good, ranging from 11 to 18 of the 20 recommended by the ERAS Society. The implementation resulted in fewer postoperative complications. LOS for ES patients was shorter when compared to conventional care. Mortality, specifically reported in three studies, was equal or lower with ERAS. Readmission rates varied widely and were generally higher for the intervention group but without statistical significance. The studies reviewed agreed that ERAS in emergency surgery (ES) was feasible and safe with generally better outcomes. Lower compliance with some of the ERAS items shows the need for the protocol to be adapted to ES patients. More evidence is clearly required as to what can improve outcomes and how this can be formulated into an effective care pathway for the heterogeneous ES patient.

  17. Predicting medical complications after spine surgery: a validated model using a prospective surgical registry.

    Science.gov (United States)

    Lee, Michael J; Cizik, Amy M; Hamilton, Deven; Chapman, Jens R

    2014-02-01

    The possibility and likelihood of a postoperative medical complication after spine surgery undoubtedly play a major role in the decision making of the surgeon and patient alike. Although prior study has determined relative risk and odds ratio values to quantify risk factors, these values may be difficult to translate to the patient during counseling of surgical options. Ideally, a model that predicts absolute risk of medical complication, rather than relative risk or odds ratio values, would greatly enhance the discussion of safety of spine surgery. To date, there is no risk stratification model that specifically predicts the risk of medical complication. The purpose of this study was to create and validate a predictive model for the risk of medical complication during and after spine surgery. Statistical analysis using a prospective surgical spine registry that recorded extensive demographic, surgical, and complication data. Outcomes examined are medical complications that were specifically defined a priori. This analysis is a continuation of statistical analysis of our previously published report. Using a prospectively collected surgical registry of more than 1,476 patients with extensive demographic, comorbidity, surgical, and complication detail recorded for 2 years after surgery, we previously identified several risk factor for medical complications. Using the beta coefficients from those log binomial regression analyses, we created a model to predict the occurrence of medical complication after spine surgery. We split our data into two subsets for internal and cross-validation of our model. We created two predictive models: one predicting the occurrence of any medical complication and the other predicting the occurrence of a major medical complication. The final predictive model for any medical complications had a receiver operator curve characteristic of 0.76, considered to be a fair measure. The final predictive model for any major medical complications had

  18. Ergonomics in laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Supe Avinash

    2010-01-01

    Full Text Available Laparoscopic surgery provides patients with less painful surgery but is more demanding for the surgeon. The increased technological complexity and sometimes poorly adapted equipment have led to increased complaints of surgeon fatigue and discomfort during laparoscopic surgery. Ergonomic integration and suitable laparoscopic operating room environment are essential to improve efficiency, safety, and comfort for the operating team. Understanding ergonomics can not only make life of surgeon comfortable in the operating room but also reduce physical strains on surgeon.

  19. Duke Surgery Patient Safety: an open-source application for anonymous reporting of adverse and near-miss surgical events.

    Science.gov (United States)

    Pietrobon, Ricardo; Lima, Raquel; Shah, Anand; Jacobs, Danny O; Harker, Matthew; McCready, Mariana; Martins, Henrique; Richardson, William

    2007-05-01

    Studies have shown that 4% of hospitalized patients suffer from an adverse event caused by the medical treatment administered. Some institutions have created systems to encourage medical workers to report these adverse events. However, these systems often prove to be inadequate and/or ineffective for reviewing the data collected and improving the outcomes in patient safety. To describe the Web-application Duke Surgery Patient Safety, designed for the anonymous reporting of adverse and near-miss events as well as scheduled reporting to surgeons and hospital administration. SOFTWARE ARCHITECTURE: DSPS was developed primarily using Java language running on a Tomcat server and with MySQL database as its backend. Formal and field usability tests were used to aid in development of DSPS. Extensive experience with DSPS at our institution indicate that DSPS is easy to learn and use, has good speed, provides needed functionality, and is well received by both adverse-event reporters and administrators. This is the first description of an open-source application for reporting patient safety, which allows the distribution of the application to other institutions in addition for its ability to adapt to the needs of different departments. DSPS provides a mechanism for anonymous reporting of adverse events and helps to administer Patient Safety initiatives. The modifiable framework of DSPS allows adherence to evolving national data standards. The open-source design of DSPS permits surgical departments with existing reporting mechanisms to integrate them with DSPS. The DSPS application is distributed under the GNU General Public License.

  20. [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.

  1. Robotics in Colorectal Surgery

    Science.gov (United States)

    Weaver, Allison; Steele, Scott

    2016-01-01

    Over the past few decades, robotic surgery has developed from a futuristic dream to a real, widely used technology. Today, robotic platforms are used for a range of procedures and have added a new facet to the development and implementation of minimally invasive surgeries. The potential advantages are enormous, but the current progress is impeded by high costs and limited technology. However, recent advances in haptic feedback systems and single-port surgical techniques demonstrate a clear role for robotics and are likely to improve surgical outcomes. Although robotic surgeries have become the gold standard for a number of procedures, the research in colorectal surgery is not definitive and more work needs to be done to prove its safety and efficacy to both surgeons and patients. PMID:27746895

  2. Barriers to participation in global surgery academic collaborations, and possible solutions: a qualitative study.

    Science.gov (United States)

    Fallah, Parisa Nicole; Bernstein, Mark

    2018-04-06

    OBJECTIVE There is a global lack of access to surgical care, and this issue disproportionately affects those in low- and middle-income countries. Global surgery academic collaborations (GSACs) between surgeons in high-income countries and those in low- and middle-income countries are one possible sustainable way to address the global surgical need. The objective of this study was to examine the barriers to participation in GSACs and to suggest ways to increase involvement. METHODS A convenience sample of 86 surgeons, anesthesiologists, other physicians, residents, fellows, and nurses from the US, Canada, and Norway was used. Participants were all health care providers from multiple specialties and multiple academic centers with varied involvement in GSACs. More than half of the participants were neurosurgeons. Participants were interviewed in person or over Skype in Toronto over the course of 2 months by using a predetermined set of open-ended questions. Thematic content analysis was used to evaluate the participants' responses. RESULTS Based on the data, 3 main themes arose that pointed to individual, community, and system barriers for involvement in GSACs. Individual barriers included loss of income, family commitments, young career, responsibility to local patients, skepticism of global surgery efforts, ethical concerns, and safety concerns. Community barriers included insufficient mentorship and lack of support from colleagues. System barriers included lack of time, minimal academic recognition, insufficient awareness, insufficient administrative support and organization, and low political and funding support. CONCLUSIONS Steps can be taken to address some of these barriers and to increase the involvement of surgeons from high-income countries in GSACs. This could lead to a necessary scale-up of global surgery efforts that may help increase worldwide access to surgical care.

  3. Safety and efficacy of prolonged epidural analgesia after oncologic colorectal surgery

    Directory of Open Access Journals (Sweden)

    R. V. Garyaev

    2012-01-01

    Full Text Available This study demonstrates effective thoracic epidural analgesia by ropivacain 0.2 %, phentanyl 2 mkg/ml, adrenaline 2 mkg/ml in single-use infusion pumps in 124 patients, who underwent surgery for colorectal cancer. Safe, effective and controllable analgesia was observed during surgery and postoperative period. Prolonged analgesia facilitates early rehabilitation and improves gastrointestinal peristaltic activity.  Prolonged epidural analgesia is the recommended method of analgesia in this group of patients.

  4. The effect of expedited rotator cuff surgery in injured workers: a case-control study.

    Science.gov (United States)

    Razmjou, Helen; Lincoln, Sandra; Boljanovic, Dragana; Gallay, Stephen; Henry, Patrick; Richards, Robin R; Holtby, Richard

    2017-07-01

    Expediting rotator cuff surgery is expected to facilitate recovery and return to work in injured workers. This case-control study examined the effect of expedited rotator cuff surgery on recovery and work status in injured workers. Injured workers who had undergone an expedited rotator cuff surgery funded by parallel-pay insurance (study group) were compared with workers who had used the public health insurance (control group) while adjusting for sex, age, severity of pathology, and follow-up period. Disability was measured by the American Shoulder and Elbow Surgeons (ASES) Standardized Assessment Form score. The percentage of patients who exceeded the minimal clinically important difference of 17 points in the ASES was calculated. The study group waited less time to have surgery than the control group (P workers who underwent expedited rotator cuff surgery reported less disability and had a more successful return to work after surgery than injured workers who waited longer for specialist assessment and surgery within the public health system. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  5. Operating force information on-line acquisition of a novel slave manipulator for vascular interventional surgery.

    Science.gov (United States)

    Zhao, Yan; Guo, Shuxiang; Xiao, Nan; Wang, Yuxin; Li, Youxiang; Jiang, Yuhua

    2018-04-02

    Vascular interventional surgery has its advantages compared to traditional operation. Master-slave robotic technology can further improve the operation accuracy, efficiency and safety of this complicated and high risk surgery. However, on-line acquisition of operating force information of catheter and guidewire remains to be a significant obstacle on the path to enhancing robotic surgery safety. Thus, a novel slave manipulator is proposed in this paper to realize on-line sensing of guidewire torsional operating torque and axial operation force during robotic assisted operations. A strain sensor is specially designed to detect the small scale torsional operation torque with low rotational frequency. Additionally, the axial operating force is detected via a load cell, which is incorporated into a sliding mechanism to eliminate the influence of friction. For validation, calibration and performance evaluation experiments are conducted. The results indicate that the proposed operation torque and force detection device is effective. Thus, it can provide the foundation for enabling accurate haptic feedback to the surgeon to improve surgical safety.

  6. Advanced laparoscopic bariatric surgery Is safe in general surgery training.

    Science.gov (United States)

    Kuckelman, John; Bingham, Jason; Barron, Morgan; Lallemand, Michael; Martin, Matthew; Sohn, Vance

    2017-05-01

    Bariatric surgery makes up an increasing percentage of general surgery training. The safety of resident involvement in these complex cases has been questioned. We evaluated patient outcomes in resident performed laparoscopic bariatric procedures. Retrospective review of patients undergoing a laparoscopic bariatric procedure over seven years at a tertiary care single center. Procedures were primarily performed by a general surgery resident and proctored by an attending surgeon. Primary outcomes included operative volume, operative time and leak rate with perioperative outcomes evaluated as secondary outcomes. A total of 1649 bariatric procedures were evaluated. Operations included laparoscopic bypass (690) and laparoscopic sleeve gastrectomy (959). Average operating time was 136 min. Eighteen leaks (0.67%) were identified. Graduating residents performed an average of 89 laparoscopic bariatric cases during their training. There were no significant differences between resident levels with concern to operative time or leak rate (p 0.97 and p = 0.54). General surgery residents can safely perform laparoscopic bariatric surgery. When proctored by a staff surgeon, a resident's level of training does not significantly impact leak rate. Published by Elsevier Inc.

  7. Ethics, economics and the regulation and adoption of new medical devices: case studies in pelvic floor surgery

    Science.gov (United States)

    2010-01-01

    Background Concern has been growing in the academic literature and popular media about the licensing, introduction and adoption of surgical devices before full effectiveness and safety evidence is available to inform clinical practice. Our research will seek empirical survey evidence about the roles, responsibilities, and information and policy needs of the key stakeholders in the introduction into clinical practice of new surgical devices for pelvic floor surgery, in terms of the underlying ethical principals involved in the economic decision-making process, using the example of pelvic floor procedures. Methods/Design Our study involves three linked case studies using, as examples, selected pelvic floor surgery devices representing Health Canada device safety risk classes: low, medium and high risk. Data collection will focus on stakeholder roles and responsibilities, information and policy needs, and perceptions of those of other key stakeholders, in seeking and using evidence about new surgical devices when licensing and adopting them into practice. For each class of device, interviews will be used to seek the opinions of stakeholders. The following stakeholders and ethical and economic principles provide the theoretical framework for the study: Stakeholders - federal regulatory body, device manufacturers, clinicians, patients, health care institutions, provincial health departments, and professional societies. Clinical settings in two centres (in different provinces) will be included. Ethics - beneficence, non-maleficence, autonomy, justice. Economics - scarcity of resources, choices, opportunity costs. For each class of device, responses will be analysed to compare and contrast between stakeholders. Applied ethics and economic theory, analysis and critical interpretation will be used to further illuminate the case study material. Discussion The significance of our research in this new area of ethics will lie in providing recommendations for regulatory bodies

  8. Ethics, economics and the regulation and adoption of new medical devices: case studies in pelvic floor surgery

    Directory of Open Access Journals (Sweden)

    Ross Sue

    2010-08-01

    Full Text Available Abstract Background Concern has been growing in the academic literature and popular media about the licensing, introduction and adoption of surgical devices before full effectiveness and safety evidence is available to inform clinical practice. Our research will seek empirical survey evidence about the roles, responsibilities, and information and policy needs of the key stakeholders in the introduction into clinical practice of new surgical devices for pelvic floor surgery, in terms of the underlying ethical principals involved in the economic decision-making process, using the example of pelvic floor procedures. Methods/Design Our study involves three linked case studies using, as examples, selected pelvic floor surgery devices representing Health Canada device safety risk classes: low, medium and high risk. Data collection will focus on stakeholder roles and responsibilities, information and policy needs, and perceptions of those of other key stakeholders, in seeking and using evidence about new surgical devices when licensing and adopting them into practice. For each class of device, interviews will be used to seek the opinions of stakeholders. The following stakeholders and ethical and economic principles provide the theoretical framework for the study: Stakeholders - federal regulatory body, device manufacturers, clinicians, patients, health care institutions, provincial health departments, and professional societies. Clinical settings in two centres (in different provinces will be included. Ethics - beneficence, non-maleficence, autonomy, justice. Economics - scarcity of resources, choices, opportunity costs. For each class of device, responses will be analysed to compare and contrast between stakeholders. Applied ethics and economic theory, analysis and critical interpretation will be used to further illuminate the case study material. Discussion The significance of our research in this new area of ethics will lie in providing

  9. Efficacy and Safety of Transdermal Buprenorphine versus Oral Tramadol/Acetaminophen in Patients with Persistent Postoperative Pain after Spinal Surgery

    Directory of Open Access Journals (Sweden)

    Jae Hyup Lee

    2017-01-01

    Full Text Available Purpose. Control of persistent pain following spinal surgery is an unmet clinical need. This study compared the efficacy and safety of buprenorphine transdermal system (BTDS to oral tramadol/acetaminophen (TA in Korean patients with persistent, moderate pain following spinal surgery. Methods. Open-label, interventional, randomized multicenter study. Adults with persistent postoperative pain (Numeric Rating Scale [NRS] ≥ 4 at 14–90 days postsurgery were enrolled. Patients received once-weekly BTDS (n=47; 5 μg/h titrated to 20 μg/h or twice-daily TA (n=40; tramadol 37.5 mg/acetaminophen 325 mg, one tablet titrated to 4 tablets for 6 weeks. The study compared pain reduction with BTDS versus TA at week 6. Quality of life (QoL, treatment satisfaction, medication compliance, and adverse events (AEs were assessed. Findings. At week 6, both groups reported significant pain reduction (mean NRS change: BTDS −2.02; TA −2.76, both P<0.0001 and improved QoL (mean EQ-5D index change: BTDS 0.10; TA 0.19, both P<0.05. The BTDS group achieved better medication compliance (97.8% versus 91.0%. Incidence of AEs (26.1% versus 20.0% and adverse drug reactions (20.3% versus 16.9% were comparable between groups. Implications. For patients with persistent pain following spinal surgery, BTDS is an alternative to TA for reducing pain and supports medication compliance. This trial is registered with Clinicaltrials.gov: NCT01983111.

  10. The future of glaucoma surgery

    Directory of Open Access Journals (Sweden)

    Arsham Sheybani

    2015-01-01

    Full Text Available Glaucoma surgery is ripe for innovation. In the last few years, there has been a substantial increase in the number of devices approaching commercialization. While not all that is new is necessarily good, the role of these devices in changing glaucoma surgery is equally important in terms of both success and failure. Trabeculectomy, the most commonly performed incisional filtration surgery for glaucoma, is subjective by nature and certainly has risks. As devices aim to standardize glaucoma surgery, specifically subconjunctival filtration surgery, predictability and in turn safety should theoretically improve. This may allow the glaucoma surgeon to intervene earlier in the disease process, prevent more advanced vision loss and potentially decrease the burden of medications.

  11. Suicidal Ideation and Behaviours Among Adolescents Receiving Bariatric Surgery: A Case-Control Study.

    Science.gov (United States)

    McPhee, Jeanne; Khlyavich Freidl, Eve; Eicher, Julia; Zitsman, Jeffrey L; Devlin, Michael J; Hildebrandt, Tom; Sysko, Robyn

    2015-11-01

    This study examined the prevalence and correlates of suicidal ideation and behaviour (SI/B) among adolescents receiving bariatric surgery. Charts of 206 adolescents receiving bariatric surgery were reviewed. Cases with SI/B (current/lifetime reported at baseline or event occurring in the programme n = 31, 15%) were case matched on gender, age and surgery type to 31 adolescents reporting current or past psychiatric treatment and 31 adolescents denying lifetime SI/B or psychiatric treatment. Before surgery, adolescents with SI/B reported significantly lower total levels of health-related quality of life (p = 0.01) and greater depressive symptoms (p = 0.004) in comparison with candidates who never received psychiatric treatment. No significant differences were found between groups for the change in depressive symptoms or body mass index following surgery. As in studies of adults, a notable subset of adolescents receiving bariatric surgery indicated pre-operative or post-operative SI/B. It is critical that clinicians evaluate and monitor adolescent patients undergoing bariatric surgery for risk of SI/B. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

  12. Suicidal Ideation and Behaviors among Adolescents Receiving Bariatric Surgery: A Case-Control Study

    Science.gov (United States)

    McPhee, Jeanne; Freidl, Eve Khlyavich; Eicher, Julia; Zitsman, Jeffrey L.; Devlin, Michael J.; Hildebrandt, Tom; Sysko, Robyn

    2015-01-01

    Objective This study examined the prevalence and correlates of suicidal ideation and behavior (SI/B) among adolescents receiving bariatric surgery. Method Charts of 206 adolescents receiving bariatric surgery were reviewed. Cases with SI/B (current/lifetime reported at baseline or event occurring in the program n= 31, 15%) were case-matched on gender, age, and surgery type to 31 adolescents reporting current or past psychiatric treatment, and 31 adolescents denying lifetime SI/B or psychiatric treatment. Results Before surgery, adolescents with SI/B reported significantly lower total levels of health-related quality of life (p=0.01) and greater depressive symptoms (p=0.004) in comparison to candidates who never received psychiatric treatment. No significant differences were found between groups for the change in depressive symptoms or body mass index following surgery. Conclusions As in studies of adults, a notable subset of adolescents receiving bariatric surgery indicated pre- or post-operative SI/B. It is critical that clinicians evaluate and monitor adolescent patients undergoing bariatric surgery for risk of SI/B. PMID:26377705

  13. A study on safety climate at nuclear power plants

    International Nuclear Information System (INIS)

    Fukui, Hirokazu; Yoshida, Michio; Yoshiyama, Naohiro

    2001-01-01

    In the current study, we define safety climate as an organizational environment that induces members of the organization to give consideration to safety or take safety actions. It is of utmost importance that people holding managerial positions in an organization have a good understanding of the characteristics of the safety climate of the organization and implement safety promotion activities effectively. In the current research, we studied the rating scales and the characteristics of a safety climate. A survey was conducted, targeting technical engineers who belong to the three power stations of Kansai Electric Power Co., Inc. The questionnaire mainly consisted of questions concerning safety measures taken by individuals and questions concerning safety measures taken by the organization, to which the individuals belong. As a result of a factor analysis of the responses, we extracted five factors, namely, 'confidence in knowledge and skill', attitude of supervisors,' 'safety education in workplace', 'clarity of tasks' and 'safety confirmation/report'. In studying the rating scales of the safety climate, we selected five items from each of the above five factors, and used the total scores of the ratings of the five items as scores of each factor. Then, we examined the correlation between scores of personal factors and scores of organizational environment factors. We treated the scores of safety confirmation/report' and 'confidence in knowledge and skill', which are personal factors, as criterion variables, and the scores of 'attitude of supervisors', 'safety education in workplace' and 'clarity of tasks', which are organizational environment factors, as predictor variables. As a result, we found that levels of 'safety confirmation/report' and 'confidence in knowledge and skill' can be deduced from the scores of 'attitude of supervisors', 'safety education in workplace' and 'clarity of tasks.' Hence, we have decided to use these three organizational environment

  14. Use of fibrin sealants in cardiovascular surgery: a systematic review.

    Science.gov (United States)

    Rousou, John A

    2013-05-01

    Fibrin sealants are used for hemostasis and tissue adherence. This systematic review summarizes published clinical data for fibrin sealant use in cardiovascular surgery. A literature search for the following terms was conducted using PubMed and EMBASE: (TISSEEL or Tissucol or Beriplast P or Evicel or Quixil or Crosseal or Reliseal or Fibringluraas or Bolheal or Tachosil or Vivostat or Vitagel or Artiss or "fibrin glue" or "fibrin sealant" or "fibrin tissue adhesive") and (cardiac or cardiovascular or vascular or heart or coronary or surgery). Case reports and series were excluded; although reports of controlled trials were preferred, uncontrolled trial data were also considered. Clinical trials and chart review analyses of fibrin sealants were identified and summarized. Although clinical trial data were available for other agents, the majority of published studies examined TISSEEL. Overall, TISSEEL and other fibrin sealants showed improvements over standard of care or control groups for a variety of predefined endpoints. Safety findings are also summarized. Data from these studies showed that fibrin sealants were well tolerated and provided effective hemostasis in a range of cardiac and aortic surgeries. © 2013 Wiley Periodicals, Inc.

  15. Feasibility and safety of outpatient breast cancer surgery

    DEFF Research Database (Denmark)

    Duriaud, Helle Molter; Kroman, Niels; Kehlet, Henrik

    2018-01-01

    INTRODUCTION: Improvement in perioperative care programmes has facilitated post-operative recovery and use of short-term or outpatient procedures. The aim of this study was to assess the feasibility and safety of an outpatient breast cancer programme in patients referred to a large breast cancer...

  16. Maternal and perinatal outcomes after bariatric surgery: a case control study.

    Science.gov (United States)

    de Alencar Costa, Laura Arrais Sydrião; Araujo Júnior, Edward; de Lucena Feitosa, Francisco Edson; Dos Santos, Andréa Cavalcante; Moura Júnior, Luiz Gonzaga; Costa Carvalho, Francisco Herlânio

    2016-05-01

    To compare the results of maternal and perinatal pregnancies of obese women after bariatric surgery. A retrospective cross-sectional study was carried out on 63 women who had undergone bariatric surgery and 73 obese women (control). Demographic data, the characteristics of the bariatric surgery, and the maternal and perinatal results were evaluated. The Student's t-test and chi-square test (χ2) were used to compare the groups. The gestational complications of the prevalence of gestational diabetes mellitus, anemia, and preeclampsia were analyzed using simple and multivariate logistical regression and odd ratios (OD) with their respective confidence intervals (CI) of 95%. The average body mass index (BMI) at the 1st prenatal appointment of the control group was 34.6±3.3 kg/m2 and that of the post-surgical group was 26.5±4.2 kg/m2. The Roux-en-Y Gastric Bypass was used in 100% of cases; no complications were observed during or after the surgeries. The average weight loss in patients with a prior bariatric surgery was statistically significant (P=0.000). The average weight at birth of the control group was significantly higher than in the post-bariatric surgery group (P=0.017). The women who had a prior bariatric surgery had a higher chance of anemia (OR=3.5; CI 95%: 1.5-8.3) and a reduced chance of macrosomia (OR=0.2; CI 95%:0.1-0.5), and prematurity (OR=0.3; CI 95%:0.1-0.7). Those women who had been submitted to bariatric surgery presented better maternal and perinatal results when compared to obese women.

  17. 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…

  18. Simultaneous bilateral cataract surgery: economic analysis; Helsinki Simultaneous Bilateral Cataract Surgery Study Report 2.

    Science.gov (United States)

    Leivo, Tiina; Sarikkola, Anna-Ulrika; Uusitalo, Risto J; Hellstedt, Timo; Ess, Sirje-Linda; Kivelä, Tero

    2011-06-01

    To present an economic-analysis comparison of simultaneous and sequential bilateral cataract surgery. Helsinki University Eye Hospital, Helsinki, Finland. Economic analysis. Effects were estimated from data in a study in which patients were randomized to have bilateral cataract surgery on the same day (study group) or sequentially (control group). The main clinical outcomes were corrected distance visual acuity, refraction, complications, Visual Function Index-7 (VF-7) scores, and patient-rated satisfaction with vision. Health-care costs of surgeries and preoperative and postoperative visits were estimated, including the cost of staff, equipment, material, floor space, overhead, and complications. The data were obtained from staff measurements, questionnaires, internal hospital records, and accountancy. Non-health-care costs of travel, home care, and time were estimated based on questionnaires from a random subset of patients. The main economic outcome measures were cost per VF-7 score unit change and cost per patient in simultaneous versus sequential surgery. The study comprised 520 patients (241 patients included non-health-care and time cost analyses). Surgical outcomes and patient satisfaction were similar in both groups. Simultaneous cataract surgery saved 449 Euros (€) per patient in health-care costs and €739 when travel and paid home-care costs were included. The savings added up to €849 per patient when the cost of lost working time was included. Compared with sequential bilateral cataract surgery, simultaneous bilateral cataract surgery provided comparable clinical outcomes with substantial savings in health-care and non-health-care-related costs. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  19. Re-birth after coronary bypass graft surgery: a hermeneutic-phenomenological study.

    Science.gov (United States)

    Abbasi, Mohammad; Mohammadi, Nooredin; Nasrabadi, Alireza Nikbakht; Fuh, Suh Boudouin; Sadeghi, Tahereh

    2014-03-31

    Although coronary artery bypass graft surgery has significant effects on reducing the symptoms of coronary artery disease, there is not enough knowledge and understanding of lived experience of patients after surgery. Understanding lived experience of this group of patients would be helpful for healthcare staff to provide better services to the patients. The aim of this study was to describe with a deeper understanding, the lived experiences of patients after Coronary Artery Bypass Graft Surgery. Using a hermeneutic phenomenological approach and a Van-Manen analysis method, in-depth semi-structured interviews were conducted with eleven participants who had lived experienced of at least six months post - coronary artery bypass graft surgery. Re-birth was the main theme that emerged in the process of data analysis. This theme was derived from four sub-themes including "feels younger", ''vigorous heart'', ''intrepid life'' and ''oriented to be healthy''. Life after a coronary artery bypass graft surgery is often appreciated as a re-birth by persons with these experiences as surgery did not only provide a feeling of wellness, but also added a sensation of youthfulness and improvement in the quality of life for these participants. In addition, they would actively participate in health promotional activities such as; adherence to medication and diet regimes, changes in lifestyle to maintain their health.

  20. Systemic and Topical Use of Tranexamic Acid in Spinal Surgery: A Systematic Review

    Science.gov (United States)

    Winter, Sebastian F.; Santaguida, Carlo; Wong, Jean; Fehlings, Michael G.

    2015-01-01

    Study Design Combination of narrative and systematic literature reviews. Objectives Massive perioperative blood loss in complex spinal surgery often requires blood transfusions and can negatively affect patient outcome. Systemic use of the antifibrinolytic agent tranexamic acid (TXA) has become widely used in the management of surgical bleeding. We review the clinical evidence for the use of intravenous TXA as a hemostatic agent in spinal surgery and discuss the emerging role for its complementary use as a topical agent to reduce perioperative blood loss from the surgical site. Through a systematic review of published and ongoing investigations on topical TXA for spinal surgery, we wish to make spine practitioners aware of this option and to suggest opportunities for further investigation in the field. Methods A narrative review of systemic TXA in spinal surgery and topical TXA in surgery was conducted. Furthermore, a systematic search (using PRISMA guidelines) of PubMed (MEDLINE), EMBASE, and Cochrane CENTRAL databases as well as World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov (National Institutes of Health), and International Standard Randomized Controlled Trial Number registries was conducted to identify both published literature and ongoing clinical trials on topical TXA in spinal surgery. Results Of 1,631 preliminary search results, 2 published studies were included in the systematic review. Out of 285 ongoing clinical trials matching the search criteria, a total of 4 relevant studies were included and reviewed. Conclusion Intravenous TXA is established as an efficacious hemostatic agent in spinal surgery. Use of topical TXA in surgery suggests similar hemostatic efficacy and potentially improved safety as compared with intravenous TXA. For spinal surgery, the literature on topical TXA is sparse but promising, warranting further clinical investigation and consideration as a clinical option in cases with

  1. Implementation of laparoscopic approach in colorectal surgery - a single center's experience.

    Science.gov (United States)

    Kwiatkowski, Andrzej P; Stępińska, Gabriela; Stanowski, Edward; Paśnik, Krzysztof

    2018-03-01

    Implementation of the laparoscopic approach in colorectal surgery has not happened as rapidly as in cholecystectomy, because of concerns about oncological safety. The results of controlled trials in multiple centers showed the method to be safe. Consequently, surgeons decided to try the approach with colorectal surgery. This process, in our clinic, began in earnest about four years ago. To analyze and present the clinical outcomes of applying the laparoscopic approach to colorectal surgery in a single center. We retrospectively identified patients from a hospital database who underwent colorectal surgery - laparoscopic and open - between 2013 and 2016. Our focus was on laparoscopic cases. Study points included operative time, duration of the hospital stay, postoperative mortality and rates of complications, conversion, reoperation and readmission. Of 534 cases considered, the results showed that the relation between open and laparoscopic procedures had reversed, in favor of the latter method (2013: open: 82% vs. laparoscopic: 18%; 2016: open: 22.4% vs. laparoscopic: 77.6%). The most commonly performed procedure was right hemicolectomy. The total complication rate was 22%. The total rate of conversion to open surgery was 9.3%. The postoperative mortality rate was 3%. Use of the laparoscopic approach in colorectal surgery has increased in recent years world-wide - including in Poland - but the technique is still underused. Rapid implementation of the miniinvasive method in colorectal surgery, in centers with previous laparoscopic experience, is not only safe and feasible, but also highly recommended.

  2. The safety and efficacy of gamma knife surgery in management of glomus jugulare tumor

    Science.gov (United States)

    2010-01-01

    Background Glomus jugulare is a slowly growing, locally destructive tumor located in the skull base with difficult surgical access. The operative approach is, complicated by the fact that lesions may be both intra and extradural with engulfment of critical neurovascular structures. The tumor is frequently highly vascular, thus tumor resection entails a great deal of morbidity and not infrequent mortality. At timeslarge residual tumors are left behind. To decrease the morbidity associated with surgical resection of glomus jugulare, gamma knife surgery (GKS) was performed as an alternative in 13 patients to evaluate its safety and efficacy. Methods A retrospective review of 13 residual or unresectable glomus jagulare treated with GKS between 2004 and 2008.. Of these, 11 patients underwent GKS as the primary management and one case each was treated for postoperative residual disease and postembolization. The radiosurgical dose to the tumor margin ranged between 12-15 Gy. Results Post- gamma knife surgery and during the follow-up period twelve patients demonstrated neurological stability while clinical improvement was achieved in 5 patients. One case developed transient partial 7th nerve palsy that responded to medical treatment. In all patients radiographic MRI follow-up was obtained, the tumor size decreased in two cases and remained stable (local tumor control) in eleven patients. Conclusions Gamma knife surgery provids tumor control with a lowering of risk of developing a new cranial nerve injury in early follow-up period. This procedure can be safely used as a primary management tool in patients with glomus jugulare tumors, or in patients with recurrent tumors in this location. If long-term results with GKS are equally effective it will emerge as a good alternative to surgical resection. PMID:20819207

  3. A study on safety climate at nuclear power plants

    Energy Technology Data Exchange (ETDEWEB)

    Fukui, Hirokazu [Institute of Nuclear Safety System Inc., Mihama, Fukui (Japan); Yoshida, Michio; Yoshiyama, Naohiro [Japan Institute for Group Dynamics, Fukuoka (Japan)

    2001-09-01

    In the current study, we define safety climate as an organizational environment that induces members of the organization to give consideration to safety or take safety actions. It is of utmost importance that people holding managerial positions in an organization have a good understanding of the characteristics of the safety climate of the organization and implement safety promotion activities effectively. In the current research, we studied the rating scales and the characteristics of a safety climate. A survey was conducted, targeting technical engineers who belong to the three power stations of Kansai Electric Power Co., Inc. The questionnaire mainly consisted of questions concerning safety measures taken by individuals and questions concerning safety measures taken by the organization, to which the individuals belong. As a result of a factor analysis of the responses, we extracted five factors, namely, 'confidence in knowledge and skill', attitude of supervisors,' 'safety education in workplace', 'clarity of tasks' and 'safety confirmation/report'. In studying the rating scales of the safety climate, we selected five items from each of the above five factors, and used the total scores of the ratings of the five items as scores of each factor. Then, we examined the correlation between scores of personal factors and scores of organizational environment factors. We treated the scores of safety confirmation/report' and 'confidence in knowledge and skill', which are personal factors, as criterion variables, and the scores of 'attitude of supervisors', 'safety education in workplace' and 'clarity of tasks', which are organizational environment factors, as predictor variables. As a result, we found that levels of 'safety confirmation/report' and 'confidence in knowledge and skill' can be deduced from the scores of 'attitude of supervisors', 'safety

  4. EnViSoRS: Enhanced Vision System for Robotic Surgery. A User-Defined Safety Volume Tracking to Minimize the Risk of Intraoperative Bleeding

    Directory of Open Access Journals (Sweden)

    Veronica Penza

    2017-05-01

    Full Text Available In abdominal surgery, intraoperative bleeding is one of the major complications that affect the outcome of minimally invasive surgical procedures. One of the causes is attributed to accidental damages to arteries or veins, and one of the possible risk factors falls on the surgeon’s skills. This paper presents the development and application of an Enhanced Vision System for Robotic Surgery (EnViSoRS, based on a user-defined Safety Volume (SV tracking to minimize the risk of intraoperative bleeding. It aims at enhancing the surgeon’s capabilities by providing Augmented Reality (AR assistance toward the protection of vessels from injury during the execution of surgical procedures with a robot. The core of the framework consists in (i a hybrid tracking algorithm (LT-SAT tracker that robustly follows a user-defined Safety Area (SA in long term; (ii a dense soft tissue 3D reconstruction algorithm, necessary for the computation of the SV; (iii AR features for visualization of the SV to be protected and of a graphical gage indicating the current distance between the instruments and the reconstructed surface. EnViSoRS was integrated with a commercial robotic surgical system (the dVRK system for testing and validation. The experiments aimed at demonstrating the accuracy, robustness, performance, and usability of EnViSoRS during the execution of a simulated surgical task on a liver phantom. Results show an overall accuracy in accordance with surgical requirements (<5 mm, and high robustness in the computation of the SV in terms of precision and recall of its identification. The optimization strategy implemented to speed up the computational time is also described and evaluated, providing AR features update rate up to 4 fps, without impacting the real-time visualization of the stereo endoscopic video. Finally, qualitative results regarding the system usability indicate that the proposed system integrates well with the commercial surgical robot and

  5. Efficacy and safety of venous thromboembolism prophylaxis with apixaban in major orthopedic surgery

    Directory of Open Access Journals (Sweden)

    Werth S

    2012-03-01

    Full Text Available Sebastian Werth, Kai Halbritter, Jan Beyer-WestendorfCenter for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital “Carl Gustav Carus” Dresden, Dresden, GermanyAbstract: Over the last 15 years, low-molecular-weight heparins (LMWHs have been accepted as the “gold standard” for pharmaceutical thromboprophylaxis in patients at high risk of venous thromboembolism (VTE in most countries around the world. Patients undergoing major orthopedic surgery (MOS represent a population with high risk of VTE, which may remain asymptomatic or become symptomatic as deep vein thrombosis or pulmonary embolism. Numerous trials have investigated LMWH thromboprophylaxis in this population and demonstrated high efficacy and safety of these substances. However, LMWHs have a number of disadvantages, which limit the acceptance of patients and physicians, especially in prolonged prophylaxis up to 35 days after MOS. Consequently, new oral anticoagulants (NOACs were developed that are of synthetic origin and act as direct and very specific inhibitors of different factors in the coagulation cascade. The most developed NOACs are dabigatran, rivaroxaban, and apixaban, all of which are approved for thromboprophylaxis in MOS in a number of countries around the world. This review is focused on the pharmacological characteristics of apixaban in comparison with other NOACs, on the impact of NOAC on VTE prophylaxis in daily care, and on the management of specific situations such as bleeding complications during NOAC therapy.Keywords: major orthopedic surgery, apixaban, dabigatran, edoxaban, rivaroxaban, deep vein thrombosis, venous thromboembolism, VTE prophylaxis

  6. Magnetic resonance imaging for cerebral lesions during minimal invasive mitral valve surgery: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Barbero, Cristina; Ricci, Davide; Cura Stura, Erik; Pellegrini, Augusto; Marchetto, Giovanni; ElQarra, Suad; Boffini, Massimo; Passera, Roberto; Valentini, Maria Consuelo; Rinaldi, Mauro

    2017-02-21

    Recent data have highlighted a higher rate of neurological injuries in minimal invasive mitral valve surgery (MIMVS) compared with the standard sternotomy approach; therefore, the role of specific clamping techniques and perfusion strategies on the occurrence of this complication is a matter of discussion in the medical literature. The purpose of this trial is to prospectively evaluate major, minor and silent neurological events in patients undergoing right mini-thoracotomy mitral valve surgery using retrograde perfusion and an endoaortic clamp or a transthoracic clamp. A prospective, blinded, randomized controlled study on the rate of neurological embolizations during MIMVS started at the University of Turin in June 2014. Major, minor and silent neurological events are being investigated through standard neurological evaluation and magnetic resonance imaging assessment. The magnetic resonance imaging protocol includes conventional sequences for the morphological and quantitative assessment and nonconventional sequences for the white matter microstructural evaluation. Imaging studies are performed before surgery as baseline assessment and on the third postoperative day and, in patients who develop postoperative ischemic lesions, after 6 months. Despite recent concerns raised about the endoaortic setting with retrograde perfusion, we expect to show equivalence in terms of neurological events of this technique compared with the transthoracic clamp in a selected cohort of patients. With the first results expected in December 2016 the findings would be of help in confirming the efficacy and safety of MIMVS. ClinicalTrials.gov, Identifier: NCT02818166 . Registered on 8 February 2016 - trial retrospectively registered.

  7. HBOC-201 as an alternative to blood transfusion: efficacy and safety evaluation in a multicenter phase III trial in elective orthopedic surgery.

    Science.gov (United States)

    Jahr, Jonathan S; Mackenzie, Colin; Pearce, L Bruce; Pitman, Arkadiy; Greenburg, A Gerson

    2008-06-01

    The ability of hemoglobin based oxygen carrier-201 (HBOC-201) to safely reduce and/or eliminate perioperative transfusion was studied in orthopedic surgery patients. A randomized, single-blind, packed red blood cell (PRBC)-controlled, parallel-group multicenter study was conducted. Six hundred eighty-eight patients were randomized to treatment with HBOC-201 (H, n = 350) or PRBC (R, n = 338) at the first transfusion decision. Primary endpoints were transfusion avoidance and blinded assessment [Mann-Whitney estimator (MW)] of safety noninferiority. Groups were compared directly and by paired/matching group analyses predicated on a prospectively defined dichotomy [treatment success (HH) vs. failure (HR)] in the H arm and an equivalently defined dichotomy [3 (R3+) units PRBC] in the R arm, based on need (moderate vs. high) for additional oxygen carrying capacity. A total of 59.4% of patients in the H arm avoided PRBC transfusion. Adverse events (8.47 vs. 5.88), and serious adverse events (SAEs) (0.35 vs. 0.25) per patient were higher in the H versus R arms (p 80 years), volume overload and undertreatment contributed to this imbalance. HBOC-201 eliminated transfusion in the majority of subjects. The between arms (H vs. R) safety analysis was unfavorable and likely related to patient age, volume overload, and undertreatment and was isolated to patients that could not be managed by HBOC-201 alone. However, patients transfusion when treated with up to 10 units of HBOC-201.

  8. Surgery resident selection and evaluation. A critical incident study.

    Science.gov (United States)

    Edwards, J C; Currie, M L; Wade, T P; Kaminski, D L

    1993-03-01

    This article reports a study of the process of selecting and evaluating general surgery residents. In personnel psychology terms, a job analysis of general surgery was conducted using the Critical Incident Technique (CIT). The researchers collected 235 critical incidents through structured interviews with 10 general surgery faculty members and four senior residents. The researchers then directed the surgeons in a two-step process of sorting the incidents into categories and naming the categories. The final essential categories of behavior to define surgical competence were derived through discussion among the surgeons until a consensus was formed. Those categories are knowledge/self-education, clinical performance, diagnostic skills, surgical skills, communication skills, reliability, integrity, compassion, organization skills, motivation, emotional control, and personal appearance. These categories were then used to develop an interview evaluation form for selection purposes and a performance evaluation form to be used throughout residency training. Thus a continuum of evaluation was established. The categories and critical incidents were also used to structure the interview process, which has demonstrated increased interview validity and reliability in many other studies. A handbook for structuring the interviews faculty members conduct with applicants was written, and an interview training session was held with the faculty. The process of implementation of the structured selection interviews is being documented currently through qualitative research.

  9. Current status of robotic bariatric surgery: a systematic review

    Science.gov (United States)

    2013-01-01

    Background Bariatric surgery is an effective treatment to obtain weight loss in severely obese patients. The feasibility and safety of bariatric robotic surgery is the topic of this review. Methods A search was performed on PubMed, Cochrane Central Register of Controlled Trials, BioMed Central, and Web of Science. Results Twenty-two studies were included. Anastomotic leak rate was 8.51% in biliopancreatic diversion. 30-day reoperation rate was 1.14% in Roux-en-Y gastric bypass and 1.16% in sleeve gastrectomy. Major complication rate in Roux-en-Y gastric bypass resulted higher than in sleeve gastrectomy ( 4,26% vs. 1,2%). The mean hospital stay was longer in Roux-en-Y gastric bypass (range 2.6-7.4 days). Conclusions The major limitation of our analysis is due to the small number and the low quality of the studies, the small sample size, heterogeneity of the enrolled patients and the lack of data from metabolic and bariatric outcomes. Despite the use of the robot, the majority of these cases are completed with stapled anastomosis. The assumption that robotic surgery is superior in complex cases is not supported by the available present evidence. The major strength of the robotic surgery is strongly facilitating some of the surgical steps (gastro-jejunostomy and jejunojejunostomy anastomosis in the robotic Roux-en-Y gastric bypass or the vertical gastric resection in the robotic sleeve gastrectomy). PMID:24199869

  10. "Like a trip to McDonalds": a grounded theory study of patient experiences of day surgery.

    Science.gov (United States)

    Mottram, Anne

    2011-02-01

    The amount and complexity of (ambulatory) day surgery is rapidly expanding internationally. Nurses have a responsibility to provide quality care for day surgery patients. To do this they must understand all aspects of the patient experience. There is dearth of research into day surgery using a sociological frame of reference. The study investigated patients' experiences of day surgery using a sociological frame of reference. A qualitative study using the grounded theory approach was used. The study was based in two day surgery units in two urban public hospitals in the United Kingdom. 145 patients aged 18-70 years and 100 carers were purposely selected from the orthopaedic, ear nose and throat and general surgical lists. They were all English speaking and were of varied socio-economic background. The data was collected from 2004 to 2006. Semi-structured interviews were conducted on three occasions: before surgery, 48 h following surgery and one month following discharge. Permission was received from the Local Research Ethics Committee. Analysis of the data involved line-by-line analysis, compilation of key words and phrases (codes) and constant comparison of the codes until categories emerged. Patients liked day surgery and placed it within the wider societal context of efficiency and speed. Time was a major issue for them. They wished surgery, like all other aspects of their life to be a speedy process. They likened it to a McDonald's experience with its emphasis on speed, predictability and control. This study throws new light on patient experiences and offers an understanding of day surgery against a western culture which emphasises the importance of speed and efficiency. It is a popular choice for patients but at times it can be seen to be a mechanistic way of providing care. The implications for nurses to provide education and information to add to the quality of the patient experience are discussed. Copyright © 2010 Elsevier Ltd. All rights reserved.

  11. De-hospitalization of the pediatric day surgery by means of a freestanding surgery center: pilot study in the lazio region

    Directory of Open Access Journals (Sweden)

    Mangia Giovanni

    2012-02-01

    Full Text Available Abstract Background Day surgery should take place in appropriate organizational settings. In the presence of high volumes, the organizational models of the Lazio Region are represented by either Day Surgery Units within continuous-cycle hospitals or day-cycle Day Surgery Centers. This pilot study presents the regional volumes provided in 2010 and the additional volumes that could be provided based on the best performance criterion with a view to suggesting the setting up of a regional Freestanding Center of Pediatric Day Surgery. Methods This is an observational retrospective study. The activity volumes have been assessed by means of a DRG (Diagnosis Related Group-specific indicator that measures the ratio of outpatients to the total number of treated patients (freestanding indicator, FI. The included DRGs had an FI exceeding the 3rd quartile present in at least a health-care facility and a volume exceeding 0.5% of the total patients of the pediatric surgery and urology facilities of the Lazio Region. The relevant data have been provided by the Public Health Agency and relate to 2010. The best performance FI has been used to calculate the theoretical volume of transferability of the remaining facilities into freestanding surgery centers. Patients under six months of age and DRGs common to other disciplines have been excluded. The Chi Square test has been used to compare the FI of the health-care facilities and the FI of the places of origin of the patients. Results The DRG provided in 2010 amounted to a total of 5768 belonging to 121 types of procedures. The application of the criteria of inclusion have led to the selection of seven final DRG categories of minor surgery amounting to 3522 cases. Out of this total number, there were 2828 outpatients and 694 inpatients. The recourse of the best performance determines a potential transfer of 497 cases. The total outpatient volume is 57%. The Chi Square test has pointed to a statistically significant

  12. Comparative study of postoperative stability between conventional orthognathic surgery and a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy for skeletal class III correction.

    Science.gov (United States)

    Mah, Deuk-Hyun; Kim, Su-Gwan; Oh, Ji-Su; You, Jae-Seek; Jung, Seo-Yun; Kim, Won-Gi; Yu, Kyung-Hwan

    2017-02-01

    The purpose of this study is to compare the postoperative stability of conventional orthognathic surgery to a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy (BSSRO). The study included 20 patients who underwent BSSRO for skeletal class III conventional orthognathic surgery and 20 patients who underwent a surgery-first orthognathic approach. Serial lateral cephalograms were analyzed to identify skeletal changes before surgery (T0), immediately after surgery (T1), and after surgery (T2, after 1 year or at debonding). The amount of relapse of the mandible in the conventional orthognathic surgery group from T1 to T2 was 2.23±0.92 mm ( P surgery-first orthognathic approach group from T1 to T2 was 3.49±1.71 mm ( P surgery-first orthognathic approach. Therefore, careful planning and skeletal stability should be considered in orthognathic surgery.

  13. Developing the Blueprint for a General Surgery Technical Skills Certification Examination: A Validation Study.

    Science.gov (United States)

    de Montbrun, Sandra; Louridas, Marisa; Szasz, Peter; Harris, Kenneth A; Grantcharov, Teodor P

    There is a recognized need to develop high-stakes technical skills assessments for decisions of certification and resident promotion. High-stakes examinations requires a rigorous approach in accruing validity evidence throughout the developmental process. One of the first steps in development is the creation of a blueprint which outlines the potential content of examination. The purpose of this validation study was to develop an examination blueprint for a Canadian General Surgery assessment of technical skill certifying examination. A Delphi methodology was used to gain consensus amongst Canadian General Surgery program directors as to the content (tasks or procedures) that could be included in a certifying Canadian General Surgery examination. Consensus was defined a priori as a Cronbach's α ≥ 0.70. All procedures or tasks reaching a positive consensus (defined as ≥80% of program directors rated items as ≥4 on the 5-point Likert scale) were then included in the final examination blueprint. Two Delphi rounds were needed to reach consensus. Of the 17 General Surgery Program directors across the country, 14 (82.4%) and 10 (58.8%) program directors responded to the first and second round, respectively. A total of 59 items and procedures reached positive consensus and were included in the final examination blueprint. The present study has outlined the development of an examination blueprint for a General Surgery certifying examination using a consensus-based methodology. This validation study will serve as the foundational work from which simulated model will be developed, pilot tested and evaluated. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  14. Ergonomics in office-based surgery: a survey-guided observational study.

    Science.gov (United States)

    Esser, Adam C; Koshy, James G; Randle, Henry W

    2007-11-01

    The practice of office-based surgery is increasing in many specialties. Using Mohs surgery as a model, we investigated the role of ergonomics in office-based surgery to limit work-related musculoskeletal disorders. All Mayo Clinic surgeons currently performing Mohs surgery and Mohs surgeons trained at Mayo Clinic between 1990 and 2004 received a questionnaire survey between May 2003 and September 2004. A sample of respondents were videotaped during surgery. The main outcome measures were survey responses and an ergonomist's identification of potential causes of musculoskeletal disorders. All 17 surgeons surveyed responded. Those surveyed spend a mean of 24 hours per week in surgery. Sixteen said they had symptoms caused by or made worse by performing surgery. Symptom onset occurred on average at age 35.4 years. The most common complaints were pain and stiffness in the neck, shoulders, and lower back and headaches. Videotapes of 6 surgeons revealed problems with operating room setup, awkward posture, forceful exertion, poor positioning, lighting, and duration of procedures. Symptoms of musculoskeletal injuries are common and may begin early in a physician's career. Modifying footwear, flooring, table height, operating position, lighting, and surgical instruments may improve the ergonomics of office-based surgery.

