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Patient Safety in Surgery Jan 2024Organizational factors may influence surgical outcomes, regardless of extensively studied factors such as patient preoperative risk and surgical complexity. This study... (Review)
Review
BACKGROUND
Organizational factors may influence surgical outcomes, regardless of extensively studied factors such as patient preoperative risk and surgical complexity. This study was designed to explore how operating room organization determines surgical performance and to identify gaps in the literature that necessitate further investigation.
METHODS
We conducted a systematic review according to PRISMA guidelines to identify original studies in Pubmed and Scopus from January 1, 2000 to December 31, 2019. Studies evaluating the association between five determinants (team composition, stability, teamwork, work scheduling, disturbing elements) and three outcomes (operative time, patient safety, costs) were included. Methodology was assessed based on criteria such as multicentric investigation, accurate population description, and study design.
RESULTS
Out of 2625 studies, 76 met inclusion criteria. Of these, 34 (44.7%) investigated surgical team composition, 15 (19.7%) team stability, 11 (14.5%) teamwork, 9 (11.8%) scheduling, and 7 (9.2%) examined the occurrence of disturbing elements in the operating room. The participation of surgical residents appeared to impact patient outcomes. Employing specialized and stable teams in dedicated operating rooms showed improvements in outcomes. Optimization of teamwork reduced operative time, while poor teamwork increased morbidity and costs. Disturbances and communication failures in the operating room negatively affected operative time and surgical safety.
CONCLUSION
While limited, existing scientific evidence suggests that operating room staffing and environment significantly influences patient outcomes. Prioritizing further research on these organizational drivers is key to enhancing surgical performance.
PubMed: 38287316
DOI: 10.1186/s13037-023-00388-3 -
Indian Journal of Ophthalmology Feb 2024Keratoconus is a corneal disorder characterized by the progressive thinning and bulging of the cornea. Currently, the major goal of management is to halt its...
Keratoconus is a corneal disorder characterized by the progressive thinning and bulging of the cornea. Currently, the major goal of management is to halt its progression, restore normal corneal strength, prevent acute complications, and save vision. Penetrating keratoplasty and deep anterior lamellar keratoplasty as conventional surgical methods for advanced keratoconus are limited by relatively high rates of immune intolerance, slow post-operational recovery, high costs, and shortage of donor corneas. Recently, the development of lenticule addition keratoplasty enables the restoration of corneal thickness simply by implanting a lenticule into the stromal pocket created with the femtosecond laser, which can originate from cadaver corneas or more appealing, be extracted from patients via a small-incision lenticule extraction (SMILE) surgery. As the first systematic review in this field, we critically review publications on lenticule addition keratoplasty and provide our perspectives on its clinical application and the focus of future research.
Topics: Humans; Keratoconus; Corneal Transplantation; Cornea; Keratoplasty, Penetrating; Lasers; Corneal Stroma
PubMed: 38271413
DOI: 10.4103/IJO.IJO_695_23 -
Nursing Open Jan 2024The aim of this review was to determine the effectiveness of the e-learning programs for improving the knowledge and professional practices of nursing personnel in... (Meta-Analysis)
Meta-Analysis Review
AIM
The aim of this review was to determine the effectiveness of the e-learning programs for improving the knowledge and professional practices of nursing personnel in managing pressure injuries patients.
DESIGN
Systematic review and meta-analysis.
METHODS
Systematic search was done in EMBASE, SCOPUS, Cochrane library, MEDLINE, Google Scholar, ScienceDirect and Clinicaltrials.gov databases until August 2022. Meta-analysis was carried out using random-effects model, and the results were reported as pooled standardized mean differences (SMD), or odds ratios (OR) with 95% confidence intervals (CIs).
RESULTS
Eight studies were included in the analysis. Most of the studies had higher risk of bias. The pooled SMD for knowledge score and for the classification skill were 1.40 (95%CI: 0.45-2.35; I = 93.1%) and 1.75 (95%CI: 0.94-3.24; I = 78.3%) respectively. The pooled OR for the classification skills was 1.75 (95%CI: 0.94-3.24; I = 78.3%).
PATIENT OR PUBLIC CONTRIBUTION
No patient or public contribution.
