scholarly journals Evaluation of risk and quality management in a Casablanca operating theatre

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Rigobert Lotoko Kapasa ◽  
Sanaa Belabbes ◽  
Abdelaziz Hannoun ◽  
Radouane Belouali ◽  
Btissam Taybi

Risks at the level of the operating room are permanent and different from one surgical intervention to another. They have diverse sources, hence the importance of risk management concept for a good functioning of the operating room in order to enhance care quality.The recurrent absence of surgical instruments (surgery forceps and other instruments) in their box is still a major problem within the operating room. It often happens during the surgical interventions, whether are major or minor, that the surgical team uses many boxes to fill these lacks.The objective of this study is to help the clinic to establish an ongoing improvement dynamic of processes within the operating room. It is consisted of tracing the steps of management of the patient to be operated, from their first contact with the process staff to their exit from the operating room to the functional unit. With the help of cartography, the connections between the operating room process and the processes of support, the liaison between activities, fluxes and resources are easily understood.The analysis and the prioritization of dominant problems are done according to (SMART) indicators and QQQQCC methodology. The absence of surgical instruments (surgery forceps and other instruments) in their storing boxes was chosen as a dominant problem within this process in complicity with key persons of the operating room and the clinic managers through many meetings.Through the analysis of the causes effects or ishikawa diagram, the weak organizational culture, the competences insufficiency, unsuitable workforce, and the under motivation of staff sterilization service have been recognized as causes of the origin of the problem because it is at the equipment packaging step where the instruments are intertwined.In conclusion, an arsenal of solutions and actions are set up to overcome this problem and as the staff enhancement responsible for sorting and packaging boxes of sterilization (currently only the major is dedicated to these tasks, continuous staff training, a team in charge of monitoring and evaluation of risks and quality within the operating…

2016 ◽  
pp. 39-43
Author(s):  
Dinh Binh Tran ◽  
Dinh Tan Tran

Objective: To study nosocomial infections and identify the main agents causing hospital infections at Hue University Hospital. Subjects and Methods: A cross-sectional descriptive study of 385 patients with surgical interventions. Results: The prevalence of hospital infections was 5.2%, surgical site infection was the most common (60%), followed by skin and soft tissue infections (35%), urinary tract infections (5%). Surgical site infection (11.6%) in dirty surgery. There were 3 bacterial pathogens isolated, including Staphylococcus aureus (50%), Pseudomonas aeruginosa and Enterococcusspp (25%). Conclusion: Surgical site infection was high in hospital-acquired infections. Key words: hospital infections, surgical intervention, surgical site infection, bacteria


2020 ◽  
Author(s):  
Joan Torrent-Sellens ◽  
Ana Jiménez-Zarco ◽  
Francesc Saigí-Rubió

BACKGROUND Increasingly intelligent and autonomous robots are destined to have a huge impact on our society. Their adoption, however, represents a major change to the healthcare sector’s traditional practices, which, in turn, poses certain challenges. To what extent is it possible to foresee a near-future scenario in which minor routine surgery is directed by robots? And what are the patients’ or general public’s perceptions of having surgical procedures performed on them by robots, be it totally or partially? A patient’s trust in robots and AI may facilitate the spread and use of such technologies. OBJECTIVE The goal of our study was to establish the factors that influence how people feel about having a medical operation performed on them by a robot. METHODS We used data from a 2017 Flash Eurobarometer (number 460) of European Commission with 27,901 citizens aged 15 years and over in the 28 countries of the European Union. The research designs and tests a technology acceptance model (TAM). Logistic regression (odds ratios, OR) to model the predictors of trust in robot-assisted surgery was calculated through motivational factors, robots using experience and sociodemographic independent variables. RESULTS The negative relationship between most of the predictors of ease of use, expected benefits and attitude towards robots, and confidence in robot-assisted surgery was contrasted. The only non-sociodemographic predictor variable that has a positive relationship with trust in robots participating in a surgical intervention is previous experience in the use of robots. In this context, we analyze the confidence predictors for three different levels of robot use experience (zero use, average use, and high use). The results obtained indicate that, as the experience of using robots increases, the predictive coefficients related to information, attitude and perception of robots become more negative. Research results also determined that variables of a sociodemographic nature played an important predictive role. It was confirmed that the effect of experience on trust in robots for surgical interventions was greater among men, people between 40 and 54 years old, and those with higher educational levels. CONCLUSIONS Despite the considerable benefits for the patient that the use of robots can bring in a surgical intervention, the results obtained show that trust in robots goes beyond rational decision-making. By contrasting the reasons that generate trust and mistrust in robots, especially by highlighting the experience of use as a key element, the research makes a new contribution to the state of the art and draws practical implications of the use of robots for health policy and practice.