  15. [Robotic general surgery: where do we stand in 2013?].

    Science.gov (United States)

    Buchs, Nicolas C; Pugin, François; Ris, Frédéric; Jung, Minoa; Hagen, Monika E; Volonté, Francesco; Azagury, Dan; Morel, Philippe

    2013-06-19

    While the number of publications concerning robotic surgery is increasing, the level of evidence remains to be improved. The safety of robotic approach has been largely demonstrated, even for complex procedures. Yet, the objective advantages of this technology are still lacking in several fields, notably in comparison to laparoscopy. On the other hand, the development of robotic surgery is on its way, as the enthusiasm of the public and the surgical community can testify. Still, clear clinical indications remain to be determined in the field of general surgery. The study aim is to review the current literature on robotic general surgery and to give the reader an overview in 2013.

  16. Incidence and prognostic factors for postoperative frozen shoulder after shoulder surgery: a prospective cohort study.

    Science.gov (United States)

    Koorevaar, Rinco C T; Van't Riet, Esther; Ipskamp, Marcel; Bulstra, Sjoerd K

    2017-03-01

    Frozen shoulder is a potential complication after shoulder surgery. It is a clinical condition that is often associated with marked disability and can have a profound effect on the patient's quality of life. The incidence, etiology, pathology and prognostic factors of postoperative frozen shoulder after shoulder surgery are not known. The purpose of this explorative study was to determine the incidence of postoperative frozen shoulder after various operative shoulder procedures. A second aim was to identify prognostic factors for postoperative frozen shoulder after shoulder surgery. 505 consecutive patients undergoing elective shoulder surgery were included in this prospective cohort study. Follow-up was 6 months after surgery. A prediction model was developed to identify prognostic factors for postoperative frozen shoulder after shoulder surgery using the TRIPOD guidelines. We nominated five potential predictors: gender, diabetes mellitus, type of physiotherapy, arthroscopic surgery and DASH score. Frozen shoulder was identified in 11% of the patients after shoulder surgery and was more common in females (15%) than in males (8%). Frozen shoulder was encountered after all types of operative procedures. A prediction model based on four variables (diabetes mellitus, specialized shoulder physiotherapy, arthroscopic surgery and DASH score) discriminated reasonably well with an AUC of 0.712. Postoperative frozen shoulder is a serious complication after shoulder surgery, with an incidence of 11%. Four prognostic factors were identified for postoperative frozen shoulder: diabetes mellitus, arthroscopic surgery, specialized shoulder physiotherapy and DASH score. The combination of these four variables provided a prediction rule for postoperative frozen shoulder with reasonable fit. Level II, prospective cohort study.

  17. Carotid body paragangliomas : a systematic study on management with surgery and radiotherapy

    NARCIS (Netherlands)

    Suarez, Carlos; Rodrigo, Juan P.; Mendenhall, William M.; Hamoir, Marc; Silver, Carl E.; Gregoire, Vincent; Strojan, Primoz; Neumann, Hartmut P. H.; Obholzer, Rupert; Offergeld, Christian; Langendijk, Johannes A.; Rinaldo, Alessandra; Ferlito, Alfio

    The definitive universally accepted treatment for carotid body tumors (CBT) is surgery. The impact of surgery on cranial nerves and the carotid artery has often been underestimated. Alternatively, a few CBTs have been followed without treatment or irradiation. The goal of this study is to summarize

  18. Probabilistic studies for a safety assurance program

    International Nuclear Information System (INIS)

    Iyer, S.S.; Davis, J.F.

    1985-01-01

    The adequate supply of energy is always a matter of concern for any country. Nuclear power has played, and will continue to play an important role in supplying this energy. However, safety in nuclear power production is a fundamental prerequisite in fulfilling this role. This paper outlines a program to ensure safe operation of a nuclear power plant utilizing the Probabilistic Safety Studies

  19. A qualitative study of regional anaesthesia for vitreo-retinal surgery.

    Science.gov (United States)

    McCloud, Christine; Harrington, Ann; King, Lindy

    2014-05-01

    The aim of this research was to collect experiential knowledge about regional ocular anaesthesia - an integral component of most vitreo-retinal surgery. Anaesthesia for vitreo-retinal surgery has predominantly used general anaesthesia, because of the length and complexity of the surgical procedure. However, recent advances in surgical instrumentation and techniques have reduced surgical times; this decision has led to the adoption of regional ocular anaesthesia for vitreo-retinal day surgery. Although regional ocular anaesthesia has been studied from several perspectives, knowledge about patients' experience of the procedure is limited. An interpretive qualitative research methodology underpinned by Gadamer's philosophical hermeneutics. Eighteen participants were interviewed in-depth between July 2006-December 2007 following regional ocular anaesthesia. Interview data were thematically analysed by coding and grouping concepts. Four themes were identified: 'not knowing': the time prior to the experience of a regional eye block; 'experiencing': the experience of regional ocular anaesthesia; 'enduring': the capacity participants displayed to endure regional ocular anaesthesia with the hope that their vision would be restored; and 'knowing': when further surgery was required and past experiences were recalled. The experience of regional ocular anaesthesia had the capacity to invoke anxiety in the participants in this study. Many found the experience overwhelming and painful. What became clear was the participant's capacity to stoically 'endure' regional ocular anaesthesia, indicating the value people placed on visual function. © 2013 John Wiley & Sons Ltd.

  20. Can povidone-iodine solution be used safely in a spinal surgery?

    Science.gov (United States)

    Chang, Fang-Yeng; Chang, Ming-Chau; Wang, Shih-Tien; Yu, Wing-Kwang; Liu, Chien-Lin; Chen, Tain-Hsiung

    2006-06-01

    Intra-operative incidental contamination of surgical wounds is not rare. Povidone-iodine solution can be used to disinfect surgical wounds. Although povidone-iodine is a good broad-spectrum disinfecting agent, it has occasionally been reported to have a negative effect on wound healing and bone union. Therefore, its safety in a spinal surgery is unclear. A prospective, single-blinded, randomized study was accordingly conducted to evaluate the safety of povidone-iodine solution in spinal surgeries. Ascertained herein was the effect of wound irrigation with diluted povidone-iodine solution on wound healing, infection rate, fusion status and clinical outcome of spinal surgeries. From January 2002 to August 2003, 244 consecutive cases undergoing primary instrumented lumbosacral posterolateral fusion due to degenerative spinal disorder with segmental instability had been collected and randomly divided into two groups: the study group (120 cases, 212 fusion levels) and the control group (124 cases, 223 fusion levels). Excluded were those patients with a prior spinal surgery, spinal trauma, malignant tumor, infectious spondylitis, rheumatoid arthritis, ankylosing spondylitis, metabolic bone disease, skeletal immaturity or with an immunosuppressive treatment. In the former group, wounds were irrigated with 0.35% povidone-iodine solution followed by normal saline solution just before the bone-grafting and instrumentation procedure. However, only with normal saline solution in the latter. All the operations were done by the same surgeon with a standard technique. All the patients were treated in the same postoperative fashion as well. Later on, wound healing, infection rate, spinal bone fusion and clinical outcome were evaluated in both groups. A significant improvement of back and leg pain scores, modified Japanese Orthopedic Association function scores (JOA) and ambulatory capacity have been observed in both groups. One hundred and seven patients in the study group and one

  1. Changes in taste preference after colorectal surgery: A longitudinal study.

    Science.gov (United States)

    Welchman, Sophie; Hiotis, Perryhan; Pengelly, Steven; Hughes, Georgina; Halford, Jason; Christiansen, Paul; Lewis, Stephen

    2015-10-01

    Nutrition is a key component of surgical enhanced recovery programmes. However, alterations in food preferences are often reported as reasons for patients not eating in the early postoperative period. We hypothesised that taste preferences are altered in the early postoperative period and this dysgeusia affects patients' food choices during this critical time. This is a longitudinal study looking at taste preferences of patients recovering from surgery. Patients undergoing colonic resections were recruited. Using visual analogue scales participants completed a questionnaire, taste tests and preference scoring of food images for the 6 groups of taste (bitter, salty, savoury, sour, spicy and sweet) preoperatively and on postoperative days 1-3. Patients were also offered snacks postoperatively, which represented foods from the six groups and consumption was measured. Differences from baseline were assessed using the Friedman's and Wilcoxon tests. 31 patients were studied. In the immediate postoperative period participants reported deterioration in their sense of taste (p ≤ 0.001), increased nausea (p palatability for salty taste increased (p = 0.001) following surgery. The highest rated images were for savoury food with only the ratings for salty food increasing after surgery (p foods in the postoperative period. Bitter, sour and spicy foods were the least frequently consumed. This is the first study to investigate postsurgical patients' food preferences. A consistent change in all the individual tastes with the exception of salty in the postoperative period was observed. The most desirable tastes were for savoury and sweet, reflecting patients' preoperative preferences. An improved understanding of taste may improve the resumption of eating after colonic surgery. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  2. Pivotal ERIVANCE basal cell carcinoma (BCC) study: 12-month update of efficacy and safety of vismodegib in advanced BCC.

    Science.gov (United States)

    Sekulic, Aleksandar; Migden, Michael R; Lewis, Karl; Hainsworth, John D; Solomon, James A; Yoo, Simon; Arron, Sarah T; Friedlander, Philip A; Marmur, Ellen; Rudin, Charles M; Chang, Anne Lynn S; Dirix, Luc; Hou, Jeannie; Yue, Huibin; Hauschild, Axel

    2015-06-01

    Primary analysis from the pivotal ERIVANCE BCC study resulted in approval of vismodegib, a Hedgehog pathway inhibitor indicated for treatment of adults with metastatic or locally advanced basal cell carcinoma (BCC) that has recurred after surgery or for patients who are not candidates for surgery or radiation. An efficacy and safety analysis was conducted 12 months after primary analysis. This was a multinational, multicenter, nonrandomized, 2-cohort study in patients with measurable and histologically confirmed locally advanced or metastatic BCC taking oral vismodegib (150 mg/d). Primary outcome measure was objective response rate (complete and partial responses) assessed by independent review facility. After 12 months of additional follow-up, median duration of exposure to vismodegib was 12.9 months. Objective response rate increased from 30.3% to 33.3% in patients with metastatic disease, and from 42.9% to 47.6% in patients with the locally advanced form. Median duration of response in patients with locally advanced BCC increased from 7.6 to 9.5 months. No new safety signals emerged with extended treatment duration. Limitations include low prevalence of advanced BCC and challenges of designing a study with heterogenous manifestations. The 12-month update of the study confirms the efficacy and safety of vismodegib in management of advanced BCC. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  3. Minimally-invasive glaucoma surgeries (MIGS) for open angle glaucoma: A systematic review and meta-analysis.

    Science.gov (United States)

    Lavia, Carlo; Dallorto, Laura; Maule, Milena; Ceccarelli, Manuela; Fea, Antonio Maria

    2017-01-01

    MIGS have been developed as a surgical alternative for glaucomatous patients. To analyze the change in intraocular pressure (IOP) and glaucoma medications using different MIGS devices (Trabectome, iStent, Excimer Laser Trabeculotomy (ELT), iStent Supra, CyPass, XEN, Hydrus, Fugo Blade, Ab interno canaloplasty, Goniscopy-assisted transluminal trabeculotomy) as a solo procedure or in association with phacoemulsification. Randomized control trials (RCT) and non-RCT (non randomized comparative studies, NRS, and before-after studies) were included. Studies with at least one year of follow-up in patients affected by primary open angle glaucoma, pseudoexfoliative glaucoma or pigmentary glaucoma were considered. Risk of Bias assessment was performed using the Cochrane Risk of Bias and the ROBINS-I tools. The main outcome was the effect of MIGS devices compared to medical therapy, cataract surgery, other glaucoma surgeries and other MIGS on both IOP and use of glaucoma medications 12 months after surgery. Outcomes measures were the mean difference in the change of IOP and glaucoma medication compared to baseline at one and two years and all ocular adverse events. The current meta-analysis is registered on PROSPERO (reference n° CRD42016037280). Over a total of 3,069 studies, nine RCT and 21 case series with a total of 2.928 eyes were included. Main concerns about risk of bias in RCTs were lack of blinding, allocation concealment and attrition bias while in non-RCTs they were represented by patients' selection, masking of participants and co-intervention management. Limited evidence was found based on both RCTs and non RCTs that compared MIGS surgery with medical therapy or other MIGS. In before-after series, MIGS surgery seemed effective in lowering both IOP and glaucoma drug use. MIGS showed a good safety profile: IOP spikes were the most frequent complications and no cases of infection or BCVA loss due to glaucoma were reported. Although MIGS seem efficient in the

  4. Effect of Surgical Safety Checklist on Mortality of Surgical Patients in the α University Hospitals

    Directory of Open Access Journals (Sweden)

    R. Mohebbifar

    2014-01-01

    Full Text Available Background & Aims: Patient safety is one of the indicators of risk management in clinical governance system. Surgical care is one of the most sophisticated medical care in the hospitals. So it is not surprising that nearly half of the adverse events, 66% were related to surgery. Pre-flight aircraft Inspection model is starting point for designing surgical safety checklist that use for audit procedure. The aim of this study is to evaluate the effect of the use of surgical safety checklist on surgical patients mortality and complications. Materials and Methods: This is a prospective descriptive study. This study was conducted in 2012 in the North West of Iran. The population consisted of patients who had undergoing surgery in α university of medical science`s hospital which have surgical department. In this study, 1125 patients underwent surgery within 3 months were studied. Data collection tool was designed based on WHO model and Surgcical Care and Outcomes Assessment Program(SCOAP. Data analysis was performed using the SPSS-20 statistical software and logistic regression analysis was used to calculate P values for each comparison. Results: No significant differences between patients in the two periods (before and after There was. All complications rate reduced from 11 percent to 4 percent after the intervention by checklist (p<0.001. In the all hospitals mortality rate was decreased from 3.44% to 1.3% (p <0.003. Overall rate of surgical site infection and unplanned return to the operating room was reduced (p<0.001 and p<0.046. Conclusion: Many people every year due to lack of safety in hospitals, lose their lives. Despite the risks, such as leaving surgery sets in patient body and wrong surgery is due to lack of proper safety programs during surgery. By using safety checklist in all hospitals mortality rate and complications was reduced but this reduction was extremely in α3 hospital (from 5.2% to 1.48%.

  5. Prognosis of oesophageal adenocarcinoma and squamous cell carcinoma following surgery and no surgery in a nationwide Swedish cohort study

    Science.gov (United States)

    Mattsson, Fredrik

    2018-01-01

    Objectives To assess the recent prognostic trends in oesophageal adenocarcinoma and oesophageal squamous cell carcinoma undergoing resectional surgery and no such surgery. Additionally, risk factors for death were assessed in each of these patient groups. Design Cohort study. Setting A population-based, nationwide study in Sweden. Participants All patients diagnosed with oesophageal adenocarcinoma and oesophageal squamous cell carcinoma in Sweden from 1 January 1990 to 31 December 2013, with follow-up until 14 May 2017. Outcome measures Observed and relative (to the background population) 1-year, 3-year and 5-year survivals were analysed using life table method. Multivariable Cox regression provided HR with 95% CI for risk factors of death. Results Among 3794 patients with oesophageal adenocarcinoma and 4631 with oesophageal squamous cell carcinoma, 82% and 63% were men, respectively. From 1990–1994 to 2010–2013, the relative 5-year survival increased from 12% to 15% for oesophageal adenocarcinoma and from 9% to 12% for oesophageal squamous cell carcinoma. The corresponding survival following surgery increased from 27% to 45% in oesophageal adenocarcinoma and from 24% to 43% in oesophageal squamous cell carcinoma. In patients not undergoing surgery, the survival increased from 3% to 4% for oesophageal adenocarcinoma and from 3% to 6% for oesophageal squamous cell carcinoma. Women with oesophageal squamous cell carcinoma had better prognosis than men both following surgery (HR 0.71, 95% CI 0.61 to 0.83) and no surgery (HR 0.86, 95% CI 0.81 to 0.93). Conclusions The prognosis has improved over calendar time both in oesophageal adenocarcinoma and oesophageal squamous cell carcinoma in Sweden that did and did not undergo surgery. Women appear to have better prognosis in oesophageal squamous cell carcinoma than men, independent of treatment. PMID:29748347

  6. A study on the efficacy and safety of combining dental surgery with tonsillectomy in pediatrics

    Directory of Open Access Journals (Sweden)

    Syed F

    2018-03-01

    Full Text Available Faizaan Syed,1 Joshua C Uffman,1,2 Dmitry Tumin,1 Catherine M Flaitz,3,4 Joseph D Tobias,1,2 Vidya T Raman1,2 1Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, 2Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, 3Department of Dentistry, Nationwide Children’s Hospital, 4Division of Dentistry, The Ohio State University College of Dentistry, Columbus, OH, USA Purpose: Few data exist on combining pediatric surgical procedures under a single general anesthetic encounter (general anesthesia. We compared perioperative outcomes of combining dental surgical procedures with tonsillectomy during one anesthetic vs separate encounters. Methods: We classified elective tonsillectomy ± adenoidectomy and restorative dentistry as combined (group C or separate (group S. Outcomes included anesthesia time, recovery duration, the need for overnight hospital stay, and postoperative complications. Results: Patients aged 4±1 years underwent tonsillectomy and dental surgery in combination (n=7 or separately (n=27. No differences were noted in total anesthesia time (C: median: 150, interquartile range [IQR]: 99, 165 vs S: median: 109, IQR: 92, 132; 95% CI of difference in median: –58, +10 minutes; P=0.115 and total recovery time (C: median: 54, IQR: 40, 108 vs S: median: 72, IQR: 58, 109; 95% CI of difference in median: –16, +48 minutes; P=0.307. The need for overnight stay (C: 4 of 7, S: 20 of 27; P=0.394 did not differ between the groups. No postoperative complications were noted in either group. Conclusion: These preliminary data support the potential feasibility of combining dental procedures with tonsillectomy during a single anesthetic encounter. Such care may not only reduce costs but also limit parental work absences and increase convenience for patient families. When compared with procedures performed separately, combined procedures did not result in increased morbidity or

  7. Nonelective surgery at night and in-hospital mortality

    DEFF Research Database (Denmark)

    van Zaane, Bas; van Klei, Wilton A; Buhre, Wolfgang F

    2015-01-01

    BACKGROUND: Evidence suggests that sleep deprivation associated with night-time working may adversely affect performance resulting in a reduction in the safety of surgery and anaesthesia. OBJECTIVE: Our primary objective was to evaluate an association between nonelective night-time surgery and in...

  8. 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...

  9. A phase 1–2, prospective, double blind, randomized study of the safety and efficacy of Sulfasalazine for the treatment of progressing malignant gliomas: study protocol of [ISRCTN45828668

    International Nuclear Information System (INIS)

    Robe, Pierre A; Martin, Didier; Albert, Adelin; Deprez, Manuel; Chariot, Alain; Bours, Vincent

    2006-01-01

    The prognosis of patients suffering from WHO grade 3 and 4 astrocytic glioma remains poor despite surgery, radiation therapy and the use of current chemotherapy regimen. Indeed, the median survival of glioblastoma multiforme (WHO grade 4) patients is at best 14.6 month with only 26.5 percents of the patients still alive after 2 years and the median survival of anaplastic astrocytomas (WHO grade 3) is 19.2 month. Recent evidence suggests that the transcription factor NF-kappaB is constitutively expressed in malignant gliomas and that its inhibition by drugs like Sulfasalazine may block the growth of astrocytic tumors in vitro and in experimental models of malignant gliomas. ULg-GBM-04/1 is a prospective, randomized, double blind single-center phase 1–2 study. A total of twenty patients with progressive malignant glioma despite surgery, radiation therapy and a first line of chemotherapy will be recruited and assigned to four dosage regimen of Sulfasalazine. This medication will be taken orally t.i.d. at a daily dose of 1.5–3–4 or 6 g, continuously until complete remission, evidence of progression or drug intolerance. Primary endpoints are drug safety in the setting of malignant gliomas and tumor response as measured according to MacDonald's criteria. An interim analysis of drug safety will be conducted after the inclusion of ten patients. The complete evaluation of primary endpoints will be conducted two years after the enrolment of the last patient or after the death of the last patient should this occur prematurely. The aim of this study is to evaluate the safety and efficacy of Sulfasalazine as a treatment for recurring malignant gliomas. The safety and efficacy of this drug are analyzed as primary endpoints. Overall survival and progression-free survival are secondary endpoint

  10. 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...... surgery. DESIGN: Observational cohort study. SETTING: Prospectively and consecutively reported data from the Danish Anaesthesia Database were linked to The Danish National Registry of Patients and The Civil Registration System. Records on vital status, admittance, discharges, codes of diagnosis......; therefore cluster randomized clinical trials comparing different clinical set ups may be warranted evaluating health care organizational factors....

  11. Assessment of safety levels in operation rooms at two major tertiary care public hospitals of Karachi. Safe surgery saves life

    International Nuclear Information System (INIS)

    Minhas, M.S.; Muzzammil, M.; Effendi, J.

    2017-01-01

    The objectives of this study are to determine the knowledge and attitude towards surgical safety among the health care professionals including surgeons, anaesthetist, hospital administrators, and operation room personnel and raise awareness towards the importance of safe surgery. Method: A pilot cross- sectional study of 543 healthcare providers working in the operating rooms and the surgical intensive care units was conducted in two tertiary care hospitals, within a study period of one month. A structured questionnaire was constructed and an informed verbal consent was taken. The questionnaire was then distributed; data collected and analysed on SPSS 20.0. Results: A total of 543 respondents participated in the study out of which there were 375 (69%) men and 168 (31%) women. The ages ranged between 23-58 years, mean 40.5+-24.74. There were 110 (20.25%) surgeons, 58 (10.68%) anaesthetist, 132 (24.30%) trainees, 125 (23.02%) technicians, and were 118 (21.73%) nurses. The question regarding briefing operation room personnel is important for patient safety was agreed by 532 (98%) respondents. Amongst the respondents, 239 (44%) did not feel safe to be operated in their own setup. Team communication improvement through the check list implementation was agreed by 483 (89%) respondents. 514 (94.7%) opted for the checklist to be used while they are being operated. That operation room personnel frequently disregard established protocols was agreed by 374 (69%) respondents. 193 (35.54%) of the respondents stated that it is difficult for them to speak up in the or if they perceive a problem with patient care. Conclusion: Operation room personnel were not aware of several important areas related to briefing, communication, safety attitude, following standard protocols and use of WHO Surgical Safety check list. A pre-post intervention study should be conducted after formal introduction of the Checklist. Successful implementation will require taking all stake holders on board

  12. 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

  13. Single-dose intra-articular bupivacaine plus morphine after knee arthroscopic surgery: a meta-analysis of randomised placebo-controlled studies

    Science.gov (United States)

    Wang, Yi-lun; Zeng, Chao; Xie, Dong-xing; Yang, Ye; Wei, Jie; Yang, Tuo; Li, Hui; Lei, Guang-hua

    2015-01-01

    Objectives To evaluate the efficacy and safety of single-dose intra-articular bupivacaine plus morphine after knee arthroscopic surgery. Design Meta-analysis. Data sources and study eligibility criteria A comprehensive literature search, using Medline (1966–2014), the Cochrane Central Register of Controlled Trials and Embase databases, was conducted to identify randomised placebo-controlled trials that used a combination of single-dose intra-articular bupivacaine and morphine for postoperative pain relief. Results 12 articles were included in this meta-analysis. The mean visual analogue scale (VAS) scores of the bupivacaine plus morphine group were significantly lower than those of the placebo group (weighted mean difference (WMD) −1.75; 95% CI −2.16 to −1.33; pbupivacaine plus morphine group were also significantly lower than those of the placebo group (WMD −1.46; 95% CI −1.63 to −1.29; pbupivacaine plus morphine after knee arthroscopic surgery is effective for pain relief, and its short-term side effects remain similar to saline placebo. PMID:26078306

  14. Late Causes of Death After Pediatric Cardiac Surgery: A 60-Year Population-Based Study.

    Science.gov (United States)

    Raissadati, Alireza; Nieminen, Heta; Haukka, Jari; Sairanen, Heikki; Jokinen, Eero

    2016-08-02

    Comprehensive information regarding causes of late post-operative death following pediatric congenital cardiac surgery is lacking. The study sought to analyze late causes of death after congenital cardiac surgery by era and defect severity. We obtained data from a nationwide pediatric cardiac surgery database and Finnish population registry regarding patients who underwent cardiac surgery at Causes of death were determined using International Classification of Diseases diagnostic codes. Deaths among the study population were compared to a matched control population. Overall, 10,964 patients underwent 14,079 operations, with 98% follow-up. Early mortality (death rates correlated with defect severity. Heart failure was the most common mode of CHD-related death, but decreased after surgeries performed between 1990 and 2009. Sudden death after surgery for atrial septal defect, ventricular septal defect, tetralogy of Fallot, and transposition of the great arteries decreased to zero following operations from 1990 to 2009. Deaths from neoplasms, respiratory, neurological, and infectious disease were significantly more common among study patients than controls. Pneumonia caused the majority of non-CHD-related deaths among the study population. CHD-related deaths have decreased markedly but remain a challenge after surgery for severe cardiac defects. Premature deaths are generally more common among patients than the control population, warranting long-term follow-up after congenital cardiac surgery. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  15. A study of passive safety conditions for fast reactor core

    International Nuclear Information System (INIS)

    Shimizu, Akinao

    1991-01-01

    A study has been made for passive safety conditions of fast reactor cores. Objective of the study is to develop a concept of a core with passive safety as well as a simple safety philosophy. A simple safety philosophy, which is wore easy to explain to the public, is needed to enhance the public acceptance for nuclear reactors. The present paper describes a conceptual plan of the study including the definition of the problem a method of approach and identification of tasks to be solved

  16. [Advantages and disadvantages of minimally invasive surgery in colorectal cancer surgery].

    Science.gov (United States)

    Zheng, Minhua; Ma, Junjun

    2017-06-25

    Since the emergence of minimally invasive technology twenty years ago, as a surgical concept and surgical technique for colorectal cancer surgery, its obvious advantages have been recognized. Laparoscopic technology, as one of the most important technology platform, has got a lot of evidence-based support for the oncological safety and effectiveness in colorectal cancer surgery Laparoscopic technique has advantages in terms of identification of anatomic plane and autonomic nerve, protection of pelvic structure, and fine dissection of vessels. But because of the limitation of laparoscopic technology there are still some deficiencies and shortcomings, including lack of touch and lack of stereo vision problems, in addition to the low rectal cancer, especially male, obese, narrow pelvis, larger tumors, it is difficult to get better view and manipulating triangle in laparoscopy. However, the emergence of a series of new minimally invasive technology platform is to make up for the defects and deficiencies. The robotic surgical system possesses advantages, such as stereo vision, higher magnification, manipulator wrist with high freedom degree, filtering of tremor and higher stability, but still has disadvantages, such as lack of haptic feedback, longer operation time, high operation cost and expensive price. 3D system of laparoscopic surgery has similar visual experience and feelings as robotic surgery in the 3D view, the same operating skills as 2D laparoscopy and a short learning curve. The price of 3D laparoscopy is also moderate, which makes the 3D laparoscopy more popular in China. Transanal total mesorectal excision (taTME) by changing the traditional laparoscopic pelvic surgery approach, may have certain advantages for male cases with narrow pelvic and patients with large tumor, and it is in accordance with the technical concept of natural orifice, with less minimally invasive and better cosmetics, which can be regarded as a supplemental technique of the

  17. Modeling the Relationship between Safety Climate and Safety Performance in a Developing Construction Industry: A Cross-Cultural Validation Study.

    Science.gov (United States)

    Zahoor, Hafiz; Chan, Albert P C; Utama, Wahyudi P; Gao, Ran; Zafar, Irfan

    2017-03-28

    This study attempts to validate a safety performance (SP) measurement model in the cross-cultural setting of a developing country. In addition, it highlights the variations in investigating the relationship between safety climate (SC) factors and SP indicators. The data were collected from forty under-construction multi-storey building projects in Pakistan. Based on the results of exploratory factor analysis, a SP measurement model was hypothesized. It was tested and validated by conducting confirmatory factor analysis on calibration and validation sub-samples respectively. The study confirmed the significant positive impact of SC on safety compliance and safety participation , and negative impact on number of self-reported accidents/injuries . However, number of near-misses could not be retained in the final SP model because it attained a lower standardized path coefficient value. Moreover, instead of safety participation , safety compliance established a stronger impact on SP. The study uncovered safety enforcement and promotion as a novel SC factor, whereas safety rules and work practices was identified as the most neglected factor. The study contributed to the body of knowledge by unveiling the deviations in existing dimensions of SC and SP. The refined model is expected to concisely measure the SP in the Pakistani construction industry, however, caution must be exercised while generalizing the study results to other developing countries.

  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. Robot-assisted surgery in gynecological oncology

    DEFF Research Database (Denmark)

    Kristensen, Steffen E; Mosgaard, Berit J; Rosendahl, Mikkel

    2017-01-01

    INTRODUCTION: Robot-assisted surgery has become more widespread in gynecological oncology. The purpose of this systematic review is to present current knowledge on robot-assisted surgery, and to clarify and discuss controversies that have arisen alongside the development and deployment. MATERIAL...... was performed by screening of titles and abstracts, and by full text scrutiny. From 2001 to 2016, a total of 76 references were included. RESULTS: Robot-assisted surgery in gynecological oncology has increased, and current knowledge supports that the oncological safety is similar, compared with previous...

  20. A new small-animal model for the study of acquired heterotopic ossification after hip surgery.

    Science.gov (United States)

    Anthonissen, Joris; Ossendorf, Christian; Hock, Johanna Lisa; Ritz, Ulrike; Hofmann, Alexander; Rommens, Pol Maria

    2015-01-01

    Heterotopic ossification (HO)--the formation of bone in soft tissues--is a frequent problem after surgery of the hip and pelvis, but little is known about its underlying pathogenic mechanisms. It is vital to study the underlying pathogenesis in animal models to develop and evaluate new prophylactic regimens directed against HO. However, previously developed small-animal models for the study of HO imitate neither surgery nor trauma-mechanisms that potentially cause HO. Hence, the goal of this study was to develop a novel small-animal model imitating hip surgery that can reliably produce HO. Twenty male Wistar rats were subjected to surgery of the right hip during which the femoral canal was reamed in three steps up to 2 mm, and a muscle lesion was made. Twelve weeks after surgery, the amount of heterotopic bone was assessed using micro-computed tomography. Eighteen of 20 animals showed HO around the hip 12 weeks after surgery. The amount of heterotopic bone varied from very small particles up to near ankylosis. A rat model of hip/pelvic surgery that does not use exogenous osteogenic stimulus and can reliably produce HO was developed.

  1. A 1-year videoconferencing-based psychoeducational group intervention following bariatric surgery: results of a randomized controlled study.

    Science.gov (United States)

    Wild, Beate; Hünnemeyer, Katharina; Sauer, Helene; Hain, Bernhard; Mack, Isabelle; Schellberg, Dieter; Müller-Stich, Beat Peter; Weiner, Rudolf; Meile, Tobias; Rudofsky, Gottfried; Königsrainer, Alfred; Zipfel, Stephan; Herzog, Wolfgang; Teufel, Martin

    2015-01-01

    For severely obese patients, bariatric surgery has been recommended as an effective therapy. The Bariataric Surgery and Education (BaSE) study aimed to assess the efficacy of a videoconferencing-based psychoeducational group intervention in patients after bariatric surgery. The BaSE study is a randomized, controlled multicenter clinical trial involving 117 patients undergoing bariatric surgery (mean preoperative body mass index [BMI] 49.9 kg/m(2), SD 6.4). Patients were enrolled between May 2009 and November 2012 and were randomly assigned to receive either conventional postsurgical visits or, in addition, a videoconferencing-based 1-year group program. Primary outcome measures were weight in kilograms, health-related quality of life (HRQOL), and general self-efficacy (GSE). Secondary outcome measures were depression symptoms and eating behavior. 94% of the patients completed the study. Mean weight loss for all patients was 45.9 kg (SD 16.4) 1 year after surgery (mean excess weight loss [EWL] 63%). Intention-to-treat analyses revealed no differences in weight loss, EWL, HRQOL, or self-efficacy between study groups at 1 year after surgery. However, patients with clinically significant depression symptoms (CSD) at baseline assigned to the intervention group (n = 29) had a significantly better HRQOL (P = .03), lower depression scores (P = .02), and a trend for a better EWL (.06) 1 year after surgery compared with the control group (n = 20). We could not prove the efficacy of the group program for the whole study sample. However, results indicate that the intervention is effective for the important subgroup of patients with CSD. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  2. A study of complications affecting surgery performance: an ISM-based roadmap to patient flow.

    Science.gov (United States)

    Dev, Navin K; Shankar, Ravi; Arvind, Kamal

    2013-01-01

    The aim of this study is to highlight the value of the success rate performance of a surgery while planning patient flow within a supply chain of a health care organization/hospital. The paper has considered one of the common surgeries, cataract, and the complications that subsequently result from this surgery. The study employs interpretive structural modeling (ISM) approach to draw a roadmap to study various complications causing cataract that subsequently help in planning and coordination of patient flow. The study finds that there is a hierarchy of causes and certain complications, the persistence of which gives a higher success rate performance in cataract surgery as compared to others. The paper provides leverage to the decision maker while organizing the patient flow depending upon the information of hierarchy of complication of a disease, and accordingly ensures the availability of resources to the patient. The study is of value in identifying the degree of complications from cataract surgery. Given the degree of complication, the patient logistics can be planned myopically in a health care organization which largely depends upon the degree of success rate. The paper attempts to suggest that the hierarchy obtained through ISM can be implemented in the modules of an enterprise resource planning (ERP) set up.

  3. [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

    Laparoscopic surgery for colorectal cancer is currently accepted and widespread worldwide. However, according tol the surgical experience on this approach, surgical and short-term oncologic results may vary. Studies comparing laparoscopic vs. open surgery in our population are scarce. To determine the superiority of the laparoscopic vs. open technique for colorectal cancer surgery. This retrospective and comparative study collected data from patients operated on for colorectal cancer between 1999 and 2011 at the Angeles Lomas Hospital, Mexico. A total of 82 patients were included in this study; 47 were operated through an open approach and 35 laparoscopically. Mean operative time was significantly lower in the open approach group (p= 0.008). There were no significant difference between both techniques for intraoperative bleeding (p= 0.3980), number of lymph nodes (p= 0.27), time to initiate oral feeding (p= 0.31), hospital stay (p= 0.12), and postoperative pain (p= 0.19). Procedure-related complications rate and type were not significantly different in both groups (p= 0.44). Patients operated laparoscopically required significantly less analgesic drugs (p= 0.04) and less need for epidural postoperative analgesia (p= 0.01). Laparoscopic approach is as safe as the traditional open approach for colorectal cancer. Early oncological and surgical results confirm its suitability according to this indication.

  4. Ethical considerations in bariatric surgery in a developing country.

    Science.gov (United States)

    Puia, Aida; Puia, Ion Cosmin; Cristea, Paul Gabriel

    2017-01-01

    Obesity is the fastest growing health problem worldwide. Ethical issues linked to obesity are numerous and still under debate even in countries with a long history in obesity treatment. From 2007 to 2015 we performed several types of bariatric surgical approaches on 250 patients with an average body mass index (BMI) of 42. The age range was 12-64 years. No death was recorded. Direct or phone contact was possible with 90% of them during follow-up. Starting from a specific question based approach in ethics we present aspects regarding obesity surgery in Romania. Patients' safety, informed consent, cost cover, the role of bariatric surgery in children and bariatric surgeons' training are discussed. Co-morbidities improved or even disappeared in 90% of our patients. Informed consent is a major problem, due to the lack of public knowledge necessary. The private system in Romania offers bariatric surgery at lower prices than Western Europe but is still out of reach for a person with an average income. Lack of maturity and disharmonic family relations raise a series of challenges in assessing the best interest of children and adolescents. Ethics committees, which operate according to well-defined processes, are more and more active in universities and research centers in Romania, checking that methods and performance of scientific studies meet adequate standards. A detailed informed consent, thorough preoperative patient assessment and method selection are mandatory for good results in obesity surgery. Insufficient financial resources combined with the long time necessary to acquire the expertise for laparoscopic bariatric surgery may represent an additional pressure on both physicians and patients.

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

    DEFF Research Database (Denmark)

    Jennum, Poul; Sabers, Anne; Christensen, Jakob

    2016-01-01

    severely affected by their disease as indicated by health care use and social impact before the surgical procedure. Patients who underwent epilepsy surgery had a significantly lower costs associated with the use of medication, outpatient services, inpatient admissions, and accident and emergency visits...... after surgery. The surgical intervention had no significant effects on social status in terms of occupation and educational level. CONCLUSION: Although epilepsy surgery was followed by a reduction in inpatient and outpatient health care use, medication and use of accident and emergency facilities...

  6. Female plastic surgery patients prefer mirror-reversed photographs of themselves: A prospective study.

    Science.gov (United States)

    de Runz, Antoine; Boccara, David; Chaouat, Marc; Locatelli, Katia; Bertheuil, Nicolas; Claudot, Frédérique; Bekara, Farid; Mimoun, Maurice

    2016-01-01

    The use of a patient's image in plastic surgery is common today. Thus, plastic surgeons should master the use of the image and be aware of the implications of the patients' perception of themselves. The mere-exposure effect is a psychological phenomenon in which a person tends to rate things more positively merely because (s)he is familiar with them. Faces are asymmetric, so faces in photos are different from those observed in mirrors. The main objective of this study was to assess whether patients within a plastic surgery population, particularly those undergoing facial aesthetic surgery, preferred standard photographs or mirror-reversed photographs of themselves. A prospective study was conducted in a plastic surgery department, which included women who were admitted to the hospital the day before their procedures. The patients were separated into the following two groups: Group 1 was composed of patients who were undergoing facial aesthetic surgeries, and Group 2 consisted of other patients who presented to the plastic surgery department for surgery. The patients were required to rate their appreciation of their own faces and to choose between standard and mirror-reversed photos of themselves. A total of 214 patients participated. The median age was 47.9 years (interquartile range (IQR): 36.4-60.6), and the median face appreciation was 5 (IQR: 5-7). The preference for the mirror-reversed photograph was significantly different from chance (p < 0.001, binomial (214, 156, 0.5)); 73% of the patients preferred the mirror-reversed photographs. The proportions of patients who preferred the mirror-reversed photograph differed significantly (p = 0.047) between Groups 1 (84%) and 2 (70%). Plastic surgery patients have a significant preference for mirror-reversed photographs of themselves over standard photographs. This preference is even more pronounced among patients who are undergoing facial aesthetic surgery. III. Copyright © 2015 British Association of Plastic

  7. Case-mix study of single incision laparoscopic surgery (SILS) vs. Conventional laparoscopic surgery in colonic cancer resections

    DEFF Research Database (Denmark)

    Mynster, Tommie; Wille-Jørgensen, Peer

    2013-01-01

    of administrations or amount of opioids were seen. Conclusion. With reservation of a small study group we find SILS is like worthy to CLS in colorectal cancer surgery and a benefit in postoperative recovery and pain is possible, but has to be investigated in larger randomised studies.......Single incision laparoscopic surgery (SILS) may be even less invasive to a patient than conventional laparoscopic surgery (CLS). Aim of the study of the applicability of the procedure, the first 1½ year of experiences and comparison with CLS for colonic cancer resections Material and methods. Since...

  8. The case for restraint in spinal surgery: does quality management have a role to play?

    Science.gov (United States)

    Deyo, Richard A; Mirza, Sohail K

    2009-08-01

    Most quality improvement efforts in surgery have focused on the technical quality of care provided, rather than whether the care was indicated, or could have been provided with a safer procedure. Because risk is inherent in any procedure, reducing the number of unnecessary operations is an important issue in patient safety. In the case of lumbar spine surgery, several lines of evidence suggest that, in at least some locations, there may be excessively high surgery rates. This evidence comes from international comparisons of surgical rates; study of small area variations within countries; increasing surgical rates in the absence of new indications; comparisons of surgical outcomes between geographic areas with high or low surgical rates; expert opinion; the preferences of well-informed patients; and increasing rates of repeat surgery. From a population perspective, reducing unnecessary surgery may have a greater impact on complication rates than improving the technical quality of surgery that is performed. Evidence suggests this may be true for coronary bypass surgery in the US and hysterectomy rates in Canada. Though similar studies have not been done for spine surgery, wide geographic variations in surgical rates suggest that this could be the case for spine surgery as well. We suggest that monitoring geographic variations in surgery rates may become an important aspect of quality improvement, and that rates of repeat surgery may bear special attention. Patient registries can help in this regard, if they are very complete and rigorously maintained. They can provide data on surgical rates; offer post-marketing surveillance for new surgical devices and techniques; and help to identify patient subgroups that may benefit most from certain procedures.

  9. Influences on choice of surgery as a career: a study of consecutive cohorts in a medical school.

    Science.gov (United States)

    Sobral, Dejano T

    2006-06-01

    To examine the differential impact of person-based and programme-related features on graduates' dichotomous choice between surgical or non-surgical field specialties for first-year residency. A 10-year cohort study was conducted, following 578 students (55.4% male) who graduated from a university medical school during 1994-2003. Data were collected as follows: at the beginning of medical studies, on career preference and learning frame; during medical studies, on academic achievement, cross-year peer tutoring and selective clinical traineeship, and at graduation, on the first-year residency selected. Contingency and logistic regression analyses were performed, with graduates grouped by the dichotomous choice of surgery or not. Overall, 23% of graduates selected a first-year residency in surgery. Seven time-steady features related to this choice: male sex, high self-confidence, option of surgery at admission, active learning style, preference for surgery after Year 1, peer tutoring on clinical surgery, and selective training in clinical surgery. Logistic regression analysis, including all features, predicted 87.1% of the graduates' choices. Male sex, updated preference, peer tutoring and selective training were the most significant predictors in the pathway to choice. The relative roles of person-based and programme-related factors in the choice process are discussed. The findings suggest that for most students the choice of surgery derives from a temporal summation of influences that encompass entry and post-entry factors blended in variable patterns. It is likely that sex-unbiased peer tutoring and selective training supported the students' search process for personal compatibility with specialty-related domains of content and process.

  10. Clinical experience with the first 40 cases with femtosecond laser cataract surgery technology: safety of the learning curve

    Directory of Open Access Journals (Sweden)

    Joao Crispim

    2015-10-01

    Full Text Available ABSTRACT Objective: To evaluate the introduction of the femtosecond laser (FSL to perform the key steps of the traditional cataract surgery process and the operational difficulties and safety of this new technology during routine use in an operating room in Brazil. Methods A retrospective study was conducted using the first cases operated on at a single center using the laser platform LenSx/Alcon with a soft contact lens patient interface.All patients underwent a detailed preoperative assessment.The anterior capsulotomy, nuclear fragmentation, and corneal incisions were created with the FSL; then, the surgery was completed following the standard phacoemulsification procedure. The main outcome measurements were difficulties and complications related to the learning curve and an analysis of postoperative uncorrected distance visual acuity (UDVA. Results: Of 31 patients (40 eyes, 9 patients had FSL cataract surgery in both eyes.The mean age was 64 ± 12 years (ranging from 42 to 82, the mean cataract nuclear sclerosis was grading 2 ± 0.6 (ranging from 1 to 4, and the preoperative mean UDVA in logMAR was 0.4 ± 0.2 (ranging from 0.1 to 1.3. Anterior capsulotomy was complete in all patients, and scissors were not needed to cut off any intact portion. The postoperative corneal incisions were not completely linear and showed some irregularities. Laser phaco-fragmentation was effective, with the division of the nucleus into smaller segments easily performed before phacoemulsification.After 1 month, the postoperative mean UDVA in logMAR was 0.1 ± 0.1 (ranging from 0.0 to 0.4 (P < 0.0001. Conclusion: With increasing surgical cases and experience, the phacoemulsification steps are performed precisely and effectively with FSL pretreatment, resulting in a safe learning curve.

  11. News media reports of patient deaths following 'medical tourism' for cosmetic surgery and bariatric surgery.

    Science.gov (United States)

    Turner, Leigh

    2012-04-01

    Contemporary scholarship examining clinical outcomes in medical travel for cosmetic surgery identifies cases in which patients traveled abroad for medical procedures and subsequently returned home with infections and other surgical complications. Though there are peer-reviewed articles identifying patient deaths in cases where patients traveled abroad for commercial kidney transplantation or stem cell injections, no scholarly publications document deaths of patients who traveled abroad for cosmetic surgery or bariatric surgery. Drawing upon news media reports extending from 1993 to 2011, this article identifies and describes twenty-six reported cases of deaths of individuals who traveled abroad for cosmetic surgery or bariatric surgery. Over half of the reported deaths occurred in two countries. Analysis of these news reports cannot be used to make causal claims about why the patients died. In addition, cases identified in news media accounts do not provide a basis for establishing the relative risk of traveling abroad for care instead of seeking elective cosmetic surgery at domestic health care facilities. Acknowledging these limitations, the case reports suggest the possibility that contemporary peer-reviewed scholarship is underreporting patient mortality in medical travel. The paper makes a strong case for promoting normative analyses and empirical studies of medical travel. In particular, the paper argues that empirically informed ethical analysis of 'medical tourism' will benefit from rigorous studies tracking global flows of medical travelers and the clinical outcomes they experience. The paper contains practical recommendations intended to promote debate concerning how to promote patient safety and quality of care in medical travel. © 2012 Blackwell Publishing Ltd.

  12. Improving Patient Safety in Anesthesia: A Success Story?

    International Nuclear Information System (INIS)

    Botney, Richard

    2008-01-01

    Anesthesia is necessary for surgery; however, it does not deliver any direct therapeutic benefit. The risks of anesthesia must therefore be as low as possible. Anesthesiology has been identified as a leader in improving patient safety. Anesthetic mortality has decreased, and in healthy patients can be as low as 1:250,000. Trends in anesthetic morbidity have not been as well defined, but it appears that the risk of injury is decreasing. Studies of error during anesthesia and Closed Claims studies have identified sources of risk and methods to reduce the risks associated with anesthesia. These include changes in technology, such as anesthetic delivery systems and monitors, the application of human factors, the use of simulation, and the establishment of reporting systems. A review of the important events in the past 50 years illustrates the many steps that have contributed to the improvements in anesthesia safety

  13. Assessment of competence in video-assisted thoracoscopic surgery lobectomy: A Danish nationwide study.

    Science.gov (United States)

    Petersen, René Horsleben; Gjeraa, Kirsten; Jensen, Katrine; Møller, Lars Borgbjerg; Hansen, Henrik Jessen; Konge, Lars

    2018-04-18

    Competence in video-assisted thoracoscopic surgery lobectomy has previously been established on the basis of numbers of procedures performed, but this approach does not ensure competence. Specific assessment tools, such as the newly developed video-assisted thoracoscopic surgery lobectomy assessment tool, allow for structured and objective assessment of competence. Our aim was to provide validity evidence for the video-assisted thoracoscopic surgery lobectomy assessment tool. Video recordings of 60 video-assisted thoracoscopic surgery lobectomies performed by 18 thoracic surgeons were rated using the video-assisted thoracoscopic surgery lobectomy assessment tool. All 4 centers of thoracic surgery in Denmark participated in the study. Two video-assisted thoracoscopic surgery experts rated the videos. They were blinded to surgeon and center. The total internal consistency reliability Cronbach's alpha was 0.93. Inter-rater reliability between the 2 raters was Pearson's r = 0.71 (P video-assisted thoracoscopic surgery lobectomy assessment tool scores for the 10 procedures performed by beginners were 22.1 (standard deviation [SD], 8.6) for the 28 procedures performed by the intermediate surgeons, 31.2 (SD, 4.4), and for the 20 procedures performed by experts 35.9 (SD, 2.9) (P better than intermediates (P better than beginners (P video-assisted thoracoscopic surgery lobectomy (video-assisted thoracoscopic surgery lobectomy assessment tool) in a clinical setting. The discriminatory ability among expert surgeons, intermediate surgeons, and beginners proved highly significant. The video-assisted thoracoscopic surgery lobectomy assessment tool could be an important aid in the future training and certification of thoracic surgeons. Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  14. Bariatric surgery in individuals with liver cirrhosis: A narrative review

    Directory of Open Access Journals (Sweden)

    Everton Cazzo

    Full Text Available Summary Introduction: Bariatric surgery has become the gold standard treatment for morbid obesity, but there is no consensus regarding its safety and efficacy among individuals with chronic liver diseases. Objective: To critically evaluate the existing evidence on literature about bariatric surgery in individuals with liver cirrhosis. Method: Narrative review performed by means of an online search in the MEDLINE and LILACS databases. Results: Bariatric surgery is safe and effective in individuals with chronic liver disease without clinical decompensation or significant portal hypertension. Individuals with severe liver function impairment present significantly higher surgical morbidity and mortality. Among candidates to liver transplantation, surgery may be performed before, after and even during transplantation, and there is a predominant trend to perform it after. Vertical sleeve gastrectomy seems to be the most adequate technique in this group of subjects. Conclusion: Bariatric surgery is safe and effective in individuals with compensated cirrhosis without significant portal hypertension, but presents higher morbidity. Among candidates to liver transplantation and/or individuals with severe portal hypertension, morbidity and mortality are significantly higher.