Topics: Humans; Clinical Competence; Computer-Assisted Instruction; Nurses; Pressure Ulcer
PubMed: 38268243
DOI: 10.1002/nop2.2039 -
BJS Open Jan 2024Point-of-care tests (POCT) for haemoglobin are increasingly used to guide intraoperative transfusion. However, their accuracy compared to central laboratory tests is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Point-of-care tests (POCT) for haemoglobin are increasingly used to guide intraoperative transfusion. However, their accuracy compared to central laboratory tests is unknown. The objective was to perform a systematic review and meta-analysis of method comparison studies assessing the accuracy of POCT versus central laboratory haemoglobin tests in patients undergoing surgery.
METHODS
Electronic databases were searched from inception to April 2020 (updated August 2023). Any methodological approach comparing haemoglobin measurements between POCT and central laboratory in patients undergoing surgery under anaesthesia in the operating room were included. Data abstraction was guided by PRISMA and risk of bias was assessed by QUADAS-2. Data were extracted independently and in duplicate by two reviewers. Outcomes included mean differences between POCT and central laboratory haemoglobin with associated standard deviations and 95% limits of agreement (LOA).
RESULTS
Of 3057 citations, 34 studies were included (n = 2427, 6857 paired measurements). Several devices were compared (pulse co-oximetry, n = 25; HemoCue, n = 10; iSTAT, n = 6; blood gas analysers, n = 10; haematology analyser, n = 2). Median sample size was 41 patients, and 11 studies were funded by device manufacturers. Fifteen of 34 studies had low risk of bias. Pooled mean differences (95% LOA) were: pulse co-oximeters 2.3 g/l (-25.2-29.8), HemoCue -0.3 g/l (-11.1-10.5), iSTAT -0.3 g/l (-8.4-7.8) and blood gas analysers -2.6 g/l (-17.8-12.7).
CONCLUSION
All POCT examining intraoperative haemoglobin measurement yielded pooled mean difference LOAs larger than the allowable limit difference of ±4 g/dl. Intraoperative haemoglobin measured by POCT should not be considered interchangeable with central laboratory values and caution is necessary when using these tests to guide intraoperative transfusion.
Topics: Humans; Anesthesia; Hemoglobins; Operating Rooms
PubMed: 38266123
DOI: 10.1093/bjsopen/zrad148 -
Annals of Surgery Jun 2024To evaluate the current evidence for surgical sabermetrics: digital methods of assessing surgical nontechnical skills and investigate the implications for enhancing...
OBJECTIVE
To evaluate the current evidence for surgical sabermetrics: digital methods of assessing surgical nontechnical skills and investigate the implications for enhancing surgical performance.
BACKGROUND
Surgeons need high-quality, objective, and timely feedback to optimize performance and patient safety. Digital tools to assess nontechnical skills have the potential to reduce human bias and aid scalability. However, we do not fully understand which of the myriad of digital metrics of performance assessment have efficacy for surgeons.
METHODS
A systematic review was conducted by searching PubMed, EMBASE, CINAHL, and PSYCINFO databases following PRISMA-ScR guidelines. MeSH terms and keywords included "Assessment," "Surgeons," and "Technology". Eligible studies included a digital assessment of nontechnical skills for surgeons, residents, and/or medical students within an operative context.
RESULTS
From 19,229 articles screened, 81 articles met the inclusion criteria. The studies varied in surgical specialties, settings, and outcome measurements. A total of 122 distinct objective, digital metrics were utilized. Studies digitally measured at least 1 category of surgical nontechnical skill using a single (n=54) or multiple objective measures (n=27). The majority of studies utilized simulation (n=48) over live operative settings (n=32). Surgical Sabermetrics has been demonstrated to be beneficial in measuring cognitive load (n=57), situation awareness (n=24), communication (n=3), teamwork (n=13), and leadership (n=2). No studies measured intraoperative decision-making.
CONCLUSIONS
The literature detailing the intersection between surgical data science and operative nontechnical skills is diverse and growing rapidly. Surgical Sabermetrics may provide a promising modifiable technique to achieve desirable outcomes for both the surgeon and the patient. This study identifies a diverse array of measurements possible with sensor devices and highlights research gaps, including the need for objective assessment of decision-making. Future studies may advance the integration of physiological sensors to provide a holistic assessment of surgical performance.