2021 ◽  
Vol 10 (7) ◽  
pp. 1336
Author(s):  
Toshifumi Takahashi ◽  
Shinya Somiya ◽  
Katsuhiro Ito ◽  
Toru Kanno ◽  
Yoshihito Higashi ◽  
...  

Introduction: Cystine stone development is relatively uncommon among patients with urolithiasis, and most studies have reported only on small sample sizes and short follow-up periods. We evaluated clinical courses and treatment outcomes of patients with cystine stones with long-term follow-up at our center. Methods: We retrospectively analyzed 22 patients diagnosed with cystine stones between January 1989 and May 2019. Results: The median follow-up was 160 (range 6–340) months, and the median patient age at diagnosis was 46 (range 12–82) years. All patients underwent surgical interventions at the first visit (4 extracorporeal shockwave lithotripsy, 5 ureteroscopy, and 13 percutaneous nephrolithotripsy). The median number of stone events and surgical interventions per year was 0.45 (range 0–2.6) and 0.19 (range 0–1.3) after initial surgical intervention. The median time to stone events and surgical intervention was 2 years and 3.25 years, respectively. There was a significant difference in time to stone events and second surgical intervention when patients were divided at 50 years of age at diagnosis (p = 0.02, 0.04, respectively). Conclusions: Only age at a diagnosis under 50 was significantly associated with recurrent stone events and intervention. Adequate follow-up and treatment are needed to manage patients with cystine stones safely.


Author(s):  
Ayobobola A. Apampa ◽  
Ayesha Ali ◽  
Bryar Kadir ◽  
Zubair Ahmed

Abstract Purpose The objective of this systematic review is to compare the safety and efficacy of surgical fixation of rib fractures against non-surgical interventions for the treatment of flail chest in the adult population. Methods A search was performed on the 22nd of July 2020 to identify articles comparing surgical fixation versus clinical management for flail chest in adults, with a description of the outcome parameters (resource utility, mortality, adverse effects of the intervention and adverse progression in pulmonary status). Relevant randomised controlled trials were selected, their risk of bias assessed, and the data then extracted and analysed. Results 157 patients were included from four studies in the analyses, with 79 and 78 patients in the surgical and non-surgical groups, respectively. The pooled effects of all outcomes tended towards favouring surgical intervention. Surgical intervention was associated with lower rates of pneumonia (I2 = 46%, Tau2 = 0.16, p = 0.16), significantly lower rates of tracheostomy (I2 = 76%, Tau2 = 0.67, p = 0.02), and a significantly lower duration of mechanical ventilation (I2 = 88%, Tau2 = 33.7, p < 0.01) in comparison to the non-surgical management methods. Conclusion Our results suggest that surgical intervention reduces the need for tracheostomy, reduces the time spent in the intensive care unit following a traumatic flail chest injury and could reduce the risk of acquiring pneumonia after such an event. There is a need for further well-designed studies with sufficient sample sizes to confirm the results of this study and also detect other possible effects of surgical intervention in the treatment of traumatic flail chest in adults.