  15. Effectiveness and safety of endoscopic radial incision and cutting for severe benign anastomotic stenosis after surgery for colorectal carcinoma: a three-case series.

    Science.gov (United States)

    Asayama, Naoki; Nagata, Shinji; Shigita, Kenjiro; Aoyama, Taiki; Fukumoto, Akira; Mukai, Shinichi

    2018-03-01

    Benign colonic anastomotic stenosis sometimes occurs after surgical resection and usually requires surgical or endoscopic dilation. Limited data are available on the effectiveness and safety of the endoscopic radial incision and cutting (RIC) method at sites other than the esophagus. The aim of this retrospective study was to investigate the effectiveness and safety of RIC dilation for severe benign anastomotic colonic stenosis. Subjects were 3 men (median age 72 years, range 65 - 76 years) who developed severe benign anastomotic stenosis after surgical resection for colorectal carcinoma and were subsequently treated by RIC dilation at Hiroshima City Asa Citizens Hospital between May 2014 and December 2016. Severe anastomotic stenosis was defined as a narrowed anastomosis through which a standard colonoscope could not be passed. The median interval from surgery to RIC was 21 months (range 9 - 29 months). RIC was successful in all 3 patients and reduced the severity of dyschezia postoperatively; 2 patients experienced improvement after a single RIC session and the other after 6 RIC sessions. No treatment-related adverse events or re-stenosis requiring repeat dilation was noted during a median follow-up of 27 months (range 8 - 37 months). Our findings indicate that the RIC technique can be applied safely and effectively to various sites in the colon, avoiding the need for reoperation.

  16. Chronic Electromagnetic Exposure at Occupational Safety Level Does Not Affect the Metabolic Profile nor Cornea Healing after LASIK Surgery

    Directory of Open Access Journals (Sweden)

    David Crouzier

    2014-01-01

    Full Text Available LASIK eye surgery has become a very common practice for myopic people, especially those in the military. Sometimes undertaken by people who need to keep a specific medical aptitude, this surgery could be performed in secret from the hierarchy and from the institute medical staff. However, even though the eyes have been previously described as one of the most sensitive organs to electromagnetic fields in the human body, no data exist on the potential deleterious effects of electromagnetic fields on the healing eye. The consequences of chronic long-lasting radar exposures at power density, in accordance with the occupational safety standards (9.71 GHz, 50 W/m2, were investigated on cornea healing. The metabolic and clinical statuses after experimental LASIK keratotomy were assessed on the different eye segments in a New Zealand rabbit model. The analysis methods were performed after 5 months of exposure (1 hour/day, 3 times/week. Neither clinical or histological examinations, nor experimental data, such as light scattering, 1H-NMR HRMAS metabolomics, 13C-NMR spectra of lipidic extracts, and antioxidant status, evidenced significant modifications. It was concluded that withdrawing the medical aptitude of people working in electromagnetic field environments (i.e., radar operators in the navy after eye surgery was not justified.

  17. Prevalence of Musculoskeletal Disorders Among Surgeons Performing Minimally Invasive Surgery: A Systematic Review.

    Science.gov (United States)

    Alleblas, Chantal C J; de Man, Anne Marie; van den Haak, Lukas; Vierhout, Mark E; Jansen, Frank Willem; Nieboer, Theodoor E

    2017-12-01

    The aim of this study was to review musculoskeletal disorder (MSD) prevalence among surgeons performing minimally invasive surgery. Advancements in laparoscopic surgery have primarily focused on enhancing patient benefits. However, compared with open surgery, laparoscopic surgery imposes greater ergonomic constraints on surgeons. Recent reports indicate a 73% to 88% prevalence of physical complaints among laparoscopic surgeons, which is greater than in the general working population, supporting the need to address the surgeons' physical health. To summarize the prevalence of MSDs among surgeons performing laparoscopic surgery, we performed a systematic review of studies addressing physical ergonomics as a determinant, and reporting MSD prevalence. On April 15 2016, we searched Pubmed, EMBASE, the Cochrane Library, Web of Science, CINAHL, and PsychINFO. Meta-analyses were performed using the Hartung-Knapp-Sidik-Jonkman method. We identified 35 articles, including 7112 respondents. The weighted average prevalence of complaints was 74% [95% confidence interval (95% CI) 65-83]. We found high inconsistency across study results (I = 98.3%) and the overall response rate was low. If all nonresponders were without complaints, the prevalence would be 22% (95% CI 16-30). From the available literature, we found a 74% prevalence of physical complaints among laparoscopic surgeons. However, the low response rates and the high inconsistency across studies leave some uncertainty, suggesting an actual prevalence of between 22% and 74%. Fatigue and MSDs impact psychomotor performance; therefore, these results warrant further investigation. Continuous changes are enacted to increase patient safety and surgical care quality, and should also include efforts to improve surgeons' well-being.

  18. Plasma glutamine levels before cardiac surgery are related to post-surgery infections; an observational study

    Directory of Open Access Journals (Sweden)

    Hanneke Buter

    2016-11-01

    Full Text Available Abstract Background A low plasma glutamine level was found in 34% of patients after elective cardiothoracic surgery. This could be a result of the inflammation caused by surgical stress or the use of extracorporeal circulation (ECC. But it is also possible that plasma glutamine levels were already lowered before surgery and reflect an impaired metabolic state and a higher likelihood to develop complications. In the present study plasma glutamine levels were measured before and after cardiac surgery and we questioned whether there is a relation between plasma glutamine levels and duration of ECC and the occurrence of postoperative infections. Methods We performed a single-centre prospective, observational study in a closed-format, 20-bed, mixed ICU in a tertiary teaching hospital. We included consecutive patients after elective cardiac surgery with use of extracorporeal circulation. Blood samples were collected on the day prior to surgery and at admission on the ICU. The study was approved by the local Medical Ethics Committee (Regional Review Committee Patient-related Research, Medical Centre Leeuwarden, nWMO 115, April 28th 2015. Results Ninety patients were included. Pre-operative plasma glutamine level was 0.42 ± 0.10 mmol/l and post-operative 0.38 ± 0.09 mmol/l (p < 0.001. There was no relation between duration of extracorporeal circulation or aortic occlusion time and changes in plasma glutamine levels. A logistic regression analysis showed a significant correlation between the presence of a positive culture during the post-operative course and pre-operative plasma glutamine levels (p = 0.04. Conclusion Plasma glutamine levels are significantly lower just after cardiac surgery compared to pre-operative levels. We did not find a relation between the decrease in plasma glutamine levels and the duration of extracorporeal circulation or aortic clamp time. There was a correlation between pre-operative plasma glutamine levels

  19. 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.

  20. The use of throat packs in pediatric cleft lip/palate surgery: a retrospective study.

    Science.gov (United States)

    Smarius, B J A; Guillaume, C H A L; Jonker, G; van der Molen, A B Mink; Breugem, C C

    2018-02-22

    Throat packs are commonly used to prevent ingestion or aspiration of blood and other debris during cleft lip/palate surgery. However, dislodgement or (partial) retainment after extubation could have serious consequences. The aim of the present study was to investigate the effect of omitting pharyngeal packing during cleft lip/palate surgery on the incidence of early postoperative complications in children. A retrospective study was performed on all children who underwent cleft lip/palate surgery at the Wilhelmina Children's Hospital. This study compared the period January 2010 through December 2012 when pharyngeal packing was applied according to local protocol (group A) with the period January 2013 till December 2015 when pharyngeal packing was no longer applied after removal from the protocol (group B). Data were collected for sex, age at operation, cleft lip/palate type, type of repair, lateral incisions, length of hospital stay, and complications in the first 6 weeks after surgery. Early complications included wound dehiscence, postoperative bleeding, infection, fever, upper respiratory tract infection (URTI), and lower respiratory tract infection (LRTI). This study included 489 cleft lip/palate operations (group A n = 246, group B n = 243). A total of 39 (15.9%) early complications were recorded in group A and a total of 40 (16.5%) in group B. There were no significant differences (P = 0.902) in complications between the two groups; however, there was a significant difference (P cleft lip/palate surgery was not associated with an increased early postoperative complication rate. Therefore, the traditional, routine placement of a throat pack during cleft lip/palate surgery can be questioned. The traditional, routine placement of a throat pack during cleft lip/palate surgery can be questioned.

  1. 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 operative type in the acute surgical site infection group were significantly different than those in the non-acute surgical site infection group (p operative type, operative time, blood loss, and drainage time were independent predictors of acute 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.

  2. Patient Safety in Interventional Radiology: A CIRSE IR Checklist

    NARCIS (Netherlands)

    Lee, M. J.; Fanelli, F.; Haage, P.; Hausegger, K.; van Lienden, K. P.

    2012-01-01

    Interventional radiology (IR) is an invasive speciality with the potential for complications as with other invasive specialities. The World Health Organization (WHO) produced a surgical safety checklist to decrease the morbidity and mortality associated with surgery. The Cardiovascular and

  3. Combined surgery versus cataract surgery alone for eyes with cataract and glaucoma.

    Science.gov (United States)

    Zhang, Mingjuan Lisa; Hirunyachote, Phenpan; Jampel, Henry

    2015-07-14

    publications that cited the studies included in the review. We also contacted investigators and experts in the field to identify additional trials. We included randomized controlled trials (RCTs) of participants who had open-angle, pseudoexfoliative, or pigmentary glaucoma and age-related cataract. The comparison of interest was combined cataract surgery (phacoemulsification) and any type of glaucoma surgery versus cataract surgery (phacoemulsification) alone. Two review authors independently assessed study eligibility, collected data, and judged risk of bias for included studies. We used standard methodological procedures expected by the Cochrane Collaboration. We included nine RCTs, with a total of 655 participants (657 eyes), and follow-up periods ranging from 12 to 30 months. Seven trials were conducted in Europe, one in Canada and South Africa, and one in the United States. We graded the overall quality of the evidence as low due to observed inconsistency in study results, imprecision in effect estimates, and risks of bias in the included studies.Glaucoma surgery type varied among the studies: three studies used trabeculectomy, three studies used iStent® implants, one study used trabeculotomy, and two studies used trabecular aspiration. All of these studies found a statistically significant greater decrease in mean IOP postoperatively in the combined surgery group compared with cataract surgery alone; the mean difference (MD) was -1.62 mmHg (95% confidence interval (CI) -2.61 to -0.64; 489 eyes) among six studies with data at one year follow-up. No study reported the proportion of participants with a reduction in the number of medications used after surgery, but two studies found the mean number of medications used postoperatively at one year was about one less in the combined surgery group than the cataract surgery alone group (MD -0.69, 95% CI -1.28 to -0.10; 301 eyes). Five studies showed that participants in the combined surgery group were about 50% less likely

  4. Active Bleeding after Cardiac Surgery: A Prospective Observational Multicenter Study.

    Directory of Open Access Journals (Sweden)

    Pascal H Colson

    Full Text Available To estimate the incidence of active bleeding after cardiac surgery (AB based on a definition directly related on blood flow from chest drainage; to describe the AB characteristics and its management; to identify factors of postoperative complications.AB was defined as a blood loss > 1.5 ml/kg/h for 6 consecutive hours within the first 24 hours or in case of reoperation for hemostasis during the first 12 postoperative hours. The definition was applied in a prospective longitudinal observational study involving 29 French centers; all adult patients undergoing cardiac surgery with cardiopulmonary bypass were included over a 3-month period. Perioperative data (including blood product administration were collected. To study possible variation in clinical practice among centers, patients were classified into two groups according to the AB incidence of the center compared to the overall incidence: "Low incidence" if incidence is lower and "High incidence" if incidence is equal or greater than overall incidence. Logistic regression analysis was used to identify risk factors of postoperative complications.Among 4,904 patients, 129 experienced AB (2.6%, among them 52 reoperation. Postoperative bleeding loss was 1,000 [820;1,375] ml and 1,680 [1,280;2,300] ml at 6 and 24 hours respectively. Incidence of AB varied between centers (0 to 16% but was independent of in-centre cardiac surgical experience. Comparisons between groups according to AB incidence showed differences in postoperative management. Body surface area, preoperative creatinine, emergency surgery, postoperative acidosis and red blood cell transfusion were risk factors of postoperative complication.A blood loss > 1.5 ml/kg/h for 6 consecutive hours within the first 24 hours or early reoperation for hemostasis seems a relevant definition of AB. This definition, independent of transfusion, adjusted to body weight, may assess real time bleeding occurring early after surgery.

  5. Active Bleeding after Cardiac Surgery: A Prospective Observational Multicenter Study.

    Science.gov (United States)

    Colson, Pascal H; Gaudard, Philippe; Fellahi, Jean-Luc; Bertet, Héléna; Faucanie, Marie; Amour, Julien; Blanloeil, Yvonnick; Lanquetot, Hervé; Ouattara, Alexandre; Picot, Marie Christine

    2016-01-01

    To estimate the incidence of active bleeding after cardiac surgery (AB) based on a definition directly related on blood flow from chest drainage; to describe the AB characteristics and its management; to identify factors of postoperative complications. AB was defined as a blood loss > 1.5 ml/kg/h for 6 consecutive hours within the first 24 hours or in case of reoperation for hemostasis during the first 12 postoperative hours. The definition was applied in a prospective longitudinal observational study involving 29 French centers; all adult patients undergoing cardiac surgery with cardiopulmonary bypass were included over a 3-month period. Perioperative data (including blood product administration) were collected. To study possible variation in clinical practice among centers, patients were classified into two groups according to the AB incidence of the center compared to the overall incidence: "Low incidence" if incidence is lower and "High incidence" if incidence is equal or greater than overall incidence. Logistic regression analysis was used to identify risk factors of postoperative complications. Among 4,904 patients, 129 experienced AB (2.6%), among them 52 reoperation. Postoperative bleeding loss was 1,000 [820;1,375] ml and 1,680 [1,280;2,300] ml at 6 and 24 hours respectively. Incidence of AB varied between centers (0 to 16%) but was independent of in-centre cardiac surgical experience. Comparisons between groups according to AB incidence showed differences in postoperative management. Body surface area, preoperative creatinine, emergency surgery, postoperative acidosis and red blood cell transfusion were risk factors of postoperative complication. A blood loss > 1.5 ml/kg/h for 6 consecutive hours within the first 24 hours or early reoperation for hemostasis seems a relevant definition of AB. This definition, independent of transfusion, adjusted to body weight, may assess real time bleeding occurring early after surgery.

  6. Oncoplastia surgery breast conservation. First results

    International Nuclear Information System (INIS)

    Morales Tirado, Roxana; Breff Frometa, Alain; Alfonso Coto, Juan Carlos; Galvez Chavez, Julio Cesar

    2009-01-01

    Oncoplastic surgery is an important tool in the treatment patients with breast cancer stages I and II. A prospective study descriptive period between October 2005 and October 2006, which included 10 patients younger than 60 years in stages I and II, selected from the universe that came to the National Cancer Institute and Havana Radiobiology (INOR), following the inclusion criteria and exclusion. Were assessed before and after surgery from surveys that collected data questioning the patients and data clinical examination performed by the plastic surgeon. The predominant lesion was invasive ductal cancer and most patients were in stage I. There were no loco-regional recurrence in 2 year period. The most common complication was dehiscence surgical wound. Good aesthetic results were obtained in sixty percent of cases. It is confirmed that the surgery is Breast Oncoplastic very effective for the oncological safety and promising in terms of aesthetic results. (Author)

  7. Neer Award 2016: Outpatient total shoulder arthroplasty in an ambulatory surgery center is a safe alternative to inpatient total shoulder arthroplasty in a hospital: a matched cohort study.

    Science.gov (United States)

    Brolin, Tyler J; Mulligan, Ryan P; Azar, Frederick M; Throckmorton, Thomas W

    2017-02-01

    Recent emphasis on safe and efficient delivery of high-quality health care has increased interest in outpatient total joint arthroplasty. The purpose of this study was to evaluate the safety of outpatient total shoulder arthroplasty (TSA) by comparing episode-of-care complications in matched cohorts of patients with anatomic TSA as an outpatient or inpatient procedure. Thirty patients with outpatient TSA at a freestanding ambulatory surgery center (ASC) were compared with an age- and comorbidities-matched cohort of 30 patients with traditional inpatient TSA to evaluate 90-day episode-of-care complications, including hospital admissions or readmissions and reoperations. Two-tailed t-tests were used to evaluate differences, and differences of P surgery and disrupted his subscapularis repair. Three minor complications in the hospital cohort were mild asymptomatic anterior subluxation, blood transfusion, and superficial venous thrombosis. The complication rates (13% vs. 10%) were not significantly different. Outpatient TSA is a safe alternative to hospital admission in appropriately selected patients. Further investigation is warranted to evaluate the longer term outcomes and cost-effectiveness of outpatient TSA. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  8. Current status of cerebral glioma surgery in China.

    Science.gov (United States)

    Wu, Jin-song; Zhang, Jie; Zhuang, Dong-xiao; Yao, Cheng-jun; Qiu, Tian-ming; Lu, Jun-feng; Zhu, Feng-ping; Mao, Ying; Zhou, Liang-fu

    2011-09-01

    The treatment of gliomas is highly individualized. Surgery for gliomas is essentially for histological diagnosis, to alleviate mass effect, and most importantly, to favor longer survival expectancy. During the past two decades, many surgical techniques and adjuvants have been applied to glioma surgery in China, which lead to a rapid development in the field of cerebral glioma surgery. This article broadly and critically reviewed the existing studies on cerebral glioma surgery and to portrait the current status of glioma surgery in China. A literature search was conducted covering major innovative surgical techniques and adjuvants for glioma surgery in China. The following databases were searched: the Pubmed (January 1995 to date); China Knowledge Resource Integrated Database (January 1995 to date) and VIP Database for Chinese Technical Periodicals (January 1995 to date). A selection criterion was established to exclude duplicates and irrelevant studies. The outcome measures were extracted from included studies. A total of 3307 articles were initially searched. After excluded by abstracts and full texts, 69 studies conducted in the mainland of China were included and went through further analysis. The philosophy of surgical strategies for cerebral gliomas in China is undergoing tremendous change. Nowadays Chinese neurosurgeons pay more attention to the postoperative neurofunctional status of the patients. The aim of the glioma surgery is not only the more extensive tumor resection but also the maximal safety of intervention. The well balance of longer overall survival and higher quality of life should be judged with respect to each individual patient.

  9. Using human factors engineering to improve patient safety in the cardiovascular operating room.

    Science.gov (United States)

    Gurses, Ayse P; Martinez, Elizabeth A; Bauer, Laura; Kim, George; Lubomski, Lisa H; Marsteller, Jill A; Pennathur, Priyadarshini R; Goeschel, Chris; Pronovost, Peter J; Thompson, David

    2012-01-01

    Despite significant medical advances, cardiac surgery remains a high risk procedure. Sub-optimal work system design characteristics can contribute to the risks associated with cardiac surgery. However, hazards due to work system characteristics have not been identified in the cardiovascular operating room (CVOR) in sufficient detail to guide improvement efforts. The purpose of this study was to identify and categorize hazards (anything that has the potential to cause a preventable adverse patient safety event) in the CVOR. An interdisciplinary research team used prospective hazard identification methods including direct observations, contextual inquiry, and photographing to collect data in 5 hospitals for a total 22 cardiac surgeries. We performed thematic analysis of the qualitative data guided by a work system model. 60 categories of hazards such as practice variations, high workload, non-compliance with evidence-based guidelines, not including clinicians' in medical device purchasing decisions were found. Results indicated that hazards are common in cardiac surgery and should be eliminated or mitigated to improve patient safety. To improve patient safety in the CVOR, efforts should focus on creating a culture of safety, increasing compliance with evidence based infection control practices, improving communication and teamwork, and designing better tools and technologies through partnership among all stakeholders.

  10. Application of Metabolomics to Study Effects of Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Paulina Samczuk

    2018-01-01

    Full Text Available Bariatric surgery was born in the 1950s at the University of Minnesota. From this time, it continues to evolve and, by the same token, gives new or better possibilities to treat not only obesity but also associated comorbidities. Metabolomics is also a relatively young science discipline, and similarly, it shows great potential for the comprehensive study of the dynamic alterations of the metabolome. It has been widely used in medicine, biology studies, biomarker discovery, and prognostic evaluations. Currently, several dozen metabolomics studies were performed to study the effects of bariatric surgery. LC-MS and NMR are the most frequently used techniques to study main effects of RYGB or SG. Research has yield many interesting results involving not only clinical parameters but also molecular modulations. Detected changes pertain to amino acid, lipids, carbohydrates, or gut microbiota alterations. It proves that including bariatric surgery to metabolic surgery is warranted. However, many molecular modulations after those procedures remain unexplained. Therefore, application of metabolomics to study this field seems to be a proper solution. New findings can suggest new directions of surgery technics modifications, contribute to broadening knowledge about obesity and diseases related to it, and perhaps develop nonsurgical methods of treatment in the future.

  11. A Pilot Study on Telephone Cognitive Behavioral Therapy for Patients Six-Months Post-Bariatric Surgery

    Science.gov (United States)

    Cassin, Stephanie E.; Wnuk, Susan; Du, Chau; Jackson, Timothy; Hawa, Raed; Parikh, Sagar V.

    2017-01-01

    Objective This study aimed to determine the feasibility and preliminary efficacy of a post-operative telephone-based cognitive behavioral therapy intervention (Tele-CBT) in improving eating pathology and psychosocial functioning. Methods Six-month post-operative bariatric surgery patients (n = 19) received six sessions of Tele-CBT. Study outcome variables included binge eating (BES), emotional eating (EES), depressive symptoms (PHQ-9), and anxiety symptoms (GAD-7). Results Retention was 73.7 % post-intervention. Tele-CBT resulted in significant reductions in mean difference scores on BES, EES-Total, EES-Anxiety, EES-Anger, PHQ9, and GAD7. Tele-CBT patients experienced a mean weight loss of 8.62 ± 15.02 kg between 6-months post-surgery (pre-Tele-CBT) and 12-months post-surgery. Conclusions These preliminary results suggest that post-surgery Tele-CBT is feasible and can improve post-surgery symptoms of psychopathology in this uncontrolled study, supporting the need for a randomized controlled trial. PMID:27491293

  12. Robotic surgery for rectal cancer: current immediate clinical and oncological outcomes.

    Science.gov (United States)

    Araujo, Sergio Eduardo Alonso; Seid, Victor Edmond; Klajner, Sidney

    2014-10-21

    Laparoscopic rectal surgery continues to be a challenging operation associated to a steep learning curve. Robotic surgical systems have dramatically changed minimally invasive surgery. Three-dimensional, magnified and stable view, articulated instruments, and reduction of physiologic tremors leading to superior dexterity and ergonomics. Therefore, robotic platforms could potentially address limitations of laparoscopic rectal surgery. It was aimed at reviewing current literature on short-term clinical and oncological (pathological) outcomes after robotic rectal cancer surgery in comparison with laparoscopic surgery. A systematic review was performed for the period 2002 to 2014. A total of 1776 patients with rectal cancer underwent minimally invasive robotic treatment in 32 studies. After robotic and laparoscopic approach to oncologic rectal surgery, respectively, mean operating time varied from 192-385 min, and from 158-297 min; mean estimated blood loss was between 33 and 283 mL, and between 127 and 300 mL; mean length of stay varied from 4-10 d; and from 6-15 d. Conversion after robotic rectal surgery varied from 0% to 9.4%, and from 0 to 22% after laparoscopy. There was no difference between robotic (0%-41.3%) and laparoscopic (5.5%-29.3%) surgery regarding morbidity and anastomotic complications (respectively, 0%-13.5%, and 0%-11.1%). Regarding immediate oncologic outcomes, respectively among robotic and laparoscopic cases, positive circumferential margins varied from 0% to 7.5%, and from 0% to 8.8%; the mean number of retrieved lymph nodes was between 10 and 20, and between 11 and 21; and the mean distal resection margin was from 0.8 to 4.7 cm, and from 1.9 to 4.5 cm. Robotic rectal cancer surgery is being undertaken by experienced surgeons. However, the quality of the assembled evidence does not support definite conclusions about most studies variables. Robotic rectal cancer surgery is associated to increased costs and operating time. It also seems to be

  13. Curative Metatarsal Bone Surgery Combined with Intralesional Administration of Recombinant Human Epidermal Growth Factor in Diabetic Neuropathic Ulceration of the Forefoot: A Prospective, Open, Uncontrolled, Nonrandomized, Observational Study

    Directory of Open Access Journals (Sweden)

    Aristides L. Garcia Herrera, MD, PhD

    2017-01-01

    Conclusions: The combination of curative metatarsal bone surgery with intralesional administration of recombinant human EGF resulted in a significant reduction in the re-epithelization time, recidivism, and development of new diabetic lesions. The safety profile was appropriate. However, more randomized, triple-blind, and placebo trials are needed to evaluate the efficacy and safety of this new therapy.

  14. AN EXPERIMENTAL STUDY OF THE EFFICACY AND SAFETY OF VARIOUS ENDOSCOPIC HEMOSTASIS TECHNIQUES

    Directory of Open Access Journals (Sweden)

    A. I. Cherepanin

    2014-01-01

    Full Text Available ABSTRACT. The treatment of bleeding peptic ulcers remains one of the pressing challenges in urgent surgery. Currently available endoscopic hemostasis modalities only partially meet the requirements of safety, efficiency and reliability, and therefore total and postoperative mortality rates are still high, both in our country, and around the world. The aim of the study was to identify the benefits and shortcomings of endoscopic radiofrequency energy exposure compared to standard hemostatic techniques used in the world practice to treat bleeding peptic ulcers. 

  15. Trajectory of sleep disturbances in patients undergoing lung cancer surgery: a prospective study.

    Science.gov (United States)

    Halle, Ingrid Helene; Westgaard, Therese Krystad; Wahba, Alexander; Oksholm, Trine; Rustøen, Tone; Gjeilo, Kari Hanne

    2017-08-01

    Patients with lung cancer report sleep difficulties to be frequent and bothersome symptoms. This study describes the trajectory of sleep from before and up to 12 months after surgery for lung cancer. Further, it investigates possible associations between sleep disturbance, demographic and clinical characteristics before surgery. This study is part of a longitudinal multicentre study. Sleep disturbance was measured by The General Sleep Disturbance Scale (GSDS) that investigates frequencies of sleep difficulties (21 items) and a total sum score ≥43 indicates a clinically meaningful level of sleep disturbance (score range 0-147). Linear mixed models were used to study changes in sleep from baseline to 1, 5, 9 and 12 months after surgery. The percentage of patients (n = 264) reporting sleep disturbances was 60.9% at baseline, 68.5% at Month 1, 55.4% at Month 5, 51.3% at Month 9 and 49.7% at Month 12. The increase to and decrease from Month 1 was the only significant alteration in the occurrence of sleep disturbance. The patients reported most problems within the subscales sleep quantity, early awakenings and sleep quality. Factors associated with sleep disturbance were lower age, use of pain medication and psychotropic medication and higher comorbidity score. Lung cancer patients sleep poorly, before as well as after surgery. There is a need to address sleeping disturbance routinely in clinical practice and screening for sleeping problems is indicated. Further studies are warranted concerning factors that contribute to sleep disturbance and how they best can be treated. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  16. Quantitative work demands, emotional demands, and cognitive stress symptoms in surgery nurses.

    Science.gov (United States)

    Elfering, Achim; Grebner, Simone; Leitner, Monika; Hirschmüller, Anja; Kubosch, Eva Johanna; Baur, Heiner

    2017-06-01

    In surgery, cognitive stress symptoms, including problems in concentrating, deciding, memorising, and reflecting are risks to patient safety. Recent evidence points to social stressors as antecedents of cognitive stress symptoms in surgery personnel. The current study tests whether cognitive stress symptoms are positively associated with emotional abuse, emotional- and task-related demands and resources in surgery work. Forty-eight surgery nurses from two hospitals filled out the Copenhagen Psychosocial Questionnaire in its German version. Task-related and emotional demands were positively related to cognitive stress symptoms. In a stepwise, multiple, linear regression of cognitive stress symptoms on task-related and emotional demands, emotional abuse and emotional demands were unique predictors (p emotional abuse, emotional demands, and, therefore, communication and cooperation team climate in surgery personnel.

  17. The structure, organisation and perioperative management of ambulatory surgery and anaesthesia in France: Methodology of the SFAR-OPERA study.

    Science.gov (United States)

    Albaladejo, Pierre; Aubrun, Frédéric; Samama, Charles-Marc; Jouffroy, Laurent; Beaussier, Marc; Benhamou, Dan; Romegoux, Pauline; Skaare, Kristina; Bosson, Jean-Luc; Ecoffey, Claude

    2017-10-01

    The organization of health care establishments and perioperative care are essential for ensuring the quality of care and safety of patients undergoing outpatient surgery. In order to correctly inventory these organizations and practices, in 2013-2014, the French society of anaesthesia and intensive care organized an extensive practical survey in French ambulatory surgery units entitled the "OPERA" study (Organisation periopératoire de l'anesthésie en chirurgie ambulatoire). From among all of the ambulatory surgery centres listed by the Agences régionales de santé (Regional health agencies, France), 206 public and private centres were randomly selected. A structural (typology, organization) survey and a medical-practice survey (focusing on the management of postoperative pain, nausea and vomiting as well as the prevention of venous thromboembolism) were collected and managed by a prospective audit of practices occurring on two randomly selected days. The latter was further accompanied by an additional audit specifically focussing on ten representative procedures: (1) stomatology surgery (third molar removal); (2) knee arthroscopy; (3) surgery of the abdominal wall (including inguinal hernia); (4) perianal surgery; (5) varicose vein surgery; (6) digestive laparoscopy-cholecystectomy; (7) breast surgery (tumourectomy); (8) uterine surgery; (9) hallux valgus and (10) hand surgery (excluding carpal tunnel). Over the 2 days of observation, 7382 patients were included comprising 2174 patients who underwent one of the procedures from the above list. The analysis of these data will provide an overview of the organization of health establishments, the modalities thus supported and compliance with standards. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  18. From an urologist view: are we safe with endoscopic surgery? Overview of ergonomic problems encountered by the urologist during video endoscopic surgery.

    Science.gov (United States)

    Sataa, Sallami; Benzarti, Aida; Ben Jemaa, Abdelmajid

    2012-12-01

    The importance of minimally invasive surgery in urology has constantly increased in the last 20 years. Endoscopic resection of prostate and bladder tumors is actually a gold standard with many advantages for patients. To analyze the problems related to the ergonomic conditions faced by urologist during video endoscopic surgery by review of the recent literature. All evidence-based experimental ergonomic studies conducted in the fields of urology endoscopic surgery and applied ergonomics for other professions working with a display were identified by PubMed searches. Data from ergonomic studies were evaluated in terms of efficiency as well as comfort and safety aspects. Constraint postures for urologists are described and ergonomic requirements for optimal positions are discussed. The ergonomics of urological endoscopic surgery place urologists at risk for potential injury. The amount of neck flexion or extension, the amount of shoulder girdle adduction or abduction used, and stability of the upper extremities during surgery; which are maintained in a prolonged static posture; are the main risk factors. All these constraints may lead to muscle and joint fatigue, pain, and eventual musculoskeletal injury. Moreover, these issues may impact surgical accuracy. Urologist posture, operating period, training are important ergonomic factor during video surgery to prevent musculoskeletal disorders.

  19. Virtual reality training in laparoscopic surgery: A systematic review & meta-analysis.

    Science.gov (United States)

    Alaker, Medhat; Wynn, Greg R; Arulampalam, Tan

    2016-05-01

    Laparoscopic surgery requires a different and sometimes more complex skill set than does open surgery. Shortened working hours, less training times, and patient safety issues necessitates that these skills need to be acquired outside the operating room. Virtual reality simulation in laparoscopic surgery is a growing field, and many studies have been published to determine its effectiveness. This systematic review and meta-analysis aims to evaluate virtual reality simulation in laparoscopic abdominal surgery in comparison to other simulation models and to no training. A systematic literature search was carried out until January 2014 in full adherence to PRISMA guidelines. All randomised controlled studies comparing virtual reality training to other models of training or to no training were included. Only studies utilizing objective and validated assessment tools were included. Thirty one randomised controlled trials that compare virtual reality training to other models of training or to no training were included. The results of the meta-analysis showed that virtual reality simulation is significantly more effective than video trainers, and at least as good as box trainers. The use of Proficiency-based VR training, under supervision with prompt instructions and feedback, and the use of haptic feedback, has proven to be the most effective way of delivering the virtual reality training. The incorporation of virtual reality training into surgical training curricula is now necessary. A unified platform of training needs to be established. Further studies to assess the impact on patient outcomes and on hospital costs are necessary. (PROSPERO Registration number: CRD42014010030). Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  20. Treatment of Benign Thyroid Nodules: Comparison of Surgery with Radiofrequency Ablation.

    Science.gov (United States)

    Che, Y; Jin, S; Shi, C; Wang, L; Zhang, X; Li, Y; Baek, J H

    2015-07-01

    Nodular goiter is one of the most common benign lesions in thyroid nodule. The main treatment of the disease is still the traditional surgical resection, however there are many problems such as general anesthesia, surgical scar, postoperative thyroid or parathyroid function abnormalities, and high nodules recurrence rate in residual gland. The purpose of this study was to compare the efficacy, safety, and cost-effectiveness of 2 treatment methods, surgery and radiofrequency ablation, for the treatment of benign thyroid nodules. From May 2012 to September 2013, 200 patients with nodular goiters who underwent surgery (group A) and 200 patients treated by radiofrequency ablation (group B) were enrolled in this study. Inclusion criteria were the following: 1) cosmetic problem, 2) nodule-related symptoms, 3) hyperfunctioning nodules related to thyrotoxicosis, and 4) refusal of surgery (for group B). An internally cooled radiofrequency ablation system and an 18-ga internally cooled electrode were used. We compared the 2 groups in terms of efficacy, safety, and cost-effectiveness during a 1-year follow-up. After radiofrequency ablation, the nodule volume decreased significantly from 5.4 to 0.4 mL (P = .002) at the 12-month follow-up. The incidence of complications was significantly higher from surgery than from radiofrequency ablation (6.0% versus 1.0%, P = .002). Hypothyroidism was detected in 71.5% of patients after surgery but in none following radiofrequency ablation. The rate of residual nodules (11.9% versus 2.9%, P = .004) and hospitalization days was significantly greater after surgery (6.6 versus 2.1 days, P radiofrequency ablation are both effective treatments of nodular goiter. Compared with surgery, the advantages of radiofrequency ablation include fewer complications, preservation of thyroid function, and fewer hospitalization days. Therefore, radiofrequency ablation should be considered a first-line treatment for benign thyroid nodules. © 2015 by American

  1. Implementation of the Spanish ERAS program in bariatric surgery.

    Science.gov (United States)

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

    2018-03-08

    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, comparing it with a historical cohort receiving standard care. A multi-centric prospective study was performed, including 233 consecutive patients undergoing bariatric surgery during 2015 and following ERAS protocol. It was compared with a historical cohort of 286 patients, who underwent bariatric surgery at the same institutions between 2013 and 2014 and following standard care. Compliance with the protocol, morbidity, mortality, hospital stay and readmission were evaluated. Bariatric techniques performed were Roux-en-Y gastric bypass and sleeve gastrectomy. There were no significant differences in complications, mortality and readmission. Postoperative pain and hospital stay were significantly lower in the ERAS group. The total compliance to protocol was 80%. The Spanish National ERAS protocol is a safe issue, obtaining similar results to standard care in terms of complications, reoperations, mortality and readmissions. It is associated with less postoperative pain and earlier hospital discharge.

  2. 30 Years of Robotic Surgery.

    Science.gov (United States)

    Leal Ghezzi, Tiago; Campos Corleta, Oly

    2016-10-01

    The idea of reproducing himself with the use of a mechanical robot structure has been in man's imagination in the last 3000 years. However, the use of robots in medicine has only 30 years of history. The application of robots in surgery originates from the need of modern man to achieve two goals: the telepresence and the performance of repetitive and accurate tasks. The first "robot surgeon" used on a human patient was the PUMA 200 in 1985. In the 1990s, scientists developed the concept of "master-slave" robot, which consisted of a robot with remote manipulators controlled by a surgeon at a surgical workstation. Despite the lack of force and tactile feedback, technical advantages of robotic surgery, such as 3D vision, stable and magnified image, EndoWrist instruments, physiologic tremor filtering, and motion scaling, have been considered fundamental to overcome many of the limitations of the laparoscopic surgery. Since the approval of the da Vinci(®) robot by international agencies, American, European, and Asian surgeons have proved its factibility and safety for the performance of many different robot-assisted surgeries. Comparative studies of robotic and laparoscopic surgical procedures in general surgery have shown similar results with regard to perioperative, oncological, and functional outcomes. However, higher costs and lack of haptic feedback represent the major limitations of current robotic technology to become the standard technique of minimally invasive surgery worldwide. Therefore, the future of robotic surgery involves cost reduction, development of new platforms and technologies, creation and validation of curriculum and virtual simulators, and conduction of randomized clinical trials to determine the best applications of robotics.

  3. Adjuvant radiotherapy after breast conserving surgery - a comparative effectiveness research study.

    Science.gov (United States)

    Corradini, Stefanie; Niyazi, Maximilian; Niemoeller, Olivier M; Li, Minglun; Roeder, Falk; Eckel, Renate; Schubert-Fritschle, Gabriele; Scheithauer, Heike R; Harbeck, Nadia; Engel, Jutta; Belka, Claus

    2015-01-01

    The purpose of this retrospective outcome study was to validate the effectiveness of postoperative radiotherapy in breast conserving therapy (BCT) and to evaluate possible causes for omission of radiotherapy after breast conserving surgery (BCS) in a non-trial population. Data were provided by the population-based Munich Cancer Registry. The study included epidemiological data of 30.811 patients diagnosed with breast cancer from 1998 to 2012. The effect of omitting radiotherapy was analysed using Kaplan-Meier-estimates and Cox proportional hazard regression. Variables predicting omission of radiotherapy were analysed using multivariate logistic regression. Use of postoperative radiotherapy after BCS was associated with significant improvements in local control and survival. 10-year loco-regional recurrence-free-survival was 90.8% with postoperative radiotherapy vs. 77.6% with surgery alone (pstudy shows a decrease in local control and a survival disadvantage if postoperative radiotherapy after breast conserving surgery is omitted in an unselected cohort of primary breast cancer patients. Due to its epidemiological nature, it cannot answer the question in whom postoperative radiotherapy can be safely omitted. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Protocol for a multicentre, multistage, prospective study in China using system-based approaches for consistent improvement in surgical safety.

    Science.gov (United States)

    Yu, Xiaochu; Jiang, Jingmei; Liu, Changwei; Shen, Keng; Wang, Zixing; Han, Wei; Liu, Xingrong; Lin, Guole; Zhang, Ye; Zhang, Ying; Ma, Yufen; Bo, Haixin; Zhao, Yupei

    2017-06-15

    Surgical safety has emerged as a crucial global health issue in the past two decades. Although several safety-enhancing tools are available, the pace of large-scale improvement remains slow, especially in developing countries such as China. The present project (Modern Surgery and Anesthesia Safety Management System Construction and Promotion) aims to develop and validate system-based integrated approaches for reducing perioperative deaths and complications using a multicentre, multistage design. The project involves collection of clinical and outcome information for 1 20 000 surgical inpatients at four regionally representative academic/teaching general hospitals in China during three sequential stages: preparation and development, effectiveness validation and improvement of implementation for promotion. These big data will provide the evidence base for the formulation, validation and improvement processes of a system-based stratified safety intervention package covering the entire surgical pathway. Attention will be directed to managing inherent patient risks and regulating medical safety behaviour. Information technology will facilitate data collection and intervention implementation, provide supervision mechanisms and guarantee transfer of key patient safety messages between departments and personnel. Changes in rates of deaths, surgical complications during hospitalisation, length of stay, system adoption and implementation rates will be analysed to evaluate effectiveness and efficiency. This study was approved by the institutional review boards of Peking Union Medical College Hospital, First Hospital of China Medical University, Qinghai Provincial People's Hospital, Xiangya Hospital Central South University and the Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences. Study findings will be disseminated via peer-reviewed journals, conference presentations and patent papers. © Article author(s) (or their employer(s) unless otherwise

  5. Patch in Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alireza Alizadeh Ghavidel

    2014-06-01

    Full Text Available Introduction: Excessive bleeding presents a risk for the patient in cardiovascular surgery. Local haemostatic agents are of great value to reduce bleeding and related complications. TachoSil (Nycomed, Linz, Austria is a sterile, haemostatic agent that consists of an equine collagen patchcoated with human fibrinogen and thrombin. This study evaluated the safety and efficacy of TachoSil compared to conventional technique.Methods: Forty-two patients scheduled for open heart surgeries, were entered to this study from August 2010 to May 2011. After primary haemostatic measures, patients divided in two groups based on surgeon’s judgment. Group A: 20 patients for whom TachoSil was applied and group B: 22 patients that conventional method using Surgicel (13 patients or wait and see method (9 cases, were performed in order to control the bleeding. In group A, 10 patients were male with mean age of 56.95±15.67 years and in group B, 9 cases were male with mean age of 49.95±14.41 years. In case group 70% (14/20 of the surgeries were redo surgeries versus 100% (22/22 in control group.Results: Baseline characteristics were similar in both groups. In TachoSil group 75% of patients required transfusion versus 90.90% in group B (P=0.03.Most transfusions consisted of packed red blood cell; 2±1.13 units in group A versus 3.11±1.44 in group B (P=0.01, however there were no significant differences between two groups regarding the mean total volume of intra and post-operative bleeding. Re-exploration was required in 10% in group A versus 13.63% in group B (P=0.67.Conclusion: TachoSil may act as a superior alternative in different types of cardiac surgery in order to control the bleeding and therefore reducing transfusion requirement.

  6. 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

  7. Can Tranexamic Acid Reduce Blood Loss during Major Cardiac Surgery? A Pilot Study.

    Science.gov (United States)

    Compton, Frances; Wahed, Amer; Gregoric, Igor; Kar, Biswajit; Dasgupta, Amitava; Tint, Hlaing

    2017-09-01

    We examined the effectiveness of tranexamic acid in preventing intraoperative blood loss during major cardiac surgery. Out of initial 81 patients undergoing major cardiac surgery (both coronary artery bypass and valve repair procedures) at our teaching hospital, sixty-seven patients were selected for this study. We compared estimated blood loss, decrease in percent hemoglobin and hematocrit following surgery between two groups of patients (none of them received any blood product during surgery), one group receiving no tranexamic acid (n=17) and another group receiving tranexamic acid (n=25). In the second study, we combined these patients with patients receiving modest amounts of blood products (1-2 unit) and compared these parameters between two groups of patients (25 patients received no tranexamic acid, 42 patients received tranexamic acid). In patients who received no blood product during surgery, those who received no tranexamic acid showed statistically significant (independent t-test two tailed at p tranexamic acid (mean: 987.2 mL, SD: 459.9, n=25). We observed similar results when the patients receiving no blood products and patients receiving modest amount of blood products were combined based on the use of tranexamic acid or not. No statistically significant difference was observed in percent reduced hemoglobin or hematocrit following surgery in any group of patients. We conclude that intraoperative antifibrinolytic therapy with tranexamic acid does not reduce intraoperative blood loss during major cardiac surgery which contradicts popular belief. © 2017 by the Association of Clinical Scientists, Inc.

  8. Employment status and sick-leave following obesity surgery: a five-year prospective cohort study.

    Science.gov (United States)

    Andersen, John Roger; Hernæs, Ulrikke J V; Hufthammer, Karl Ove; Våge, Villy

    2015-01-01

    Background. Severe obesity is a risk factor for lower participation in paid work, but whether employment increases and sick leave decreases after obesity surgery is not well documented. Methods. We assessed 224 Norwegian patients with severe obesity (mean age: 40; mean BMI: 49; 61% female) regarding employment status (working versus not working) and the number of days of sick leave during the preceding 12 months, before and five years after obesity surgery (75% follow-up rate). Logistic regression analysis was used to study preoperative predictors of employment status after surgery. Results. There were no change in the employment rate over time (54% versus 58%), but the number of days of sick leave per year was significantly reduced, from a mean of 63 to a mean of 26, and from a median of 36 to a median of 4. Most of this change was attributable to patients with zero days of sick leave, which increased from 25% to 41%. Being female, older, having low education level, receiving disability pension and not being employed before obesity surgery were important risk factors for not being employed after obesity surgery. The type of obesity surgery, BMI and marital status were not useful predictors. Conclusions. Our findings suggest that undergoing obesity surgery is not associated with a higher rate of employment, although it may reduce the number of days of sick leave. Additional interventions are likely needed to influence the employment status of these patients. The significant preoperative predictors of not being employed in this study provide suggestions for further research.

  9. Employment status and sick-leave following obesity surgery: a five-year prospective cohort study

    Directory of Open Access Journals (Sweden)

    John Roger Andersen

    2015-09-01

    Full Text Available Background. Severe obesity is a risk factor for lower participation in paid work, but whether employment increases and sick leave decreases after obesity surgery is not well documented.Methods. We assessed 224 Norwegian patients with severe obesity (mean age: 40; mean BMI: 49; 61% female regarding employment status (working versus not working and the number of days of sick leave during the preceding 12 months, before and five years after obesity surgery (75% follow-up rate. Logistic regression analysis was used to study preoperative predictors of employment status after surgery.Results. There were no change in the employment rate over time (54% versus 58%, but the number of days of sick leave per year was significantly reduced, from a mean of 63 to a mean of 26, and from a median of 36 to a median of 4. Most of this change was attributable to patients with zero days of sick leave, which increased from 25% to 41%. Being female, older, having low education level, receiving disability pension and not being employed before obesity surgery were important risk factors for not being employed after obesity surgery. The type of obesity surgery, BMI and marital status were not useful predictors.Conclusions. Our findings suggest that undergoing obesity surgery is not associated with a higher rate of employment, although it may reduce the number of days of sick leave. Additional interventions are likely needed to influence the employment status of these patients. The significant preoperative predictors of not being employed in this study provide suggestions for further research.

  10. The Arrival of Robotics in Spine Surgery: A Review of the Literature.

    Science.gov (United States)

    Ghasem, Alexander; Sharma, Akhil; Greif, Dylan N; Alam, Milad; Maaieh, Motasem Al

    2018-04-18

    Systematic Review. The authors aim to review comparative outcome measures between robotic and free-hand spine surgical procedures including: accuracy of spinal instrumentation, radiation exposure, operative time, hospital stay, and complication rates. Misplacement of pedicle screws in conventional open as well as minimally invasive surgical procedures has prompted the need for innovation and allowed the emergence of robotics in spine surgery. Prior to incorporation of robotic surgery in routine practice, demonstration of improved instrumentation accuracy, operative efficiency, and patient safety is required. A systematic search of the PubMed, OVID-MEDLINE, and Cochrane databases was performed for papers relevant to robotic assistance of pedicle screw placement. Inclusion criteria were constituted by English written randomized control trials, prospective and retrospective cohort studies involving robotic instrumentation in the spine. Following abstract, title, and full-text review, 32 articles were selected for study inclusion. Intrapedicular accuracy in screw placement and subsequent complications were at least comparable if not superior in the robotic surgery cohort. There is evidence supporting that total operative time is prolonged in robot assisted surgery compared to conventional free-hand. Radiation exposure appeared to be variable between studies; radiation time did decrease in the robot arm as the total number of robotic cases ascended, suggesting a learning curve effect. Multi-level procedures appeared to tend toward earlier discharge in patients undergoing robotic spine surgery. The implementation of robotic technology for pedicle screw placement yields an acceptable level of accuracy on a highly consistent basis. Surgeons should remain vigilant about confirmation of robotic assisted screw trajectory, as drilling pathways have been shown to be altered by soft tissue pressures, forceful surgical application, and bony surface skiving. However, the effective

  11. Concomitant atrial fibrillation surgery for people undergoing cardiac surgery

    Science.gov (United States)

    Huffman, Mark D; Karmali, Kunal N; Berendsen, Mark A; Andrei, Adin-Cristian; Kruse, Jane; McCarthy, Patrick M; Malaisrie, S C

    2016-01-01

    Background People with atrial fibrillation (AF) often undergo cardiac surgery for other underlying reasons and are frequently offered concomitant AF surgery to reduce the frequency of short- and long-term AF and improve short- and long-term outcomes. Objectives To assess the effects of concomitant AF surgery among people with AF who are undergoing cardiac surgery on short-term and long-term (12 months or greater) health-related outcomes, health-related quality of life, and costs. Search methods Starting from the year when the first “maze” AF surgery was reported (1987), we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (March 2016), MEDLINE Ovid (March 2016), Embase Ovid (March 2016), Web of Science (March 2016), the Database of Abstracts of Reviews of Effects (DARE, April 2015), and Health Technology Assessment Database (HTA, March 2016). We searched trial registers in April 2016. We used no language restrictions. Selection criteria We included randomised controlled trials evaluating the effect of any concomitant AF surgery compared with no AF surgery among adults with preoperative AF, regardless of symptoms, who were undergoing cardiac surgery for another indication. Data collection and analysis Two review authors independently selected studies and extracted data. We evaluated the risk of bias using the Cochrane ‘Risk of bias’ tool. We included outcome data on all-cause and cardiovascular-specific mortality, freedom from atrial fibrillation, flutter, or tachycardia off antiarrhythmic medications, as measured by patient electrocardiographic monitoring greater than three months after the procedure, procedural safety, 30-day rehospitalisation, need for post-discharge direct current cardioversion, health-related quality of life, and direct costs. We calculated risk ratios (RR) for dichotomous data with 95% confidence intervals (CI) using a fixed-effect model when heterogeneity was low (I2 ≤ 50%) and random

  12. Current Practices and Barriers to the Integration of Oncoplastic Breast Surgery: A Canadian Perspective.

    Science.gov (United States)

    Maxwell, Jessica; Roberts, Amanda; Cil, Tulin; Somogyi, Ron; Osman, Fahima

    2016-10-01

    Despite the safety and popularity of oncoplastic surgery, there is limited data examining utilization and barriers associated with its incorporation into practice. This study examines the use of oncoplastic techniques in breast conserving surgery and determines the barriers associated with their implementation. A 13-item survey was mailed to all registered general surgeons in Ontario, Canada. The survey assessed surgeon demographics, utilization of specific oncoplastic techniques, and perceived barriers. A total of 234 survey responses were received, representing a response rate of 32.2 % (234 of 725). Of the respondents, 166 surgeons (70.9 %) reported a practice volume of at least 25 % breast surgery. Comparison was made between general surgeons performing oncoplastic breast surgery (N = 79) and those who did not use these techniques (N = 87). Surgeon gender, years in practice, fellowship training, and access to plastic surgery were similar across groups. Both groups rated the importance of breast cosmesis similarly. General surgeons with a practice volume involving >50 % breast surgery were more likely to use oncoplastic techniques (OR 8.82, p < .001) and involve plastic surgeons in breast conserving surgery (OR 2.21, p = .02). For surgeons not performing oncoplastic surgery, a lack of training and access to plastic surgeons were identified as significant barriers. For those using oncoplastic techniques, the absence of specific billing codes was identified as a limiting factor. Lack of training, access to plastic surgeons, and absence of appropriate reimbursement for these cases are significant barriers to the adoption of oncoplastic techniques.