Topics: Humans; Clinical Competence; Operating Rooms; Surgeons
PubMed: 38258573
DOI: 10.1097/SLA.0000000000006211 -
International Journal of Surgery... Apr 2024
Topics: Operating Rooms; Humans
PubMed: 38241303
DOI: 10.1097/JS9.0000000000001093 -
World Journal of Emergency Surgery :... Jan 2024Hemorrhage control is a time-critical task, and recent studies have demonstrated that a shorter time to definitive care is positively associated with patient survival... (Review)
Review
BACKGROUND
Hemorrhage control is a time-critical task, and recent studies have demonstrated that a shorter time to definitive care is positively associated with patient survival and functional outcomes. The concept of direct transport to the operating room was proposed in the 1960s to reduce treatment time. Some trauma centers have developed protocols for direct-to-operating room resuscitation (DOR) programs. Moreover, few studies have reported the clinical outcomes of DOR in patients with trauma; however, their clinical effect in improving the efficiency and quality of care remains unclear. In this systematic review, we aimed to consolidate all published studies reporting the effect of DOR on severe trauma and evaluate its utility.
METHODS
The PubMed, EMBASE, and Cochrane databases were searched from inception to April 2023, to identify all articles published in English that reported the effect of direct-to-operating room trauma resuscitation for severe trauma. The articles were reviewed as references of interest.
RESULTS
We reviewed six studies reporting the clinical effect of operating room trauma resuscitation. A total of 3232 patients were identified. Five studies compared the actual mortality with the predicted mortality using the trauma score and injury severity score, while one study compared mortality using propensity matching. Four studies reported that the actual survival rate for overall injuries was better than the predicted survival rate, whereas two studies reported no difference. Some studies performed subgroup analyses. Two studies showed that the survival rate for penetrating injuries was better than the predicted survival rate, and one showed that the survival rate for blunt injuries was better than the predicted survival rate. Five studies reported the time to surgical intervention, which was within 30 min. Two studies time-compared surgical intervention, which was shorter in patients who underwent DOR.
CONCLUSION
Implementing DOR is likely to have a beneficial effect on mortality and can facilitate rapid intervention in patients with severe shock. Future studies, possibly clinical trials, are needed to ensure a proper comparison of the efficiency.
Topics: Humans; Operating Rooms; Wounds, Penetrating; Wounds, Nonpenetrating; Resuscitation; Shock
PubMed: 38238854
DOI: 10.1186/s13017-023-00532-5 -
The Journal of Hospital Infection Mar 2024Postoperative surgical site infection is a serious problem. Coverage of sterile goods may be important to protect the goods from bacterial air contamination while... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Postoperative surgical site infection is a serious problem. Coverage of sterile goods may be important to protect the goods from bacterial air contamination while awaiting surgery.
AIM
To evaluate the effectiveness of this practice in a systematic review covering five databases using search terms related to bacterial contamination in the operating room and on surgical instruments.
METHODS
MEDLINE, Cochrane, CINAHL, Embase, and Web of Science databases were searched from inception to February 13, 2023, for randomized and non-randomized controlled studies of covering interventions conducted in the operating room setting. The outcome was bacterial air contamination measured as colony-forming units, and a meta-analysis was performed in separate time periods of coverage. This systematic review and meta-analysis is reported according to the PRISMA statement, and the protocol was prospectively registered in PROSPERO (CRD42022323113). The time points ranged from 30 min to 24 h.
FINDINGS
The results showed that covering sterile goods significantly prevented bacterial air contamination as compared to uncovered goods. The meta-analysis was in favour of covering sterile goods for protection from bacterial air contamination, and showed an effect size Z of 4.76 (P<0.00001; confidence interval: -1.94 to -0.81). The heterogeneity analysis showed a heterogeneity of 83%.
CONCLUSION
No negative effects regarding bacterial contamination were found, and so we conclude that protection with a sterile cover decreases bacterial air contamination of sterile goods while waiting for surgery to start.
