The Analysis of the Intraoperative Complications During the Transitional Period from In-patient Cataract Surgery to Ambulatory Day Surgery

Purpose: To report the incidence of posterior capsular rupture (PCR) of phacoemulsification and the contributing factors during the transitional period from in-patient model to ambulatory day surgery model. Method: The medical records and intraoperative complication reports were systemically reviewed during the period of August 2015 to October 2020. The PCR rate was analyzed according to the following factors: type of surgery (day surgery vs. in-patient surgery), gender, age, surgery performed in the month containing long holiday (Chinese New Year and National day), surgery performed in the first month of the residents’ rotation, increase of surgical volume comparing to the previous month, stage of the day surgery transition and whether it was before or after the implementation of safety recommendation based on clinical audit results in January 2018. The univariable logistic regression model was initially performed.Results: Within the study period, 29 493 cases of phacoemulsification surgery were enrolled in the study, 14 451 of them were performed as day surgery while 15 042 of them were inpatient surgery. The overall incidence of PCR was 1.17% (346 cases) among the 29 493 planned phacoemulsification surgery. The increase incidence of PCR was associated with older age and male gender. The incidence of PCR decreased significantly after the implementation of safety recommendations. Conclusion: The ambulatory day surgery for cataract patients could provide safe, efficient, and quality services. During the transitional period from in-patient to day surgery, careful planning and organization with dynamic clinical audit surveillance can further reduce the incidence of intraoperative complications, especially intraoperative PCR.

A Taxonomy of container security on computational clouds: concerns and solutions

VirtualizationincloudcomputinghasbeenusedincombinationwithenvironmentsPlatformas a Service (PaaS) and Infrastructure as a Service (IaaS) in order to provide performance, isolation, and scalability. However, containers and virtual machines (VMs) are susceptible to the vulnerabilities present in the core of operating system as well as container solutions, which are a risk for information and service operation of all entities sharing a same host. The safety recommendation guides aims to mitigate the security in this scenario, but the selection of containerization solutions taking into account security requirements is a complex task. Thus, we propose a security taxonomy focused on containers to cloud computing in order to assist the classification and evaluation containers security mechanisms and solutions.

Seeing the Big Picture of Mishaps

The analysis of major accidents in safety-critical systems requires a “big-picture” approach, with the capacity to accommodate contributing factors from within the organisations involved and from dysfunctional interactions between different parts of the broader system. Rasmussen’s AcciMap approach is useful in this regard, as it illustrates how multiple factors throughout the system combined to produce an accident. This article describes the application of this technique to the Überlingen mid-air collision and draws on this application to discuss the benefits of the AcciMap Approach. These include its capacity to incorporate contributing factors from all system levels and illustrate their interrelationships succinctly; to depict the activities of front-line workers within the context in which they occurred; and to aid safety recommendation development.