  13. 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

  14. Important Non-Technical Skills in Video-Assisted Thoracoscopic Surgery Lobectomy: Team Perspectives.

    Science.gov (United States)

    Gjeraa, Kirsten; Mundt, Anna S; Spanager, Lene; Hansen, Henrik J; Konge, Lars; Petersen, René H; Østergaard, Doris

    2017-07-01

    Safety in the operating room is dependent on the team's non-technical skills. The importance of non-technical skills appears to be different for minimally invasive surgery as compared with open surgery. The aim of this study was to identify which non-technical skills are perceived by team members to be most important for patient safety, in the setting of video-assisted thoracoscopic surgery (VATS) lobectomy. This was an explorative, semistructured interview-based study with 21 participants from all four thoracic surgery centers in Denmark that perform VATS lobectomy. Data analysis was deductive, and directed content analysis was used to code the text into the Oxford Non-Technical Skills system for evaluating operating teams' non-technical skills. The most important non-technical skills described by the VATS teams were planning and preparation, situation awareness, problem solving, leadership, risk assessment, and teamwork. These non-technical skills enabled the team to achieve shared mental models, which in turn facilitated their efforts to anticipate next steps. This was viewed as important by the participants as they saw VATS lobectomy as a high-risk procedure with complementary and overlapping scopes of practice between surgical and anesthesia subteams. This study identified six non-technical skills that serve as the foundation for shared mental models of the patient, the current situation, and team resources. These findings contribute three important additions to the shared mental model construct: planning and preparation, risk assessment, and leadership. Shared mental models are crucial for patient safety because they enable VATS teams to anticipate problems through adaptive patterns of both implicit and explicit coordination. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Life after pelvic organ prolapse surgery: a qualitative study in Amhara region, Ethiopia.

    Science.gov (United States)

    Gjerde, Janne L; Rortveit, Guri; Adefris, Mulat; Belayneh, Tadesse; Blystad, Astrid

    2018-05-29

    Women living in resource constrained settings often have limited knowledge of and access to surgical treatment for pelvic organ prolapse. Additionally, little is known about experiences during recovery periods or about the reintegration process for women who do gain access to medical services, including surgery. This study aimed to explore women's experiences related to recovery and reintegration after free surgical treatment for pelvic organ prolapse in a resource-constrained setting. The study had a qualitative design and used in-depth interviews in the data collection with a purposive sample of 25 participants, including 12 women with pelvic organ prolapse. Recruitment took place at the University of Gondar Hospital, Ethiopia, where women with pelvic organ prolapse had been admitted for free surgical treatment. In-depth interviews were carried out with women at the hospital prior to surgery and in their homes 5-9 months following surgery. Interviews were also conducted with health-care providers (8), representatives from relevant organizations (3), and health authorities (2). The fieldwork was carried out in close collaboration with a local female interpreter. The majority of the women experienced a transformation after prolapse surgery. They went from a life dominated by fear of disclosure, discrimination, and divorce due to what was perceived as a shameful and strongly prohibitive condition both physically and socially, to a life of gradually regained physical health and reintegration into a social life. The strong mobilization of family-networks for most of the women facilitated work-related help and social support during the immediate post-surgery period as well as on a long-term basis. The women with less extensive social networks expressed greater challenges, and some struggled to meet their basic needs. All the women openly disclosed their health condition after surgery, and several actively engaged in creating awareness about the condition. Free surgical

  16. Structured versus long-chain triglycerides: a safety, tolerance, and efficacy randomized study in colorectal surgical patients.

    Science.gov (United States)

    Bellantone, R; Bossola, M; Carriero, C; Malerba, M; Nucera, P; Ratto, C; Crucitti, P; Pacelli, F; Doglietto, G B; Crucitti, F

    1999-01-01

    After trauma or surgery, researchers have suggested that medium-chain triglycerides have metabolic advantages, although they are toxic in large doses. To try to reduce this potential toxicity, structured lipids, which provide a higher oxidation rate, faster clearance from blood, improved nitrogen balance, and less accumulation in the reticuloendothelial system, could be used. Therefore, we evaluated, through a blind randomized study, the safety, tolerance, and efficacy of structured triglycerides, compared with long-chain triglycerides (LCT), in patients undergoing colorectal surgery. Nineteen patients were randomized to receive long-chain or structured triglycerides as a lipid source. They received the same amount of calories (27.2/kg/d), glucose (4 g/kg/d), protein (0.2 g/kg/d), and lipids (11.2 kcal/kg/d). Patients were evaluated during and after the treatment for clinical and laboratory variables, daily and cumulative nitrogen balance, urinary excretion of 3-methyl-histidine, and urinary 3-methylhistidine/creatinine ratio. No adverse effect that required the interruption of the treatment was observed. Triglyceride levels and clinical and laboratory variables were similar in the two groups. A predominantly positive nitrogen balance was observed from day 2 until day 5 in the LCT group and from day 1 until day 4 in the structured triglycerides group. The cumulative nitrogen balance (in grams) for days 1 to 3 was 9.7+/-5.2 in the experimental group and 4.4+/-11.8 in the control group (p = .2). For days 1 to 5 it was 10.7+/-10.5 and 6.5+/-17.9 (p = .05), respectively. The excretion of 3-methylhistidine was higher in the control group but decreased in the following days and was similar to the experimental group on day 5. This study represents the first report in which structured triglycerides are administered in postoperative patients to evaluate safety, tolerance, and efficacy. It suggests that Fe73403 is safe, well tolerated, and efficacious in terms of nitrogen

  17. 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

  18. Safety and efficacy of hysteroscopic sterilization compared with laparoscopic sterilization: an observational cohort study

    Science.gov (United States)

    Mao, Jialin; Pfeifer, Samantha; Schlegel, Peter

    2015-01-01

    Objective To compare the safety and efficacy of hysteroscopic sterilization with the “Essure” device with laparoscopic sterilization in a large, all-inclusive, state cohort. Design Population based cohort study. Settings Outpatient interventional setting in New York State. Participants Women undergoing interval sterilization procedure, including hysteroscopic sterilization with Essure device and laparoscopic surgery, between 2005 and 2013. Main outcomes measures Safety events within 30 days of procedures; unintended pregnancies and reoperations within one year of procedures. Mixed model accounting for hospital clustering was used to compare 30 day and 1 year outcomes, adjusting for patient characteristics and other confounders. Time to reoperation was evaluated using frailty model for time to event analysis. Results We identified 8048 patients undergoing hysteroscopic sterilization and 44 278 undergoing laparoscopic sterilization between 2005 and 2013 in New York State. There was a significant increase in the use of hysteroscopic procedures during this period, while use of laparoscopic sterilization decreased. Patients undergoing hysteroscopic sterilization were older than those undergoing laparoscopic sterilization and were more likely to have a history of pelvic inflammatory disease (10.3% v 7.2%, P<0.01), major abdominal surgery (9.4% v 7.9%, P<0.01), and cesarean section (23.2% v 15.4%, P<0.01). At one year after surgery, hysteroscopic sterilization was not associated with a higher risk of unintended pregnancy (odds ratio 0.84 (95% CI 0.63 to 1.12)) but was associated with a substantially increased risk of reoperation (odds ratio 10.16 (7.47 to 13.81)) compared with laparoscopic sterilization. Conclusions Patients undergoing hysteroscopic sterilization have a similar risk of unintended pregnancy but a more than 10-fold higher risk of undergoing reoperation compared with patients undergoing laparoscopic sterilization. Benefits and risks of both procedures

  19. Compliance and Effectiveness of WHO Surgical Safety Check list: A JPMC Audit

    OpenAIRE

    Anwer, Mariyah; Manzoor, Shahneela; Muneer, Nadeem; Qureshi, Shamim

    2016-01-01

    Objective: To assess World Health Organization (WHO) Surgical Safety Checklist (SSC), compliance and its effectiveness in reducing complications and final outcome of patients. Methods: This was a prospective study done in Department of General Surgery (Ward 02), Jinnah Postgraduate Medical Centre (JPMC), Karachi. The study included Total 3638 patients who underwent surgical procedure in elective theatre in four years from November 2011 to October 2015 since the SSC was included as part of his...

  20. Using an International Medical Advisory Board to guide clinical governance in a corporate refractive surgery model.

    Science.gov (United States)

    Vukich, John A

    2009-07-01

    To describe the role played by the International Medical Advisory Board (IMAB) in clinical and corporate governance at Optical Express, a corporate provider of refractive surgery. A review of goals, objectives, and actions of the IMAB. The IMAB has contributed to study design, data analysis, and selection of instruments and procedures. Through interactions with Optical Express corporate and clinical staff, the IMAB has supported management's effort to craft a corporate culture focused on continuous improvement in the safety and visual outcomes of refractive surgery. The IMAB has fashioned significant changes in corporate policies and procedures and has had an impact on corporate culture at Optical Express.

  1. 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

  2. Prosthetic valve obstruction: Redo surgery or fibrinolysis?

    Directory of Open Access Journals (Sweden)

    Avinash Inamdar

    2017-01-01

    Full Text Available Objective: The aim of this study was to compare the efficacy and safety of surgery versus fibrinolytic therapy in patients with prosthetic valve obstruction. Materials and Methods: We compared 15 patients of prosthetic valve thrombosis treated by surgical line of management and another 15 patients treated by thrombolysis. All patients were initially assessed by clinical evaluation and diagnosis confirmed by transthoracic and transesophageal two-dimensional echocardiography. Depending on hemodynamic stability, pannus, or thrombus on transesophageal echocardiography, the patients were assigned surgical or medical line of management. Results: Patients mortality rate was 40% in fibrinolytic group and 13.33% in surgical group. Recurrence was 40% in fibrinolytic group while there was no recurrence till date in surgery group. Complications were more in fibrinolytic group as opposed to surgery group patient. Conclusion: From our experience, we conclude that redo surgery is effective and definitive treatment, especially in patients with stable hemodynamic conditions.

  3. The Incidence of Propionibacterium acnes in Open Shoulder Surgery: A Controlled Diagnostic Study.

    Science.gov (United States)

    Mook, William R; Klement, Mitchell R; Green, Cynthia L; Hazen, Kevin C; Garrigues, Grant E

    2015-06-17

    Propionibacterium acnes has arisen as the most common microorganism identified at the time of revision shoulder arthroplasty. There is limited evidence to suggest how frequently false-positive cultures occur. The purpose of this prospective controlled study was to evaluate culture growth from specimens obtained during open shoulder surgery. Patients undergoing an open deltopectoral approach to the shoulder were prospectively enrolled. Patients with a history of shoulder surgery or any concern for active or previous shoulder infection were excluded. Three pericapsular soft-tissue samples were taken from the shoulder for bacterial culture and were incubated for fourteen days. A sterile sponge was also analyzed in parallel with the tissue cultures. In addition, similar cultures were obtained from patients who had undergone previous shoulder surgery. Overall, 20.5% of surgeries (twenty-four of 117) yielded at least one specimen removed for culture that was positive for bacterial growth, and 13.0% of sterile control specimens (seven of fifty-four) had positive culture growth (p = 0.234). P. acnes represented 83.0% of all positive cultures (thirty-nine of forty-seven) at a median incubation time of fourteen days. Among the subjects who had not undergone previous surgery, 17.1% (fourteen of eighty-two) had at least one positive P. acnes culture. Male sex was univariably associated with a greater likelihood of bacterial growth (p surgery and had received two or more preoperative corticosteroid injections had a higher likelihood of bacterial growth (p = 0.047). The clinical importance of positive P. acnes cultures from specimens obtained from open shoulder surgery remains uncertain. Male sex and preoperative corticosteroid injections were associated with a higher likelihood of bacterial growth on culture and are risk factors that merit further investigation. Previously reported incidences of positive P. acnes culture results from specimens from primary and revision shoulder

  4. Electrophysiological evaluation of phrenic nerve injury during cardiac surgerya prospective, controlled, clinical study

    Directory of Open Access Journals (Sweden)

    Ege Turan

    2004-01-01

    Full Text Available Abstract Background According to some reports, left hemidiaphragmatic paralysis due to phrenic nerve injury may occur following cardiac surgery. The purpose of this study was to document the effects on phrenic nerve injury of whole body hypothermia, use of ice-slush around the heart and mammary artery harvesting. Methods Electrophysiology of phrenic nerves was studied bilaterally in 78 subjects before and three weeks after cardiac or peripheral vascular surgery. In 49 patients, coronary artery bypass grafting (CABG and heart valve replacement with moderate hypothermic (mean 28°C cardiopulmonary bypass (CPB were performed. In the other 29, CABG with beating heart was performed, or, in several cases, peripheral vascular surgery with normothermia. Results In all patients, measurements of bilateral phrenic nerve function were within normal limits before surgery. Three weeks after surgery, left phrenic nerve function was absent in five patients in the CPB and hypothermia group (3 in CABG and 2 in valve replacement. No phrenic nerve dysfunction was observed after surgery in the CABG with beating heart (no CPB or the peripheral vascular groups. Except in the five patients with left phrenic nerve paralysis, mean phrenic nerve conduction latency time (ms and amplitude (mV did not differ statistically before and after surgery in either group (p > 0.05. Conclusions Our results indicate that CPB with hypothermia and local ice-slush application around the heart play a role in phrenic nerve injury following cardiac surgery. Furthermore, phrenic nerve injury during cardiac surgery occurred in 10.2 % of our patients (CABG with CPB plus valve surgery.

  5. Study on the KALIMER safety approach

    International Nuclear Information System (INIS)

    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

  6. Preclinical cadaveric study of transanal endoscopic da Vinci® surgery.

    Science.gov (United States)

    Hompes, R; Rauh, S M; Hagen, M E; Mortensen, N J

    2012-08-01

    Single-port platforms are increasingly being used for transanal surgery and may be associated with a shorter learning curve than transanal endoscopic microsurgery. However, these procedures remain technically challenging, and robotic technology could overcome some of the limitations and increase intraluminal manoeuvrability. An initial experimental experience with transanal endoscopic da Vinci(®) surgery (TEdS) using a glove port on human cadavers is reported. After initial dry laboratory experiments, the feasibility of TEdS and ideal set-up were further evaluated in human cadavers. For transanal access a glove port was constructed on-table by using a circular anal dilator, a standard wound retractor and a surgical glove. A da Vinci(®) Si HD system was used in combination with the glove port for transanal endoscopic resections. It was possible to perform all necessary tasks to complete a full-thickness excision and closure of the rectal wall, with cadavers in both prone and supine positions. The stable magnified view, combined with the EndoWrist(®) technology of the robotic instruments, made every task straightforward. Intraluminal manoeuvrability could be improved further by intersecting the robotic instruments. The glove port proved to be very reliable and the inherent flexibility of the glove facilitated docking of the robotic arms in a narrow confined space. Using a reliable and universally available glove port, TEdS was feasible and a preferred set-up was determined. Further clinical trials will be necessary to assess the safety and efficacy of this technique. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  7. Patient Safety in Interventional Radiology: A CIRSE IR Checklist.

    LENUS (Irish Health Repository)

    2012-02-01

    Interventional radiology (IR) is an invasive speciality with the potential for complications as with other invasive specialities. The World Health Organization (WHO) produced a surgical safety checklist to decrease the morbidity and mortality associated with surgery. The Cardiovascular and Interventional Society of Europe (CIRSE) set up a task force to produce a checklist for IR. Use of the checklist will, we hope, reduce the incidence of complications after IR procedures. It has been modified from the WHO surgical safety checklist and the RAD PASS from Holland.

  8. Timing of drainage tube removal after thyroid surgery: a retrospective study.

    Science.gov (United States)

    Minami, Shigeki; Sakimura, Chika; Hayashida, Naomi; Yamanouchi, Kosho; Kuroki, Tamotsu; Eguchi, Susumu

    2014-01-01

    The aim of this study was to evaluate the chronological changes in the amount of drainage fluid after thyroidectomy, and to establish standard indications for the drain to be removed. We examined a cohort of 249 patients undergoing thyroid surgery. The patients were divided into four groups: a Graves' group, a non-dissection group, a central-dissection group and a lateral-dissection group. The amount of drainage was measured every 6 h, and the drain was removed postoperatively when the drainage decreased in amount and contained serous fluid after a meal. In all four groups, the most drainage occurred in the first 6 h after surgery. The total amount of drainage from the operation to the time of drain removal was significantly higher in Graves' group and in the lateral-dissection group than in the other two groups. The median wound drainage significantly decreased from 12 to 18 h after surgery in all four groups. In the lateral-dissection group, the wound drainage significantly decreased again in the first 24-30 h. The findings of this study suggest that drains can be removed postoperatively if the drainage was less than 15 mL during a 6-h period and contain serous fluid.

  9. Behavioral integrity for safety, priority of safety, psychological safety, and patient safety : a team-level study

    NARCIS (Netherlands)

    Leroy, H.; Dierynck, B.; Anseel, F.; Simons, T.; Halbesleben, J.R.; McCaughey, D.; Savage, G.T.; Sels, L.

    2012-01-01

    This article clarifies how leader behavioral integrity for safety helps solve follower's double bind between adhering to safety protocols and speaking up about mistakes against protocols. Path modeling of survey data in 54 nursing teams showed that head nurse behavioral integrity for safety

  10. 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.

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

    International Nuclear Information System (INIS)

    Svensson, Ola; Salo, Ilkka; Allwin, Pernilla

    2004-11-01

    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

  12. Transjugular Intrahepatic Portosystemic Shunt before Abdominal Surgery in Cirrhotic Patients: A Retrospective, Comparative Study

    Directory of Open Access Journals (Sweden)

    Evelyne Vinet

    2006-01-01

    Full Text Available Surgery in cirrhotic patients is associated with high morbidity and mortality related to portal hypertension and liver insufficiency. Therefore, preoperative portal decompression is a logical approach to facilitate abdominal surgery and hopefully to improve postoperative survival. The present study evaluated the clinical outcomes of 18 patients (mean age 58 years with cirrhosis (seven alcoholics and 11 nonalcoholics who underwent transjugular intrahepatic portosystemic shunt (TIPS placement before antrectomy (n=5, colectomy (n=10, small-bowel resection (n=1, pancreatectomy (n=1 and nephrectomy (n=1. TIPS was performed a mean (± SD of 72±21 days before surgery and induced a marked mean decrease in portohepatic gradient from 21.4±3.9 mmHg to 8.4±3.4 mmHg. Cirrhotic patients (n=17 who underwent elective abdominal surgery without preoperative TIPS placement were used as the control group. Both groups were matched for age, etiology of cirrhosis, indications for surgery, type of surgery and coagulation parameters. The mean Pugh score was significantly higher in the TIPS group (7.7 versus 6.2. No significant differences were observed for operative blood loss, postoperative complications, duration of hospitalization and one-month (83% versus 88% or one-year (54% versus 63% cumulative survival rate. Analysis using the Cox proportional hazards model showed that neither TIPS placement nor preoperative Pugh score were independent predictors for survival. The present study suggests that preoperative TIPS placement does not improve postoperative evolution after abdominal surgery in cirrhotic patients with good or moderately impaired liver function.

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

    International Nuclear Information System (INIS)

    Lowe, Andrew; Hayward, Brent

    2006-08-01

    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 results of the

  14. 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.

  15. Evaluation of mandibular condylar changes in patients following orthognathic surgery: A retrospective study

    Directory of Open Access Journals (Sweden)

    Vikas Aneja

    2017-01-01

    Full Text Available Background: Condylar resorption as a cause of relapse after orthognathic surgery is well known. Several authors have presented evidence of the relation between orthognathic surgery and condylar remodeling and resorption. This study was done to appraise the condylar changes along with the form and function following orthognathic surgery, as well as to assess what factors may have contributed to the problems. Methodology: A diagnosis of progressive condylar resorption (PCR was made by comparison of preoperative and postoperative radiographs (cephalometric radiograms, as well as clinical evaluations. The radiographs were taken for each patient preoperatively and postoperatively, which include immediately after osteotomy, at 6 months and 24 months. Additional radiographs were taken when required. Then, preoperative and postoperative tracings were compared at 24 months postoperatively. Results and Conclusion: It can be concluded from this study that females of relative low age (<18 years appeared to be a high-risk factor for the occurrence of condylar alteration including PCR. A steep mandibular plane angle, the low facial height ratio (post/ant, and magnitude of surgery were also significantly related to the occurrence of condylar alteration, but the multivariance regression showed that these parameters had only limited value.

  16. [Use and Safety of Preoperative Oral Rehydration Therapy Using a Jelly Type Oral Rehydration Solution].

    Science.gov (United States)

    Yamada, Tomomi; Mukai, Nobuhiro; Tsuchida, Keiichirou; Hayashi, Kazuko

    2015-04-01

    Traditionally, perioperative nutritional management centered on fluid therapy, but in recent years, with the spread of enhanced recovery after surgery (ERAS) protocols, the utility of oral rehydration therapy (ORT) has been reported. There are few reports, however, on the safety of using jelly type oral rehydration solutions for ORT. We examined the effects of OS-1 jelly on gastric fluid and investigated its safety. A total of 147 patients (age range, 4-91 years), scheduled for elective surgery at our institution for whom ORT was indicated, were enrolled in this study. If the surgery was scheduled for the morning, patients were given two bottles of 200 g OS-1 jelly during the previous evening meal. If surgery was scheduled for the afternoon, two additional 200 g bottles were given to the patient with the morning meal on the day of surgery. Patients were allowed to drink water until two hours before the surgery. Gastric fluid was aspirated with a gastric tube after anesthesia induction, after which, volume and pH were measured. In all cases, gastric content was aspirated as a liquid, not a jelly. The volume and pH were 11.4 ± 14.6 ml and 2.8 ± 2.2, respectively. No major difference was seen in comparison with the data for OS-1 liquid. No postoperative aspiration pneumonia or reflux of gastric contents at the time of anesthesia induction was seen in any of the patients. From the present findings, if the time of water intake is strictly controlled, preoperative rehydration therapy using jelly-type oral rehydration solution is thought to be safe and comparable to liquid solution regarding its effects on gastric fluid.

  17. Advantages of robotics in benign gynecologic surgery.

    Science.gov (United States)

    Truong, Mireille; Kim, Jin Hee; Scheib, Stacey; Patzkowsky, Kristin

    2016-08-01

    The purpose of this article is to review the literature and discuss the advantages of robotics in benign gynecologic surgery. Minimally invasive surgery has become the preferred route over abdominal surgery. The laparoscopic or robotic approach is recommended when vaginal surgery is not feasible. Thus far, robotic gynecologic surgery data have demonstrated feasibility, safety, and equivalent clinical outcomes in comparison with laparoscopy and better clinical outcomes compared with laparotomy. Robotics was developed to overcome challenges of laparoscopy and has led to technological advantages such as improved ergonomics, visualization with three-dimensional capabilities, dexterity and range of motion with instrument articulation, and tremor filtration. To date, applications of robotics in benign gynecology include hysterectomy, myomectomy, endometriosis surgery, sacrocolpopexy, adnexal surgery, tubal reanastomosis, and cerclage. Though further data are needed, robotics may provide additional benefits over other approaches in the obese patient population and in higher complexity cases. Challenges that arose in the earlier adoption stage such as the steep learning curve, costs, and operative times are becoming more optimized with greater experience, with implementation of robotics in high-volume centers and with improved training of surgeons and robotic teams. Robotic laparoendoscopic single-site surgery, albeit still in its infancy where technical advantages compared with laparoscopic single-site surgery are still unclear, may provide a cost-reducing option compared with multiport robotics. The cost may even approach that of laparoscopy while still conferring similar perioperative outcomes. Advances in robotic technology such as the single-site platform and telesurgery, have the potential to revolutionize the field of minimally invasive gynecologic surgery. Higher quality evidence is needed to determine the advantages and disadvantages of robotic surgery in benign

  18. Endoscopic Versus Microscopic Transsphenoidal Surgery in the Treatment of Pituitary Adenoma: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Li, Aijun; Liu, Weisheng; Cao, Peicheng; Zheng, Yuehua; Bu, Zhenfu; Zhou, Tao

    2017-05-01

    Inconsistent findings have been reported regarding the efficacy and safety of endoscopic and microscopic transsphenoidal surgery for pituitary adenoma. This study aimed to assess the benefits and shortcomings of these surgical methods in patients with pituitary adenoma. The electronic databases PubMed, Embase, and the Cochrane Library were systematically searched, as well as proceedings of major meetings. Eligible studies with a retrospective or prospective design that evaluated endoscopic versus microscopic methods in patients with pituitary adenoma were included. Primary outcomes included gross tumor removal, cerebrospinal fluid leak, diabetes insipidus, and other complications. Overall, 23 studies (4 prospective and 19 retrospective) assessing 2272 patients with pituitary adenoma were included in the final analysis. Endoscopic transsphenoidal surgery was associated with a higher incidence of gross tumor removal (odds ratio, 1.52; 95% confidence interval, 1.11-2.08; P = 0.009) than those with microscopic transsphenoidal surgery. In addition, endoscopic transsphenoidal surgery had no significant effect on the risk of cerebrospinal fluid leak, compared with microscopic transsphenoidal surgery. Furthermore, endoscopic transsphenoidal surgery was associated with a 22% reduction in risk of diabetes insipidus compared with microscopic transsphenoidal surgery, but the difference was not statistically significant. Endoscopic transsphenoidal surgery significantly reduced the risk of septal perforation (odds ratio, 0.29; 95% confidence interval, 0.11-0.78; P = 0.014) and was not associated with the risk of meningitis, epistaxis, hematoma, hypopituitarism, hypothyroidism, hypocortisolism, total mortality, and recurrence. Endoscopic transsphenoidal surgery is associated with higher gross tumor removal and lower incidence of septal perforation in patients with pituitary adenoma. Future large-scale prospective randomized controlled trials are needed to verify these findings

  19. 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.

  20. Temporomandibular joint dysfunction and orthognathic surgery: a retrospective study

    Directory of Open Access Journals (Sweden)

    Raoul Gwénael

    2010-11-01

    Full Text Available Abstract Background Relations between maxillo-mandibular deformities and TMJ disorders have been the object of different studies in medical literature and there are various opinions concerning the alteration of TMJ dysfunction after orthognathic surgery. The purpose of the present study was to evaluate TMJ disorders changes before and after orthognathic surgery, and to assess the risk of creating new TMJ symptoms on asymptomatic patients. Methods A questionnaire was sent to 176 patients operated at the Maxillo-Facial Service of the Lille's 2 Universitary Hospital Center (Chairman Pr Joël Ferri from 01.01.2006 to 01.01.2008. 57 patients (35 females and 22 males, age range from 16 to 65 years old, filled the questionnaire. The prevalence and the results on pain, sounds, clicking, joint locking, limited mouth opening, and tenseness were evaluated comparing different subgroups of patients. Results TMJ symptoms were significantly reduced after treatment for patients with pre-operative symptoms. The overall subjective treatment outcome was: improvement for 80.0% of patients, no change for 16.4% of patients, and an increase of symptoms for 3.6% of them. Thus, most patients were very satisfied with the results. However the appearance of new onset of TMJ symptoms is common. There was no statistical difference in the prevalence of preoperative TMJ symptoms and on postoperative results in class II compared to class III patients. Conclusions These observations demonstrate that: there is a high prevalence of TMJ disorders in dysgnathic patients; most of patients with preoperative TMJ signs and symptoms can improve TMJ dysfunction and pain levels can be reduced by orthognathic treatment; a percentage of dysgnathic patients who were preoperatively asymptomatic can develop TMJ disorders after surgery but this risk is low.

  1. Glove failure in elective thyroid surgery: A prospective randomized study

    Directory of Open Access Journals (Sweden)

    Dariusz Timler

    2015-06-01

    Full Text Available Objectives: To analyze perforation rate in sterile gloves used by surgeons in the operating theatre of the Department of Endocrinological and General Surgery of Medical University of Lodz. Material and Methods: Randomized and controlled trial. This study analyses the incidents of tears in sterile surgical gloves used by surgeons during operations on 3 types of thyroid diseases according to the 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10 codes. Nine hundred seventy-two pairs (sets of gloves were collected from 321 surgical procedures. All gloves were tested immediately following surgery using the water leak test (EN455-1 to detect leakage. Results: Glove perforation was detected in 89 of 972 glove sets (9.2%. Statistically relevant more often glove tears occurred in operator than the 1st assistant (p < 0.001. The sites of perforation were localized mostly on the middle finger of the non-dominant hand (22.5%, and the non-dominant ring finger (17.9%. Conclusions: This study has proved that the role performed by the surgeon during the procedure (operator, 1st assistant has significant influence on the risk of glove perforations. Nearly 90% of glove perforations are unnoticed during surgery.

  2. The Prevalence of Ostomy-related Complications 1 Year After Ostomy Surgery: A Prospective, Descriptive, Clinical Study.

    Science.gov (United States)

    Carlsson, Eva; Fingren, Jeanette; Hallén, Anne-Marie; Petersén, Charlotta; Lindholm, Elisabet

    2016-10-01

    Despite advancements in the creation and care of stomas, ostomy and peristomal skin complications are common immediately following surgery as well as in the months and years thereafter. A prospective study to determine the prevalence of ostomy and peristomal skin complications and the influence of ostomy configuration on such complications was conducted 1 year after ostomy surgery among all patients at a university hospital in Sweden. All participants received regular (10 to 14 days post discharge, 6 weeks, 3 months, 6 months, and 1 year post surgery) ostomy follow-up care by a wound ostomy continence (WOC) nurse. All consecutive elective and emergency patients who had undergone surgery to create a colostomy (end colostomy), end ileostomy, or loop ileostomy were eligible to participate. Patients who were reoperated during their first year post-surgery, patients with a urostomy, and patients with double ostomies were excluded from the study. Patient data collected included age, gender, diagnosis, elective or emergency surgery, open or laparoscopic surgical procedure, presence of a colorectal surgeon specialist at surgery, type of ostomy (colostomy, end ileostomy, loop ileostomy), preoperative ostomy siting, counseling, body mass index, American Society of Anesthesiologists classification, and radiation and/or chemotherapy status. Ostomies were evaluated by 4 WOC nurses as to stoma configuration, convexity use, patient self-sufficiency in stoma care, and complications. All 207 patients (53% women) who were eligible agreed to participate in the study. Patient median age was 70 years (range 19-94); 74% underwent elective surgery. Main diagnoses were colorectal cancer (62%) and inflammatory bowel disease (19%). Ostomy types were: colostomy (71%), end ileostomy (26%), and loop ileostomy (3%). One or more complications occurred in 35% of the patients (27% ostomy complications, 11% peristomal skin complications). A colostomy hernia was the most common surgical complication

  3. Factors involved in dental surgery fires: a review of the literature.

    Science.gov (United States)

    VanCleave, Andrea M; Jones, James E; McGlothlin, James D; Saxen, Mark A; Sanders, Brian J; Walker, LaQuia A

    2014-01-01

    Surgical fires are well-characterized, readily preventable, potentially devastating operating room catastrophes that continue to occur from 20 to 100 times per year or, by one estimate, up to 600 times per year in US operating rooms, sometimes with fatal results. The most significant risk factors for surgical fires involve (a) the use of an ignition source, such as laser or electrocautery equipment, in or around an oxygen-enriched environment in the head, neck, and upper torso area and (b) the concurrent delivery of supplemental oxygen, especially via nasal cannula. Nonetheless, while these 2 conditions occur very commonly in dental surgery, especially in pediatric dental surgery where sedation and anesthesia are regularly indicated, there is a general absence of documented dental surgical fires in the literature. Barring the possibility of underreporting for fear of litigation, this may suggest that there is another mechanism or mechanisms present in dental or pediatric dental surgery that mitigates this worst-case risk of surgical fires. Some possible explanations for this include: greater fire safety awareness by dental practitioners, incidental ventilation of oxygen-enriched environments in patient oral cavities due to breathing, or suction used by dental practitioners during procedures. This review of the literature provides a background to suggest that the practice of using intraoral suction in conjunction with the use of supplemental oxygen during dental procedures may alter the conditions needed for the initiation of intraoral fires. To date, there appear to be no published studies describing the ability of intraoral suctioning devices to alter the ambient oxygen concentration in an intraoral environment. In vivo models that would allow examination of intraoral suction on the ambient oxygen concentration in a simulated intraoral environment may then provide a valuable foundation for evaluating the safety of current clinical dental surgical practices

  4. 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 perception was assessed with Hayes, Perander, Smecko, and Trask's (1998) 50-item Work Safety Scale (WSS): a scale that effectively captures the dimensions identified by safety experts to influence perceptions of workplace safety. ANOVA was used to test for differences in the mean scores of the 4 groups. Post Hoc analysis revealed differences of statistical significance between the 2 younger cohorts and the 2 older cohorts. The results indicated a positive association between age and safety perception. Older workers had the best perceptions on safety, indicated the highest level of job satisfaction, were the most compliant with safety procedures, and recorded the lowest accident involvement rate. From a practical perspective, understanding age-related perceptions of workplace safety would benefit management's decisions regarding workers' adaptability, general work effectiveness, accident frequency, implementation of safety management policies, and handling of age-related accident characteristics.

  5. 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

  6. Safety and efficacy of a new tourniquet system

    Directory of Open Access Journals (Sweden)

    Sato Junko

    2012-08-01

    Full Text Available Abstract Background In upper limb surgery, the pneumatic tourniquet is an essential tool to provide a clean, bloodless surgical field, improving visualization of anatomical structures and preventing iatrogenic failure. Optimal inflation pressure to accomplish these objects without injuring normal tissue and inducing complications is not yet established. Use of the minimum tourniquet pressure necessary to produce a bloodless surgical field is preferable in order to prevent injury to normal tissue. Various methods have been implemented in an effort to lower effective cuff pressure. The purpose of this study is to report clinical experience with a new tourniquet system in which pressure is synchronized with systolic blood pressure (SBP using a vital information monitor. Methods We routinely used the tourniquet system in 120 consecutive upper limb surgeries performed under general anaesthesia in our operating room instead of our clinic. Cuff pressure was automatically regulated to additional 100 mmHg based on the SBP and was renewed every 2.5 minutes intervals. Results An excellent bloodless field was obtained in 119 cases, with the exception of one case of a 44-year-old woman who underwent internal screw fixation of metacarpal fracture. No complications, such as compartment syndrome, deep vein disorder, skin disorder, paresis, or nerve damage, occurred during or after surgery. Conclusions This new tourniquet system, synchronized with SBP, can be varied to correspond with sharp rises or drops in SBP to supply adequate pressure. The system reduces labor needed to deflate and re-inflate to achieve different pressures. It also seemed to contribute to the safety in upper limb surgery, in spite of rare unexpected oozing mid-surgery, by reducing tissue pressure.

  7. A Longitudinal Study of Motivations Before and Psychosexual Outcomes After Genital Gender-Confirming Surgery in Transmen.

    Science.gov (United States)

    van de Grift, Tim C; Pigot, Garry L S; Boudhan, Siham; Elfering, Lian; Kreukels, Baudewijntje P C; Gijs, Luk A C L; Buncamper, Marlon E; Özer, Müjde; van der Sluis, Wouter; Meuleman, Eric J H; Bouman, Mark-Bram; Mullender, Margriet G

    2017-12-01

    Genital dissatisfaction is an important reason for transmen to undergo genital gender-confirming surgery (GCS; phalloplasty or metoidioplasty). However, little is known about motives for choosing specific techniques, how transmen benefit postoperatively, and whether psychosexual outcomes improve. To evaluate motivations for and psychosexual outcomes after GCS. A longitudinal study of 21 transmen at least 1 year after GCS was conducted. Participants were recruited through their surgeon. Data were collected when they applied for surgery and at least 1 year after surgery. Data collection included semistructured questionnaires on motivations for surgery, postoperative experiences, and standardized measures of psychological symptoms, body image, self-esteem, sexuality, and quality of life (pre- and postoperative). Information on surgical complications and corrections was retrieved from medical records. Most participants underwent phalloplasty with urethral lengthening using a radial forearm flap. Although problematic voiding symptoms were prevalent, many participants were satisfied with their penile function. The strongest motivations to pursue penile surgery were confirmation of one's identity (100%), enabling sexual intercourse (78%), and voiding while standing (74%). No significant differences between postoperative and reference values were observed for standardized measures. After surgery, transmen were more sexually active (masturbation and with a partner) and used their genitals more frequently during sex compared with before surgery (31-78%). The present study provides input for preoperative decision making: (i) main motives for surgery include identity confirmation, voiding, and sexuality, (ii) surgery can result in more sexual activity and genital involvement during sex, although some distress can remain, but (iii) complications and voiding symptoms are prevalent. Study strengths include its longitudinal design and the novelty of the studied outcomes. The main

  8. Serum levels of bupivacaine after pre-peritoneal bolus vs. epidural bolus injection for analgesia in abdominal surgery: A safety study within a randomized controlled trial.

    Science.gov (United States)

    Mungroop, Timothy H; van Samkar, Ganapathy; Geerts, Bart F; van Dieren, Susan; Besselink, Marc G; Veelo, Denise P; Lirk, Philipp

    2017-01-01

    Continuous wound infiltration (CWI) has become increasingly popular in recent years as an alternative to epidural analgesia. As catheters are not placed until the end of surgery, more intraoperative opioid analgesics might be needed. We, therefore, added a single pre-peritoneal bolus of bupivacaine at the start of laparotomy, similar to the bolus given with epidural analgesia. This was a comparative study within a randomized controlled trial (NTR4948). Patients undergoing hepato-pancreato-biliary surgery received either a pre-peritoneal bolus of 30ml bupivacaine 0.25%, or an epidural bolus of 10ml bupivacaine 0.25% at the start of laparotomy. In a subgroup of patients, we sampled blood and determined bupivacaine serum levels 20, 40, 60 and 80 minutes after bolus injection. We assumed toxicity of bupivacaine to be >1000 ng/ml. A total of 20 patients participated in this sub-study. All plasma levels measured as well as the upper limit of the predicted 99% confidence intervals per time point were well below the toxicity limit. In a mixed linear-effect model both groups did not differ statistically significant (p = 0.131). The intra-operative use of opioids was higher with CWI as compared to epidural (86 (SD 73) μg sufentanil vs. 50 (SD 32). In this exploratory study, the pre-peritoneal bolus using bupivacaine resulted in serum bupivacaine concentrations well below the commonly accepted toxic threshold. With CWI more additional analgesics are needed intraoperatively as compared to epidural analgesia, although this is compensated by a reduction in use of vasopressors with CWI. Netherlands Trial Register NTR4948.

  9. Combining Systems and Teamwork Approaches to Enhance the Effectiveness of Safety Improvement Interventions in Surgery: The Safer Delivery of Surgical Services (S3) Program.

    Science.gov (United States)

    McCulloch, Peter; Morgan, Lauren; New, Steve; Catchpole, Ken; Roberston, Eleanor; Hadi, Mohammed; Pickering, Sharon; Collins, Gary; Griffin, Damian

    2017-01-01

    Patient safety improvement interventions usually address either work systems or team culture. We do not know which is more effective, or whether combining approaches is beneficial. To compare improvement in surgical team performance after interventions addressing teamwork culture, work systems, or both. Suite of 5 identical controlled before-after intervention studies, with preplanned analysis of pooled data for indirect comparisons of strategies. Operating theatres in 5 UK hospitals performing elective orthopedic, plastic, or vascular surgery PARTICIPANTS:: All operating theatres staff, including surgeons, nurses, anaesthetists, and others INTERVENTIONS:: 4-month safety improvement interventions, using teamwork training (TT), systems redesign and standardization (SOP), Lean quality improvement, SOP + TT combination, or Lean + TT combination. Team technical and nontechnical performance and World Health Organization (WHO) checklist compliance, measured for 3 months before and after intervention using validated scales. Pooled data analysis of before-after change in active and control groups, comparing combined versus single and systems versus teamwork interventions, using 2-way ANOVA. We studied 453 operations, (255 intervention, 198 control). TT improved nontechnical skills and WHO compliance (P teamwork training and systems rationalization are more effective than those adopting either approach alone. This has important implications for safety improvement strategies in hospitals.

  10. Development of the McGill simulator for endoscopic sinus surgery: a new high-fidelity virtual reality simulator for endoscopic sinus surgery.

    Science.gov (United States)

    Varshney, Rickul; Frenkiel, Saul; Nguyen, Lily H P; Young, Meredith; Del Maestro, Rolando; Zeitouni, Anthony; Tewfik, Marc A

    2014-01-01

    The technical challenges of endoscopic sinus surgery (ESS) and the high risk of complications support the development of alternative modalities to train residents in these procedures. Virtual reality simulation is becoming a useful tool for training the skills necessary for minimally invasive surgery; however, there are currently no ESS virtual reality simulators available with valid evidence supporting their use in resident education. Our aim was to develop a new rhinology simulator, as well as to define potential performance metrics for trainee assessment. The McGill simulator for endoscopic sinus surgery (MSESS), a new sinus surgery virtual reality simulator with haptic feedback, was developed (a collaboration between the McGill University Department of Otolaryngology-Head and Neck Surgery, the Montreal Neurologic Institute Simulation Lab, and the National Research Council of Canada). A panel of experts in education, performance assessment, rhinology, and skull base surgery convened to identify core technical abilities that would need to be taught by the simulator, as well as performance metrics to be developed and captured. The MSESS allows the user to perform basic sinus surgery skills, such as an ethmoidectomy and sphenoidotomy, through the use of endoscopic tools in a virtual nasal model. The performance metrics were developed by an expert panel and include measurements of safety, quality, and efficiency of the procedure. The MSESS incorporates novel technological advancements to create a realistic platform for trainees. To our knowledge, this is the first simulator to combine novel tools such as the endonasal wash and elaborate anatomic deformity with advanced performance metrics for ESS.

  11. Preoperative immobility significantly impacts the risk of postoperative complications in bariatric surgery patients.

    Science.gov (United States)

    Higgins, Rana M; Helm, Melissa; Gould, Jon C; Kindel, Tammy L

    2018-03-05

    Preoperative immobility in general surgery patients has been associated with an increased risk of postoperative complications. It is unknown if immobility affects bariatric surgery outcomes. The aim of this study was to determine the impact of immobility on 30-day postoperative bariatric surgery outcomes. This study took place at a university hospital in the United States. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program 2015 data set was queried for primary minimally invasive bariatric procedures. Preoperative immobility was defined as limited ambulation most or all the time. Logistic regression analysis was performed to determine if immobile patients are at increased risk (odds ratio [OR]) for 30-day complications. There were 148,710 primary minimally invasive bariatric procedures in 2015. Immobile patients had an increased risk of mortality (OR 4.59, Pbariatric surgery outcomes. Immobile patients have a significantly increased risk of morbidity and mortality. This study provides an opportunity for the development of multiple quality initiatives to improve the safety and perioperative complication profile for immobile patients undergoing bariatric surgery. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  12. Assessment of complications in a randomized controlled study on multimodality therapy for patients following breast-conserving surgery

    International Nuclear Information System (INIS)

    Hiraoka, Masahiro; Inoue, Toshihiko; Kodama, Hiroshi; Sako, Masao

    2002-01-01

    We conducted a randomized controlled study to evaluate the safety and usefulness of a combined treatment of radiotherapy and chemotherapy with doxifluridine (5'-DFUR) plus tamoxifen (TAM) as an adjuvant therapy for breast cancer patients after conservative surgery. The complications observed in this trial are reported herein. A total of 550 patients were registered and randomized (based on factors such as T, N, with/without radiotherapy) to groups A and B. Drug regimens were: group A, 5'-DFUR 600 mg/body/day for 6 months and TAM 20 mg/body/day for 2 years; group B, 5'-DFUR 600 mg/body/day for 2 years and TAM 20 mg/body/day for 2 years. Radiotherapy (2 Gy x 5 times/week, for 5 weeks) was administered to 88.6% of evaluable patients (481/543). Radiation-related acute adverse reactions occurred in 28.5% of the 481 patients and moderate to severe reactions occurred in 1.5% of the patients. Delayed radiation-related adverse reactions occurred in 17.9% of group A patients and 25.6% of group B patients. Grade 3 reactions occurred in 6 of the group A patients (2.4%) and in 5 of the group B patients (1.9%); all adverse reactions subsided after dose reduction or discontinuation. These findings suggest that the combination therapy of irradiation and 5'-DFUR with TAM is safe for patients after breast conserving surgery. (author)

  13. Pre-operative testing for pregnancy in Dublin day surgery units.

    LENUS (Irish Health Repository)

    Wong, L F A

    2013-06-01

    The safety of anaesthetic agents in early pregnancy cannot be guaranteed. Certain types of surgery, particularly gynaecological, may also be dangerous. It is therefore important to ensure that, female patients are not inadvertently pregnant when undergoing elective surgery. Different hospitals have different policies and guidelines in place to determine female patients\\' pregnancy status prior to elective surgery.

  14. Surgical Safety Training of World Health Organization Initiatives.

    Science.gov (United States)

    Davis, Christopher R; Bates, Anthony S; Toll, Edward C; Cole, Matthew; Smith, Frank C T; Stark, Michael

    2014-01-01

    Undergraduate training in surgical safety is essential to maximize patient safety. This national review quantified undergraduate surgical safety training. Training of 2 international safety initiatives was quantified: (1) World Health Organization (WHO) "Guidelines for Safe Surgery" and (2) Department of Health (DoH) "Principles of the Productive Operating Theatre." Also, 13 additional safety skills were quantified. Data were analyzed using Mann-Whitney U tests. In all, 23 universities entered the study (71.9% response). Safety skills from WHO and DoH documents were formally taught in 4 UK medical schools (17.4%). Individual components of the documents were taught more frequently (47.6%). Half (50.9%) of the additional safety skills identified were taught. Surgical societies supplemented safety training, although the total amount of training provided was less than that in university curricula (P < .0001). Surgical safety training is inadequate in UK medical schools. To protect patients and maximize safety, a national undergraduate safety curriculum is recommended. © 2013 by the American College of Medical Quality.

  15. 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.

  16. Innovative Patient Safety Curriculum Using iPAD Game (PASSED) Improved Patient Safety Concepts in Undergraduate Medical Students.