2006 ◽  
Vol 120 (8) ◽  
pp. 676-680 ◽  
Author(s):  
R W Ridley ◽  
J B Zwischenberger

Tracheoinnominate fistula (TIF) is a rare condition with significant potential for mortality if surgical intervention is not immediate. We present two cases of successfully managed TIF. Both cases involve ligation and resection of the innominate artery at the TIF followed by a pectoralis major muscle flap. In both cases, success was largely due to a high index of suspicion and immediate control of the bleeding with transport to the operating room for surgical repair. The history, aetiology, and pathogenesis of TIF are reviewed, yielding an algorithm for recommended management of TIF.


Arts ◽  
2018 ◽  
Vol 7 (4) ◽  
pp. 59
Author(s):  
José Iglesias

After European audiences had first contact with anime in the late 1970s, animated co-productions between domestic producers and Japanese studios emerged in the early 1980s, playing a lead role in standardizing anime aesthetics and hence contributing to the broader development of anime in Spain and other major European markets. These pioneering co-productions fostered the arrival of Japanese studios to the European broadcasting scene. However, its real impact on the popularization of anime is subject to debate. Appealing to a European audience, these series lacked some of the most recognizable features associated with anime as a larger medium. Nonetheless, in some of these animated productions there was an underlying animesque flair in the shape of conventionalized elements, character design, facial expressions, rhythm, camera action and tropes. Neither entirely domestic nor fully Japanese, these hybrid productions set up a ‘bridge’ between European and American animated visual language and anime mainstream features, thereby shaping the collective idea of what anime is for the first generation of viewers in Spain and Europe.


Author(s):  
Generoso Abes

Consultants and more senior co-resident physicians at the Philippine General Hospital (PGH) would call him “Caloy.” Hardly would I hear anybody (including our ENT department secretary) address him as Dr. Reyes. This was not because he was not a respected faculty member. Rather, he was everybody’s friend and he probably preferred to be addressed by his nickname. Dr. Carlos P. Reyes was a tall, friendly guy, easily recognizable while walking through the short PGH corridor stretching from the old ENT Ward (Ward 3) to the old ENT operating room (OR) called Floor 15, later designated as the PGH Nursing Office. He would almost always be holding either an expensive photography camera, electronic gadget, ENT OR instrument, or car magazines – suggesting his varied interests aside from having good knowledge of Otolaryngology, particularly Otology. He would usually stop and chat with an acquaintance about his new medical or non-medical interests. I first met Dr. Caloy when I was the first year resident assigned to the Otology section. He would call me “Ging” while presenting the ear patients at the outpatient department (OPD) Ear Clinic, only to learn later that he would address all unfamiliar persons by that name. He was kind, helpful and very understanding. Equipped with ample information in Otology he gathered from postgraduate studies abroad, he would selflessly share these with the residents in order to sharpen our diagnostic acumen. He would instruct us to rely on concise yet complete clinical examination, involving audiologic evaluation tools and meager radiologic information in considering differential diagnoses. He was quite willing to assist us in our learning processes, particularly on how to distinguish middle ear from inner ear disorders, and cochlear versus retrocochlear diseases. Since we did not have any audiologist at that time, he admonished us to carry out the needed audiometric evaluations on our ear patients ourselves in order to learn both the techniques of the procedures and their limitations. Hence, after the OPD clinic we would not only perform routine pure tone and speech audiometric tests but also special examinations like the Bekesy test, short increment sensitivity index (SISI) test, alternate binaural loudness balance (ABLB) test and the test for tone decay. We would then discuss the test results during our next ear clinic and we would listen and be amazed at how Dr. Caloy would integrate the information and arrive at the complex diagnosis. Dr. Caloy was our mentor at the time when refinements in tympanoplasty and mastoidectomy aroused the excitement and imagination of budding otologists worldwide. Whereas canal down mastoidectomy was the usual norm to safely remove common mastoid pathology like cholesteatoma, Dr. Caloy introduced the concept of intact canal wall mastoidectomy that avoids or mitigates recurrent postoperative cleaning of the mastoid bone. The period was also the dawn of neuro-otology when Dr. William House popularized the transmastoid approach for acoustic neuroma and the endolymphatic mastoid shunt as treatment for Meniere’s disease. In order to teach us the anatomical and surgical principles of performing these procedures, Dr. Caloy set up the first temporal bone dissection laboratory in the country at the mezzanine above the ENT conference room. He would offer the course to all ENT residents-in-training and consultants nationwide. He practically revolutionized the method of otologic surgery by requiring ENT surgeons to practice doing ear surgery in the temporal bone dissection lab prior to performing ear surgeries in the operating room. In addition, he advocated the use of the operating microscope and dental drills in place of the old bone gouges, chisels and bone ronguers. His ideas were later adopted by other ENT training institutions as we see today. The requirement that every ENT resident must undergo temporal bone dissection in the course of his training obviously stemmed from the efforts of Dr. Caloy. Many senior ENT consultants who are still with us today were former students of Dr. Caloy in his temporal bone lab Unfortunately, before finishing my residency training, Dr Caloy expeditiously left the PGH ENT department for unknown reasons. He then set up his private clinic in Quezon City and later joined the ENT department of University of Santo Tomas. Reflecting on the significant yet probably unknown achievements of Dr. Caloy toward the advancement of otology and neuro-otology in our country, I realize how blessed I was to be one of his students during that brief period when he was still with us at UP-PGH. With our profound gratitude Sir, we will always remember you.