Topics: Humans; Operating Rooms; Bacteria; Surgical Instruments
PubMed: 38224855
DOI: 10.1016/j.jhin.2023.12.014 -
World Journal of Surgical Oncology Jan 2024Many studies have explored the relationship between C-reactive protein (CRP) levels and survival outcomes in patients with ovarian cancer (OC); however, consistent... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Many studies have explored the relationship between C-reactive protein (CRP) levels and survival outcomes in patients with ovarian cancer (OC); however, consistent results have not been reported. As such, this meta-analysis was performed to accurately assess the prognostic and clinicopathological roles of CRP in OC.
METHODS
The PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched for relevant studies published from inception to April 7, 2023. The effect of CRP level(s) and OC prognostic outcomes was analyzed by computing the combined hazard ratio (HR) and corresponding 95% confidence interval (CI). Thereafter, the association between CRP level(s) and clinicopathological factors was evaluated using a combined odds ratio (OR) and corresponding 95% CI.
RESULTS
The present meta-analysis included 15 studies comprising 3202 subjects. According to the combined data, higher CRP levels were markedly associated with unfavorable overall survival (OS) (HR 1.23 [95% CI 1.11-1.37]; p < 0.001) and progression-free survival (PFS) (HR 1.55 [95% CI 1.30-1.84]; p < 0.001) in patients with OC. Furthermore, the results indicated that high CRP levels were significantly correlated with International Federation of Gynecology and Obstetrics (FIGO) stages III-IV (p < 0.001), residual tumor size ≥ 1 cm (p < 0.001), histological grade 3 (p = 0.040), and ascites volume ≥ 500 mL (p < 0.001).
CONCLUSION
The results of this meta-analysis demonstrated that higher serum CRP levels were strongly associated with dismal OS and PFS in subjects with OC. High CRP levels were also significantly associated with clinical factors implicated in tumor aggressiveness and the development of OC.
Topics: Humans; Female; Prognosis; C-Reactive Protein; Ovarian Neoplasms; Progression-Free Survival; Proportional Hazards Models
PubMed: 38172843
DOI: 10.1186/s12957-023-03290-5 -
Journal of Pediatric Surgery Feb 2024Children born in Sub-Saharan Africa (SSA) have an 85 % risk of requiring surgical care by the age of 15 [1,2]. Yet, children's surgery has been largely neglected by...
The Need for Children's Surgical Care Prioritisation in National Surgical Care Policies: A Systematic Review of National Surgical Obstetric and Anaesthetic Plans (NSOAPs) in Sub-Saharan Africa.
BACKGROUND
Children born in Sub-Saharan Africa (SSA) have an 85 % risk of requiring surgical care by the age of 15 [1,2]. Yet, children's surgery has been largely neglected by global health policies. National Surgical Obstetric and Anaesthetic Plans' (NSOAPs) reflect countries' strategic health priorities, policies, and targets related to surgical care. This study assessed the prioritisation of children's surgical care in national surgical care policies in SSA.
METHODS
This systematic review of national surgical care policies in SSA conducted in December 2022, analysed NSOAPs developed in SSA electronically for search terms "child∗", "pediatric∗", "paediatric∗" and evaluated manually for children's surgical care in relation to the NSOAP domains, health system building blocks, and surgical care. Policies were evaluated for collaboration.
RESULTS
Eight policies met the inclusion criteria. In the 797 (M = 99.63; SD = 34.83) text-containing pages analysed, there were 258 (15.5; 0-164) mentions of children's surgery search terms. Twenty-five percent (n = 2) of the NSOAPs dedicated sections to children's surgical care, 62.5 % (n = 5) mentioned children's surgery, and 12.5 % (n = 1) did not mention children's surgery. Children's surgery received citations in 25 % (n = 2) of backgrounds, 37.5 % (n = 3) of situational analyses, 87.5 % (n = 7) of strategic frameworks, 37.5 % (n = 3) of monitoring and evaluation, and 25 % (n = 2) of the costing sections. Overall, 62.5 % (n = 5) of countries included a children's surgery stakeholder.
CONCLUSION
NSOAPs are a pragmatic measure of national surgical care priorities. Our findings suggest children's surgery is not widely recognised even where commitments to improving surgical care exist. Greater prioritisation of children's surgery is needed in surgical policy development.
Topics: Child; Humans; Africa South of the Sahara; Anesthetics; Global Health; Policy
PubMed: 38135547
DOI: 10.1016/j.jpedsurg.2023.10.040