    Science.gov (United States)

    Kow, A W C; Ang, B L S; Chong, C S; Tan, W B; Menon, K R

    2016-11-01

    While healthcare outcomes have improved significantly, the complex management of diseases in the hospitals has also escalated the risks in patient safety. Therefore, in the process of training medical students to be proficient in medical knowledge and skills, the importance of patient safety cannot be neglected. A new innovation using mobile apps gaming system (PAtient Safety in Surgical EDucation-PASSED) to teach medical students on patient safety was created. Students were taught concepts of patient safety followed by a gaming session using iPad games created by us. This study aims to evaluate the outcome of patient safety perception using the PASSED games created. An interactive iPad game focusing on patient safety issues was created by the undergraduate education team in the Department of Surgery, Yong Loo Lin School of Medicine at the National University of Singapore. The game employed the unique touched-screen feature with clinical scenarios extracted from the hospital sentinel events. Some of the questions were time sensitive, with extra bonus marks awarded if the student provided the correct answer within 10 s. Students could reattempt the questions if the initial answer was wrong. However, this entailed demerit points. Third-year medical students posted to the Department of Surgery experienced this gaming system in a cohort of 55-60 students. Baseline understanding of the students on patient safety was evaluated using Attitudes to Patient Safety Questionnaire III (APSQ-III) prior to the game. A 20 min talk on concept of patient safety using the WHO Patient Safety Guidelines was conducted. Following this, students downloaded the apps from ITune store and played with the game for 20-30 min. The session ended with the students completing the postintervention questionnaire. A total of 221 3rd year medical students responded to the survey during the PASSED session. Majority of the students felt that the PASSED game had trained them to understand the

  17. The effects of power, leadership and psychological safety on resident event reporting.

    Science.gov (United States)

    Appelbaum, Nital P; Dow, Alan; Mazmanian, Paul E; Jundt, Dustin K; Appelbaum, Eric N

    2016-03-01

    Although the reporting of adverse events is a necessary first step in identifying and addressing lapses in patient safety, such events are under-reported, especially by frontline providers such as resident physicians. This study describes and tests relationships between power distance and leader inclusiveness on psychological safety and the willingness of residents to report adverse events. A total of 106 resident physicians from the departments of neurosurgery, orthopaedic surgery, emergency medicine, otolaryngology, neurology, obstetrics and gynaecology, paediatrics and general surgery in a mid-Atlantic teaching hospital were asked to complete a survey on psychological safety, perceived power distance, leader inclusiveness and intention to report adverse events. Perceived power distance (β = -0.26, standard error [SE] 0.06, 95% confidence interval [CI] -0.37 to 0.15; p leadership practices build psychological safety and minimise power distance between low- and high-status members in order to support greater reporting of adverse events. © 2016 John Wiley & Sons Ltd.

  18. Intentional Unilateral Epidural Block for Surgery in a Pregnant Patient

    African Journals Online (AJOL)

    Kuczkowski KM. The safety of anaesthetics in pregnant women .Expert Opin Drug Saf. 2006. Mar;5(2):251-64. Review. 6. Steinberg ES, Santos AC: Surgical anesthesia during pregnancy. IntAnesthesiolClin1990;28:58-66. 7. Duncan PG, Pope WD, Cohen MM, Greer N: Fetal risk of anesthesia and surgery duringpregnancy.

  19. A study of software safety analysis system for safety-critical software

    International Nuclear Information System (INIS)

    Chang, H. S.; Shin, H. K.; Chang, Y. W.; Jung, J. C.; Kim, J. H.; Han, H. H.; Son, H. S.

    2004-01-01

    The core factors and requirements for the safety-critical software traced and the methodology adopted in each stage of software life cycle are presented. In concept phase, Failure Modes and Effects Analysis (FMEA) for the system has been performed. The feasibility evaluation of selected safety parameter was performed and Preliminary Hazards Analysis list was prepared using HAZOP(Hazard and Operability) technique. And the check list for management control has been produced via walk-through technique. Based on the evaluation of the check list, activities to be performed in requirement phase have been determined. In the design phase, hazard analysis has been performed to check the safety capability of the system with regard to safety software algorithm using Fault Tree Analysis (FTA). In the test phase, the test items based on FMEA have been checked for fitness guided by an accident scenario. The pressurizer low pressure trip algorithm has been selected to apply FTA method to software safety analysis as a sample. By applying CASE tool, the requirements traceability of safety critical system has been enhanced during all of software life cycle phases

  20. Current status of cardiovascular surgery in Japan, 2013 and 2014: A report based on the Japan Cardiovascular Surgery Database (JCVSD). 1: Mission and history of JCVSD.

    Science.gov (United States)

    Takamoto, Shinichi; Motomura, Noboru; Miyata, Hiroaki; Tsukihara, Hiroyuki

    2018-01-01

    The Japan Cardiovascular Surgery Database (JCVSD) was created in 2000 with the support of the Society of Thoracic Surgeons (STS). The STS database content was translated to Japanese using the same disease criteria and in 2001, data entry for adult cardiac surgeries was initiated online using the University Hospital Medical Information Network (UMIN). In 2008, data entry for congenital heart surgeries was initiated in the congenital section of JCVSD and preoperative expected mortality (JapanSCORE) in adult cardiovascular surgeries was first calculated using the risk model of JCVSD. The Japan Surgical Board system merged with JCVSD in 2011, and all cardiovascular surgical data were registered in the JCVSD from 2012 onward. The reports resulting from the data analyses of the JCVSD will encourage further improvements in the quality of cardiovascular surgeries, patient safety, and medical care in Japan.

  1. Case-Cohort Studies: Design and Applicability to Hand Surgery.

    Science.gov (United States)

    Vojvodic, Miliana; Shafarenko, Mark; McCabe, Steven J

    2018-04-24

    Observational studies are common research strategies in hand surgery. The case-cohort design offers an efficient and resource-friendly method for risk assessment and outcomes analysis. Case-cohorts remain underrepresented in upper extremity research despite several practical and economic advantages over case-control studies. This report outlines the purpose, utility, and structure of the case-cohort design and offers a sample research question to demonstrate its value to risk estimation for adverse surgical outcomes. The application of well-designed case-cohort studies is advocated in an effort to improve the quality and quantity of observational research evidence in hand and upper extremity surgery. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  2. A prospective study comparing endoscopic subcutaneous mastectomy plus immediate reconstruction with implants and breast conserving surgery for breast cancer.

    Science.gov (United States)

    Fan, Lin-Jun; Jiang, Jun; Yang, Xin-Hua; Zhang, Yi; Li, Xing-Gang; Chen, Xian-Chun; Zhong, Ling

    2009-12-20

    Breast conserving surgery (BCS) has been the standard surgical procedure for the treatment of early breast cancer. Endoscopic subcutaneous mastectomy (ESM) plus immediate reconstruction with implants is an emerging procedure. The objective of this prospective study was to evaluate the clinical outcomes of these two surgical procedures in our clinical setting. From March 2004 to October 2007, 43 patients with breast cancer underwent ESM plus axillary lymph node dissection and immediate reconstruction with implants, while 54 patients underwent BCS. The clinical and pathological characteristics, surgical safety, and therapeutic effects were compared between the two groups. There were no significant differences in the age, clinical stage, histopathologic type of tumor, operative blood loss, postoperative drainage time, and postoperative complications between the two groups (P > 0.05). The postoperative complications were partial necrosis of the nipple and superficial skin flap in the ESM patients, and hydrops in the axilla and residual cavity in the BCS patients. There was no significant difference in the rate of satisfactory postoperative cosmetic outcomes between the ESM (88.4%, 38/43) and BCS (92.6%, 50/54) patients (P > 0.05). During follow-up of 6 months to 4 years, all patients treated with ESM were disease-free, but 3 patients who underwent BCS had metastasis or recurrence -one of these patients died of multiple organ metastasis. After considering the wide indications for use, high surgical safety, and favorable cosmetic outcomes, we conclude that ESM plus axillary lymph node dissection and immediate reconstruction with implants - the new surgery of choice for breast cancer - warrants serious consideration as the prospective next standard surgical procedure.

  3. Nordic studies in reactor safety

    International Nuclear Information System (INIS)

    Pershagen, N.

    1993-01-01

    The Nordic Nuclear Safety Research Programme SIK programme in reactor safety is part of a major joint Nordic research effort in nuclear safety. The report summarizes the achievements of the SIK programme, which was carried out during 1990-1993 in collaboration between Nordic nuclear utilities, safety authorities, and research institutes. Three main projects were successfully completed dealing with: 1) development and application of a living PSA concept for monitoring the risk of core damage, and of safety indicators for early warning of possible safety problems; 2) review and intercomparison of severe accident codes, case studies of potential core melt accidents in nordic reactors, development of chemical models for the MAAP code, and outline of a system for computerized accident management support; 3) compilation of information about design and safety features of neighbouring reactors in Germany, Lithuania and Russia, and for naval reactors and nuclear submarines. The report reviews the state-of-the-art in each subject matter as an introduction to the individual project summaries. The main findings of each project are highlighted. The report also contains an overview of reactor safety research in the Nordic countries and a summary of fundamental reactor safety principles. (au) (69 refs.)

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

    NARCIS (Netherlands)

    Pearse, Rupert M.; Moreno, Rui P.; Bauer, Peter; Pelosi, Paolo; Metnitz, Philipp; Spies, Claudia; Vallet, Benoit; Vincent, Jean-Louis; Hoeft, Andreas; Rhodes, Andrew; Moreno, Rui; Pearse, Rupert; Damster, Sandrine; Golder, Kim; Hewson, Russell; Januszewska, Marta; Leva, Brigitte; Ramos, Vasco; Hoste, Eric; Huyghens, Luc; Jacobs, Rita; van Mossevelde, Veerle; Opdenacker, Godelieve; Poelaert, Jan; Spapen, Herbert; Leleu, Kris; Rijckaert, Dirk; de Decker, Koen; Foubert, Luc; de Neve, Nikolaas; Biston, Patrick; Piagnerelli, Michael; Collin, Vincent; Blauwen, Nadia den; Clauwaert, Charlotte; de Crop, Luc; Verbeke, An; Roeselare, Heilige Hartziekenhuis; Derumeaux, Pieter; Gardin, Christophe; Kindt, Sebastiaan; Louage, Sofie; Verhamme, Bruno; Druwé, Patrick; Lahaye, Ingrid; Rosseel, Francis; Rutsaert, Robert; Vanlinthout, Luc; de Kock, Marc; Forget, Patrice; Georges, Pascal; Grosu, Irina; Kahn, David; Lois, Fernande; Momeni, Mona; Pospiech, Audrey; Yemnga, Bernadette; Jadoul, Jean-Luc; Malbrain, Manu; Bosinceanu, Dana; Collard, Edith; Jorens, Philippe; Reyntiens, Dirk; Smitz, Carine; Vercauteren, Marcel; Fagnoul, David; van Obbergh, Luc; Goranović, Tatjana; Mazul-Sunko, Branka; Toplice, Krapinske; Oremuš, Krešimir; Bešlić, Gabrijela; Duzel, Viktor; Hauptman, Ada; Peremin, Sanja; Šribar, Andrej; Župčić, Miroslav; Brod, Slavonski; Mirković, Ivan; Bauer, Zlata Šarić; Belavić, Matija; Blažanin, Božidar; Katušin, Mirjana Lončarić; Krijan, Antonija Brozović; Mišković, Petar; Šimić-Korać, Nataša; Topić, Jasna; Žilić, Antonio; Žuni, Josip; Acan, Ivana; Adanić, Mirta; Ivanov, Nikola; Šarić, Jadranka Pavičić; Tomulić, Katarina; Visković, Nataša; Bošnjak, Silvana; Drenjančevic, Ivana Haršanji; Kristek, Gordana; Kvolik, Slavica; Markić, Stela; Rakipovic, Andreja Stojanovic; Tot, Ozana Katarina; Venzera- Azenic, Darija; Fabris, Lada Kalagac; Bačak-Kocman, Iva; Balenović, Igor; Bandić, Daniela; Deutsch, Patricia Adrianne Judith; Divjak, Loredana; Filipović, Ina Grčić; Gužvinec, Zvonka; Krznarić, Zrinka; Lončarić, Yvonne; Magaš, Jelena Vadlja; Mitrović, Marek; Okić, Marija; Pavlek, Mario; Ramov, Elza; Rezek, Karolina; Sekulić, Ante; Tomasevic, Boris; Mirić, Mirjana; Tomašević, Anita; Mahečić, Tina Tomić; Vrbanović, Vilena; Bobinac, Mirna; Božić, Alfred; Debelic, Danijela; Frkovic, Vedran; Batinica, Inga Mladić; Baranović, Senka; Gavranović, Željka; Kikec, Mirna; Maldini, Branka; Marić, Stela; Agnić, Ivan; Delić, Nikola; Dropulić, Nataša; Gašpić, Toni Kljaković; Ilić, Darko; Ivančev, Božena; Karanović, Nenad; Kuščević, Dorjan; Marović, Zlatko; Milić, Matija; Nevešćanin, Ana; Petković, Tatjana; Smoje, Mario; Brozović, Gordana; Jelisavac, Milana; Matolić, Martina; Oberhofer, Dagmar; Pavičić, Ana Marija; Šakić, Kata; Bozovic, Margarita Delija; Krecek, Zvjezdana Kotorac; Krobot, Renata; Andabaka, Tatjana; Bratanić, Mislav; Dzepina, Orjana; Kraljev, Martina; Šeric, Julija; Šimurina, Tatjana; Grujić, Rosa; Nacevski-Bulaja, Biljana; Barižon, Mirna; Danira, Vrančić; Dražen, Bulaja; Dušanka, Kimer; Halužan, Marijana Bašić; Joško, Žaja; Katica, Roca; Labor, Magda; Marinković, Tea Grgurević; Mihovilčević, Danči; Marija, Bego; Srečko, Marinković; Vranković, Srđan; Kyprianou, Theodoros; Neophytou, Kyriakos; Cerny, Vladimir; Cvachovec, Karel; Belikova, Barbora; Drab, Michal; Hudacek, Kamil; Krikava, Ivo; Stourac, Petr; Zadrazilova, Katarina; Bicek, Vladimír; Brabcová, Milena; Klozová, Radka; Vajter, Jaromír; Vymazal, Tomáš; Toft, Palle; Blichfeldt, Louise; Hansen, Bo Dilling; Moller, Kirsten; Nielsen, Jeppe Sylvest; Frederiksen, Joachim; Andersen, Johnny Dohn; Kühne, Jan Peter; Leivdal, Siv; Stendell, Line; Simonsen, Martin; Zoltowski, Marcin Konrad; Ali, Zahida Salman; Freundlich, Morten; Pilypaite, Jurgita; Clausen, Nicola Groes; Thorup, Line; Hansen, Frank; Bestle, Morten; Hansen, Christian Steen; Afshari, Arash; Bille, Anders Bastholm; Lefort, Michele; Secher, Erik L.; Liboriussen, Lisbeth; Herodes, Veiko; Härma, Eve; Marvet, Kadri; Pool, Kristiina; Kallas, Pille; Mägi, Triinu-Kreete; Sütt, Jaan; Vijar, Kerli; Visk, Evelin; Vinnal, Mare; Ellermaa, Jaanus; Liibusk, Liia; Tikkerberi, Artur; Falk, Ilme; Mällo, Esta; Talving, Jaak; Pettilä, Ville; Hovilehto, Seppo; Kirsi, Anne; Mustola, Seppo; Tiainen, Pekka; Toivonen, Juhani; Dabnell, Sandra; Kaminski, Tadeusz; Sysimetsa, Anu; Kaukonen, Maija; Silvasti, Päivi; Vainio, Kaisa; Lund, Vesa; Sjövall, Sari; Saarinen, Kari; Viitanen, Matti; Ahonen, Tommi; Alaspää, Ari; Zittling, Ritva; Saarinen, Aarne; Moisander, Annette; Wagner, Bodo; Laru-Sompa, Raili; Elomaa, Esa; Lavonen, Leena; Nevantaus, Juha; Geier, Klaus; Kavasmaa, Tomi; Koorits, Ursula; Kubjas, Mare; Lauritsalo, Seppo; Ottelin, Lauri; Palve, Markki; Pynnönen, Jari; Rääbis, Inga; Saarelainen, Minna; Heikkilä, Tapani; Kontula, Timo; Lehtimäki, Markku; Liimatainen, Jari; Moilanen-Oikarinen, Mari; Pakarinen, Marika; Palanne, Riku; Seppänen, Hanna; Pulkkinen, Anni; Vääräniemi, Heikki; Paananen, Sami; Koskenkari, Juha; Sälkiö, Sinikka; Vakkala, Merja; Koskue, Talvikki; Loisa, Pekka; Laitio, Ruut; Hautamäki, Raku; Koivisto, Simo-Pekka; Futier, Emmanuel; Lefrant, Jean-Yves; Leon, Alain; Bonnet, Francis; Marret, Emmanuel; Spielvogel, Catherine; Papageorgiou, Chryssa; Szymkiewicz, Olga; Tounou-Akue, Felix; Aubrun, Frederic; Bonnet, Aurélie; Gazon, Mathieu; Guiraud, Michel; Laurent, Virginie; Béclère, Antoine; Tachon, Guillaume; Demars, Nadège; Dumenil, Anne-Sylvie; Mercier, Frederic; Landais, Alain; Mentec, Herve; Bazin, Marie; Gonnu, Sophie; Petit, Antoine; Albaladejo, Pierre; Almeras, Luc; Bataillard, Amélie; Rossi-Blancher, Marine; Lefrant, Jean Yves; Barthel, Florian; Hallel, Dan; Sbai, Hicham; Khalifeh, Pamela; Lidzborski, Lionel; Jully, Marion; Platon, Ecaterina; Pottecher, Julien; Baumgarten, Romain; Schultz, Christel; ElMiloudi, Fayçal; Lefebvre, Julie; Waton, Karen; Sprunck, Adrien; Steib, Annick; Thibaud, Adrien; Thuet, Vincent; Kieffer, Vianney; Dubois-Vallaud, Delphine; Jacob, Laurent; Becanne, Xavier; Cherfaoui, Salim; Gauzit, Remy; Godier, Anne; Lakhdari, Mourad; Samma, Charles; Bigeon, Jean-Yves; Burtin, Philippe; Halchini, Constantin; Lacroix, Magali; Pinna, Frederic; Barbes, Aurélie; Just, Bernard; Mateu, Philippe; Benayoun, Laurent; Berger, Philippe; Granier, Nathalie; Perrigault, Pierre Francois; Libert, Nicolas; de Rudnicki, Stephan; Merat, Stéphane; Bourdet, Benoit; Ferré, Fabrice; Minville, Vincent; Piriou, Vincent; Rague, Philippe; Wallet, Florent; Lebuffe, Gilles; Desbordes, Jacques; Robin, Emmanuel; Ichai, Carole; Orban, Jean-Christophe; Marx, Gernot; Sander, Michael; Gottschalk, André; Piontek, André; Unterberg, Matthias; Hilpert, Justus; Kees, Martin; Triltsch, Andreas; Wiegand-Löhnert, Carola; Glöckner, Christiane; Hohn, Andreas; Rose, Elmar; Schröder, Stefan; Wiese, Oliver; Awlakpui, Eli; Scheidemann, Mona; Wittmann, Maria; Ramminger, Axel; Dresden, Carus; Gama de Abreu, Marcelo; Heller, Axel; Marx, Christine; Neidel, Julia; Goldmann, Anton; von Heymann, Christian; Laetsch, Beatrix; Maahs, Esther; Scholz, Lars; Frenzel, Dirk; Massarat, Kyros; Lenhart, Franz-Peter; Reichle, Florian; Rudlof, Kristina; Borchers, Friedrich; Buettner, Christoph; Schmutzler, Martin; Burgard, Gerald; Lucht, Alexander; Wagner, Jan; Pilge, Stefanie; Schneider, Gerhard; Untergehrer, Gisela; Bis, Beata; Krassler, Jens; Dittmann, Jan; Haberkorn, Jörg; Eberitsch, Jürgen; Eberitsch, Karola; Nippraschk, Thomas; Wepler, Ulrich; Engelen, Wolf-Christian; Nau, Carla; Scholler, Axel; Schüttler, Jürgen; Wintzheimer, Simone; Bloos, Frank; Braune, Anke; Fergen, Daniela; Ludewig, Katrin; Paxian, Markus; Reinhart, Konrad; Graf, Nikolaus; Schwarzkopf, Konrad; Berger, Katharina; Habicher, Marit; Kasperiunaite, Ruta; Savelsberg, Sabine; Krep, Henning; Reindl, Michael; Weber, Matthias; Bauer, Wolfgang; Bingold, Florian; Christ, Saskia; Friederich, Patrick; Kaviani, Reza; Auer, Patrick; Bonnländer, Georg; Drescher, Jürgen; Braun, Roland; Eichenauer, Tim; Kerner, John; Bierbaum, Kathrin; Brünner, Horst; Grond, Stefan; Perez-Platz, Ursula; Andresen, Bent; Linstedt, Ulf; Stegmann, Nils; Erkens, Uwe; Kopcke, Jens; Meyer, Andreas; Brestrich, Hartmut; Ernst, Sandra; Merkel, Stella; Krieger, Lena; Luers, Frank; Weyland, Andreas; Noeldge-Schomburg, Gabriele; Menckie, Thomas; Wasmund, Christina; Bredtmann, Ralph-Dieter; Erler, Ines; Raufhake, Carsten; Haumann, Christine; Möllemann, Angela; Oehmichen, Uwe; Sergejewa, Olga; Lehning, Brigitte; Czeslick, Elke; Geyer, Michaela; Malcharek, Michael; Sablotzki, Armin; Stier, Marina; Feld, Florian; Rossaint, Rolf; Simon, Verena; Armaganidis, Apostolos; Koulenti, Despoina; Kotanidou, Anastasia; Nanas, Serafim; Papastylianou, Androula; Psevdi, Aikaterini; Stathopoulos, Anastasios; Voulas, Asklepieion; Kanna, Efthymia; Koutsikou, Anastasia; Moustaka, Alexandra; Chovas, Achilleas; Komnos, Apostolos; Zafiridis, Tilemachos; Franses, Josef; Lavrentieva, Athena; Koraki, Eleni; Katsenos, Chrysostomos; Kasianidou, Maria Flora; Nasopoulou, Pantelia; Spyropoulou, Eleni; Gousia, Chrysoula; Katsanoulas, Constantine; Lathyris, Dimitrios; Kyriazopoulos, George; Sfyras, Dimitrios; Tsirogianni, Athanasia; Kostopanagiotou, Georgia; Lignos, Mihail; Matsota, Paraskevi; Christopoulos, Christos; Mouratidou, Alexandra; Vrettou, Efstratia; Boufidis, Spyros; Moka, Eleni; Arnaoutoglou, Eleni; Koulouras, Vasileios; Nakos, George; Papathanakos, Georgios; Anthopoulos, Georgios; Choutas, Georgios; Karapanos, Dimitrios; Tzani, Vaso; Gkiokas, Georgios; Nastos, Konstantinos; Nikolakopoulos, Fotios; Dragoumanis, Christos; Nikitidis, Nikos; Pneumatikos, Ioannis; Theodorou, Vassiliki; Zacharouli, Danai; Kandi, Stella; Tasopoulos, Konstantinos; Arvaniti, Kostoula; Matamis, Dimitrios; Mplougoura, Eva; Petropoulou, Polixeni; Soumpasis, Ioannis; Amaniti, Ekaterini; Giannakou-Peftoulidou, Maria; Gkeka, Eleni; Soultati, Ioanna; Kokinou, Maria; Papatheodorou, Lambrini; Stafylaraki, Maria; Giasnetsova, Tatiana; Gritsi-Gerogianni, Nikoleta; Kydona, Christina; Kiskira, Olga; Koulentis, Ioannis; Apsokardos, Alexandros; Dimitropoulos, Konstantinos; Soldatou, Ourania; Nathanail, Christodoulos; Papazotos, Alexios; Tsakas, Pirros; Clouva-Molyvdas, Phyllis-Maria; Kolotoura, Athina; Sartzi, Monika; Papanikolaou, Spiros; Polakis, Pavlos; Karatzas, Stylianos; Kyparissi, Aikaterini; Papavasilopoulou, Theonymfi; Koukoubani, Triantafillia; Mastora, Evangelia; Spyropoulou-Pagdatoglou, Kyriaki; Nyktari, Vasileia; Malliotakis, Polychronis; Papaioannou, Alexandra; Bekos, Vasileios; Maragkou, Elisavet; Spring, Anna; Evagelatos, Stavros; Ioakeimidou, Aikaterini; Noulas, Nikos; Molnár, Zsolt; Csüllög, Emese; Elekes, Enikő; Molnár, Tamás; Katona, Zsuzsana; Kremer, Ildiko; Miko, Angela; Csomos, Akos; Galambos, Zsuzsanna; Szucs, Akos; Nyikos, Gyorgy; Szekeres, Gabor; Szabo, Ervin; Kranitz, Katalin; Simon, Melinda; Szigeti, Janos; Gaál, Emánuel; Havas, Attila; Ille, Alexandru; Bráz, Krisztina; Nagy, Geza; Sigurdsson, Gisli; Sigurbjörnsson, Fridrik T.; Sigurdsson, Gisli H.; Kárason, Sigurbergur; Sigurdardottir, Elin Edda; Blöndal, Ásbjörn; Gunnarsson, Björn; Westbrook, Andrew; Broderick, Alan; Hafeez, Parvaiz; Hanumanthaiah, Deepak; Brohan, Janette; O'Chroinin, Donal; Bailey, Kevin; Ramamoorthy, Karthik; Doyle, Yvonne; Freir, Noelle; O'Rourke, James; Jonson, Philip; Saeed, Sabir; Hayes, Ivan; Loughrey, John; Frohlich, Stephen; McCauley, Nuala; Ryan, Donal; Fitzpatrick, Gerry; Kevin, Leo; Thomas, Jubil; Warde, Barry; Woolhead, Alan; Duggan, Michelle; Egan, Cara; Crowley, Seamus; Lebese, Soloman; Bergin, Anne; Page, Rory; Collins, Daniel; McKenny, Michael; Della Rocca, Giorgio; Grasso, Salvatore; Bresciani, Anna; Carmino, Livio; Ghelfi, Silvia; Lorenzelli, Laura; Novelli, Maria Teresa; Pescarmona, Chiara; Roasio, Agostino; Gatta, Alessandro; Nastasi, Mauro; Sanseverino, Manlio; Tinti, Carla; Bianchin, Andrea; Tormena, Maria; Franco, Antonio; Marini, Federica; Di Mauro, Piero; Rapido, Francesca; Tommasino, Concezione; Bellotti, Ferdinando; Boninsegna, Daniele; Castellani, Gianluca; Sances, Daniele; Spano, Gianluca; Tredici, Stefano; Vezzoli, Dario; Fucecchio, Igneo; Bacci, Alessandro; Coppini, Roberta; Dell'unto, Sandro; Mori, Emanuele; Stanzani, Maria Rosa; Tosi, Monica; Collareta, Michele; Forfori, Francesco; Franchi, Matteo; Mancino, Giuseppe; Battistella, Massimo; Baricocchi, Elisa; Bona, Francesco; Debernardi, Felicino; Giacoletto, Gianmarco; Iacobellis, Antonio; Massucco, Paolo; Moselli, Nora; Muratore, Andrea; Palomba, Graziella; Sardo, Elena; de Simone, Michele; Suita, Luisa; Zocca, Edoardo; Bucci, Barbara; Della Corte, Francesco; Piciucco, Tiziana; Viarengo, Valeria; Bettelli, Gabriella; Cantarini, Eugenia; Giampieri, Marina; Tanfani, Alessandra; Recchia, Eugenio; Milano, S. Raffaele; Bignami, Elena; Bruno, Giovanna; Costagliola, Roberto; Gandolfi, Azzurra; Greco, Massimiliano; Lembo, Rosalba; Monti, Giacomo; Nicelli, Elisa; Pasculli, Nicola; Turi, Stefano; Baroselli, Antonio; Brazzoni, Marcella; Buttazzoni, Mattia; Buttera, Stefania; Centonze, Carlo; Serena, Giovanni; Spagnesi, Lorenzo; Toretti, Ilaria; Vilardi, Anna; Zearo, Ester; Arpino, Ines; Baraldi, Sara; Guarnerio, Chiara; Molene, Vincenzo; Monea, Maria Concetta; Vaccarisi, Enrico; Vicari, Luigi; Albante, Alida; Aversano, Marco; Loiacono, Cinzia; Marandola, Maurizio; Fusari, Maurizio; Petrucci, Nicola; Galla, Amerigo; Mascia, Antonio; Primieri, Paolo; Di Noto, Anna; Gratarola, Angelo; Molin, Alessandro; Spagnolo, Luigi; Spena, Claudio; Calligaro, Plinio; Marchiotto, Simonetta; Merlini, Alberto; Pedrazzoli, Eleonora; Perina, Giulia; Visentin, Renea; Fumagalli, Roberto; Garbagnati, Andrea; Manetti, Bruna; Snaier, Chiara; Somaini, Marta; Farnia, Antonio; Nani, Roberto; Pierantonio, Novello; de Michele, Michele; Gazzanelli, Sergio; Pugliese, Francesco; Ruberto, Franco; Anna, Universitaria S.; Bergamini, Elena; Tassinati, Tania; Capuzzo, Maurizia; Cirillo, Vera; Tufano, Rosalba; Oggioni, Roberto; Parrini, Vieri; Brunori, Emanuela; Capone, Micaela; Carbone, Luigi; Corradetti, Francesco; Elisei, Daniele; Fiorentino, Stefano; Francesconi, Maurizio; Gattari, Diego; Gorgoglione, Maria; Lacobone, Emanuele; Minnucci, Francesco; Montironi, Claudio; Riccioni, Gianrenato; Tappata, Giuseppe; Zompanti, Valeria; Verdenelli, Paola; Cerutti, Elisabetta; Ranieri, Vito Marco; Golubovska, Iveta; Grigorjevs, Sergejs; Rikmane, Maija; Rozkalne, Daina; Stepanovs, Jevgenijs; Suba, Olegs; Kazune, Sigita; Miscuk, Aleksej; Nemme, Janis; Oss, Peteris; Sipylaite, Jurate; Macas, Andrius; Ragaisis, Vytautas; Kontrimaviciute, Egle; Tomkute, Gabija; Boerma, Christiaan; Kramer, Irene Fleur; Poeze, Martijn; Ziekenhuis, Antonius; Maria, John; Pelzer, Gerardus; Winsser, Lex; Nijsten, Maarten; Schoorl, Michiel; Spanjersberg, Rob; Buhre, Wolfgang; Dieleman, Stefan; van Klei, Wilton; Bouw, Martijn; Pickkers, Peter; van der A, Marieke; Schreiner, Frodo; Zandvliet, Ria; van den Berg, Roy; de Wit, Esther; Keijzer, Christaan; Hollmann, Markus; Preckel, Benedikt; van Acker, Gijs; Dennesen, Paul; Veld, Bas; Kuijpers-Visser, Agnes; Inan, T.; Koopman-van Gemert, A.; Ponssen, Huibert; Brouwer, Tammo; Koopmans, Matty; van Bommel, Jasper; van Duijn, Ditty; van der Hoven, Ben; Ormskerk, Patricia; Beck, Oliver; Schiere, Sjouke; Reidinga, Auke; Venema, Allart; Hoogendoorn, Marga; Olthof, Kees; Flaatten, Hans; Jammer, Ib; Dokka, Vegard; Monsen, Svein Arne; Ytrebo, Lars Marius; Noursadeghi, Mostafa; Shahzad, Ahmed; Boksasp, Ola Dagfinn; Roiss, Christoph; Strietzel, Hans Frank; Gina, Anne; Berntsen, Schie; Haugland, Helge; Vingsnes, Svein Ove; Axelsson, Patric; Olsen, Thomas; Katre, Sanjay; Aakeroey, Kristin; Mikstacki, Adam; Tamowicz, Barbara; Bożiłow, Dominika; Goch, Robert; Grabowski, Piotr; Kupisiak, Jacek; Małłek, Małgorzata; Szyca, Robert; Kostyrka, Włodzimierz; Choma, Robert; Jankowski, Grzegorz; Kościelniak, Władysław; Pietraszek, Paweł; Szarowar, Bartosz; Matos, Ricardo; França, Carlos; Lacerda, António Pais; Ormonde, Lucindo; Rosa, Rosário; Pereira, Inês; Vitor, Paula; Bento, Henrique Completo; Lopes, Maria Raquel; Carvalho, Marques; Faria, Manuela; de Sousa, Ana Cláudia; de Freitas, Pereira; Almeida, Eduardo; Mealha, Rui; Vicente, Rachel; Monte, Raquel; Rua, Fernando; Barros, Nelson; Esteves, Francisco; Gouveia Pinheiro, Célia Maria; Real, Vila; Oliveira, Vítor Miguel; Oliveira, Maria Fátima; Martins, Isabel; Saraiva, José Pedro; Assunção, José Pedro; Bártolo, Anabela; Carvalho, Anabela; Correia, Carlos; Martins, Salomé; Milheiro, Ruth; Diaz, Alejandro; Gonçalves, Maria Imelda; Ribeiro, Rosa; Estilita, Joana; Glória, Carlos; de Almeida, José; Barros, Filipa; Ramos, Armindo; Camara, Margarida; Maul, Edward Richard; Nobrega, Julio; Langner, Anuscka; Maia, Dionísio; Afonso, Ofélia; Faria, Filomena; Serra, Sofia; Botelho, Maria Manuela; Ferreira, Pedro; Mourão, Luís; Oliveira, Ana Vintém; Resende, Margarida; Aleman, Miguel; Fonseca, Jorge; Isidoro, Marta; de Meneses, Helena; Pêgas, António; Pereira, José; Pereira, Luis; Ramos, Bárbara; Matos, Francisco; Castro, Maria de Lurdes Gonçalves; Martins, Ana; Ramos, Cristina; de Sousa, Manuel; Bento, Luís; Botas, Conceição; Lopes, Vitor; Mendes, Rosa; Grigoras, Ioana; Blaj, Mihaela; Damian, Mihaela; Lupusoru, Andreea; Ristescu, Irina; Codreanu, Monica; Diaconescu, Ciresica; Nistor, Alina; Stelian, Dorin Stanescu; Streanga, Livia; Berneanu, Maria; Bordeianu, Cristina; Florenta, Calarasu; Iacob, Alina; Lupu, Mary Nicoleta; Mocanu, Iulian; Moraru, Coca; Meran, Carleta; Nicolae, Bacalbasa; Sandu, Madalina; Turcanu, Roxana; Epure, Florina; Grigore, Monica; Hotaranu, Cristina; Popescu, Nicoleta; Baban, Oleg; Baciu, Manuela; Ciobanu, Aurica; Denciu, Catalin Ioan; Gurau, Vitalie; Maftei, Ion; Moldovan, Ion; Ungureanu, Liviu; Bogdan, Prodan; Corneci, Dan; Dinu, Melania; Madalina, Dutu; Rely, Manolescu; Silvius, Negoita; Tomescu, Dana; Gabriela, Droc; Dinescu, Stelian Adrian; Calin, Mitre; Ionescu, Daniela; Margarit, Simona; Vasian, Horatiu; Albu, Corina; Balasa, Carmen; Cadrigati, Alina; Dragulescu, Dorian; Gavra, Loredana; Hentia, Ciprian; Macarie, Claudiu; Manescu, Mihaela; Nediglea, Ioan; Ocica, Dana; Ovidiu, Bedreag; Papurica, Marius; Plavat, Cosmin; Popa, Claudia; Ramneantu, Mihaela; Sandesc, Dorel; Sandici, Zoran; Sarandan, Mihaela; Belciu, Ioana; Tincu, Eugen; Ursu, Irina; Aignatoaie, Mariana; Huzuneanu, Mariana; Cocu, Simona; Hagau, Natalia; Ciubotaru, Roxana; Copotoiu, Sanda-Maria; Copotoiu, Ruxandra; Ioana, Ghitescu; Kovacs, Judit; Leonard, Azamfirei; Szederjesi, Ianos; Genoveva, Vanvu; Mosnegutu, Simona; Surbatovic, Maja; Djordjevic, Dragan; Djordjevic, Biljana; Grujic, Krasimirka; Jovanovic, Dusko; Krstic-Lecic, Ivana; Obradovic, Jovana; Zeba, Snjezana; Jevdjic, Jasna; Miletic, Milos; Zunic, Filip; Bulasevic, Aleksandra; Brko, Radoslava; Gazibegovic, Narcisa; Kendrisic, Mirjana; Vojinovic, Radisa; Firment, Jozef; Zahorec, Roman; Capková, Judita; Grochova, Monika; Trenkler, Stefan; Griger, Martin; Bakosova, Erika; Kvasnica, Martin; Saniova, Beata; Sulaj, Miroslav; Zacharovska, Andrea; Simkova, Alexandra; Číková, Andrea; Gebhardtova, Andrea; Hanuljaková, Slávka; Koutun, Juraj; Martonová, Andrea; Žilinčárová, Veronika; Galkova, Katarína; Krbila, Stefan; Sobona, Viliam; Ocenasova, Marieta; Novak-Jankovic, Vesna; Stecher, Adela; Stivan, Feri; Grynyuk, Andriy; Damjanovska, Marija; Kostadinov, Ivan; Knezevic, Mile; Malivojevic, Marko; Borovsak, Zvonko; Kamenik, Mirt; Mekiš, Dušan; Osojnik, Irena; Kosec, Lučka; Kapš, Silva Ostojič; Aleksic, Dragoslav; Gerjevič, Božena; Kalan, Katja; Ursic, Tomaz; Aldecoa, Cesar; González, Juan Montejo; Artigas, Anna; Garcia, Andres; Lisi, Alberto; Perez, Isabel; Perez, Gisela; Poch, Nuria; Vaquer, Sergi; Balciscueta, Goiatz; Barrasa, Helena; Cabanes, Sara; Maynar, Javier; Poveda, Yolanda; Rodero, Amaia Quintano; Vallejo, Ana; Duque, Patricia; Garcia-Bunger, Beatriz; Elvira, Maria Adoracion; Lajara, Ana María; Palencia, María; Ramos, Rafael; Fernandez, Ana Saez; León, Juan Tirapu; López, Jaione Iza; Murillo, Francisco Yoldi; Ramirez, Eva Turumbay; Rico, Patricia Unzué; Patricia, Marta; Vizcaíno, Martín; Bernat Álvarez, Maria José; Real, Kenneth Planas; Serra, Arantxa Mas; Aracil, Norma; Bodega, Begoña Menendez; García, Raquel Fernández; García, Marivi Álvarez; Gordon, Borja de la Quintana; Jodrá, Alicia Gutiérrez; López, Angela De Santos; Ros, Juan José Llavador; Soto, Rocío Ayala; Sepúlveda, Isabel; Díez, Esperanza Pascual; Fernández, Luisa Fernández; Gulina, Carlos Soria; Arviza, Laura Pérez; Fernandez, Lorena Mouriz; Gómez, Antía Río; Martínez, Concepción Alonso; Rodríguez, Ana Belén Rodríguez; Soto, Carmen Lopez; Garcia, Clara; Lorenzo, Mario; Pinilla, Elena; Rico, Jesus; Ruperez, Irene; Alonso, Eduardo; Leira, Fernando; Maseda, David Pestaña Emilio; Royo, Concepcion; Villagran, Jose; Candi, Giralt Murillo; Esteva, Garcia Eduardo; Folgado, Raquel Mansilla; Fornaguera, Nadal Joan; Montse, Pijoan Calonge; Prat, Anna Sape; Sintes, Dolores; Arteta, Donaldo Arteta; Delgado, Horacio García; López-Cuervo, Juan Fajardo; López, Mikel Celaya; Ramírez, Alejandro; Saldaña, Francisco José; Aliste, Pilar; Anchuelo, Ana Hermira; Campos, Ascensión García; Catalán, Mercedes; Gómez, Mónica García; Gonzalaez, Olga Gonzalez; López, Eloísa López; Navacerrada, Isabel Real; de Quevedo, Sara Arlanzón; Serrano, Matilde Gonzalez; Silvestre, Francisco Perez-Cerdá; Torrente, Francisco Martinez; Arocas, Blanca; Martinez, Ernesto Pastor; Soro, Marina; Maroto, Fernando; Algarra, Ruth Robledo; Aleixandre, Inés Silla; Argente, Gemma Rodriguez; Lleó, Ana Broseta; Rubio, Antonio Vela; Sánchez, José Luis Vicente; Valcárcel, Irene Enríquez; Balust, Clara; Balust, Jaume; Borrat, Xavier; Carretero, Maria Jose; Gracia, Isabel; Matute, Purificacion; Mercadal, Jordi; Pujol, Roger; Tena, Beatriz; Ubre, Marta; Albalad, Dolores Dorda; Alcaide, Concepción Muñoz; Caballero, Jesus; Cervantes, Angels Camps; Clanchet, Miriam de Nadal; Estruch, Nuria Montferrer; Ferrer, Mercè Ballvé; Fornells, Albert Lacasta; Galera, Eduard Terrer; Martinez, Irene Garcia; Muñoz, Susana Manrique; Pelavski, Andres; Perez, Pilar Tormos; Posada, Miguel Angel Gonzalez; de Prat, Ivette Chocron; Rello, Jordi; Serrano, Llum García; Sieiro, José Manuel Naya; Silva, Lorena; Sole, Maria Jose Colomina; Suñé, Alfons Biarnes; Villach, Isabel Rochera; Herreras, José Ignacio Gómez; Poves, Rodrigo; Rafael, Beatriz Martinez; Almeida, Icier Martinez; Collates, Angel Fernandez; Bartolomé, Maria Jose; Cimadevilla, Bonifacio; González, Antonio Manuel González; Llevot, Jose Manuel Rabanal; Mira, Juan Carlos Diaz de Terán; Molina, Begoña González; Pardo, Sara; Sánchez, Carlos López; Williams, Monica; Zaldibar, Estibaliz; Corsini, Lourdes Muñoz; Fraile, José Ramón Rodríguez; de la Lastra, Maria; Sacramento, Monir Kabiri; Saña, Francisco Javier López; Ålvarez, Josep Trenado; Bulnes, Maria Luisa Cantón; Carrasco, Violeta Gándara; Crespo, María del Rocío Míguez; Cubillos, Diana Narváez; Laza, Enrique Laza; Pérez, María del Pino Heredia; Seisdedos, Ángel Arenzana; Torres, Bartolomé Fernández; Ampuero, Marian Santos; Llano, Marta Chicot; Mata, Esperanza; Munoz, Manuel; Orts, Mar; Planas, Antonio; Ramasco, Fernando; Roman, Carlos; Durán, Marina Varela; Fernandez, Sabela del Río; Otero, Yolanda Sanduende; Pineiro, Susana Lopez; Pardal, Cristina Barreiro; Alcantud, Jesús Fernández; Antolinos, Mercedes Ayuso; Barrios, Francisco; Casanova, Ana Collantes; Castro, Manuel Ruiz; Crespo, Beatriz Infantes; Felipe, Uzuri Lancha; Fuster, Marta Liceras; García, Máximo Sanz; Garrote, Begoña Herrero; Gonzalez, Ricardo Moreno; Granero, Maria José Montes; de la Guía, Carlos Lloreda; López, Raquel Chaves; López, Santiago de Frutos; Martinez, Jose Javier Marco; Mostaza, Angel Garcia; Moreno, Antonio Jiménez; Osado, Irene Riquelme; Pastor, Ana Bardina; Peña, Rosa; Pérez, Mónica Rustarazo; Piña, María Aliaño; Romero, Carlos Aranda; Rodríguez, Elena Rodríguez; Sáez, Vicente Pedroviejo; Safatle, Fernando; Salvan, Javier Hernández; Sampedro, Mar Galán; de la Torre, Patricia Alfaro; Toro, Jonatan Pérez; Unzúe, Crsitina Lasa; Vargas, Maria José; Bernal, David Garcia; Echevarria, Mercedes; Iglesias, Alejandro Ubeda; Loza, Ana; Morillo, Araceli Rodriguez; Serrano, Pedro Diaz; Sevilla, Fernando Caba Barrientos; Cacho, Elena; Calderón, Ricardo; Dufur, Mercedes; Marginet, Carolina; Monedero, Pablo; Yepes, Maria José; Alvarez, Luzdivina Rellán; Carballal, Francisca Fernández; Castiñeiras, Alberto Pensado; García, Paula Dieguez; López, Lorena Ramos; Maceiras, Pablo Rama; Puente, María Socorro Martínez; Rilo, Maria Teresa Rey; Alonso, Ana Esther Trujillo; Fernández, Sonia Rodríguez; García, Rafael Omaña; García, Aníbal Pérez; Puentes, Rafael Bello; Aguado, Domingo Nunez; Carballo, Carlos Lopez; Fernandez, Ricardo Fernandez; Presedo, Amadeo Toledo; de Rabago, Ricardo Bermejo Diaz; Velasco, Ana Rodriguez; Capel, Yolanda Jiménez; Cortés, Ana Fernández; García, Esther Martínez; Gimeno, Laura Martinez; Klamburg, Jordi; Omedas, Rosa Castillo; Núñez, Miriam González; Maristany, Clara Llubià; Ruiz, Enrique Moret; Artigas, Xavier; Castrillón, Sebastian; Espinosa, Nieves; Gomez-Caro, Ana María; Illa, Susana; India, Inmaculada; Martín-Huerta, Beatriz; Moral, Victoria; Moreno, Marisa; Fernández, Cristina Iglesias; García, Violeta Fernández; Hernández, Pedro Picatto; Checa, Angel Alberto Honrubia; Diaz, David Salvatierra; Noguera, Manuel Linero; Varela, Ignacio Pujol; Gallego, Miguel González; García, Oscar Martínez; Irujo, José Javier Ariño; Perrino, Carlos González; Picazo, Julio Rey; Timoneda, Francisco López; Arroyo, María Manzanero; Blanco, Isabel Albalá; Borja, Marcos Martínez; Burcio, Sara Martín; Castro, Nilda Martinez; Cerdeiriña, Aránzazu Puente; Concostrina, Marta de la Torre; Cristina, Medrano Viñas; Díaz, Trinidad Dorado; Esteruelas, Juan Avellanosa; Ingelmo, Ildefonso Ingelmo; Insuga, Paco Duran; Llamas, Elisabeth Claros; Lopez, Jose Juan Martín; Martín, María Beltran; Martín, Elena Elías; Mesa, Eva Ureta; Monterde, Manuela Loren; Montoiro, Paloma Alonso; Móstoles, Maria Luisa Gonzalez; Olarte, Eva Velasco; Pérez, Adolfo Martínez; Perez, Fernando Domínguez; Romero, Ana Serrano; Rous, Diego Parise; Ruiz, Nuria Mané; Ruiz, Jose Angel Palomo; Saiz, Alvaro Ruigomez; Terol, Alvaro de la Vega; Toha, Angel Candela; Utrera, Fernando Alvarez; Alberdi, Fermín; Elósegui, Itxaso; García, Javier; Garde, Pilar Marco; Mintegui, Escudero Itziar; Sáez, Iker García; Salas, Estibaliz; Zabarte, Mercedes; Diaz-Boladeras, Rosa-Maria; Mora-Guevara, Emilio; Zamora, Julia Ferreras; Bonet, Alfons; Salo, Lidia; Salinas, Unai; Zaballos, Juan; Alvarez, Ana Abella; Garrido, Carlos Jimenez; Roa, Juan Ramón Hita; Vidal, Federico Gordo; Garcia-Egea, Jorge; Elson, Monica Zamora; Seron-Arbeloa, Carlos; Asensio, Miguel Angel Mendiola; Simeón, Rosa Gastaldo; Alameda, Luis Enrique Muñoz; Angulo, Guillermo Oeding; Aranzubia, Monserrat; Arcas, Jose Juan; Arevalo, Julian; Belvert, Belén Quesada; Calvo, César Pérez; Cremades, Marta; Crespo, Pascual; Cuarental, Ana; del Olmo, Mercedes; Fernández, Pablo Turrión; Vega, José Luis Franqueza García Isabel Garcia; Herrera, Elena II; Llorente, Miguel Angel Alcala; Rabes, Cecilia Martin; de Maeyer, Ana Gamo; Marquez, Manuel Pérez; Mendoza, Diego López; Muñoz, José María Milicua; Martínez, Natividad Arias; Oviedo, Arnoldo Santos; Garrigues, Pau Benavent; Íñigo, José Alonso; Ferrandiz, Sergi Tormo; Sanchez-Morcillo, Silvia; Sánchez, Matilde Lafuente; Parra, Asunción Marqués; Vidal, Sonia Gomar; Allué, Raquel Montoiro; Etayo, Begoña Zalba; Rodriguez, Raquel Bustamante; Villen, Luis Martin; Jimenez, Cristina Molla; de Zayas, Ricardo Salas; Moreno, Cristina Dolera; Pacheco, Fernando SanJose; Pascual, Jose Luis Anton; Gude, Fernando Tejera; Riestra, Eva Manteiga; Delgado, Francisco Cota; Prados, Maria Victoria de la Torre; Barrios, Javier; Cervera-Montes, Manuel; García-Sanz, Mercedes; García, Vicente; Sanmiguel, Guillermo; Álvaro, Julian López; Barrachima, Beatriz Bornay; Bermejo, Francisco Jose Romero; Pilar, Alberto Garcia Fernandez; Garcia, Martinez; Ramírez, Carolina Navarro; Ramos, Jorge Gómez; Samaniego, Luis Angel; Belenguer-Muncharaz, Alberto; Ferrándiz-Selles, Amparo; Mateu-Campos, Maria-Lidon; Domínguez, David; Espinosa, Elena; León, Teresa; Betancor, Nazario Ojeda; Cortes, Javier Garcia; Díaz, Juan José Díaz; Canalechevarria, Ana Manzano; Novales, Beatriz Fores; Peña, Jose Manuel Garcia; Delgado, Tomas Rodriguez; Roquerio, Beatriz Santamaria; Sainz, Juan Jose Gomez; Soto, Teresa Tebar; Chew, Michelle; Seeman-Lodding, Heléne; Dahm, Peter; Hergès, Helena Odenstedt; Lundborg, Christoffer; Söndergaard, Sören; Rylander, Christian; Sari, Ferenc; Tibblin, Anna Oscarsson; Adolfsson, Anne; Klarin, Bengt; Schrey, Susann; Merisson, Edyta; Rydén, Jörgen; Divander, Mona Britt; Hedin, Annika; Hedlund, Daniel; Lindkvist, Mikael Axelsson; Jawad, Monir; Layous, Lona; Wernerman, Jan; Björne, Håkan; Brattström, Olof; Olheden, Staffan; Oldner, Anders; Sellden, Eva; Walder, Bernhard; Wickboldt, Nadine; Rossi, Ariane; Steiner, Luzius; Djurdjevic, Mirjana; Lussmann, Roger; Geisen, Martin; Hofer, Christoph; Turina, Matthias; Grocott, Mike; Goldhill, David; Everett, Lynn; Harris, Katy; Wright, Maggie; Adams, David; Alderson, Lorraine; Baker, Julie; Christie, Iain; Ferguson, Colin; Hill, Matthew; Holmes, Kate; Hutton, Andrew; Minto, Gary; Moor, Paul; Porter, Andrew; Struthers, Richard; Akotia, Niven; Belhaj, Alaa; Chang, Serene; Collantes, Enrique; Eigener, Katrin; Husband, Michael; Khan, Ahsun; Kong, Ming-Li; McAlees, Eleanor Jane; MacDonald, Neil; Niebrzegowska, Edyta; Parnell, Wendy; Smith, Amanda; Chhatwal, Ally; Jhingan, Smriti; Muswell, Richard; Poon, Yoyo; Singh, Nidhita; Stephens, Robert; Vasan, Robin; Waife, Nicola; Weda, Tahmina; Clarke, Adrian; Szakmany, Tamas; Fletcher, Simon; Rosbergen, Melissa; Blunt, Mark; Prince, Liz; Wong, Kate; Kumar, Ram; Stilwell, Sarah; Couper, Keith; Crooks, Neil; Gao-Smith, Fang; Melody, Teresa; Snaith, Catherine; Patel, Jaimin; Parekh, Dhruv; Yeung, Joyce; Loughnan, Bernadette; Moosajee, Vas; Rope, Tamsin; Edger, Lliam; Dawson, Julie; Hadfield, Daniel; Hopkins, Phil; McDonald, Lisa; Willars, Chris; Campbell, Gillian; Craig, Jayne; Smith, Andrew; Ladipo, Karleen; Lockwood, Geoff; Moreno, Juan; Ballington, Ruth; Hamandishe, Sibongilele; Rogerson, David; Cowman, Sarah; Hayden, Paul; Pinto, Nuno; Sandhar, Taj; Arawwawala, Dilshan; Brotherston, Lauren; Mitchell-Inwang, Christine; Walsh, Helena; Alagarsamy, Famila; Goon, Serena; Karcheva, Sylvia; Krepska, Amy; McKinney, Brian; Patil, Vishal; Batchelor, Nicholas; Day, Christopher; Finch, Louise; Gibson, Charlie; Grayling, Matthew; Hubble, Sheena; Key, William; Knight, Thomas; Loosley, Alexander; Margetts, Paul; Stewart, Hannah; Bewley, Jeremy; Hurley, Katrina; Murphy, Ruth; Philpott, Catherine; Pollock, Kathryn; Sweet, Katie; Thomas, Matthew; Tucker, Katy; Windsor, David; Conway, Daniel; Gold, Steve; Quraishi, Tanviha; Cupitt, Jason; Baddeley, Sally; Brown, John David; Foo, Irwin; Mantle, Damien; Carvalho, Peter; Huddart, Sam; Kirk-Bayley, Justin; Smith, Rebecca; Milligan, Lisa; Poulose, Sonia; Sarkar, Som; Nolan, Jerry; Pedley, Emma; Padkin, Andrew; Pesian, Siamak; Rajamanickam, Satish; Ramkumar, Konnur; Thomas, Jerry; Crayford, Alison; Turner, Angus; Bottrill, Fiona; Webb, Stephen; Jhanji, Shaman; MacCallum, Niall; Wessels, Kate; Wigmore, Tim; Meikle, Alistair; Wilson, Stephen; White, Stuart; Bonnett, Andrew; Rushton, Andrew; Williams, Colin; Zuzan, Oliver; Hall, Andrew; Montgomery, Jane; Piggot, Ailie; Read, Richard; Stocker, Mary; Tamm, Tiina; Agarwal, Banwari; Ward, Stephen; Brown, Lucy; Joy, Manju; Venkatesh, Suresh; Hughes, Thomas; Zsisku, Lajos; Roy, Alistair; Hooper, Victoria; Mouland, Johanna; Nightingale, Jeremy; Rose, Steve; Chiam, Patrick; Chohan, Harnita; Dickson, Chris; Gibb, Sarah; Higham, Charley; Harvey, Caroline; Janarthanan, Chandra; Jones, Laura; Kapoor, Avinash; Moll, Mark; Roberts, Louise; Saunders, David; Arnold, Glenn; Gibbs, Claire; Jhurgursing, Mhairi; Pierro, Dena; Pritchard, Frances; Doyle, Patrick; Templeton, Maie; Wilson, Robert; Zantua, Kim; Collyer, Thomas; Featherstone, James; Worton, Rachael; Bruce, Jane; McGuigan, Kate; Price, Grant; Moreton, Sarah; Pulletz, Mark; Anderson, Helen; Baxter, Ian; Beckingsale, Alex; Callaghan, Mark; Datta, Ansu; Dawson, Jo; Gollogly, Jackit; Izod, Chris; Lobaz, Steve; MacFie, Caroline; Patel, Manju; Payne, Heather; Singh, Raj; Timms, Gemma; McLeod, Shaun; O'Brian, Peter; Horner, Elspeth; Joshi, Vivekananda; Stuart-Smith, Karen; Seale, Tania; Bolger, Clare; Collins, Hannah; Ekins, Emma; Hawkins, Lesley; Jonas, Max; Linford, Karen; Wadams, Beverley; Beach, Madeleine; Vizcaychipi, Marcela; Jewsbury, William; Davies, Simon; Balaji, Packianathaswamy; Kangaraj, Muthuraj; Pissay, Nagesh; Smith, Neil; Gopalakrishnan, Senthilkumar; MacKinnon, John; Strandvik, Gustav; Francis, Ruth; Jennings, Adrian; Keating, Matthew; Kumar, Sajith; Leese, Sarah; Magee, Cliona; Pilsbury, Jane; Ralph, James; Riddington, David; Sachdeva, Rajneesh; Snelson, Catherine; Vasanth, Suresh; Wilde, Judith; Lavender, Beth; Lyons, Rachel; Watters, Malcolm; Adams, Tim; Dyer, Simon; Tindall, Lucy; Claxton, Andrew; Netke, Meenu; Akouds, Esam; Bates, Debrah; Gallagher, Heather; Hatton, Jonathan; Holroyd, William; Mitra, Atideb; Nurse, Trudy; Reed, Deborah; Desikan, Somi; Barber, Russell; Childs, Sophie; O'Carroll-Kuehn, Britta; Wyldbore, Mark; Al-Abdaly, Ayad; Amatya, Suman; Bhaskaran, Sherly; Chandan, Garud; Chaudhry, Suman; Chikungwa, Moses; Earnshaw, Greg; Grewal, Moni; Haque, Shamimul; Hawkins, John; Javaid, Ahmed; Jackson, Clare; Kamel, Miriam; Marla, Ruchira; Mculloch, Dori-Ann; Parker, Tom; Salib, Yussof; Saravanmuthu, Ramesh; Secker, Chris; Sockalingam, Siva; Taylor, Anne; Austine, Pauline; Kanade, Vrushali; Paal, Dora; Mok, May Un Sam; Burtenshaw, Andrew; Davis, Laura; Ellahee, Parvez; Freeman, David; Pierson, Richard; Wollaston, Julie; Karmarkar, Amara; Ball, Clare; Calton, Emily; Maxwell, Louise; Walker, Rachel; Bland, Martin; Bullock, Lynne; Harrison-Briggs, Donna; Hodge, Paul; Krige, Anton; Dempsey, Ged; Hammell, Claire; Loveridge, Robert; Parker, Robert; Snell, Jane; Wright, Carl; Baker, Andy; Barr, Katharine; Belcher, Alex; Bonnington, Sam; Bougeard, Anne-Marie; Fitzgerald, Emma; Ford, Rachael; Gillard, Chantal; Griffiths, Liz; Greenberg, Lizzie; Huber, Jonathan; Mathieu, Steve; Richardson, Neil; Tompsett, Laura; White, Nigel; Patel, Santosh; Corner, Victoria; Thomas, Richard; Trodd, Dawn; Wilson, Jennifer; Copley, Ed; Flutter, Laura; Hulme, Jonathan; Susarla, Jay; Thwaites, Alison; Jayasundera, Suraj; McAfee, Sean; Chantler, Jonathan; McKechnie, Stuart; Neely, Julia; Mouton, Ronelle; Scarth, Edward; Soar, Jasmeet; Buss, Joanne; Currie, Vicki; Sange, Mansoor; Kuttler, Anja; Power, Fiona; Alexander, David; Dunne, Kevin; Shinner, Guy; Black, Euan; Haldane, Grant; Kerr, Jennie; Saran, Taj; Ward, Geraldine; Jefferies, Fiona; Alexander, Peter; Royle, Alison; Nahla, Farid; Bowles, Tim; Gregory, Maggie; Ahern, Rebecca; Cartlidge, David; Craker, Lloyd; Thompson, Christopher; Bidd, Heena; Giles, Julian; Manser, Amanda; Parry, Gareth; Chan, Peter; Das, Dinesh; Fahmy, Nisreen; Higgins, David; Khader, Ahmed; Stone, Alex; Leonardi, Silvia; Rose, Oliver; Bright, Elizabeth; Ercole, Ari; Rafi, Muhammed Amir; Ramasamy, Radhika; Sheshgiri, Bengeri; Merrill, Colin; Page, Valerie; Walker, Elaine; Harris, Stephen; Hughes, Sarah; Morrison, Alan; Razouk, Khaled; Ayman, Mustafa; al-Subaie, Nawaf; Arif, Fuhazia; Cashman, Jeremy; Cecconi, Maurizio; Edsell, Mark; Fossati, Nicoletta; Hammond, Sarah Jane; Hamilton, Mark; Lonsdale, Dagan; Moran, Carl; Siegmueller, Claas; Velzeboer, Freya; Wong, Patrick; Jakeman, Alicia; Mowatt, Chris