Author(s):  
Aruna Mahanta ◽  
Keshav Saran Agrawal

Background: most of the gynaecological interventions are generally done under regional anaesthesia. Currently dexmedetomidine came out as a beneficial adjunct for regional analgesia as well as anaesthesia. It is a highly selective α-2 agonist. Aims & objectives: to compare the effects & behavior of dexmedetomidine with clonidine when both are used with bupivacaine for spinal analgesia. Material and Methods: 100 cases of ASA grade 1 & 2 who were undergoing elective gynaecological surgical intervention were studied. They were divided into two groups (50 each). Group I received combination of bupivacaine & clonidine while group II received combination of bupivacaine + dexmedetomidine. Results: Average duration of onset of sensory block was earlier in group II. Arrival of motor block in Group I was slightly on lower side than Group II. Ten cases in Group I and eighteen cases from group II had notable bradycardia and hypotension. Discussion: Our study concludes that dexmedetomidine when used in combination with bupivacaine is very effective in gynaecological surgical interventions that demand longer duration & have comparatively lesser side effects. Keywords: dexmedetomidine, clonidine, Bupivacaine, gynaecological procedures.


Author(s):  
Patricia Egan ◽  
Anthony Pierce ◽  
Audrey Flynn ◽  
Sean Paul Teeling ◽  
Marie Ward ◽  
...  

Healthcare systems internationally are working under increasing demand to use finite resources with greater efficiency. The drive for efficiency utilises process improvement methodologies such as Lean Six Sigma. This study outlines a pilot Lean Six Sigma intervention designed to release nursing time to care within a peri-operative environment; this was achieved by collaborating with stakeholders to redesign the process for laparoscopic hernia surgical case preparation (set up) material. Across 128 laparoscopic hernia surgical cases, the pilot resulted in a 55% decrease in overall nursing time spent in gathering and preparing materials for laparoscopic hernia surgical cases, with a corresponding reduction in packaging waste. The major impact of releasing nursing time to care within busy Operating Room environments enabled nurses to focus on continuing to deliver high-quality care to their patients and reduce pressure expressed by the Operating Room nurses. The results have led to an ongoing review of other surgical procedures preparation to further release nursing time and will be of interest to perioperative teams internationally.


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