    2012-01-01

    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 international

  5. 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

    International Nuclear Information System (INIS)

    Svenson, O.; Allwin, P.; Salo, I.

    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)

  6. Empirical Analysis of Construction Safety Climate - A Study

    OpenAIRE

    S.V.S.RAJA PRASAD; K.P.REGHUNATH

    2010-01-01

    Safety in the construction industry has always been a major issue. Though much improvement in construction safety has been achieved, the industry still continues to lag behind most other industries with regard to safety. The safety climate of any organization consists of employee’s attitudes towards and perceptions of, health and safety behavior. Construction workers attitudes towards safety are influenced by their perceptions of risk, management, safety rulesand procedures. A measure of safe...

  7. 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

  8. Clonidine or remifentanil for adequate surgical conditions in patients undergoing endoscopic sinus surgery: a randomized study

    Directory of Open Access Journals (Sweden)

    Laurent Bairy

    2017-05-01

    Full Text Available Background Deliberate hypotension is one way to achieve a bloodless surgical field in endoscopic sinus surgery (ESS. We compared two anaesthesia regimens to induce deliberate hypotension and attempted to determine the most efficient one. Methods Fifty-nine patients undergoing ESS were minimized into two groups. In the CLO group, patients received I.V. sufentanil 0.15 µg/kg together with I.V. clonidine 2–3 µg/kg. In the REMI group, patients received remifentanil at a rate of up to 1 µg/kg/min. Fromme scores were collected 15 min after the incision and at the end of the procedure. Mean arterial pressure readings (MAP, heart rate readings, time to eyes opening, time to extubation, pain scores, analgesic requirements, and oxygen needs were collected and compared. Results There were no significant differences in Fromme scores between the two groups. The averaged MAP from 15 min to the end of the procedure was significantly lower in the REMI group; these patients also received more ephedrine. Significantly fewer patients in the CLO group needed oxygen therapy to keep their Pulse Oximeter Oxygen Saturation within 3% of their preoperative values. Patients in this group also needed less piritramide in the recovery room, and their pain scores were lower at discharge from the recovery room. Discussion Although both anaesthesia regimens offered a similar quality of surgical field, this study suggests that clonidine had a better average safety profile. Furthermore, patients who received this regimen required fewer painkillers immediately after surgery.

  9. Learning curve for laparoendoscopic single-site surgery for an experienced laparoscopic surgeon

    OpenAIRE

    Pao-Ling Torng; Kuan-Hung Lin; Jing-Shiang Hwang; Hui-Shan Liu; I-Hui Chen; Chi-Ling Chen; Su-Cheng Huang

    2013-01-01

    Objectives: To assess the learning curve and safety of laparoendoscopic single-site (LESS) surgery of gynecological surgeries. Materials and methods: Sixty-three women who underwent LESS surgery by a single experienced laparoscopic surgeon from February 2011 to August 2011 were included. Commercialized single-incision laparoscopic surgery homemade ports were used, along with conventional straight instruments. The learning curve has been defined as the additional surgical time with respect ...

  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. Benign prostatic hyperplasia: clinical treatment can complicate cataract surgery

    Directory of Open Access Journals (Sweden)

    Fernando Facio

    2010-10-01

    Full Text Available PURPOSE: To investigate the effects of alpha-1 adrenergic receptor antagonists for the treatment of benign prostatic hyperplasia (BPH regarding potential risks of complications in the setting of cataract surgery. AIM: To address recommendations, optimal control therapy, voiding symptoms and safety within the setting of cataract surgery. MATERIALS AND METHODS: A comprehensive literature review was performed using MEDLINE with MeSH terms and keywords "benign prostatic hyperplasia", "intraoperative floppy iris syndrome", "adrenergic alpha-antagonist" and "cataract surgery". In addition, reference lists from identified publications were reviewed to identify reports and studies of interest from 2001 to 2009. RESULTS: The first report of intraoperative floppy iris syndrome (IFIS was observed during cataract surgery in patients taking systemic alpha-1 AR antagonists in 2005. It has been most commonly seen related to use of tamsulosin. Changes of medication and washout periods of up to 2 weeks have been attempted to reduce the risk of complications in the setting of cataract surgery. CONCLUSION: Patients under clinical treatment for BPH should be informed about potential risks of this drug class so that it can be discuss with their healthcare providers, in particular urologist and ophthalmologist, prior to cataract surgery.

  12. Using PROMIS for measuring recovery after abdominal surgery: a pilot study

    Directory of Open Access Journals (Sweden)

    Eva van der Meij

    2018-02-01

    Full Text Available Abstract Background To assess the construct validity and responsiveness of the PROMIS Physical Function v1.2 short form 8b (PROMIS-PF, and the PROMIS Ability to Participate in Social Roles and Activities v2.0 short form 8a (PROMIS-APS in postoperative recovery. Methods An observational pilot study was conducted in which 30 patients participated, undergoing various forms of abdominal surgery. Patients completed the PROMIS-PF and PROMIS-APS, the Short Form 36 Health Survey (SF-36 and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS at several time points before and after surgery. The construct validity and responsiveness of the two PROMIS short forms were evaluated by testing pre-defined hypotheses and were considered adequate when at least 75% of the data was consistent with the hypotheses. Construct validity was evaluated by calculating Spearman correlations and the responsiveness by calculating effect sizes. Results 6/7 (85.7% of the results were consistent with the hypotheses supporting the construct validity of the PROMIS-PF. For the PROMIS-APS this was the case in 7/15 (46.7% of the results. For the PROMIS-PF, 6/7 (85.7% of the results were consistent with the hypotheses, supporting responsiveness. Regarding the responsiveness of the PROMIS-APS, only 7 out of 13 (53.8% of these results were consistent with the hypotheses. Conclusions This study supported the construct validity and the responsiveness of the PROMIS-PF v1.2 short form 8b for measuring recovery in abdominal surgery. Considering the major advantages of PROMIS, we recommend the use of the PROMIS-PF in abdominal surgery.

  13. Functional communication as a predictor of depression and anxiety symptoms among adolescents seeking bariatric surgery.

    Science.gov (United States)

    Curran, J L; Datto, G

    2014-06-01

    The purpose of the present study was to determine whether functional communication and parent-adolescent relations prospectively predict anxiety and depression symptoms among severely obese adolescents seeking bariatric surgery. Participants included 30 adolescents and their primary caregivers, who presented for enrolment in a study assessing the safety and efficacy of the laparoscopic adjustable gastric band. Adolescents and their caregivers completed questionnaires assessing anxiety and depression symptoms, functional communication, and parent-adolescent relations at baseline and immediately prior to having bariatric surgery. Regression analyses revealed that poorer parent reported functional communication at baseline predicted increases in adolescent reported anxiety and depression symptoms immediately prior to surgery (on average 8.8 months later), above and beyond baseline symptoms. Anxiety and depression symptoms did not predict functional communication over time. Parent-adolescent relations, as reported by the adolescent, were concurrently associated with adolescent reported depression symptoms at baseline, and were concurrently associated with adolescent reported anxiety and depression symptoms, as well as parent reported depression symptoms, immediately prior to surgery. Functional communication may be an important prospective risk factor for the development of anxiety and depression symptoms among severely obese adolescents seeking bariatric surgery, whereas adolescent report of the parent-adolescent relationship appears to be concurrently related to anxiety and depression symptoms. Future research should examine whether specifically targeting communication skills and family relationships within psychological treatment would improve psychosocial functioning among severely obese adolescents. © 2014 The Authors. Clinical Obesity © 2014 International Association for the Study of Obesity.

  14. Recent advances in femtosecond laser-assisted cataract surgery

    Directory of Open Access Journals (Sweden)

    Zhao-Jie Chu

    2013-07-01

    Full Text Available Perfect vision and fewer complications is our goal in cataract surgery, femtosecond laser-assisted cataract surgery hold the promise. Applications of femtosecond laser technology for capsulotomy, nuclear fragmentation and corneal incision in cataract surgery bring a new level of accuracy, reproducibility and predictability over the current cataract surgery. The femtosecond laser produces capsulotomies that are more precise, accurate, reproducible, and stronger than those created with the conventional manual technique, and further helps maintain proper positioning of the IOL. Femtosecond laser in nuclear fragmentation lead to a lower effective phacoemulsification time, and the corneal incision is more stable. But currently there are some complications and a clear learning curve associated with the use of femtosecond lasers for cataract surgery. The long-term safety and visual outcomes still need further investigation.

  15. [A study on English loan words in French plastic surgery].

    Science.gov (United States)

    Hansson, E; Tegelberg, E

    2014-10-01

    The French language is less and less used as an international scientific language and many French researchers publish their work in English. Nowadays, Annales de Chirurgie Plastique Esthétique is the only international plastic surgical journal published completely in French. The use of English loan words in French plastic surgery has never been studied. The aim of this study was to describe the frequency and types of English loan words in French plastic surgery. A corpus consisting of all the articles in a number of Annales de Chirurgie Plastique Esthethique, chosen by default, was created. The frequency of English loan words was calculated and the types of words were analysed. The corpus contains 367 (0.8%) English loan words. Most of them are non-integrated loan words and calques. The majority of the plastic surgical loan words describe surgical techniques. The French plastic surgical language seems to be influenced by English. The usage of loan words does not always follow the recommendations and the usage is sometimes ambiguous. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  16. Vernakalant hydrochloride for the rapid conversion of atrial fibrillation after cardiac surgery

    DEFF Research Database (Denmark)

    Kowey, Peter R; Dorian, Paul; Mitchell, L Brent

    2009-01-01

    Postoperative atrial arrhythmias are common and are associated with considerable morbidity. This study was designed to evaluate the efficacy and safety of vernakalant for the conversion of atrial fibrillation (AF) or atrial flutter (AFL) after cardiac surgery....

  17. Preoperative predictive model for acute kidney injury after elective cardiac surgery: a prospective multicentre cohort study.

    Science.gov (United States)

    Callejas, Raquel; Panadero, Alfredo; Vives, Marc; Duque, Paula; Echarri, Gemma; Monedero, Pablo

    2018-05-11

    Predictive models of CS-AKI include emergency surgery and patients with haemodynamic instability. Our objective was to evaluate the performance of validated predictive models (Thakar and Demirjian) in elective cardiac surgery and to propose a better score in the case of poor performance. A prospective, multicentre, observational study was designed. Data were collected from 942 patients undergoing cardiac surgery, after excluding emergency surgery and patients with an intraaortic balloon pump. The main outcome measure was CS-AKI defined by the composite of requiring dialysis or doubling baseline creatinine values. Both models showed poor discrimination in elective surgery (Thakar's model, AUROC = 0.57, 95% CI = 0.50-0.64 and Demirjian's model, AUROC= 0.64, 95% CI = 0.58-0.71). We generated a new model whose significant independent predictors were: anaemia, age, hypertension, obesity, congestive heart failure, previous cardiac surgery and type of surgery. It classifies patients with scores 0-3 as low risk ( 8 as high risk (>30%) of developing CS-AKI with a statistically significant correlation (p <0.001). Our model reflects acceptable discriminatory ability (AUC = 0.72, 95% CI = 0.66-0.78) which is significantly better than Thakar and Demirjian's models (p<0.01). We developed a new simple predictive model of CS-AKI in elective surgery based on available preoperative information. Our new model is easy to calculate and can be an effective tool for communicating risk to patients and guiding decision-making in the perioperative period. The study requires external validation.

  18. Efficacy and safety of TachoSil® versus standard treatment of air leakage after pulmonary lobectomy

    DEFF Research Database (Denmark)

    Marta, Gabriel Mihai; Facciolo, Francesco; Ladegaard, Lars

    2010-01-01

    Alveolar air leakage remains a serious problem in lung surgery, being associated with increased postoperative morbidity, prolonged hospital stay and greater health-care costs. The aim of this study was to evaluate the sealing efficacy and safety of the surgical patch, TachoSil®, in lung surgery....

  19. Therapeutic outcomes of transsphenoidal surgery in pediatric patients with craniopharyngiomas: a single-center study.

    Science.gov (United States)

    Yamada, Shozo; Fukuhara, Noriaki; Yamaguchi-Okada, Mitsuo; Nishioka, Hiroshi; Takeshita, Akira; Takeuchi, Yasuhiro; Inoshita, Naoko; Ito, Junko

    2018-03-30

    OBJECTIVE The aim of this study was to analyze the outcomes of transsphenoidal surgery (TSS) in a single-center clinical series of pediatric craniopharyngioma patients treated with gross-total resection (GTR). METHODS The authors retrospectively reviewed the surgical outcomes for 65 consecutive patients with childhood craniopharyngiomas (28 girls and 37 boys, mean age 9.6 years) treated with TSS (45 primary and 20 repeat surgeries) between 1990 and 2015. Tumors were classified as subdiaphragmatic or supradiaphragmatic. Demographic and clinical characteristics, including extent of resection, complications, incidence of recurrence, pre- and postoperative visual disturbance, pituitary function, and incidence of diabetes insipidus (DI), as well as new-onset obesity, were analyzed and compared between the primary surgery and repeat surgery groups. RESULTS Of the 45 patients in the primary surgery group, 26 (58%) had subdiaphragmatic tumors and 19 had supradiaphragmatic tumors. Of the 20 patients in the repeat surgery group, 9 (45%) had subdiaphragmatic tumors and 11 had supradiaphragmatic tumors. The only statistically significant difference between the 2 surgical groups was in tumor size; tumors were larger (mean maximum diameter 30 mm) in the primary surgery group than in the repeat surgery group (25 mm) (p = 0.008). GTR was accomplished in 59 (91%) of the 65 cases; the GTR rate was higher in the primary surgery group than in the repeat surgery group (98% vs 75%, p = 0.009). Among the patients who underwent GTR, 12% experienced tumor recurrence, with a median follow-up of 7.8 years, and recurrence tended to occur less frequently in primary than in repeat surgery patients (7% vs 27%, p = 0.06). Of the 45 primary surgery patients, 80% had deteriorated pituitary function and 83% developed DI, whereas 100% of the repeat surgery patients developed these conditions. Among patients with preoperative visual disturbance, vision improved in 62% but worsened in 11%. Visual

  20. Bus safety study : a report to Congress.

    Science.gov (United States)

    2013-11-01

    Section 20021(b) of the Moving Ahead for Progress for the 21st Century (MAP-21) legislation requires the Secretary of Transportation : to submit a report of the results of a Bus Safety Study to the Committee on Banking, Housing, and Urban Affai...

  1. How to perform Mohs micrographic surgery?

    Directory of Open Access Journals (Sweden)

    Gonca Elçin

    2015-12-01

    Full Text Available A considerable number of dermatolologist in Turkey perform standard surgical excision of non-melanoma skin cancer and repair the defects functionally and cosmetically. It is possible to appropriately treat most basal cell carcinomas (BCCs and squamous cell carcinomas (SCCs with standard excision and even with curettage and electrodessication. However, for a group of patients at high risk of recurrence, standard excision cannot provide the desired oncologic cure rates. In order to increase the possibility of oncologic cure, it is recommended that high risk BCCs and SCCs should be excised with larger than 4-6 mm safety margins. On the other hand the most common localization for BCCs and SCCs are the face, and using safety margins larger than 4-6 mm on the face might contradict with the principles of tissue-preserving surgical approach. A more unfavorable situation is that the oncologic cure rates remain below 80% for high-risk BCC and SCC even after standard excisions with safety margins of wider than 4-6 mm. The goal of Mohs micrographic surgery is complete tumor removal with maximum preservation of healthy tissue.. Mohs micrographic surgery is a staged surgery that enables 100% assessment of the entire lateral and deep surgical margins microscopically in minutes after excision with horizontally cut frozen sections for residual cancer. Thus, it increases the oncologic cure rate especially for a certain group of patients with high-risk BCC and SCC. The aim of this paper was to review the Mohs technique, the most thorough method for treating BCC and SCC.

  2. Is Preventative Long-Segment Surgery for Multi-Level Spondylolysis Necessary? A Finite Element Analysis Study.

    Directory of Open Access Journals (Sweden)

    Jianqiang Mo

    Full Text Available For multi-level spondylolysis patients, surgeons commonly choose to fix all the segments with pars interarticularis defect even those without slippage and not responsible for clinical symptoms. In this study, we tried to study the necessity of the preventative long-segment surgery for the defected segment without slippage in treatment of multi-level spondylolysis patients from a biomechanical perspective.We established a bi-level spondylolysis model with pars defects at L4 and L5 segments, and simulated posterior lumbar interbody fusion (PLIF and pedicle screw fixation at L5-S1 level. Then we compared the biomechanical changes at L4 segment before and after surgery in neutral, flexion, extension, lateral bending and axial rotation position.The stress on L4 pars interarticularis was very similar before and after surgery, and reached the highest in axial rotation. The L3-L4 intradiscal pressure was almost the same, while L4-L5 intradiscal pressure changed a little in lateral bending (increase from 1.993 to 2.160 MPa and axial rotation (decrease from 1.639 to 1.307 MPa after surgery. The PLIF surgery caused a little increase of range of motion at adjacent L4-L5 and L3-L4 levels, but the change is very tiny (1 degree.The PLIF surgery will not cause significant biomechanical change at adjacent segment with pars defect in multi-level spondylolysis. On the contrary, excessive long-segment surgery will damage surrounding soft tissues which are important for maintaining the stability of spine. So a preventative long-segment surgery is not necessary for multi-level spondylolysis as long as there are no soft tissue degeneration signs at adjacent level.

  3. Is Preventative Long-Segment Surgery for Multi-Level Spondylolysis Necessary? A Finite Element Analysis Study.

    Science.gov (United States)

    Mo, Jianqiang; Zhang, Wen; Zhong, Dongyan; Xu, Hao; Wang, Lan; Yu, Jia; Luo, Zongping

    2016-01-01

    For multi-level spondylolysis patients, surgeons commonly choose to fix all the segments with pars interarticularis defect even those without slippage and not responsible for clinical symptoms. In this study, we tried to study the necessity of the preventative long-segment surgery for the defected segment without slippage in treatment of multi-level spondylolysis patients from a biomechanical perspective. We established a bi-level spondylolysis model with pars defects at L4 and L5 segments, and simulated posterior lumbar interbody fusion (PLIF) and pedicle screw fixation at L5-S1 level. Then we compared the biomechanical changes at L4 segment before and after surgery in neutral, flexion, extension, lateral bending and axial rotation position. The stress on L4 pars interarticularis was very similar before and after surgery, and reached the highest in axial rotation. The L3-L4 intradiscal pressure was almost the same, while L4-L5 intradiscal pressure changed a little in lateral bending (increase from 1.993 to 2.160 MPa) and axial rotation (decrease from 1.639 to 1.307 MPa) after surgery. The PLIF surgery caused a little increase of range of motion at adjacent L4-L5 and L3-L4 levels, but the change is very tiny (1 degree). The PLIF surgery will not cause significant biomechanical change at adjacent segment with pars defect in multi-level spondylolysis. On the contrary, excessive long-segment surgery will damage surrounding soft tissues which are important for maintaining the stability of spine. So a preventative long-segment surgery is not necessary for multi-level spondylolysis as long as there are no soft tissue degeneration signs at adjacent level.

  4. A core undergraduate curriculum in plastic surgery - a Delphi consensus study in Scandinavia

    DEFF Research Database (Denmark)

    Almeland, Stian K; Lindford, Andrew; Berg, Jais Oliver

    2017-01-01

    .00 on a 1-4 Likert scale. Final agreement in the third round resulted in a list of 68 competences with agreement above 80% (31 skills and 37 knowledge items). CONCLUSIONS: This study proposes the first scientifically developed undergraduate core curriculum in plastic surgery. It comprises of a consensus......, there appears to be a need to define the core competences that are to be taught. The aim of this study was to establish a Scandinavian core undergraduate curriculum of competences in plastic surgery, using scientific methods. METHODS: The Delphi technique for group consensus was employed. An expert panel...... of anonymous questionnaires; a final core curriculum competency list was agreed upon based on a consensus agreement level of 80%. RESULTS: Two hundred and ninety-five competences were suggested in the first round. In the second round, 76 competences (33 skills and 43 knowledge items) received a score ≥3...

  5. A study on optimization of the nuclear safety system

    International Nuclear Information System (INIS)

    Lee, Sang Hoon; Koh, Byung Joon; Kim, Jin Soo; Kim, Byoung Do; Cho, Seong Won; Kwon, Seog Kwon; Choi, Kwang Sik

    1986-12-01

    The number of nuclear facilities (nuclear power plants, research reactors, nuclear fuel facilities) under construction or in operation in Korea continues to increase and this has brought about increased importance and concerns toward nuclear safety in Korea. Also, domestic nuclear related organizations are increasingly carrying out the design/construction of nuclear power plants and the development /supply of nuclear fuels. In order to flexibly respond to these changes and to suggest direction to take, it is necessary to re-examine the current nuclear safety regulation system. This study is carried out in two stages and this report describes the results of the analysis and the assessment of the nuclear licencing system of such foreign countries as sweden and German, as the first of the two. In this regard, this study includes the analysis on the backgrounds on the choice of nuclear licensing system, the analysis on the licensing procedures, the analysis on the safety inspection system and the enforcement laws, the analysis on the structure and function of the regulatory, business and research organizations as well as the analysis on the relationship between the safety research and the regulatory duties. In this study, the German safety inspection system and the enforcement procedures and the Swedish nuclear licensing system are analyzed in detail. By comparing and assessing the finding with the current Korea Nuclear Licensing System, this study points out some reform measures of the Korean system that needs to improved. With the changing situations in mind, this study aims to develop the nuclear safety regulation system optimized for Korean situation by re-examining the current regulation system. (Author)

  6. Robotic colorectal surgery: hype or new hope? A systematic review of robotics in colorectal surgery.

    Science.gov (United States)

    Mirnezami, A H; Mirnezami, R; Venkatasubramaniam, A K; Chandrakumaran, K; Cecil, T D; Moran, B J

    2010-11-01

    Robotic colorectal surgery is an emerging field and may offer a solution to some of the difficulties inherent to conventional laparoscopic surgery. The aim of this review is to provide a comprehensive and critical analysis of the available literature on the use of robotic technology in colorectal surgery. Studies reporting outcomes of robotic colorectal surgery were identified by systematic searches of electronic databases. Outcomes examined included operating time, length of stay, blood loss, complications, cost, oncological outcome, and conversion rates. Seventeen Studies (nine case series, seven comparative studies, one randomized controlled trial) describing 288 procedures were identified and reviewed. Study heterogeneity precluded a meta-analysis of the data. Robotic procedures tend to take longer and cost more, but may reduce the length of stay, blood loss, and conversion rates. Complication profiles and short-term oncological outcomes are similar to laparoscopic surgery. Robotic colorectal surgery is a promising field and may provide a powerful additional tool for optimal management of more challenging pathology, including rectal cancer. Further studies are required to better define its role. © 2010 The Authors. Colorectal Disease © 2010 The Association of Coloproctology of Great Britain and Ireland.

  7. Weight loss after bariatric surgery and periodontal changes: a 12-month prospective study.

    Science.gov (United States)

    Sales-Peres, Silvia Helena de Carvalho; Sales-Peres, Matheus de Carvalho; Ceneviva, Reginaldo; Bernabé, Eduardo

    2017-04-01

    Several longitudinal studies have explored the association of obesity and weight gain with periodontal disease. However, the effect of weight loss on periodontal tissues remains unclear. To explore whether weight loss after bariatric surgery was associated with changes in periodontal measures over 12 months. Two public hospitals in São Paulo, Brazil. We used data from 110 morbidly obese patients (body mass index [BMI]>40 kg/m 2 or≥35 kg/m 2 with co-morbid conditions) who underwent bariatric surgery between April 2011 and March 2013. Data on demographic factors, BMI, smoking habits, and glucose levels were extracted from medical records preoperatively and after 6 and 12 months postsurgery. A full-mouth periodontal examination was conducted by trained examiners to assess probing pocket depth, clinical attachment loss, and bleeding on probing (BOP) at baseline and 6 and 12 months after surgery. Data were analyzed using linear mixed-effects models. BMI was not significantly related to the proportion of sites with BOP at baseline, but it was negatively associated with the rate of change in the proportion of sites with BOP. The greater the BMI loss, the higher the proportion of sites with BOP, particularly 6 months after surgery. However, BMI was not associated with baseline probing pocket depth and clinical attachment loss or rates of changes in these periodontal outcomes. The findings suggest that weight loss was associated with increased gingival bleeding, showing a peak at 6 months after bariatric surgery. Periodontal pocketing and attachment loss remained unchanged during the study period. Copyright © 2017. Published by Elsevier Inc.

  8. 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.

  9. Loss of control eating and weight outcomes after bariatric surgery: a study with a Portuguese sample

    OpenAIRE

    Conceição, Eva Martins; Silva, Ana Isabel Pinto Bastos Leite; Brandão, Isabel; Vaz, Ana Rita Rendeiro Ribeiro; Ramalho, Sofia Marlene Marques; Arrojado, Filipa; Costa, José; Machado, Paulo P. P.

    2014-01-01

    The present study aim is to investigate the frequency of loss of control eating (LOC) episodes in three groups with different assessment times: one before, one at short and one at long-term after bariatric surgery; as well as to explore the association of postoperative problematic eating behaviors and weight outcomes and psychological characteristics. This cross-sectional study compared a group of preoperative bariatric surgery patients (n = 176) and two postoperative groups, one at short-ter...

  10. Intraoperative Ultrasound in Patients Undergoing Transsphenoidal Surgery for Pituitary Adenoma: Systematic Review [corrected].

    Science.gov (United States)

    Marcus, Hani J; Vercauteren, Tom; Ourselin, Sebastien; Dorward, Neil L

    2017-10-01

    Transsphenoidal surgery is the gold standard for pituitary adenoma resection. However, despite advances in microsurgical and endoscopic techniques, some pituitary adenomas can be challenging to cure. We sought to determine whether, in patients undergoing transsphenoidal surgery for pituitary adenoma, intraoperative ultrasound is a safe and effective technologic adjunct. The PubMed database was searched between January 1996 and January 2016 to identify relevant publications that 1) featured patients undergoing transsphenoidal surgery for pituitary adenoma, 2) used intraoperative ultrasound, and 3) reported on safety or effectiveness. Reference lists were also checked, and expert opinions were sought to identify further publications. Ultimately, 10 studies were included, comprising 1 cohort study, 7 case series, and 2 case reports. One study reported their prototype probe malfunctioned, leading to false-positive results in 2 cases, and another study' prototype probe was too large to safely enter the sphenoid sinus in 2 cases. Otherwise, no safety issues directly related to use of intraoperative ultrasound were reported. In the only comparative study, remission occurred in 89.7% (61/68) of patients with Cushing disease in whom intraoperative ultrasound was used, compared with 83.8% (57/68) in whom it was not. All studies reported that surgeons anecdotally found intraoperative ultrasound helpful. Although there is limited and low-quality evidence available, the use of intraoperative ultrasound appears to be a safe and effective technologic adjunct to transsphenoidal surgery for pituitary adenoma. Advances in ultrasound technology may allow for more widespread use of such devices. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Improving Patient Safety with X-Ray and Anesthesia Machine Ventilator Synchronization: A Medical Device Interoperability Case Study

    Science.gov (United States)

    Arney, David; Goldman, Julian M.; Whitehead, Susan F.; Lee, Insup

    When a x-ray image is needed during surgery, clinicians may stop the anesthesia machine ventilator while the exposure is made. If the ventilator is not restarted promptly, the patient may experience severe complications. This paper explores the interconnection of a ventilator and simulated x-ray into a prototype plug-and-play medical device system. This work assists ongoing interoperability framework development standards efforts to develop functional and non-functional requirements and illustrates the potential patient safety benefits of interoperable medical device systems by implementing a solution to a clinical use case requiring interoperability.

  12. Hydrogen peroxide (H2O2): a review of its use in surgery.

    Science.gov (United States)

    Urban, Michael Vincent; Rath, Thomas; Radtke, Christine

    2017-11-16

    Hydrogen peroxide has been used in medicine for more than 100 years. It is known in surgery as a highly useful irrigation solution by virtue of both its hemostatic and its antimicrobial effects. Due to its possible negative effect on wound healing and its cytotoxic effect in higher concentrations, there are concerns about the safety of its use. The objective of this paper is to review the safety and beneficial effects of hydrogen peroxide.

  13. [Surgeons can learn from pilots: human factors in surgery].

    Science.gov (United States)

    Sockeel, P; Chatelain, E; Massoure, M-P; David, P; Chapellier, X; Buffat, S

    2009-06-01

    Human factors (HF) study is mandatory to get air transport pilot licences. In aviation, crew resource management (CRM) and declaration of adverse events (feedback) result in improving of air safety. Air missions and surgical procedures have similarities. Bridging the gap is tempting, despite severe warnings against simplistic adaptation. Putting HF theory into surgical practice: how to? Educational principles derived from CRM improve professional attitudes of a team. We propose to translate concepts of CRM to clinical teams. CRM training applying in surgery could allow the work environment to be restructured to reduce human error. Feedback: in aviation, the Bureau of Flight Safety deals with investigations for air events. Pilots, air traffic controllers can anonymously declare nuisance, resulting in a feedback for the whole air force. Adverse events are analysed. Usually, multilevel problems are found, rather than the only responsibility of the last operator. Understanding the mechanisms of human failure finally improves safety. In surgery, CRM and feedback would probably be helpful. Anyway, it requires time; people have to change their mind. Nevertheless people such as fighter pilots, who were very unwilling at the beginning, now consider HF as a cornerstone for security. But it is difficult to estimate the extent of HF-related morbidity and mortality. We propose as a first step to consider CRM and feedback in surgical procedure. HF deals with the mechanisms of human errors and the ways to improve safety and probably improve the surgical team's efficacy.

  14. Recurrent Laryngeal Nerve Palsy After Cervical Spine Surgery: A Multicenter AOSpine Clinical Research Network Study

    OpenAIRE

    Gokaslan, Ziya L.; Bydon, Mohamad; De la Garza-Ramos, Rafael; Smith, Zachary A.; Hsu, Wellington K.; Qureshi, Sheeraz A.; Cho, Samuel K.; Baird, Evan O.; Mroz, Thomas E.; Fehlings, Michael; Arnold, Paul M.; Riew, K. Daniel

    2017-01-01

    Study Design: Multicenter retrospective study. Objectives: To investigate the risk of symptomatic recurrent laryngeal nerve palsy (RLNP) following cervical spine surgery, to examine risk factors for its development, and to report its treatment and outcomes. Methods: A multicenter study from 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was performed. Each center screened for rare complications following cervical spine surgery, including RLNP. Patient...

  15. Use of Enoxaparin in Obese Adolescents During Bariatric Surgery--a Pilot Study.

    Science.gov (United States)

    Mushtaq, Alvina; Vaughns, Janelle D; Ziesenitz, Victoria C; Nadler, Evan P; van den Anker, John N

    2015-10-01

    Obese patients have a higher risk of venous thromboembolism when immobilized due to surgery. The objective of this study was to assess anti-factor Xa activity in adolescent bariatric surgical patients receiving prophylactic enoxaparin. Four morbidly obese adolescents undergoing laparoscopic sleeve gastrectomy were enrolled. Enoxaparin was administered (40 mg subcutaneous (SC) if BMI ≤50 kg/m(2) or 60 mg SC if BMI >50 kg/m(2)) for prevention of venous thromboembolism every 12 h starting after induction of anesthesia until discharge. Plasma anti-factor Xa activity was assessed over 12 h after the first dose and used as a surrogate marker for enoxaparin levels. Non-compartmental analysis of anti-factor Xa activity levels was performed and compared with previously published studies. Patients recruited were 16 to 18 years of age with a mean BMI of 52.6 ± 5.8 kg/m(2) (>99th BMI percentile). Peak anti-factor Xa activity ranged from 0.20 to 0.23 IU/mL in our study population, compared to 0.38 to 0.53 IU/mL in the cited lean comparator groups. Our current dosing practice of 40 mg SC for individuals with a BMI ≤50 kg/m(2) and 60 mg for individuals with a BMI ≥50 kg/m(2) resulted in anti-factor Xa activity that was sufficient for adequate thromboprophylaxis in adolescent bariatric surgical patients. Our data also demonstrates lower drug exposures in the obese when compared to lean patients. Therefore, randomized controlled efficacy and safety studies are urgently needed to guide the use of low-molecular-weight heparins in the pediatric and adolescent obese population.

  16. Feasibility and acceptance of a robotic surgery ergonomic training program.

    Science.gov (United States)

    Franasiak, Jason; Craven, Renatta; Mosaly, Prithima; Gehrig, Paola A

    2014-01-01

    Assessment of ergonomic strain during robotic surgery indicates there is a need for intervention. However, limited data exist detailing the feasibility and acceptance of ergonomic training (ET) for robotic surgeons. This prospective, observational pilot study evaluates the implementation of an evidence-based ET module. A two-part survey was conducted. The first survey assessed robotic strain using the Nordic Musculoskeletal Questionnaire (NMQ). Participants were given the option to participate in either an online or an in-person ET session. The ET was derived from Occupational Safety and Health Administration guidelines and developed by a human factors engineer experienced with health care ergonomics. After ET, a follow-up survey including the NMQ and an assessment of the ET were completed. The survey was sent to 67 robotic surgeons. Forty-two (62.7%) responded, including 18 residents, 8 fellows, and 16 attending physicians. Forty-five percent experienced strain resulting from performing robotic surgery and 26.3% reported persistent strain. Only 16.6% of surgeons reported prior ET in robotic surgery. Thirty-five (78%) surgeons elected to have in-person ET, which was successfully arranged for 32 surgeons (91.4%). Thirty-seven surgeons (88.1%) completed the follow-up survey. All surgeons participating in the in-person ET found it helpful and felt formal ET should be standard, 88% changed their practice as a result of the training, and 74% of those reporting strain noticed a decrease after their ET. Thus, at a high-volume robotics center, evidence-based ET was easily implemented, well-received, changed some surgeons' practice, and decreased self-reported strain related to robotic surgery.

  17. The erasure of gender in academic surgery: a qualitative study.

    Science.gov (United States)

    Webster, Fiona; Rice, Kathleen; Christian, Jennifer; Seemann, Natashia; Baxter, Nancy; Moulton, Carol-Anne; Cil, Tulin

    2016-10-01

    The number of women in surgery has steadily increased, yet their numbers in academic surgery positions and in high-ranking leadership roles remain low. To create strategies to address and improve this problem, it is essential to examine how gender plays into the advancement of a woman's career in academic surgery. Focus group (1) and one-on-one qualitative interviews (8) were conducted with women academic surgeons from various subspecialties in a large university setting. Interviews examined women surgeons' accounts of their experiences as women in surgery. Audio-recorded data were transcribed verbatim and coded thematically. NVivo10 software was used for cross-referencing of data and categorization of data into themes. Focus group data suggested that gender discrimination was pervasive in academic surgery. However, in interviews, most interviewees strongly disavowed the possibility that their gender had any bearing on their professional lives. These surgeons attempted to distance themselves from the possibility of discrimination by suggesting that differences in men and women surgeons' experiences are due to personality issues and personal choices. However, their narratives highlighted deep contradiction; they both affirmed and denied the relevance of gender for their experience as surgeons. As overt acts of discrimination become less acceptable in society, it does not necessarily disappear but rather manifests itself in covert forms. By disavowing and distancing themselves from discrimination, these women exposed the degree to which these issues continue to be pervasive in surgery. Women surgeons' ability to both identify and resist discrimination was hobbled by narratives of individualism, gender equality, and normative ideas of gender difference. Copyright © 2016. Published by Elsevier Inc.

  18. [Blood conservation effect and safety of shed mediastinal blood autotransfusion after cardiac surgery].

    Science.gov (United States)

    Komiya, T; Ban, K; Yamazaki, K; Date, O; Nakamura, T; Kanzaki, Y

    1998-10-01

    Autotransfusion of shed mediastinal blood after cardiac surgery has been used to reduce risks related to homologous blood transfusions. To document the efficacy and safety of autotransfusion, we compared clinical findings of 80 patients receiving shed mediastinal blood (autotransfusion group) with those of the control group of 52 patients. The amount of the autotransfusion was limited to 800 ml, given the potentially harmful effects of shed blood transfusion. The mean transfused shed volume was 314 +/- 236 ml (S.D.). The serum levels of FDP-E, D-dimer and TAT after autotransfusion were higher in the autotransfusion group than in the control group (p = 0.01, p = 0.0004, p = 0.001, respectively). However, postoperative blood loss and the rate of reexploration for bleeding were similar in the two groups. The patients receiving blood products were fewer in the autotransfusion group than those in the control group (21% vs 44%; p = 0.005). Autotransfusion did not increase postoperative complications, including infection. Thus, although autotransfusion of mediastinal shed blood has the potential to affect hemostasis, unless the amount of autotransfusion exceeds 800 ml, it appears that this method is clinically safe and effective as a mean of blood conservation.

  19. Iranian Parents' Supportive Umbrella during their Children Surgery: a Qualitative Study

    Directory of Open Access Journals (Sweden)

    Fatemeh Valizadeh

    2016-03-01

    Full Text Available Background Being in a position of vulnerability, distress and uncertainty reduces the ability of the parents to protect their children and makes them need support from others. The first step to aid clients more is to identify their supportive sources. This study aimed to determine parents' experiences of supportive sources during their children surgery. Materials and Methods This is a descriptive qualitative research. Purposive and maximum variation sampling applied to select 21 parents of operated children in Ahvaz hospitals, Iran. Semi structured interviews, with open question were used to data collection. Audio recording interviews put into written form word by word and finally analyzed with qualitative content analysis approach.  Results Parents considered the personnel's beyond-task-orientation performance, family comprehensive support, mutual facilitating of peers and the elixir of connection to God as the sources that supported them as an umbrella during their children surgery.     Conclusion It is essential for the health service providers to check each family thoroughly in terms of other supportive sources while providing professional support, and to use the sources in an organized way for the successful transition of parents from the stress of their children surgery.

  20. The Early vs. Late Infantile Strabismus Surgery Study: Monitoring Report

    NARCIS (Netherlands)

    H.J. Simonsz (Huib)

    1995-01-01

    textabstractAbstract: The Early vs. Late Infantile Strabismus Surgery Study Group is a group of strabismologists and orthoptists who investigate whether early or late surgery is preferable in infantile strabismus, in a non-randomized, prospective, multi-center trial. Infants between six and 18

  1. Preoperative antibiotic prophylaxis in orthognathic surgery: a randomized, double-blind, and placebo-controlled clinical study

    NARCIS (Netherlands)

    Zijderveld, S. A.; Smeele, L. E.; Kostense, P. J.; Tuinzing, D. B.

    1999-01-01

    This study evaluated the need for antibiotic prophylaxis in orthognathic surgery. Fifty-four patients (age range, 18 to 40 years) underwent bimaxillary orthognatic surgery. After randomization, a placebo (n = 19), 2,200 mg amoxicillin-clavulanic acid (n = 18), or 1,500 mg cefuroxime (n = 17) was

  2. [Comparison of robotic surgery documentary in gynecological cancer].

    Science.gov (United States)

    Vargas-Hernández, Víctor Manuel

    2012-01-01

    Robotic surgery is a surgical technique recently introduced, with major expansion and acceptance among the medical community is currently performed in over 1,000 hospitals around the world and in the management of gynecological cancer are being developed comprehensive programs for implementation. The objectives of this paper are to review the scientific literature on robotic surgery and its application in gynecological cancer to verify its safety, feasibility and efficacy when compared with laparoscopic surgery or surgery classical major surgical complications, infections are more common in traditional radical surgery compared with laparoscopic or robotic surgery and with these new techniques surgical and staying hospital are lesser than the former however, the disadvantages are the limited number of robot systems, their high cost and applies only in specialized centers that have with equipment and skilled surgeons. In conclusion robotic surgery represents a major scientific breakthrough and surgical management of gynecological cancer with better results to other types of conventional surgery and is likely in the coming years is become its worldwide.

  3. Informed Consent and Cognitive Dysfunction After Noncardiac Surgery in the Elderly.

    Science.gov (United States)

    Hogan, Kirk J; Bratzke, Lisa C; Hogan, Kendra L

    2018-02-01

    Cognitive dysfunction 3 months after noncardiac surgery in the elderly satisfies informed consent thresholds of foreseeability in 10%-15% of patients, and materiality with new deficits observed in memory and executive function in patients with normal test performance beforehand. At present, the only safety step to avoid cognitive dysfunction after surgery is to forego surgery, thereby precluding the benefits of surgery with removal of pain and inflammation, and resumption of normal nutrition, physical activity, and sleep. To assure that consent for surgery is properly informed, risks of both cognitive dysfunction and alternative management strategies must be discussed with patients by the surgery team before a procedure is scheduled.

  4. Laparoscopic Surgery for Transverse Colon Cancer: Short- and Long-Term Outcomes in Comparison with Conventional Open Surgery.

    Science.gov (United States)

    Kim, Min Ki; Won, Dae-Youn; Lee, Jin-Kwon; Kang, Won-Kyung; Kye, Bong-Hyeon; Cho, Hyeon-Min; Kim, Hyung-Jin; Kim, Jun-Gi

    2015-12-01

    Published studies on laparoscopic surgery for transverse colon cancer are scarce. More studies are necessary to evaluate the feasibility, safety, and long-term oncologic outcomes of laparoscopic surgery for transverse colon cancer. From April 1996 to December 2010, 102 consecutive patients with stage II or III disease who had undergone curative resection for transverse colon cancer were enrolled. Seventy-nine patients underwent laparoscopy-assisted colectomy (LAC), whereas 23 patients underwent conventional open colectomy (OC). Short- and long-term outcomes of the two groups were compared. The OC group had a larger tumor size (7.6 ± 3.4 cm versus 5.2 ± 2.3 cm, P = .004) and more retrieved lymph nodes (26.4 ± 11.6 versus 17.5 ± 9.4, P = .002), without differences in resection margins. In the LAC group, return to diet was faster (4.5 ± 1.2 days versus 5.4 ± 1.8 days, P = .013), and postoperative hospital stay was shorter (12.1 ± 4.2 days versus 15.9 ± 4.8 days, P = .000). There were no differences in occurrence of intra- or postoperative complications. There were no statistically significant differences in overall survival rate (OS) or disease-free survival rate (DFS) between the two groups (5-year OS, 90.4% versus 90.5%, P = .670; 5-year DFS, 84.2% versus 90.7%, P = .463). Laparoscopic surgery for transverse colon cancer has better short-term outcomes compared with open surgery, with acceptable long-term outcomes. As in colorectal cancer of other sites, laparoscopic surgery can be a feasible alternative to conventional surgery for transverse colon cancer.

  5. Sevoflurane requirement during elective ankle day surgery: the effects of etirocoxib premedication, a prospective randomised study

    Directory of Open Access Journals (Sweden)

    Jakobsson Jan G

    2008-09-01

    Full Text Available Abstract Background Anti-inflammatory drugs, NSAIDs, have become an important part of the pain management in day surgery. The aim of the present study was to evaluate the effect of Coxib premedication on the intra-operative anaesthetic requirements in patients undergoing elective ankle surgery in general anaesthesia. Type of study Prospective, randomized study of the intra-operative anaesthetic-sparing effects of etoricoxib premedication as compared to no NSAID preoperatively. Methods The intra-operative requirement of sevoflurane was studied in forty-four ASA 1–2 patients undergoing elective ankle day surgical in balanced general anaesthesia. Primary study endpoint was end-tidal sevoflurane concentration to maintain Cerebral State Index of 40 – 50 during surgery. Results All anaesthesia and surgery was uneventful, no complications or adverse events were noticed. The mean end-tidal sevoflurane concentration intra-operatively was 1.25 (SD 0.2 and 0.91 (SD 0.2 for the pre and post-operative administered group of patients respectively (p Conclusion Coxib premedication before elective day surgery has an anaesthetic sparing potential.

  6. Comparative health technology assessment of robotic-assisted, direct manual laparoscopic and open surgery: a prospective study.

    Science.gov (United States)

    Turchetti, Giuseppe; Pierotti, Francesca; Palla, Ilaria; Manetti, Stefania; Freschi, Cinzia; Ferrari, Vincenzo; Cuschieri, Alfred

    2017-02-01

    Despite many publications reporting on the increased hospital cost of robotic-assisted surgery (RAS) compared to direct manual laparoscopic surgery (DMLS) and open surgery (OS), the reported health economic studies lack details on clinical outcome, precluding valid health technology assessment (HTA). The present prospective study reports total cost analysis on 699 patients undergoing general surgical, gynecological and thoracic operations between 2011 and 2014 in the Italian Public Health Service, during which period eight major teaching hospitals treated the patients. The study compared total healthcare costs of RAS, DMLS and OS based on prospectively collected data on patient outcome in addition to healthcare costs incurred by the three approaches. The cost of RAS operations was significantly higher than that of OS and DMLS for both gynecological and thoracic operations (p DMLS. Total costs of general surgery RAS were significantly higher than those of OS (p DMLS general surgery. Indirect costs were significantly lower in RAS compared to both DMLS general surgery and OS gynecological surgery due to the shorter length of hospital stay of RAS approach (p < 0.001). Additionally, in all specialties compared to OS, patients treated by RAS experienced a quicker recovery and significantly less pain during the hospitalization and after discharge. The present HTA while confirming higher total healthcare costs for RAS operations identified significant clinical benefits which may justify the increased expenditure incurred by this approach.

  7. Attention Deficit Hyperactivity Disorder Prevalence and Correlates Pre- and Post-Bariatric Surgery: A Comparative Cross-Sectional Study.

    Science.gov (United States)

    Nielsen, Friedrich; Georgiadou, Ekaterini; Bartsch, Merle; Langenberg, Svenja; Müller, Astrid; de Zwaan, Martina

    2017-01-01

    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. 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. 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. 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. © 2017 The Author(s) Published by S. Karger GmbH, Freiburg.

  8. 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.

  9. Harmonic scalpel in multinodular goiter surgery: impact on surgery and cost analysis.

    Science.gov (United States)

    Sebag, Frederic; Fortanier, Cécile; Ippolito, Guiseppe; Lagier, Aude; Auquier, Pascal; Henry, Jean-Francois

    2009-04-01

    The aim of this study was to evaluate the potential advantages and the general operative cost of the Harmonic Scalpel (HS) in surgery for multinodular goiter (MNG). Patients undergoing total thyroidectomy (TT) for MNG were prospectively allocated in a conventional tie-and-clip (TC) group (n = 50) and an HS group (n = 50). All pre- and postoperative data were recorded. The economic evaluation was based on a microcost measurement and aimed to consider all the resources consumed for each patient during the surgical procedure. To compare the results, we used the nonparametric unpaired two-tailed Mann-Whitney test. There were 81 women and 19 men (mean age, 55 +/- 15 years). Mean preoperative TSH level was 1.2 (SD, 1.1) (TC) and 1.3 (SD, 2) (HS) (P = NS). Mean body mass index was 24.72 (SD, 8) (TC) and 25.6 (SD, 8) (HS) (P = NS). Four patients experienced a transient hypocalcemia (2 in each group). One patient had a postoperative hematoma requiring surgical evacuation (HS). One patient experienced a transient recurrent nerve palsy (TC). Mean length of surgery was 104 (SD, 32) (TC) and 84 minutes (SD, 17) (HS) (P = .0001). Mean length of hospitalization was 2 days in both groups (SD, 1) (P = NS). Mean operative cost per patient was 990 euro (SD, 191) in the TC group and 1,024 euro (SD, 143) in the HS group (P = NS). Safety and efficiency of the HS is comparable to the tie-and-clip technique in thyroid surgery. The use of the HS in MNG surgery allows for a significant reduction in the length of the procedure with a comparable cost.

  10. Risk factors for postoperative complications in robotic general surgery.

    Science.gov (United States)

    Fantola, Giovanni; Brunaud, Laurent; Nguyen-Thi, Phi-Linh; Germain, Adeline; Ayav, Ahmet; Bresler, Laurent

    2017-03-01

    The feasibility and safety of robotically assisted procedures in general surgery have been reported from various groups worldwide. Because postoperative complications may lead to longer hospital stays and higher costs overall, analysis of risk factors for postoperative surgical complications in this subset of patients is clinically relevant. The goal of this study was to identify risk factors for postoperative morbidity after robotic surgical procedures in general surgery. We performed an observational monocentric retrospective study. All consecutive robotic surgical procedures from November 2001 to December 2013 were included. One thousand consecutive general surgery patients met the inclusion criteria. The mean overall postoperative morbidity and major postoperative morbidity (Clavien >III) rates were 20.4 and 6 %, respectively. This included a conversion rate of 4.4 %, reoperation rate of 4.5 %, and mortality rate of 0.2 %. Multivariate analysis showed that ASA score >3 [OR 1.7; 95 % CI (1.2-2.4)], hematocrit value surgery [OR 1.5; 95 % CI (1-2)], advanced dissection [OR 5.8; 95 % CI (3.1-10.6)], and multiquadrant surgery [OR 2.5; 95 % CI (1.7-3.8)] remained independent risk factors for overall postoperative morbidity. It also showed that advanced dissection [OR 4.4; 95 % CI (1.9-9.6)] and multiquadrant surgery [OR 4.4; 95 % CI (2.3-8.5)] remained independent risk factors for major postoperative morbidity (Clavien >III). This study identifies independent risk factors for postoperative overall and major morbidity in robotic general surgery. Because these factors independently impacted postoperative complications, we believe they could be taken into account in future studies comparing conventional versus robot-assisted laparoscopic procedures in general surgery.

  11. Adult Reconstructive Surgery: A High-Risk Profession for Work-Related Injuries.

    Science.gov (United States)

    Alqahtani, Saad M; Alzahrani, Mohammad M; Tanzer, Michael

    2016-06-01

    Adult reconstructive surgery is an orthopedic subspecialty characterized by surgical tasks that are physical, repetitive, and require some degree of stamina from the surgeon. This can result strain and/or injury of the surgeon's musculoskeletal system. This study investigates the prevalence of work-related injuries among arthroplasty surgeons. A modified version of the physical discomfort survey was sent to surgeon members of the Hip Society, the International Hip Society, and the Canadian Orthopedic Arthroplasty via email. One hundred and eighty-three surgeons completed the survey. Overall, 66.1% of the arthroplasty surgeons reported that they had experienced a work-related injury. The most common injuries that occurred were low back pain (28%), lateral epicondylitis of the elbow (14%), shoulder tendonitis (14%), lumbar disc herniation (13%), and wrist arthritis (12%). Overall, 27% of surgeons took time off from work because of the injury. As the number of disorders diagnosed increased, there was a significant increase in the incidence of requiring time off work because of the disorder (P increased the risk of the surgeon requiring time off because of the disorder were age >55 years, practicing for more than >20 years, and performing >100 total hip arthroplasty procedures per year (P < .05). In addition, 31% of the orthopedic surgeons surveyed required surgery for their injury. Although most studies concentrate on the importance of patient safety and thus the quality of the health care system, the surgeon's safety is also considered an integral part of this system's quality. This study highlights a high prevalence of musculoskeletal work-related injuries among arthroplasty surgeons and indicates the need for the identification of preventive measures directed toward improving the operative surgical environment and work ergonomics for the surgeons. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Safety studies on Korean fusion DEMO plant using integrated safety assessment methodology

    International Nuclear Information System (INIS)

    Oh, Kyemin; Kang, Myoung-suk; Heo, Gyunyoung; Kim, Hyoung-chan

    2014-01-01

    Highlights: •The purpose of this paper is to suggest methodology that can investigate safety issues and provides a case study for Korean fusion DEMO plant. •The concepts of integrated safety assessment methodology (ISAM) that can be applied in addressing regulatory requirements and recognizing safety issues for K-DEMO were emphasized. •Phenomena identification and ranking table (PIRT) was proposed. It can recognize vulnerabilities of systems and identify the gaps in technical areas requiring additional researches. •This work is expected to contribute on the conceptual design of safety features for K-DEMO to design engineers and the guidance for regulatory requirements to licensers. -- Abstract: The purpose of this paper is to suggest methodology that can investigate safety issues and provides a case study for Korean fusion DEMO plant (K-DEMO) as a part of R and D program through the National Fusion Research Institute of Korea. Even though nuclear regulation and licensing framework is well setup due to the operating and design experience of Pressurized Water Reactors (PWRs) since 1970s, the regulatory authority of South Korea has concerns on the challenge of facing new nuclear facilities including K-DEMO due to the differences in systems, materials, and inherent safety feature from conventional PWRs. Even though the follow-up of the ITER license process facilitates to deal with significant safety issues of fusion facilities, a licensee as well as a licenser should identify the gaps between ITER and DEMO in terms of safety issues. First we reviewed the methods of conducting safety analysis for unprecedented nuclear facilities such as Generation IV reactors, particularly very high temperature reactor (VHTR), which is called as integrated safety assessment methodology (ISAM). Second, the analysis for the conceptual design of K-DEMO on the basis of ISAM was conducted. The ISAM consists of five analytical tools to develop the safety requirements from licensee

  13. Safety studies on Korean fusion DEMO plant using integrated safety assessment methodology

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Kyemin; Kang, Myoung-suk [Kyung Hee University, Youngin-si, Gyeonggi-do 446-701 (Korea, Republic of); Heo, Gyunyoung, E-mail: gheo@khu.ac.kr [Kyung Hee University, Youngin-si, Gyeonggi-do 446-701 (Korea, Republic of); Kim, Hyoung-chan [National Fusion Research Institute, Daejeon-si 305-333 (Korea, Republic of)

    2014-10-15

    Highlights: •The purpose of this paper is to suggest methodology that can investigate safety issues and provides a case study for Korean fusion DEMO plant. •The concepts of integrated safety assessment methodology (ISAM) that can be applied in addressing regulatory requirements and recognizing safety issues for K-DEMO were emphasized. •Phenomena identification and ranking table (PIRT) was proposed. It can recognize vulnerabilities of systems and identify the gaps in technical areas requiring additional researches. •This work is expected to contribute on the conceptual design of safety features for K-DEMO to design engineers and the guidance for regulatory requirements to licensers. -- Abstract: The purpose of this paper is to suggest methodology that can investigate safety issues and provides a case study for Korean fusion DEMO plant (K-DEMO) as a part of R and D program through the National Fusion Research Institute of Korea. Even though nuclear regulation and licensing framework is well setup due to the operating and design experience of Pressurized Water Reactors (PWRs) since 1970s, the regulatory authority of South Korea has concerns on the challenge of facing new nuclear facilities including K-DEMO due to the differences in systems, materials, and inherent safety feature from conventional PWRs. Even though the follow-up of the ITER license process facilitates to deal with significant safety issues of fusion facilities, a licensee as well as a licenser should identify the gaps between ITER and DEMO in terms of safety issues. First we reviewed the methods of conducting safety analysis for unprecedented nuclear facilities such as Generation IV reactors, particularly very high temperature reactor (VHTR), which is called as integrated safety assessment methodology (ISAM). Second, the analysis for the conceptual design of K-DEMO on the basis of ISAM was conducted. The ISAM consists of five analytical tools to develop the safety requirements from licensee

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

    Directory of Open Access Journals (Sweden)

    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

  15. Single-Incision Transumbilical Surgery (SITUS) versus Single-Port Laparoscopic Surgery and conventional laparoscopic surgery: a prospective randomized comparative study of performance with novices in a dry laboratory.

    Science.gov (United States)

    Schoenthaler, Martin; Avcil, Tuba; Sevcenco, Sabina; Nagele, Udo; Hermann, Thomas E W; Kuehhas, Franklin E; Shariat, Shahrokh F; Frankenschmidt, Alexander; Wetterauer, Ulrich; Miernik, Arkadiusz

    2015-01-01

    To evaluate the Single-Incision Transumbilical Surgery (SITUS) technique as compared to an established laparoendoscopic single-site surgery (LESS) technique (Single-Port Laparoscopic Surgery, SPLS) and conventional laparoscopy (CLS) in a surgical simulator model. Sixty-three medical students without previous laparoscopic experience were randomly assigned to one of the three groups (SITUS, SPLS and CLS). Subjects were asked to perform five standardized tasks of increasing difficulty adopted from the Fundamentals of Laparoscopic Surgery curriculum. Statistical evaluation included task completion times and accuracy. Overall performances of all tasks (except precision cutting) were significantly faster and of higher accuracy in the CLS and SITUS groups than in the SPLS group (p = 0.004 to p port-assisted LESS technique such as SPLS. The demonstrated advantages of SITUS may be attributed to a preservation of the basic principles of conventional laparoscopy, such as the use of straight instruments and an adequate degree of triangulation.

  16. Successful Translation of Fluorescence Navigation During Oncologic Surgery: A Consensus Report.

    Science.gov (United States)

    Rosenthal, Eben L; Warram, Jason M; de Boer, Esther; Basilion, James P; Biel, Merrill A; Bogyo, Matthew; Bouvet, Michael; Brigman, Brian E; Colson, Yolonda L; DeMeester, Steven R; Gurtner, Geoffrey C; Ishizawa, Takeaki; Jacobs, Paula M; Keereweer, Stijn; Liao, Joseph C; Nguyen, Quyen T; Olson, James M; Paulsen, Keith D; Rieves, Dwaine; Sumer, Baran D; Tweedle, Michael F; Vahrmeijer, Alexander L; Weichert, Jamey P; Wilson, Brian C; Zenn, Michael R; Zinn, Kurt R; van Dam, Gooitzen M

    2016-01-01

    Navigation with fluorescence guidance has emerged in the last decade as a promising strategy to improve the efficacy of oncologic surgery. To achieve routine clinical use, the onus is on the surgical community to objectively assess the value of this technique. This assessment may facilitate both Food and Drug Administration approval of new optical imaging agents and reimbursement for the imaging procedures. It is critical to characterize fluorescence-guided procedural benefits over existing practices and to elucidate both the costs and the safety risks. This report is the result of a meeting of the International Society of Image Guided Surgery (www.isigs.org) on February 6, 2015, in Miami, Florida, and reflects a consensus of the participants' opinions. Our objective was to critically evaluate the imaging platform technology and optical imaging agents and to make recommendations for successful clinical trial development of this highly promising approach in oncologic surgery. © 2016 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

  17. Efficacy and safety of oral robenacoxib (tablet) for the treatment of pain associated with soft tissue surgery in client-owned dogs.

    Science.gov (United States)

    Friton, Gabriele; Thompson, Caryn Marie; Karadzovska, Daniela; King, Stephen; King, Jonathan N

    2017-06-26

    Non-steroidal anti-inflammatory drugs (NSAIDs) have been proven to be effective in controlling peri-operative pain in dogs. Robenacoxib is an NSAID with high selectivity for the cyclooxygenase (COX)-2 isoform. The objective of this study was to assess the efficacy and safety of an oral tablet formulation of robenacoxib in client-owned dogs undergoing soft tissue surgery. The study was a prospective, multi-center, randomized, masked, placebo-controlled, parallel-group clinical trial. A total of 239 dogs were included and randomly allocated in a 1:1 ratio to receive either robenacoxib or placebo. Each dog received an oral tablet administration of either robenacoxib, at a target dose of 2 mg/kg, or placebo once prior to surgery and for two additional days post-operatively. All dogs also received a pre-anesthetic dose of 0.2 mg/kg butorphanol (intravenous or intramuscular). Pain assessments were performed using the short form of the Glasgow Composite Measure Pain Scale. Robenacoxib was compared to the placebo group on a success/failure basis. Treatment failure was defined as the need for rescue therapy to control post-operative pain. Significantly (P = 0.019) more dogs administered robenacoxib were considered treatment successes (89 of 116, 76.72%) compared to dogs given placebo (74 of 115, 64.35%). The percentage of treatment failure was therefore 23.28% in the robenacoxib and 35.65% in the placebo group. The least squares mean total pain scores were significantly different between groups and in favor of robenacoxib at 3 and 5 hours (P dogs receiving robenacoxib versus placebo (P dogs.

  18. [Epidemiology of the medico-legal risk associated with the practice of ambulatory surgery in France: a study based on insurance data].

    Science.gov (United States)

    Theissen, A; Fuz, F; Catineau, J; Sultan, W; Beaussier, M; Carles, M; Raucoules-Aimé, M; Niccolai, P

    2014-03-01

    The medico-legal risk specifically associated with the practice of ambulatory surgery is still not well studied. SHAM insurances are the biggest French provider of medical liability insurances. The study of the insurance claims provided by this insurer is therefore a relevant source of data on the complications related to ambulatory surgery. The aim of this study was to compare the claim rate related to ambulatory surgery with non-ambulatory surgery. We did a retrospective study on insurance claims provided by SHAM insurances between 2007 and 2011 to compare the claim rate related to ambulatory surgery with non-ambulatory surgery. We searched the files in the SHAM database, and then analyzed them. On the study period, out of a total of 29565 registered claims, 467 (1.6%) originated from ambulatory surgery. On the total of 29,098 registered claims for non-ambulatory surgery, 2151 (7.4%) led to a condemnation whereas the rate was 7% (33 out of 467 claims) for ambulatory surgery. The condemnations linked to ambulatory surgery amounted to 1.5% of the total (33 out of 2184), for a cost of 1.7 M€ (versus 400,3 M€ for non-ambulatory surgery). The average cost of a compensation is therefore 50,500 € for ambulatory surgery and 186,000 € for non-ambulatory surgery. The medical specialties concerned are primarily ophthalmology, abdominal and orthopedics surgery. The main identified causes were medical errors (n=16) and nosocomial infections (n=13). The claim rate in ambulatory surgery is proportionally less frequent with compensations three times less and were related to the most frequent type of surgery done in ambulatory settings. These data should help strengthen quality approach in ambulatory surgery. Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  19. Using virtual reality to control preoperative anxiety in ambulatory surgery patients: A pilot study in maxillofacial and plastic surgery.

    Science.gov (United States)

    Ganry, L; Hersant, B; Sidahmed-Mezi, M; Dhonneur, G; Meningaud, J P

    2018-01-06

    Preoperative anxiety may lead to medical and surgical complications, behavioral problems and emotional distress. The most common means of prevention are based on using medication and, more recently, hypnosis. The aim of our study was to determine whether a virtual reality (VR) program presenting natural scenes could be part of a new therapy to reduce patients' preoperative anxiety. Our prospective pilot study consisted of a single-blind trial in skin cancer surgery at the Henri-Mondor teaching hospital in France. In the outpatient surgery department, 20 patients with a score of >11 on the Amsterdam preoperative anxiety and information scale (APAIS) were virtually immersed into a natural universe for 5minutes. Their stress levels were assessed before and after this experience by making use of a visual analog scale (VAS), by measuring salivary cortisol levels, and by determining physiological stress based on heart coherence scores. The VAS score was significantly reduced after the simulation (P<0.009) as was the level of salivary cortisol (P<0.04). Heart coherence scores remained unchanged (P=0.056). VR allows patients to be immersed in a relaxing, peaceful environment. It represents a non-invasive way to reduce preoperative stress levels with no side effects and no need for additional medical or paramedical staff. Our results indicate that VR may provide an effective complementary technique to manage stress in surgery patients. Randomized trials are necessary to determine precise methods and benefits. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  20. Utilization of Body Contouring Procedures Following Weight Loss Surgery: A Study of 37,806 Patients.

    Science.gov (United States)

    Altieri, Maria S; Yang, Jie; Park, Jihye; Novikov, David; Kang, Lijuan; Spaniolas, Konstantinos; Bates, Andrew; Talamini, Mark; Pryor, Aurora

    2017-11-01

    Bariatric surgery has substantial health benefits; however, some patients desire body contouring (BC) procedures following rapid weight loss. There is a paucity of data regarding the true rate of BC following bariatric procedures. The purpose of our study is to examine the utilization of two common procedures, abdominoplasty, and panniculectomy, following bariatric surgery in New York State. The SPARCS longitudinal administrative database was used to identify bariatric procedures by using ICD-9 and CPT codes between 2004 and 2010. Procedures included sleeve gastrectomy, Roux-en-Y gastric bypass, and laparoscopic adjustable gastric banding. Using a unique patient identifier, we tracked those patients who subsequently underwent either abdominoplasty or panniculectomy with at least a 4-year follow-up (until 2014). Multivariable Cox proportional hazard model was used to evaluate predictors of follow-up BC surgery. 37,806 patients underwent bariatric surgery between 2004 and 2010. Only 5.58% (n = 2112) of these patients subsequently had a BC procedure, with 143 of them (6.8%) having ≥1 plastic surgery. The average time to plastic surgery after band, bypass, or sleeve was 1134.83 ± 671.09, 984.70 ± 570.53, and 903.02 ± 497.31 days, respectively (P 80%ile in yearly income were more likely to have plastic surgery after adjusting for age, race/ethnicity, comorbidities and complications (P values plastic surgery is completed by only 6% of patients following bariatric procedures. As insurance and income are associated with pursuing surgery, improved access may increase the number of patients who are able to undergo these reconstructive procedures.

  1. Circulating histones for predicting prognosis after cardiac surgery: a prospective study.

    Science.gov (United States)

    Gao, Hongxiang; Zhang, Naipu; Lu, Fangfang; Yu, Xindi; Zhu, Limin; Mo, Xi; Wang, Wei

    2016-11-01

    The objective of this study was to assess the perioperative changes in circulating histones and their relationships with other biomarkers and clinical outcomes after cardiac surgery with cardiopulmonary bypass (CPB) in patients. Forty-eight patients with congenital cardiac diseases undergoing corrective procedure with CPB were prospectively enrolled in this study. Circulating histones, N-terminal pro-brain natriuretic peptide (NT-proBNP), procalcitonin (PCT) and C-reactive protein (CRP) were measured preoperatively (T0) and at 0 (T1), 24 (T2), 48 (T3) and 72 (T4) h postoperatively. The relationships between biomarkers and clinical outcomes were analysed. Circulating histones, NT-proBNP, PCT and CRP increased significantly postoperatively, with histones reaching the peak value earliest at T1. Circulating histone levels were higher in patients with adverse events. Receiver operating characteristic curve analysis showed that peak histone levels had a better predictive value for adverse events postoperatively. Peak histone levels correlated with the peak level of NT-proBNP (r = 0.563, P histones reached peak levels faster than NT-proBNP, PCT and CRP. Furthermore, peak histone levels correlated with biomarkers and postoperative clinical outcomes. Circulating histones may be used as a prognostic indicator for patients after cardiac surgery with CPB. ClinicalTrials.gov (ID: NCT02325765). © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  2. A clinical study of the LiVac laparoscopic liver retractor system.

    Science.gov (United States)

    Gan, Philip; Bingham, Judy

    2016-02-01

    All retractors for laparoscopic operations on the gallbladder or stomach apply an upward force to the under-surface of the liver or gallbladder, most requiring an additional skin incision. The LiVac laparoscopic liver retractor system (LiVac retractor) comprises a soft silicone ring attached to suction tubing and connected to a regulated source of suction. The suction tubing extends alongside existing ports. When placed between the liver and diaphragm, and suction applied, a vacuum is created within the ring, keeping these in apposition. Following successful proof-of-concept animal testing, a clinical study was conducted to evaluate the performance and safety of the retractor in patients. The study was a dual-centre, single-surgeon, open-label study and recruited ten patients scheduled to undergo routine upper abdominal laparoscopic surgery including cholecystectomy, primary gastric banding surgery or fundoplication. The study was conducted at two sites and was approved by the institutions' ethics committees. The primary objective of the study was to evaluate the performance of the LiVac retractor in patients undergoing upper abdominal single- or multi-port laparoscopic surgery. Performance was measured by the attainment of milestones for the retractor and accessory bevel, where used, and safety outcomes through the recording of adverse events, physical parameters, pain scales, blood tests and a post-operative liver ultrasound. The LiVac retractor achieved both primary and secondary performance and safety objectives in all patients. No serious adverse events and no device-related adverse events or device deficiencies were reported. The LiVac retractor achieved effective liver retraction without clinically significant trauma and has potential application in multi- or single-port laparoscopic upper abdominal surgery. As a separate incision is not required, the use of the LiVac retractor in multi-port surgery therefore reduces the number of incisions.

  3. [Operating Room Nurses' Experiences of Securing for Patient Safety].

    Science.gov (United States)

    Park, Kwang Ok; Kim, Jong Kyung; Kim, Myoung Sook

    2015-10-01

    This study was done to evaluate the experience of securing patient safety in hospital operating rooms. Experiential data were collected from 15 operating room nurses through in-depth interviews. The main question was "Could you describe your experience with patient safety in the operating room?". Qualitative data from the field and transcribed notes were analyzed using Strauss and Corbin's grounded theory methodology. The core category of experience with patient safety in the operating room was 'trying to maintain principles of patient safety during high-risk surgical procedures'. The participants used two interactional strategies: 'attempt continuous improvement', 'immersion in operation with sharing issues of patient safety'. The results indicate that the important factors for ensuring the safety of patients in the operating room are manpower, education, and a system for patient safety. Successful and safe surgery requires communication, teamwork and recognition of the importance of patient safety by the surgical team.

  4. Recurrent Laryngeal Nerve Palsy After Cervical Spine Surgery: A Multicenter AOSpine Clinical Research Network Study.

    Science.gov (United States)

    Gokaslan, Ziya L; Bydon, Mohamad; De la Garza-Ramos, Rafael; Smith, Zachary A; Hsu, Wellington K; Qureshi, Sheeraz A; Cho, Samuel K; Baird, Evan O; Mroz, Thomas E; Fehlings, Michael; Arnold, Paul M; Riew, K Daniel

    2017-04-01

    Multicenter retrospective study. To investigate the risk of symptomatic recurrent laryngeal nerve palsy (RLNP) following cervical spine surgery, to examine risk factors for its development, and to report its treatment and outcomes. A multicenter study from 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was performed. Each center screened for rare complications following cervical spine surgery, including RLNP. Patients were included if they underwent cervical spine surgery (levels from C2 to C7) between January 1, 2005 and December 31, 2011. Data were analyzed with regard to complication treatment and outcome. Cases were compared to a control group from the AOSpine CSM and CSM-I studies. Three centers reported 19 cases of RLNP from a cohort of 1345 patients. The reported incidence of RLNP ranged from 0.6% to 2.9% between these 3 centers. Fifteen patients (79%) in the RLNP group were approached from the left side. Ten patients (52.6%) required treatment for RLNP-6 required medical therapy (steroids), 1 interventional treatment (injection laryngoplasty), and 3 conservative therapy (speech therapy). When examining outcomes, 73.7% (14/19) of cases resolved completely, 15.8% (3/19) resolved with residual effects, and in 10.5% (2/19) of cases this could not be determined. In this multicenter study examining rare complications following cervical spine surgery, the risk of RLNP after cervical spine surgery ranged from 0.6% to 2.9% between centers. Though rare, it was found that 16% of patients may experience partial resolution with residual effects, and 74% resolve completely.

  5. Effects of Intravenous Patient-Controlled Sufentanil Analgesia and Music Therapy on Pain and Hemodynamics After Surgery for Lung Cancer: A Randomized Parallel Study.

    Science.gov (United States)

    Wang, Yichun; Tang, Haoke; Guo, Qulian; Liu, Jingshi; Liu, Xiaohong; Luo, Junming; Yang, Wenqian

    2015-11-01

    Postoperative pain is caused by surgical injury and trauma; is stressful to patients; and includes a series of physiologic, psychological, and behavioral reactions. Effective postoperative analgesia helps improve postoperative pain, perioperative safety, and hospital discharge rates. This study aimed to observe the influence of postoperative intravenous sufentanil patient-controlled analgesia combined with music therapy versus sufentanil alone on hemodynamics and analgesia in patients with lung cancer. This was a randomized parallel study performed in 60 patients in American Society of Anesthesiologists class I or II undergoing lung cancer resection at the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University. Patients were randomly assigned to a music therapy (MT) group and a control (C) group. The MT group underwent preoperative and postoperative music intervention while the C group did not. Both groups received intravenous patient-controlled sufentanil analgesia. The primary outcome was the visual analogue scale (VAS) score at 24 hours after surgery. The secondary outcomes included hemodynamic changes (systolic blood pressure, diastolic blood pressure, heart rate), changes on the Self-Rating Anxiety Scale (SAS), total consumption of sufentanil, number of uses, sedation, and adverse effects. The postoperative sufentanil dose and analgesia frequency were recorded. Compared with the C group, the MT group had significantly lower VAS score, systolic and diastolic blood pressure, heart rate, and SAS score within 24 hours after surgery (p music therapy and sufentanil improves intravenous patient-controlled analgesia effects compared with sufentanil alone after lung cancer surgery. Lower doses of sufentanil could be administered to more effectively improve patients' cardiovascular parameters.

  6. Why is patient safety so hard? A selective review of ethnographic studies.

    Science.gov (United States)

    Dixon-Woods, Mary

    2010-01-01

    Ethnographic studies are valuable in studying patient safety. This is a narrative review of four reports of ethnographic studies of patient safety in UK hospitals conducted as part of the Patient Safety Research Programme. Three of these studies were undertaken in operating theatres and one in an A&E Department. The studies found that hospitals were rarely geared towards ensuring perfect performances. The coordination and mobilization of the large number of inter-dependent processes and resources needed to support the achievement of tasks was rarely optimal. This produced significant strain that staff learned to tolerate by developing various compensatory strategies. Teamwork and inter-professional communication did not always function sufficiently well to ensure that basic procedural information was shared or that the required sequence of events was planned. Staff did not always do the right things, for a wide range of different reasons, including contestations about what counted as the right thing. Structures of authority and accountability were not always clear or well-functioning. Patient safety incidents were usually not reported, though there were many different reasons for this. It can be concluded that securing patient safety is hard. There are multiple interacting influences on safety, and solutions need to be based on a sound understanding of the nature of the problems and which approaches are likely to be best suited to resolving them. Some solutions that appear attractive and straightforward are likely to founder. Addressing safety problems requires acknowledgement that patient safety is not simply a technical issue, but a site of organizational and professional politics.

  7. Use of antibiotics for urinary tract infection in women undergoing surgery for urinary incontinence: a cohort study.

    Science.gov (United States)

    Guldberg, Rikke; Kesmodel, Ulrik Schiøler; Brostrøm, Søren; Kærlev, Linda; Hansen, Jesper Kjær; Hallas, Jesper; Nørgård, Bente Mertz

    2014-02-04

    To describe the use of antibiotics for urinary tract infection (UTI) before and after surgery for urinary incontinence (UI); and for those with use of antibiotics before surgery, to estimate the risk of treatment for a postoperative UTI, relative to those without use of antibiotics before surgery. A historical population-based cohort study. Denmark. Women (age ≥18 years) with a primary surgical procedure for UI from the county of Funen and the Region of Southern Denmark from 1996 throughout 2010. Data on redeemed prescriptions of antibiotics ±365 days from the date of surgery were extracted from a prescription database. Use of antibiotics for UTI in relation to UI surgery, and the risk of being a postoperative user of antibiotics for UTI among preoperative users. A total of 2151 women had a primary surgical procedure for UI; of these 496 (23.1%) were preoperative users of antibiotics for UTI. Among preoperative users, 129 (26%) and 215 (43.3%) also redeemed prescriptions of antibiotics for UTI within 0-60 and 61-365 days after surgery, respectively. Among preoperative non-users, 182 (11.0%) and 235 (14.2%) redeemed prescriptions within 0-60 and 61-365 days after surgery, respectively. Presurgery exposure to antibiotics for UTI was a strong risk factor for postoperative treatment for UTI, both within 0-60 days (adjusted OR, aOR=2.6 (95% CI 2.0 to 3.5)) and within 61-365 days (aOR=4.5 (95% CI 3.5 to 5.7)). 1 in 4 women undergoing surgery for UI was treated for UTI before surgery, and half of them had a continuing tendency to UTIs after surgery. Use of antibiotics for UTI before surgery was a strong risk factor for antibiotic use after surgery. In women not using antibiotics for UTI before surgery only a minor proportion initiated use after surgery.

  8. A clinical pilot study of a modular video-CT augmentation system for image-guided skull base surgery

    Science.gov (United States)

    Liu, Wen P.; Mirota, Daniel J.; Uneri, Ali; Otake, Yoshito; Hager, Gregory; Reh, Douglas D.; Ishii, Masaru; Gallia, Gary L.; Siewerdsen, Jeffrey H.

    2012-02-01

    Augmentation of endoscopic video with preoperative or intraoperative image data [e.g., planning data and/or anatomical segmentations defined in computed tomography (CT) and magnetic resonance (MR)], can improve navigation, spatial orientation, confidence, and tissue resection in skull base surgery, especially with respect to critical neurovascular structures that may be difficult to visualize in the video scene. This paper presents the engineering and evaluation of a video augmentation system for endoscopic skull base surgery translated to use in a clinical study. Extension of previous research yielded a practical system with a modular design that can be applied to other endoscopic surgeries, including orthopedic, abdominal, and thoracic procedures. A clinical pilot study is underway to assess feasibility and benefit to surgical performance by overlaying CT or MR planning data in realtime, high-definition endoscopic video. Preoperative planning included segmentation of the carotid arteries, optic nerves, and surgical target volume (e.g., tumor). An automated camera calibration process was developed that demonstrates mean re-projection accuracy (0.7+/-0.3) pixels and mean target registration error of (2.3+/-1.5) mm. An IRB-approved clinical study involving fifteen patients undergoing skull base tumor surgery is underway in which each surgery includes the experimental video-CT system deployed in parallel to the standard-of-care (unaugmented) video display. Questionnaires distributed to one neurosurgeon and two otolaryngologists are used to assess primary outcome measures regarding the benefit to surgical confidence in localizing critical structures and targets by means of video overlay during surgical approach, resection, and reconstruction.

  9. Ambulatory laparoscopic minor hepatic surgery: Retrospective observational study.

    Science.gov (United States)

    Gaillard, M; Tranchart, H; Lainas, P; Tzanis, D; Franco, D; Dagher, I

    2015-11-01

    Over the last decade, laparoscopic hepatic surgery (LHS) has been increasingly performed throughout the world. Meanwhile, ambulatory surgery has been developed and implemented with the aims of improving patient satisfaction and reducing health care costs. The objective of this study was to report our preliminary experience with ambulatory minimally invasive LHS. Between 1999 and 2014, 172 patients underwent LHS at our institution, including 151 liver resections and 21 fenestrations of hepatic cysts. The consecutive series of highly selected patients who underwent ambulatory LHS were included in this study. Twenty patients underwent ambulatory LHS. Indications were liver cysts in 10 cases, liver angioma in 3 cases, focal nodular hyperplasia in 3 cases, and colorectal hepatic metastasis in 4 cases. The median operative time was 92 minutes (range: 50-240 minutes). The median blood loss was 35 mL (range: 20-150 mL). There were no postoperative complications or re-hospitalizations. All patients were hospitalized after surgery in our ambulatory surgery unit, and were discharged 5-7 hours after surgery. The median postoperative pain score at the time of discharge was 3 (visual analogue scale: 0-10; range: 0-4). The median quality-of-life score at the first postoperative visit was 8 (range: 6-10) and the median cosmetic satisfaction score was 8 (range: 7-10). This series shows that, in selected patients, ambulatory LHS is feasible and safe for minor hepatic procedures. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  10. Clinical study of salvage surgery after concurrent chemoradiotherapy

    International Nuclear Information System (INIS)

    Shimane, Toshikazu; Nakamura, Taisuke; Shimotatara, Yuko

    2013-01-01

    As the use of concurrent chemoradiotherapy (CCRT) is becoming more widespread, with numerous facilities performing it to maintain function and form, the number of cases requiring salvage surgery is also increasing. We investigated the postoperative prognosis of patients who experienced complications during salvage surgery after CCRT. Subjects were 27 patients who underwent salvage surgery following CCRT at our department during the 7-year period between January 2005 and December 2011. We selected all cases of salvage surgery, comprising neck dissections, total laryngectomies, partial laryngectomies, esophageal resections, and reconstructive surgeries, for analysis. The results were favorable, with a complication rate during salvage surgery after CCRT of 14.8% and a survival rate of 77.8%. Although it is difficult to compare these complications and outcome findings with available reports on salvage surgery without CCRT, it is believed complications can arise in approximately half of the cases. Thus, surgeons should be cognizant of the potential for serious complications, which are sometimes unexpected. Different from our findings, the prognosis following salvage surgery is generally not thought to be favorable and therefore care should be taken to detect recurrence and provide treatment early in salvage surgery cases. (author)

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

    Science.gov (United States)

    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…

  13. Conventional surgery in breast cancer

    International Nuclear Information System (INIS)

    Tapia Herrera, Andres

    2013-01-01

    General aspects of breast cancer were described from the epidemiological point of view, clinical and pathological, as well as its impact at global and national levels. Parenchyma conservative surgery and/or breast skin was analyzed exhaustively as a cancer treatment analyzed exhaustively, to your specifications, requirements, technical aspects, risks, benefits, degree of oncological safety and benefits for patients [es

  14. Safety benefits from CANDU reactor replacement - a case study

    International Nuclear Information System (INIS)

    Mottram, R.; Millard, J.W.F.; Purdy, P.

    2011-01-01

    Both total core replacement and core retubing have been used in the CANDU industry. For future plant refurbishments, based on experience both in new construction and in recent refurbishments, the concept of total core replacement has been revisited. This builds on practices for replacement of other large plant equipment like boilers. The Bruce CANDU reactors, with their local shield tanks built around the Calandria and containment closely located around that Calandria Shield Tank Assembly (CSTA), are believed to be good candidates for core replacement. A structured process was used to design a replacement CSTA suitable for Bruce A use. The work started with a study of opportunities for safety enhancements in the core. This progressed into design studies and related design assist safety analysis on the reactor. A key element of the work involved consideration of how verified features from later CANDU designs, and from our new reactor design work, could be tailored to fit this replacement core. The replacement reactor core brings in structural improvements in both calandria and end shield, and safety improvements like the natural circulation enhancing moderator cooling layout and further optimized reactivity layouts to improve shutdown system performance. Bruce Power are currently studying the business implications of this and retube techniques as part of preparation for future refurbishments. The work explained in this paper is in the context of the safety related changes and the work to choose and quantify them. (author)

  15. Safety benefits from CANDU reactor replacement. A case study

    International Nuclear Information System (INIS)

    Mottram, R.; Millard, J.W.F.; Purdy, P.

    2011-01-01

    Both total core replacement and core retubing have been used in the CANDU industry. For future plant refurbishments, based on experience both in new construction and in recent refurbishments, the concept of total core replacement has been revisited. This builds on practices for replacement of other large plant equipment like boilers. The Bruce CANDU reactors, with their local shield tanks built around the Calandria and containment closely located around that Calandria Shield Tank Assembly (CSTA), are believed to be good candidates for core replacement. A structured process was used to design a replacement CSTA suitable for Bruce A use. The work started with a study of opportunities for safety enhancements in the core. This progressed into design studies and related design assist safety analysis on the reactor. A key element of the work involved consideration of how verified features from later CANDU designs, and from our new reactor design work, could be tailored to fit this replacement core. The replacement reactor core brings in structural improvements in both calandria and end shield, and safety improvements like the natural circulation enhancing moderator cooling layout and further optimized reactivity layouts to improve shutdown system performance. Bruce Power are currently studying the business implications of this and retube techniques as part of preparation for future refurbishments. The work explained in this paper is in the context of the safety related changes and the work to choose and quantify them. (author)

  16. The orthopaedic error index: development and application of a novel national indicator for assessing the relative safety of hospital care using a cross-sectional approach.

    Science.gov (United States)

    Panesar, Sukhmeet S; Netuveli, Gopalakrishnan; Carson-Stevens, Andrew; Javad, Sundas; Patel, Bhavesh; Parry, Gareth; Donaldson, Liam J; Sheikh, Aziz

    2013-11-21

    The Orthopaedic Error Index for hospitals aims to provide the first national assessment of the relative safety of provision of orthopaedic surgery. Cross-sectional study (retrospective analysis of records in a database). The National Reporting and Learning System is the largest national repository of patient-safety incidents in the world with over eight million error reports. It offers a unique opportunity to develop novel approaches to enhancing patient safety, including investigating the relative safety of different healthcare providers and specialties. We extracted all orthopaedic error reports from the system over 1 year (2009-2010). The Orthopaedic Error Index was calculated as a sum of the error propensity and severity. All relevant hospitals offering orthopaedic surgery in England were then ranked by this metric to identify possible outliers that warrant further attention. 155 hospitals reported 48 971 orthopaedic-related patient-safety incidents. The mean Orthopaedic Error Index was 7.09/year (SD 2.72); five hospitals were identified as outliers. Three of these units were specialist tertiary hospitals carrying out complex surgery; the remaining two outlier hospitals had unusually high Orthopaedic Error Indexes: mean 14.46 (SD 0.29) and 15.29 (SD 0.51), respectively. The Orthopaedic Error Index has enabled identification of hospitals that may be putting patients at disproportionate risk of orthopaedic-related iatrogenic harm and which therefore warrant further investigation. It provides the prototype of a summary index of harm to enable surveillance of unsafe care over time across institutions. Further validation and scrutiny of the method will be required to assess its potential to be extended to other hospital specialties in the UK and also internationally to other health systems that have comparable national databases of patient-safety incidents.

  17. Surgery for trigger finger.

    Science.gov (United States)

    Fiorini, Haroldo Junior; Tamaoki, Marcel Jun; Lenza, Mário; Gomes Dos Santos, Joao Baptista; Faloppa, Flávio; Belloti, Joao Carlos

    2018-02-20

    Trigger finger is a common clinical disorder, characterised by pain and catching as the patient flexes and extends digits because of disproportion between the diameter of flexor tendons and the A1 pulley. The treatment approach may include non-surgical or surgical treatments. Currently there is no consensus about the best surgical treatment approach (open, percutaneous or endoscopic approaches). To evaluate the effectiveness and safety of different methods of surgical treatment for trigger finger (open, percutaneous or endoscopic approaches) in adults at any stage of the disease. We searched CENTRAL, MEDLINE, Embase and LILACS up to August 2017. We included randomised or quasi-randomised controlled trials that assessed adults with trigger finger and compared any type of surgical treatment with each other or with any other non-surgical intervention. The major outcomes were the resolution of trigger finger, pain, hand function, participant-reported treatment success or satisfaction, recurrence of triggering, adverse events and neurovascular injury. Two review authors independently selected the trial reports, extracted the data and assessed the risk of bias. Measures of treatment effect for dichotomous outcomes calculated risk ratios (RRs), and mean differences (MDs) or standardised mean differences (SMD) for continuous outcomes, with 95% confidence intervals (CIs). When possible, the data were pooled into meta-analysis using the random-effects model. GRADE was used to assess the quality of evidence for each outcome. Fourteen trials were included, totalling 1260 participants, with 1361 trigger fingers. The age of participants included in the studies ranged from 16 to 88 years; and the majority of participants were women (approximately 70%). The average duration of symptoms ranged from three to 15 months, and the follow-up after the procedure ranged from eight weeks to 23 months.The studies reported nine types of comparisons: open surgery versus steroid injections (two

  18. Do safety checklists improve teamwork and communication in the operating room? A systematic review.

    Science.gov (United States)

    Russ, Stephanie; Rout, Shantanu; Sevdalis, Nick; Moorthy, Krishna; Darzi, Ara; Vincent, Charles

    2013-12-01

    The aim of this systematic review was to assess the impact of surgical safety checklists on the quality of teamwork and communication in the operating room (OR). Safety checklists have been shown to impact positively on patient morbidity and mortality following surgery, but it is unclear whether this clinical improvement is related to an improvement in OR teamwork and communication. A systematic search strategy of MEDLINE, EMBASE, PsycINFO, Google Scholar, and the Cochrane Database for Systematic Reviews was undertaken to obtain relevant articles. After de-duplication and the addition of limits, 315 articles were screened for inclusion by 2 researchers and all articles meeting a set of prespecified inclusion criteria were retained. Information regarding the type of checklist, study design, assessment tools used, outcomes, and study limitations was extracted. Twenty articles formed the basis of this systematic review. All articles described an empirical study relating to a case-specific safety checklist for surgery as the primary intervention, with some measure of change/improvement in teamwork and/or communication relating to its use. The methods for assessing teamwork and communication varied greatly, including surveys, observations, interviews, and 360° assessments. The evidence suggests that safety checklists improve the perceived quality of OR teamwork and communication and reduce observable errors relating to poor team skills. This is likely to function through establishing an open platform for communication at the start of a procedure: encouraging the sharing of critical case-related information, promoting team coordination and decision making, flagging knowledge gaps, and enhancing team cohesion. However, the evidence would also suggest that when used suboptimally or when individuals have not bought in to the process, checklists may conversely have a negative impact on the function of the team. Safety checklists are beneficial for OR teamwork and

  19. 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.

  20. A clinical study of navigation accuracy during surgery

    International Nuclear Information System (INIS)

    Hirabayashi, Hidehiro; Uchiyama, Yoshitomo; Hoshida, Toru; Nakase, Hiroyuki; Morimoto, Tetsuya; Sakaki, Toshisuke

    2000-01-01

    It is essential to implement image-guided surgery or neuronavigation technologies that can be applied during functional surgery to localize targets accurately in the surgical field. Various navigation systems have been developed, such as the optical system and mechanical-arm-based system, to localize targets in the operative field. However, either the reference system, in optical systems, or the arm joint, in mechanical-arm-based systems, can sometimes interfere with surgical maneuvers. Therefore, we used the magnetic-force-based Computed Assisted Neurosurgery system (CANS system, Shimadzu, Co. Ltd., Kyoto, Japan) for neuronavigation. The purpose of this study was to evaluate the accuracy of the CANS navigation system. Ten patients with medically refractory epilepsy underwent implantation of subdural electrode grids to detect the epilepsy focus, and then lobectomy or multiple subpial transection was performed after informed consent was obtained. The male/female ratio was 6:4 and the mean age was 30.7 years. The CANS navigator system consists mainly of a magnetic source, a localizer probe with magnetic sensor, a three-dimensional locating measuring instrument (digitizer), an image scanner, and a personal computer. To determine the localization accuracy, the probe was moved on the subdural electrode grid which typically consists of 64 or 16 platinum-iridium electrode contacts (3 mm in the diameter) embedded in a Silastic sheet. The array of electrodes was 8 x 8 cm or 2 x 8 cm and the center-to-center inter-electrode distance was 10 mm. We evaluated the inter-electrode distances and spatial relationships among the electrodes to quantitate the precision of the probe tip localization and assumed the nasion origin reference system to assess the distribution of target coordinates. The measurement errors of each component derived from different planes for the same targets were evaluated in ten patients. The error in X-dimension ranged from 0.38 mm to 7.8 mm, the error in Y

  1. Bariatric surgery in adolescents: what do we know so far?

    Science.gov (United States)

    Beamish, A J; Johansson, S E; Olbers, T

    2015-03-01

    Obesity represents a vast and rapidly increasing global burden. Bariatric surgery is the only intervention achieving sustained weight loss, among its wide-ranging benefits. In this article, we describe the growing challenges presented by adolescents with severe obesity and review the literature on surgical and other treatment options. Outcomes in terms of weight loss, metabolic and quality of life improvement, reversal of obstructive sleep apnea, insulin resistance, type II diabetes mellitus, hypertension, and dyslipidemia appear comparable to those seen in adults. However, long-term data on safety and sustainability are lacking. There is a growing acceptance of the need for surgery as a treatment for the morbidly obese adolescent population, and the number of studies reporting outcomes after adolescent bariatric surgery is increasing. Accumulating evidence suggests that the benefits seen in adult bariatric surgery can be reproduced in adolescents. Thus, adolescent bariatric surgery appears to be safe and effective in achieving benefits desired in terms of weight control and improvements in metabolic health and quality of life. However, particular care must be taken when treating a young population, and long-term outcomes are awaited to properly define indications and limitations. © The Finnish Surgical Society 2014.

  2. Ramosetron compared with granisetron for the prevention of vomiting following strabismus surgery in children

    Science.gov (United States)

    Fujii, Y.; Tanaka, H.; Ito, M.

    2001-01-01

    BACKGROUND/AIMS—Postoperative vomiting occurs frequently after strabismus surgery in children. Granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, is effective for the prevention of vomiting following paediatric strabismus surgery. Ramosetron, another new antagonist of 5-hydroxytryptamine type 3 receptor, has more potent and longer acting properties than granisetron against cisplatin induced emesis. This study was undertaken to compare the efficacy and safety of granisetron and ramosetron for the prevention of vomiting following strabismus surgery in children.
METHODS—In a randomised, double blinded manner 80 children, aged 4-10 years, received intravenously granisetron 40 µg/kg or ramosetron 6 µg/kg (n=40 each) at the end of surgery. A standard general anaesthetic technique and postoperative analgesia were used. Emetic episodes and safety assessment were performed during the first 24 hours and the next 24 hours after anaesthesia.
RESULTS—The percentage of patients who were emesis free during 0-24 hours after anaesthesia was 85% with granisetron and 90% with ramosetron, respectively (p = 0.369); the corresponding rate during 24-48 hours after anaesthesia was 70% and 95% (p = 0.003). No clinically serious adverse events caused by the study drug were observed in any of the groups.
CONCLUSION—Prophylactic antiemetic therapy with ramosetron is comparable with granisetron for the prevention of vomiting during 0-24 hours after anaesthesia in children undergoing strabismus surgery. During 24-48 hours after anaesthesia, ramosetron is more effective than granisetron for prophylaxis against postoperative vomiting.

 PMID:11371485

  3. Patient safety challenges in a case study hospital--of relevance for transfusion processes?

    Science.gov (United States)

    Aase, Karina; Høyland, Sindre; Olsen, Espen; Wiig, Siri; Nilsen, Stein Tore

    2008-10-01

    The paper reports results from a research project with the objective of studying patient safety, and relates the finding to safety issues within transfusion medicine. The background is an increased focus on undesired events related to diagnosis, medication, and patient treatment in general in the healthcare sector. The study is designed as a case study within a regional Norwegian hospital conducting specialised health care services. The study includes multiple methods such as interviews, document analysis, analysis of error reports, and a questionnaire survey. Results show that the challenges for improved patient safety, based on employees' perceptions, are hospital management support, reporting of accidents/incidents, and collaboration across hospital units. Several of these generic safety challenges are also found to be of relevance for a hospital's transfusion service. Positive patient safety factors are identified as teamwork within hospital units, a non-punitive response to errors, and unit manager's actions promoting safety.

  4. [Acute cholecystitis in cholelithiasis: importance of early surgery (a comparative study)].

    Science.gov (United States)

    Meissner, K; Meiser, G; Schwaiger, E

    1989-01-20

    The results of early surgery (ES) for acute calculous cholecystitis obtained in 74 patients operated on between 3/78 and 12/87 were compared with relevant data obtained in 74 sex- and age-matched patients with a history of acute cholecystitis operated on for biliary colic or jaundice during the same period. Operative procedures, incidence of jaundice and common bile duct calculi, duration of operation, number of patients requiring blood transfusions, surgical and general complications and mortality showed no significant difference. Only operative blood loss was significantly higher in the ES group, but this was of no practical relevance. ES precludes the sequelae of emergency surgery in the delayed surgery group not infrequently necessary for failure of conservative treatment of acute cholecystitis, which necessarily precedes planned delayed surgery, and thus renders a significant reduction of over-all risk. This forms the rationale for ES as treatment concept.

  5. To study the existing system of surgical safety for cataract surgery at tertiary care ophthalmic centre to implement WHO surgical safety checklist

    OpenAIRE

    Ruchi Garg; Neeraj Garg; Shakti Kumar Gupta; J. S. Titiyal; R. Mahesh

    2016-01-01

    Background: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, named after the first President of India, was established on the 10th of March, 1967 as a National centre for ophthalmic science, to provide state of the art patient care, expand human resources for medical education and undertake research to find solutions to eye health problems of national importance. Average numbers of cataract surgeries performed per month are 700 to 1000. Methods: Anticipating implementation in 50% cases...

  6. Bariatric surgery insurance requirements independently predict surgery dropout.

    Science.gov (United States)

    Love, Kaitlin M; Mehaffey, J Hunter; Safavian, Dana; Schirmer, Bruce; Malin, Steven K; Hallowell, Peter T; Kirby, Jennifer L

    2017-05-01

    Many insurance companies have considerable prebariatric surgery requirements despite a lack of evidence for improved clinical outcomes. The hypothesis of this study is that insurance-specific requirements will be associated with a decreased progression to surgery and increased delay in time to surgery. Retrospective data collection was performed for patients undergoing bariatric surgery evaluation from 2010-2015. Patients who underwent surgery (SGY; n = 827; mean body mass index [BMI] 49.1) were compared with those who did not (no-SGY; n = 648; mean BMI: 49.4). Univariate and multivariate analysis were performed to identify specific co-morbidity and insurance specific predictors of surgical dropout and time to surgery. A total of 1475 patients using 12 major insurance payors were included. Univariate analysis found insurance requirements associated with surgical drop out included longer median diet duration (no-SGY = 6 mo; SGY = 3 mo; Psurgery dropout. Additionally, surgical patients had an average interval between initial visit and surgery of 5.8±4.6 months with significant weight gain (2.1 kg, Psurgery insurance requirements were associated with lack of patient progression to surgery in this study. In addition, delays in surgery were associated with preoperative weight gain. Although prospective and multicenter studies are needed, these findings have major policy implications suggesting insurance requirements may need to be reconsidered to improve medical care. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  7. Early complication detection after colorectal surgery (CONDOR): study protocol for a prospective clinical diagnostic study

    NARCIS (Netherlands)

    Kornmann, Verena; van Ramshorst, Bert; van Dieren, Susan; van Geloven, Nanette; Boermeester, Marja; Boerma, Djamila

    2016-01-01

    Anastomotic leakage is one of the most feared complications following colorectal surgery with a high morbidity and mortality rate. Multiple risk factors have been identified, but leakage still occurs. Early detection is crucial in order to reduce morbidity and mortality. The aim of this study is to

  8. Comparative study of intravenous Tramadol versus Ketorolac for preventing postoperative pain after third molar surgery--a prospective randomized study.

    Science.gov (United States)

    Gopalraju, Prathibha; Lalitha, Ramanujapuram Manikarnike; Prasad, Kavitha; Ranganath, Krishnappa

    2014-07-01

    The aim of this comparative, prospective, randomized, controlled study was to evaluate two different regimens of analgesics: a preoperative intravenous dose of either Tramadol or Ketorolac given 10 min prior to surgery to assess their impact on clinical recovery after third molar surgery. Forty patients requiring surgical extraction of unilateral impacted mandibular third molars similar in position were enrolled in the study. Patients were randomly divided into two groups based on permuting the numbers. Patients in Group 1 and Group 2 were administered either Tramadol 50 mg or Ketorolac 30 mg, intravenously, 10 min prior to surgery. The difference in postoperative pain was assessed by four primary points: pain intensity as measured by a 10 mm visual analogue scale hourly for 12 h, median time to rescue analgesics, number of analgesics consumed and patient's overall 5-point global assessment scale. Throughout the 12 h investigation period, patients treated with Ketorolac reported significantly lower pain intensity scores, significantly longer time to rescue analgesics (Acetaminophen 500 mg) and less intake of postoperative analgesics. In Group 2, 40% of the patient had good overall assessment as compared to Group 1 where only 25% of patients had good overall assessment. The current study shows that pre-emptive use of Inj. Ketorolac 30 mg intravenously can reduce the severity of the postoperative sequelae of asymptomatic impacted mandibular third molar surgery. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  9. Midazolam intravenous conscious sedation in oral surgery. A retrospective study of 372 cases.

    Science.gov (United States)

    Runes, J; Ström, C

    1996-01-01

    In 1987 the Swedish Dental Act was amended to allow Swedish dentists who have undergone a specific accreditation course to administer intra-venous sedation. Midazolam is a benzodiazepin derivate with express sedative and hypnotic qualities, powerful amnesia, a short half-life time and few secondary effects. From 1989-1994 midazolam intravenous conscious sedation (ICS) was administered in 372 cases in the Department of Oral and Maxillofacial Surgery, County Hospital, Falun. This study presents data on the 298 patients. Although surgical removal of impacted wisdom teeth predominated, implant surgery, reduction of fractures and correction of anomalies were also carried out. Supplementary sedative premedication was rarely used. Most patients were treated under local anaesthesia. The mean dosage was 10.45 mg (range 1.25-40 mg). Mean dosage/kg was 0.15 mg (range 0.03-0.50 mg). The average duration of anaesthesia was 50 minutes. The average recovery time was 94 minutes. Three hundred and sixty-nine of 372 planned treatments were completed. No serious complications occurred. The patients were co-operative during surgery and were satisfied with the treatment. Compared with full anaesthesia this method required less resources and is a valuable complement in management of anxious patients undergoing oral surgery.

  10. Repetitive endoscopic sinus surgery failure: a role for radical surgery?

    NARCIS (Netherlands)

    Videler, Ward J. M.; Wreesmann, Volkert B.; van der Meulen, Freerk W.; Knegt, Paul P.; Fokkens, Wytske J.

    2006-01-01

    OBJECTIVES: Endoscopic sinus surgery (ESS) is considered to be the golden standard for surgery in patients with chronic rhinosinusitis and nasal polyposis. However, there is still a small group of patients unresponsive despite repetitive surgery. Radical surgery aimed at reduction of the

  11. 2D vs. 3D imaging in laparoscopic surgery-results of a prospective randomized trial.

    Science.gov (United States)

    Buia, Alexander; Stockhausen, Florian; Filmann, Natalie; Hanisch, Ernst

    2017-12-01

    3D imaging is an upcoming technology in laparoscopic surgery, and recent studies have shown that the modern 3D technique is superior in an experimental setting. However, the first randomized controlled clinical trial in this context dates back to 1998 and showed no significant difference between 2D and 3D visualization using the first 3D generation technique, which is now more than 15 years old. Positive results measured in an experimental setting considering 3D imaging on surgical performance led us to initiate a randomized controlled pragmatic clinical trial to validate our findings in daily clinical routine. Standard laparoscopic operations (cholecystectomy, appendectomy) were preoperatively randomized to a 2D or 3D imaging system. We used a surgical comfort scale (Likert scale) and the Raw NASA Workload TLX for the subjective assessment of 2D and 3D imaging; the duration of surgery was also measured. The results of 3D imaging were statistically significant better than 2D imaging concerning the parameters "own felt safety" and "task efficiency"; the difficulty level of the procedures in the 2D and 3D groups did not differ. Overall, the Raw NASA Workload TLX showed no significance between the groups. 3D imaging could be a possible advantage in laparoscopic surgery. The results of our clinical trial show increased personal felt safety and efficiency of the surgeon using a 3D imaging system. Overall of the procedures, the findings assessed using Likert scales in terms of own felt safety and task efficiency were statistically significant for 3D imaging. The individually perceived workload assessed with the Raw NASA TLX shows no difference. Although these findings are subjective impressions of the performing surgeons without a clear benefit for 3D technology in clinical outcome, we think that these results show the capability that 3D laparoscopy can have a positive impact while performing laparoscopic procedures.

  12. Video-assisted thoracoscopic surgery lobectomy via confronting upside-down monitor setting

    OpenAIRE

    Mun, Mingyon; Ichinose, Junji; Matsuura, Yosuke; Nakao, Masayuki; Okumura, Sakae

    2017-01-01

    Video-assisted thoracoscopic surgery (VATS) has been widely accepted as a minimally invasive surgery for treatment of early-stage lung cancer. However, various VATS approaches are available. In patients with lung cancer, VATS should achieve not only minimal invasiveness but also safety and oncological clearance. In this article, we introduce our method of VATS lobectomy.

  13. Systematic review of the surgery-first approach in orthognathic surgery

    Directory of Open Access Journals (Sweden)

    Chiung Shing Huang

    2014-08-01

    Full Text Available The surgery-first approach in orthognathic surgery has recently created a broader interest in completely eliminating time-consuming preoperative orthodontic treatment. Available evidence on the surgery-first approach should be appraised to support its use in orthognathic surgery. A MEDLINE search using the keywords "surgery first" and "orthognathic surgery" was conducted to select studies using the surgery-first approach. We also manually searched the reference list of the selected keywords to include articles not selected by the MEDLINE search. The search identified 18 articles related to the surgery-first approach. There was no randomized controlled clinical trial. Four papers were excluded as the content was only personal opinion or basic scientific research. Three studies were retrospective cohort studies in nature. The other 11 studies were case reports. For skeletal Class III surgical correction, the final long-term outcomes for maxillofacial and dental relationship were not significantly different between the surgery-first approach and the orthodontics-first approach in transverse (e.g., intercanine or intermolar width dimension, vertical (e.g., anterior open bite, lower anterior facial height dimension, and sagittal (e.g., anterior-posterior position of pogonion and lower incisors dimension. Total treatment duration was substantially shorter in cases of surgery-first approach use. In conclusion, most published studies related to the surgery-first approach were mainly on orthognathic correction of skeletal Class III malocclusion. Both the surgery-first approach and orthodontics-first approach had similar long-term outcomes in dentofacial relationship. However, the surgery-first approach had shorter treatment time.

  14. Clinical Pearls in Anaesthesia for Endoscopic Endonasal Transsphenoid Pituitary Macroadenoma Surgery

    Directory of Open Access Journals (Sweden)

    Shah Shagun B

    2015-11-01

    Full Text Available Endoscopic Endonasal Trans-sphenoid Surgery (EETS aided by avant-garde neuro-navigation techniques, ultrasonic aspirators and bone curettes has come of age. Endoscopic surgery supersedes conventional microscopic approach due to better visualization, avoidance of craniotomy, brain retraction and undue neurovascular manipulation with less morbidity, blood loss and improved safety. Anaesthetic techniques must be tailored to cater for such advances in surgery.

  15. Gender-related perceptions of careers in surgery among new medical graduates: results of a cross-sectional study.

    Science.gov (United States)

    Fitzgerald, J Edward F; Tang, Siau-Wei; Ravindra, Pravisha; Maxwell-Armstrong, Charles A

    2013-07-01

    Despite promotional measures at a national level, female surgeons account for only 10% of the consultant workforce in the United Kingdom. With rising proportions of female medical graduates, it is important that surgery continues to recruit the most able candidates regardless of sex. This study investigates the differing perceptions of surgical careers among recent medical school graduates and identifies factors discouraging female doctors from pursuing a career in surgery. Newly qualified graduates from the University of Nottingham Medical School, Nottingham, UK, were invited to complete a nonmandatory questionnaire investigating career intentions and factors influencing this. Two hundred and eight questionnaires were returned (a 66% response rate). Male respondents were significantly more likely to rate surgery as an attractive or very attractive career (P = .0116). Overall, only 33 (25%) female doctors expressed interest in a surgical career as opposed to 33 (42%) male doctors (P = .010). Frequently cited reasons included no interest in surgery itself (21%) and negative attitudes toward women in surgery among the surgical teams (18%). Irrespective of career interests, 59% of male and 68% of female respondents believed surgery was not a career welcoming women (P = .186). Reasons included difficulty maintaining family life, limited flexible training, and lack of role models. This study identifies significant sex differences in the perception of surgical careers. The majority believes surgery does not welcome female trainees. Future strategies to promote surgery must address attitudes and behaviors in both sexes while taking active steps to support female surgeons during their training and in the workplace. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. The effects of healing touch on pain, nausea, and anxiety following bariatric surgery: a pilot study.

    Science.gov (United States)

    Anderson, Joel G; Suchicital, Liliana; Lang, Maria; Kukic, Azra; Mangione, Lucrezia; Swengros, Diane; Fabian, Jennifer; Friesen, Mary Ann

    2015-01-01

    Given the growth in the number of bariatric surgeries, it is important for healthcare practitioners to maximize symptom management for these patients, including the option of complementary therapies such as Healing Touch. A quasi-experimental study was conducted to determine the feasibility of a Healing Touch intervention for reducing pain, nausea, and anxiety in patients undergoing laparoscopic bariatric surgery. Following surgery, a nurse administered the Healing Touch intervention once daily. Study participants reported levels of pain, nausea, and anxiety immediately before and after the Healing Touch intervention using separate numeric rating scales. Significant decreases in pain, nausea, and anxiety were observed immediately following the intervention on post-operative days one and two, and in pain and anxiety on post-operative day three compared with pre-intervention levels. These findings indicate that the Healing Touch intervention is feasible and acceptable to patients undergoing bariatric surgery, and significantly improved pain, nausea, and anxiety in these patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. The early psychological adjustment of cleft patients after maxillary distraction osteogenesis and conventional orthognathic surgery: a preliminary study.

    Science.gov (United States)

    Cheung, Lim Kwong; Loh, John Ser Pheng; Ho, Samuel M Y

    2006-12-01

    To compare the early psychological changes of cleft lip and palate (CLP) and noncleft patients after maxillofacial corrective surgery, including maxillary distraction osteogenesis and conventional orthognathic surgery. Nine CLP patients were compared with a group of 9 non-CLP patients having similar dentofacial deformities in a prospective longitudinal cohort study. Five of the CLP patients underwent maxillary distraction osteogenesis and 4 underwent conventional orthognathic surgery. A control group of 9 noncleft patients received conventional orthognathic surgery. All patients completed a set of questionnaires to enable their psychological profile to be assessed. The data were collected immediately before surgery (T1), and at 3 weeks (T2) and 12 weeks (T3) after surgery. The CLP patients treated with distraction osteogenesis were happier, but had a higher level of social anxiety and distress than the CLP patients receiving conventional orthognathic surgery. On the other hand, the CLP patients overall were happier, with lower social anxiety and distress, than the noncleft control group. The CLP patients showed a higher level of parental self-esteem than the noncleft patients. This preliminary study shows that CLP patients were generally happier, and had a higher level of parental support, than normal patients suffering from dentofacial deformities. Maxillary distraction osteogenesis seemed to induce a higher level of anxiety and distress in CLP patients than conventional orthognathic surgery in both cleft and noncleft patients.

  18. Apical surgery vs apical surgery with simultaneous orthograde retreatment: A prospective cohort clinical study of teeth affected by persistent periapical lesion

    Directory of Open Access Journals (Sweden)

    Carlo Prati

    2018-06-01

    Full Text Available Aim: This prospective clinical study analyzed the 24-month outcome of conventional apical surgery retro-filled with calcium-silicate cement versus apical surgery with simultaneous orthograde retreatment by means of clinical and radiographic criteria. Materials and methods: This study included 83 teeth affected by persistent periapical lesions in 68 patients. Mean age was 52 years (median = 51 years; range 19–81 years. Twenty-eight cases were treated with apical surgery, 16 cases with apical surgery with simultaneous orthograde retreatment and 39 cases with orthograde retreatment in previously treated teeth established as control group. Periapical index score (PAI was used as radiographic criteria. Teeth were examined at 6 months, 1 and 2 years and classified as healed (without any symptoms and PAI ≤ 2, healing (without any symptoms and PAI = 3 or diseased (with symptoms or PAI ≥ 4 and not functional on the basis of radiographic and clinical criteria. At 24 months evaluation, healed and healing were considered as success and diseased and fracture as failure. Multilevel GLM model and an ordered logistic regression as statistical analysis was made with level of significance set at p < 0.05. Results: Total drop-out was 7% (n = 6. After 6–9 months, 6 teeth (3 from apical surgery, 2 from simultaneous treatment and 1 from orthograde retreatment were extracted for root fracture. Twenty-four-month success rate of apical surgery group was 78% (n = 17, apical surgery with simultaneous orthograde retreatment presented 81% (n = 10 and orthograde retreatment success was 80% (n = 24. There was no statistically difference between the groups at 24 months (p = 0.890. Conclusions: Both surgical techniques revealed a high percentage of healing, similar to that reported by previous studies. Apical surgery with simultaneous orthograde retreatment showed a faster healing after 12 months comparing to the control group. Riassunto: Scopo: In

  19. Surgery via natural orifices in human beings: yesterday, today, tomorrow.

    Science.gov (United States)

    Moris, Demetrios N; Bramis, Konstantinos J; Mantonakis, Eleftherios I; Papalampros, Efstathios L; Petrou, Athanasios S; Papalampros, Alexandros E

    2012-07-01

    We performed an evaluation of models, techniques, and applicability to the clinical setting of natural orifice surgery (mainly natural orifice transluminal endoscopic surgery [NOTES]) primarily in general surgery procedures. NOTES has attracted much attention recently for its potential to establish a completely alternative approach to the traditional surgical procedures performed entirely through a natural orifice. Beyond the potentially scar-free surgery and abolishment of dermal incision-related complications, the safety and efficacy of this new surgical technology must be evaluated. Studies were identified by searching MEDLINE, EMBASE, Cochrane Library, and Entrez PubMed from 2007 to February 2011. Most of the references were identified from 2009 to 2010. There were limitations as far as the population that was evaluated (only human beings, no cadavers or animals) was concerned, but there were no limitations concerning the level of evidence of the studies that were evaluated. The studies that were deemed applicable for our review were published mainly from 2007 to 2010 (see Methods section). All the evaluated studies were conducted only in human beings. We studied the most common referred in the literature orifices such as vaginal, oral, gastric, esophageal, anal, or urethral. The optimal access route and method could not be established because of the different nature of each procedure. We mainly studied procedures in the field of general surgery such as cholecystectomy, intestinal cancers, renal cancers, appendectomy, mediastinoscopy, and peritoneoscopy. All procedures were feasible and most of them had an uneventful postoperative course. A number of technical problems were encountered, especially as far as pure NOTES procedures are concerned, which makes the need of developing new endoscopic instruments, to facilitate each approach, undeniable. NOTES is still in the early stages of development and more robust technologies will be needed to achieve reliable

  20. 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.

  1. [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.

  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. Laparoscopic sacrocolpopexy for recurrent pelvic organ prolapse after failed transvaginal polypropylene mesh surgery.

    Science.gov (United States)

    Schmid, Corina; O'Rourke, Peter; Maher, Christopher

    2013-05-01

    A prospective case series to assess the safety and efficacy of laparoscopic sacrocolpopexy for the surgical management of recurrent pelvic organ prolapse (POP) after transvaginal polypropylene mesh prolapse surgery. Between January and December 2010, women with post-hysterectomy recurrent prolapse (≥ stage 2 POP-Q) after transvaginal polypropylene mesh prolapse surgery were included. Perioperative morbidity and short-term complications were recorded and evaluated. Surgical outcomes were objectively assessed utilising the Pelvic Organ Prolapse Quantification system (POP-Q), the validated, condition-specific Australian Pelvic Floor Questionnaire (APFQ) and the Patient Global Impression of Improvement (PGI-I) at 12 months. All 16 women in this study had undergone surgery with trocar-guided transvaginal polypropylene mesh kits. In 75% the recurrent prolapse affected the compartment of prior mesh surgery with the anterior (81%) and apical (75%) compartment prolapse predominating. At a mean follow-up of 12 months, all women had resolution of awareness of prolapse, had transvaginal mesh surgery is feasible and safe. Further widespread evaluation is required.

  4. To dimension safety valves. Probabilist study

    International Nuclear Information System (INIS)

    Noel, Robert; Couvreur, Denis

    1982-01-01

    The gauge of safety valves of a steam pressure apparatus is usually determined according to an operating situation envelope which it is admitted covers all that can happen in reality. For the safety of the dryer-superheaters of turbines in nuclear power stations, Electricite de France and Alsthom-Atlantique made a reliability study; its method is exposed and the results are discussed. Such a study is heavy going and complex, but in return it permits a better quantitative understanding of the various dimension and operating parameters of an installation which condition its safety. It is therefore a source of progress [fr

  5. Influence on ocular surface after cataract surgery and effect of topical diquafosol on postoperative dry eye: a multicenter prospective randomized study

    Science.gov (United States)

    Miyake, Kensaku; Yokoi, Norihiko

    2017-01-01

    Purpose To investigate influences of 3% diquafosol sodium ophthalmic solution (DQS) on ocular surface after cataract surgery and effects on postoperative dry eye. Design This study had two consecutive prospective study phases. The former was an observational study from before cataract surgery to 4 weeks after surgery and the latter was a randomized open-label study from 4 to 8 weeks after surgery. Methods Subjects were 433 eyes of 433 patients undergoing cataract surgery with intraocular lens implantation. Dry eye examination of tear breakup time (BUT), corneal and conjunctival fluorescein staining scores, total subjective symptom score (12 symptoms), and Schirmer I test were conducted before surgery and 4 weeks after surgery. Patient demographics and these examination results were used to analyze risk factors to predict postoperative dry eye. In a randomized study, 154 eyes diagnosed with dry eye postoperatively were applied either DQS or artificial tears (AT) six times daily for 4 weeks. The data of the examinations were compared. Results At 4 weeks after surgery, BUT was shortened significantly (P=0.036), fluorescein staining score increased significantly (P=0.012), but total subjective symptom score was significantly improved (Pdry eye was shortened BUT type (53.1%). The dry eye prevalence after surgery decreased (55.7%) compared with before surgery (69.7%). Females and the patient with dry eye symptoms before surgery had significant risk factors for postoperative dry eye. In a randomized study, BUT was significantly prolonged in the DQS group (P=0.015), but not in the AT group. Fluorescein staining score was significantly improved in both groups (P<0.001). Total subjective symptom score was significantly decreased in the AT group (P<0.001), but not in the DQS group. Conclusion Our study suggests that cataract surgery has harmful effects on tear film stability and ocular surface, and DQS has a capability to improve them. PMID:28360509

  6. The advantages of carbon dioxide laser applications in paediatric oral surgery. A prospective cohort study.

    Science.gov (United States)

    Hanna, R; Parker, S

    2016-11-01

    The aim of this study is to evaluate and demonstrate the advantages of the carbon dioxide laser in paediatric oral surgery patients in terms of less post-operative complications, healing without scaring, functional benefits, positive patient perception and acceptance of the treatment. One hundred fit and healthy paediatric patients (aged 4-15 years) were recruited to undergo laser surgery for different soft tissue conditions. The outcome of these laser treatments was examined. The Wong-Baker Faces Pain Rating Scale was employed to evaluate the pain before, immediately after laser treatment in the clinic and 1 day after post-operatively at home. Post-operative complications and patients' perception and satisfaction were self-reported during a review telephone call the day after treatment. The patients were reviewed 2 weeks after surgery. Laser parameter was 1.62 W, measured by power meter, continuous wave mode with 50 % emission cycle. The beam spot size at the target tissue was 0.8 mm. The pain score pre-operative, during and immediately after laser treatment was rated 0. Whilst the pain score 1 day after surgery was rated between 0 and 2, the healing time was measured over 2 weeks. None of the patients reported post-operative complications after surgery. Patients' perception and acceptance were rated very good. Laser dentistry is a promising field in modern minimally invasive dentistry, which enables provision of better care for children and adolescents. In this cohort study, the use of the carbon dioxide laser therapy offers a desirable, acceptable and minimally invasive technique in the surgical management of soft tissues in paediatric oral surgery with minimal post-operative complications.

  7. A Study on Drug Safety Monitoring Program in India

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    Ahmad, A.; Patel, Isha; Sanyal, Sudeepa; Balkrishnan, R.; Mohanta, G. P.

    2014-01-01

    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. PMID:25425751

  8. Meta-analysis of the efficacy and safety of combined surgery in the management of eyes with coexisting cataract and open angle glaucoma

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    Nan Jiang

    2018-02-01

    Full Text Available AIM: To conduct a systematic review and quantitative Meta-analysis of the efficacy and safety of combined surgery for the eyes with coexisting cataract and open angle glaucoma. METHODS: We performed a systematic search of the related literature in the Cochrane Library, PubMed, EMBASE, Web of Science databases, CNKI, CBM and Wan Fang databases, with no limitations on language or publication date. The primary efficacy estimate was identified by weighted mean difference of the percentage of intraocular pressure reduction (IOPR% from baseline to end-point, the percentage of number of glaucoma medications reduction from pre- to post-operation, and the secondary efficacy evaluations were performed by odds ratio (OR and 95% confidence interval (CI for complete and qualified success rate. Besides, ORs were applied to assess the tolerability of adverse incidents. Meta-analyses of fixed or random effect models were performed using RevMan software 5.2 to gather the consequences. Heterogeneity was evaluated by Chi2 test and the I2 measure. RESULTS: Ten studies enrolling 3108 patients were included. The combined consequences indicated that both glaucoma and combined cataract and glaucoma surgery significantly decreased IOP. For deep sclerectomy vs deep sclerectomy plus phacoemulsification and canaloplasty vs phaco-canaloplasty, the differences in IOPR% were not all statistically significant while trabeculotomy was detected to gain a quantitatively greater IOPR% compared with trabeculotomy plus phacoemulsification. Furthermore, there was no statistical significance in the complete and qualified success rate, and the rates of adverse incidents for trabeculotomy vs trabeculotomy plus phacoemulsification. CONCLUSION: Compared with trabeculotomy plus phacoemulsification, trabeculectomy alone is more effective in lowering IOP and the number of glaucoma medications, while the two surgeries can not demonstrate statistical differences in the complete success rate

  9. Meta-analysis of the efficacy and safety of combined surgery in the management of eyes with coexisting cataract and open angle glaucoma.

    Science.gov (United States)

    Jiang, Nan; Zhao, Gui-Qiu; Lin, Jing; Hu, Li-Ting; Che, Cheng-Ye; Wang, Qian; Xu, Qiang; Li, Cui; Zhang, Jie

    2018-01-01

    To conduct a systematic review and quantitative Meta-analysis of the efficacy and safety of combined surgery for the eyes with coexisting cataract and open angle glaucoma. We performed a systematic search of the related literature in the Cochrane Library, PubMed, EMBASE, Web of Science databases, CNKI, CBM and Wan Fang databases, with no limitations on language or publication date. The primary efficacy estimate was identified by weighted mean difference of the percentage of intraocular pressure reduction (IOPR%) from baseline to end-point, the percentage of number of glaucoma medications reduction from pre- to post-operation, and the secondary efficacy evaluations were performed by odds ratio (OR) and 95% confidence interval (CI) for complete and qualified success rate. Besides, ORs were applied to assess the tolerability of adverse incidents. Meta-analyses of fixed or random effect models were performed using RevMan software 5.2 to gather the consequences. Heterogeneity was evaluated by Chi 2 test and the I 2 measure. Ten studies enrolling 3108 patients were included. The combined consequences indicated that both glaucoma and combined cataract and glaucoma surgery significantly decreased IOP. For deep sclerectomy vs deep sclerectomy plus phacoemulsification and canaloplasty vs phaco-canaloplasty, the differences in IOPR% were not all statistically significant while trabeculotomy was detected to gain a quantitatively greater IOPR% compared with trabeculotomy plus phacoemulsification. Furthermore, there was no statistical significance in the complete and qualified success rate, and the rates of adverse incidents for trabeculotomy vs trabeculotomy plus phacoemulsification. Compared with trabeculotomy plus phacoemulsification, trabeculectomy alone is more effective in lowering IOP and the number of glaucoma medications, while the two surgeries can not demonstrate statistical differences in the complete success rate, qualified success rate, or incidence of adverse

  10. Plastic Surgery Inclusion in the Undergraduate Medical Curriculum: Perception, Challenges, and Career Choice—A Comparative Study

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    M. Farid

    2017-01-01

    Full Text Available Objective. The undergraduate medical curriculum has been overcrowded with core learning outcomes with no formal exposure to plastic surgery. The aim of this study was to compare medical students from two educational settings for the basic understanding, preferred learning method, and factors influencing a career choice in plastic surgery. Design and Setting. A prospective cohort study based on a web-based anonymous questionnaire sent to final year medical students at Birmingham University (United Kingdom, McGill University (Canada, and a control group (non-medical staff. The questions were about plastic surgery: (1 source of information and basic understanding; (2 undergraduate curriculum inclusion and preferred learning methods; (3 factors influencing a career choice. A similar questionnaire was sent to non-medical staff (control group. The data was analysed based on categorical outcomes (Chi-square χ2 and level of significance p≤0.05. Results. Questionnaire was analysed for 243 students (Birmingham, n=171/332, 52% (McGill n=72/132, 54%. Birmingham students (14% considered the word “plastic” synonymous with “cosmetic” more than McGill students (4%, p<0.025. Teaching was the main source of knowledge for McGill students (39%, p<0.001 while Birmingham students and control group chose the media (70%, p<0.001. McGill students (67% more than Birmingham (49%, p<0.010 considered curriculum inclusion. The preferred learning method was lectures for McGill students (61%, p<0.01 but an optional module for Birmingham (61%. A similar proportion (18% from both student groups considered a career in plastic surgery. Conclusions. Medical students recognised the need for plastic surgery inclusion in the undergraduate curriculum. There was a difference for plastic surgery source of information, operations, and preferred method of learning for students. The study highlighted the urgent need to reform plastic surgery undergraduate teaching in

  11. Study Protocol: Early Stereotactic Gamma Knife Radiosurgery to Residual Tumor After Surgery of Newly Diagnosed Glioblastoma (Gamma-GBM).

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    Brehmer, Stefanie; Grimm, Mario Alexander; Förster, Alex; Seiz-Rosenhagen, Marcel; Welzel, Grit; Stieler, Florian; Wenz, Frederik; Groden, Christoph; Mai, Sabine; Hänggi, Daniel; Giordano, Frank Anton

    2018-04-24

    Glioblastoma (GBM) is the most common malignant brain tumor in adult patients. Tumor recurrence commonly occurs around the resection cavity, especially after subtotal resection (STR). Consequently, the extent of resection correlates with overall survival (OS), suggesting that depletion of postoperative tumor remnants will improve outcome. To assess safety and efficacy of adding stereotactic radiosurgery (SRS) to the standard treatment of GBM in patients with postoperative residual tumor. Gamma-GBM is a single center, open-label, prospective, single arm, phase II study that includes patients with newly diagnosed GBM (intraoperative via frozen sections) who underwent STR (residual tumor will be identified by native and contrast enhanced T1-weighted magnetic resonance imaging scans). All patients will receive SRS with 15 Gy (prescribed to the 50% isodose enclosing all areas of residual tumor) early (within 24-72 h) after surgery. Thereafter, all patients undergo standard-of-care therapy for GBM (radiochemotherapy with 60 Gy external beam radiotherapy [EBRT] plus concomitant temozolomide and 6 cycles of adjuvant temozolomide chemotherapy). The primary outcome is median progression-free survival, secondary outcomes are median OS, occurrence of radiation induced acute (3 mo post-SRS) neurotoxicity and incidence of symptomatic radionecrosis. We expect to detect efficacy and safety signals by the immediate application of SRS to standard-of-care therapy in newly diagnosed GBM. Early postoperative SRS to areas of residual tumor could bridge the therapeutic gap between surgery and adjuvant therapies.

  12. Does a robotic surgery approach offer optimal ergonomics to gynecologic surgeons?: a comprehensive ergonomics survey study in gynecologic robotic surgery.

    Science.gov (United States)

    Lee, Mija Ruth; Lee, Gyusung Isaiah

    2017-09-01

    To better understand the ergonomics associated with robotic surgery including physical discomfort and symptoms, factors influencing symptom reporting, and robotic surgery systems components recommended to be improved. The anonymous survey included 20 questions regarding demographics, systems, ergonomics, and physical symptoms and was completed by experienced robotic surgeons online through American Association of Gynecologic Laparoscopists (AAGL) and Society of Robotic Surgery (SRS). There were 289 (260 gynecology, 22 gynecology-oncology, and 7 urogynecology) gynecologic surgeon respondents regularly practicing robotic surgery. Statistical data analysis was performed using the t-test, χ² test, and logistic regression. One hundred fifty-six surgeons (54.0%) reported experiencing physical symptoms or discomfort. Participants with higher robotic case volume reported significantly lower physical symptom report rates (pergonomic settings not only acknowledged that the adjustments were helpful for better ergonomics but also reported a lower physical symptom rate (pergonomic settings (32.7%), took a break (33.3%) or simply ignored the problem (34%). Fingers and neck were the most common body parts with symptoms. Eye symptom complaints were significantly decreased with the Si robot (pergonomics were microphone/speaker, pedal design, and finger clutch. More than half of participants reported physical symptoms which were found to be primarily associated with confidence in managing ergonomic settings and familiarity with the system depending on the volume of robotic cases. Optimal guidelines and education on managing ergonomic settings should be implemented to maximize the ergonomic benefits of robotic surgery. Copyright © 2017. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology

  13. Transesophageal Echocardiography-Guided Epicardial Left Ventricular Lead Placement by Video-Assisted Thoracoscopic Surgery in Nonresponders to Biventricular Pacing and Previous Chest Surgery.

    Science.gov (United States)

    Schroeder, Carsten; Chung, Jane M; Mackall, Judith A; Cakulev, Ivan T; Patel, Aaron; Patel, Sunny J; Hoit, Brian D; Sahadevan, Jayakumar

    2018-06-14

    The aim of the study was to study the feasibility, safety, and efficacy of transesophageal echocardiography-guided intraoperative left ventricular lead placement via a video-assisted thoracoscopic surgery approach in patients with failed conventional biventricular pacing. Twelve patients who could not have the left ventricular lead placed conventionally underwent epicardial left ventricular lead placement by video-assisted thoracoscopic surgery. Eight patients had previous chest surgery (66%). Operative positioning was a modified far lateral supine exposure with 30-degree bed tilt, allowing for groin and sternal access. To determine the optimal left ventricular location for lead placement, the left ventricular surface was divided arbitrarily into nine segments. These segments were transpericardially paced using a hand-held malleable pacing probe identifying the optimal site verified by transesophageal echocardiography. The pacing leads were screwed into position via a limited pericardiotomy. The video-assisted thoracoscopic surgery approach was successful in all patients. Biventricular pacing was achieved in all patients and all reported symptomatic benefit with reduction in New York Heart Association class from III to I-II (P = 0.016). Baseline ejection fraction was 23 ± 3%; within 1-year follow-up, the ejection fraction increased to 32 ± 10% (P = 0.05). The mean follow-up was 566 days. The median length of hospital stay was 7 days with chest tube removal between postoperative days 2 and 5. In patients who are nonresponders to conventional biventricular pacing, intraoperative left ventricular lead placement using anatomical and functional characteristics via a video-assisted thoracoscopic surgery approach is effective in improving heart failure symptoms. This optimized left ventricular lead placement is feasible and safe. Previous chest surgery is no longer an exclusion criterion for a video-assisted thoracoscopic surgery approach.

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

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    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.

  15. Diode Laser Application in Soft Tissue Oral Surgery

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    Azma, Ehsan; Safavi, Nassimeh

    2013-01-01

    Introduction: Diode laser with wavelengths ranging from 810 to 980 nm in a continuous or pulsed mode was used as a possible instrument for soft tissue surgery in the oral cavity. Discussion: Diode laser is one of laser systems in which photons are produced by electric current with wavelengths of 810, 940 and 980nm. The application of diode laser in soft tissue oral surgery has been evaluated from a safety point of view, for facial pigmentation and vascular lesions and in oral surgery excision; for example frenectomy, epulis fissuratum and fibroma. The advantages of laser application are that it provides relatively bloodless surgical and post surgical courses with minimal swelling and scarring. We used diode laser for excisional biopsy of pyogenic granuloma and gingival pigmentation. Conclusion: The diode laser can be used as a modality for oral soft tissue surgery PMID:25606331

  16. Pre-operative anxiety in patients undergoing coronary artery bypass graft surgery – A cross-sectional study

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    C. Ramesh

    Full Text Available Background: Coronary artery bypass graft surgery is an important treatment for the patients with coronary artery disease to reduce angina and enhance the quality of life. Anxiety is a usual reaction to a stressful situation and is existing in patients awaiting surgery. Objective: The objective of the study was to assess pre-operative anxiety in patients who were undergoing coronary artery bypass graft surgery. Methods: A cross-sectional study consisting of 140 patients undergoing coronary artery bypass graft surgery were included in the study using a convenience sampling technique in a tertiary care referral hospital. The data was collected using state-trait anxiety inventory. The data were entered into SPSS (version – 20.0 for windows and descriptive and inferential statistics were performed. Results: The study enrolled 140 (117 males and 23 females patients. Their mean age was 57.29 ± 8.14 (range 35–70 years. Most of the patients 118 (84% had preoperative anxiety before coronary artery bypass graft surgery. There was an association found between gender and anxiety with Pearson chi-square value of 11.57 (p < 0.001. Discussion: Patients undergoing coronary artery bypass graft surgery is experiencing the high level of pre-operative anxiety and females had higher anxiety than the males. Identification of the pre-operative anxiety in patients undergoing CABG surgery is essential because it helps the health professionals and nurses to develop effective and appropriate interventions. Keywords: Preoperative period, Anxiety, Coronary artery bypass, Perioperative care

  17. Workflow interruptions, social stressors from supervisor(s) and attention failure in surgery personnel.

    Science.gov (United States)

    Pereira, Diana; Müller, Patrick; Elfering, Achim

    2015-01-01

    Workflow interruptions and social stressors among surgery personnel may cause attention failure at work that may increase rumination about work issues during leisure time. The test of these assumptions should contribute to the understanding of exhaustion in surgery personnel and patient safety. Workflow interruptions and supervisor-related social stressors were tested to predict attention failure that predicts work-related rumination during leisure time. One hundred ninety-four theatre nurses, anaesthetists and surgeons from a Swiss University hospital participated in a cross-sectional survey. The participation rate was 58%. Structural equation modelling confirmed both indirect paths from workflow interruptions and social stressors via attention failure on rumination (both pworkflow interruptions and social stressors on rumination-could not be empirically supported. Workflow interruptions and social stressors at work are likely to trigger attention failure in surgery personnel. Work redesign and team intervention could help surgery personnel to maintain a high level of quality and patient safety and detach from work related issues to recover during leisure time.

  18. The Patient Safety Attitudes among the Operating Room Personnel

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    Cherdsak Iramaneerat

    2016-07-01

    Full Text Available Background: The first step in cultivating the culture of safety in the operating room is the assessment of safety culture among operating room personnel. Objective: To assess the patient safety culture of operating room personnel at the Department of Surgery, Faculty of Medicine Siriraj Hospital, and compare attitudes among different groups of personnel, and compare them with the international standards. Methods: We conducted a cross-sectional survey of safety attitudes among 396 operating room personnel, using a short form of the Safety Attitudes Questionnaire (SAQ. The SAQ employed 30 items to assess safety culture in six dimensions: teamwork climate, safety climate, stress recognition, perception of hospital management, working conditions, and job satisfaction. The subscore of each dimension was calculated and converted to a scale score with a full score of 100, where higher scores indicated better safety attitudes. Results: The response rate was 66.4%. The overall safety culture score of the operating room personnel was 65.02, higher than an international average (61.80. Operating room personnel at Siriraj Hospital had safety attitudes in teamwork climate, safety climate, and stress recognition lower than the international average, but had safety attitudes in the perception of hospital management, working conditions, and job satisfaction higher than the international average. Conclusion: The safety culture attitudes of operating room personnel at the Department of Surgery, Siriraj Hospital were comparable to international standards. The safety dimensions that Siriraj Hospital operating room should try to improve were teamwork climate, safety climate, and stress recognition.

  19. Complications of Impulse Generator Exchange Surgery for Deep Brain Stimulation: A Single-Center, Retrospective Study.

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    Helmers, Ann-Kristin; Lübbing, Isabel; Birkenfeld, Falk; Witt, Karsten; Synowitz, Michael; Mehdorn, Hubertus Maximilian; Falk, Daniela

    2018-05-01

    Nonrechargeable deep brain stimulation impulse generators (IGs) with low or empty battery status require surgical IG exchange several years after initial implantation. The aim of this study was to investigate complication rates after IG exchange surgery and identify risk factors. We retrospectively analyzed complications following IG exchange surgery from 2008 to 2015 in our department. Medical records of all patients who underwent IG exchange surgery were systematically reviewed. The shortest follow-up time was 19 months. From 2008 to 2015, 438 IGs were exchanged in 319 patients. Overall complication rate was 8.90%. Infection developed in 12 patients (2.74%). Six patients (1.37%) experienced local wound erosions. Hardware malfunctions were present in 11 patients (2.51%), and local hemorrhage was observed in 3 cases (0.68%). Repeated fixation of the IG was required in 2 patients (0.46%). Traction of the connecting cables necessitated surgical revision in 2 patients (0.46%). In 2 cases (0.46%), the IG was placed abdominally or exchanged for a smaller device owing to patient discomfort resulting from the initial positioning. One 80-year-old patient (0.23%) had severely worsening heart failure and died 4 days after IG exchange surgery. IG exchange surgery, although often considered a minor surgery, was associated with a complication rate of approximately 9% in our center. Patients and physicians should understand the complication rates associated with IG exchange surgery because this information might facilitate selection of a rechargeable IG. Copyright © 2018 Elsevier Inc. All rights reserved.

  20. Clinical Performance and Safety of 108 SpineJack Implantations: 1-Year Results of a Prospective Multicentre Single-Arm Registry Study

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    David Noriega

    2015-01-01

    Full Text Available This prospective, consecutive, multicentre observational registry aimed to confirm the safety and clinical performance of the SpineJack system for the treatment of vertebral compression fractures (VCF of traumatic origin. We enrolled 103 patients (median age: 61.6 years with 108 VCF due to trauma, or traumatic VCF with associated osteoporosis. Primary outcome was back pain intensity (VAS. Secondary outcomes were Oswestry Disability Index (ODI, EuroQol-VAS, and analgesic consumption. 48 hours after surgery, a median relative decrease in pain intensity of 81.5% was observed associated with a significant reduction in analgesic intake. Improvements in disability (91.3% decrease in ODI score and in quality of life (increase 21.1% of EQ-VAS score were obtained 3 months after surgery. All results were maintained at 12 months. A reduction in the kyphotic angulation was observed postoperatively (-5.4±6.3°; p<0.001, remained at 12 months (-4.4±6.0°, p=0.002. No adverse events were implant-related and none required device removal. Three patients (2.9% experienced procedure-related complications. The overall adjacent fracture rate up to 1 year after surgery was 2.9%. The SpineJack procedure is an effective, low-risk procedure for patients with traumatic VCF allowing a fast and sustained improvement in quality of life over 1 year after surgery.