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Healthcare (Basel, Switzerland) May 2024Open surgery relies heavily on the surgeon's visual acuity and spatial awareness to track instruments within a dynamic and often cluttered surgical field.
BACKGROUND
Open surgery relies heavily on the surgeon's visual acuity and spatial awareness to track instruments within a dynamic and often cluttered surgical field.
METHODS
This system utilizes a head-mounted depth camera to monitor surgical scenes, providing both image data and depth information. The video captured from this camera is scaled down, compressed using MPEG, and transmitted to a high-performance workstation via the RTSP (Real-Time Streaming Protocol), a reliable protocol designed for real-time media transmission. To segment surgical instruments, we utilize the enhanced U-Net with GridMask (EUGNet) for its proven effectiveness in surgical tool segmentation.
RESULTS
For rigorous validation, the system's performance reliability and accuracy are evaluated using prerecorded RGB-D surgical videos. This work demonstrates the potential of this system to improve situational awareness, surgical efficiency, and generate data-driven insights within the operating room. In a simulated surgical environment, the system achieves a high accuracy of 85.5% in identifying and segmenting surgical instruments. Furthermore, the wireless video transmission proves reliable with a latency of 200 ms, suitable for real-time processing.
CONCLUSIONS
These findings represent a promising step towards the development of assistive technologies with the potential to significantly enhance surgical practice.
PubMed: 38891187
DOI: 10.3390/healthcare12111112 -
BMJ Case Reports Jun 2024We introduce the case of a male patient in his 60s who was admitted to our emergency department with a persisting sore throat for the last 3 weeks and dysphagia....
We introduce the case of a male patient in his 60s who was admitted to our emergency department with a persisting sore throat for the last 3 weeks and dysphagia. Fibre-endoscopic evaluation revealed an asymmetry at the base of the tongue. In combination with elevated white cell count and C reactive protein, a computerized tomography showed a superinfected thyroglossal duct cyst. Intravenous antibiotics were initiated, and the patient was taken to the operating room for cervicotomy. The microbiological swab taken intraoperatively detected Additional imaging revealed disseminated nocardiosis with cerebral and pulmonary manifestations.The patient was treated with oral trimethoprim/sulfamethoxazole and, over time, showed complete remission of central nervous system lesions and improvement of pulmonary involvement. Following this, the treatment was stopped 8 months after the initial diagnosis. In this report, we discuss treatment standards and outcomes of nocardiosis based on our management strategies of our patient.
Topics: Humans; Male; Nocardia Infections; Thyroglossal Cyst; Middle Aged; Anti-Bacterial Agents; Trimethoprim, Sulfamethoxazole Drug Combination; Diagnosis, Differential; Tomography, X-Ray Computed; Nocardia
PubMed: 38890116
DOI: 10.1136/bcr-2024-259725 -
Interdisciplinary Cardiovascular and... Jun 2024Evaluate theoretical and practical training of thoracic surgeons-in-training in robotic-assisted thoracic surgery (RATS) in France.
OBJECTIVES
Evaluate theoretical and practical training of thoracic surgeons-in-training in robotic-assisted thoracic surgery (RATS) in France.
METHODS
A survey was distributed to thoracic surgeons-in-training in France from November 2022-February 2023.
RESULTS
We recruited 101 thoracic surgeons-in-training (77% response rate). Over half had access to a surgical robotics system at their current institution. Most (74%) considered robotic surgery training essential, 90% had attended a robotic procedure. Only 18% had performed a complete thoracic robotic procedure as the main operator. 42% of fellows and 6% of residents had performed a complete RATS procedure. Of the remaining surgeons, 23% had performed part of a robotic procedure. Theoretical courses and simulation are well developed; 72% of residents and 91% of fellows had undergone simulation training in the operating room, at training facilities, or during congress amounting to < 10 hours (for 73% of the fellows and residents), 10-20 hours (17%), 20-30 hours (8%), or > 30 hours (3%). Access to RATS was ≥1 day/week in 71% of thoracic departments with robotic access. Fellows spent a median of 2 (IQR 1-3) semesters in departments performing robotic surgery. Compared with low-volume centers, trainees at high-volume centers performed significantly more complete robotic procedures (47% vs 13%; p = 0.001), as did fellows compared with residents.
CONCLUSIONS
Few young surgeons perform complete thoracic robotic procedures during practical training, and access remains center dependent. Opportunities increase with seniority and exposure; however, increasing availability of robotic devices, theoretical formation, and simulation courses will increase opportunities.
PubMed: 38889287
DOI: 10.1093/icvts/ivae115 -
Anesthesiology Jun 2024The imbalance in anesthesia workforce supply and demand has been exacerbated post-COVID due to a surge in demand for anesthesia care, especially in non-operating room...
The imbalance in anesthesia workforce supply and demand has been exacerbated post-COVID due to a surge in demand for anesthesia care, especially in non-operating room anesthetizing sites, at a faster rate than the increase in anesthesia clinicians. The consequences of this imbalance or labor shortage compromise healthcare facilities, adversely affect the cost of care, worsen anesthesia workforce burnout, disrupt procedural and surgical schedules, and threaten academic missions and the ability to educate future anesthesiologists. In developing possible solutions, one must examine emerging trends that are affecting the anesthesia workforce, new technologies that will transform anesthesia care and the workforce, and financial considerations, including governmental payment policies. Possible practice solutions to this imbalance will require both short- and long-term multifactorial approaches that include increasing training positions and retention policies, improving capacity through innovations, leveraging technology, and addressing financial constraints.
PubMed: 38884582
DOI: 10.1097/ALN.0000000000005052 -
The Israel Medical Association Journal... Jun 2024Left ventricular assist devices (LVAD) are a staple element in contemporary treatment of advanced heart failure. LVAD surgeries are mostly done in heart transplantations...
BACKGROUND
Left ventricular assist devices (LVAD) are a staple element in contemporary treatment of advanced heart failure. LVAD surgeries are mostly done in heart transplantations centers, as a destination therapy or as a bridge to heart transplantation.
OBJECTIVES
To describe our step-by-step experience in establishing and implementing a new LVAD program in a non-heart transplant center. To give insight to our short- and long-term results of our first 25 LVAD patients.
METHODS
Preliminary steps included identifying the need for a new program and establishing the leading team. Next is defining protocols for pre-operative evaluation, operating room, post-operative management, and outpatient follow-up. The leading team needs to educate other relevant units in the hospital that will be involved in the care of these patients. It is essential to work in collaboration with a heart transplant center from the very beginning. Patient selection is of major importance especially in the early experience. Initially "low risk" patients should be enrolled.
RESULTS
We describe our first 25 LVAD patients. Our first five patients all survived beyond 2 years, with no major complications. Overall, there was one operative death due to massive GI bleeding. There were four late deaths due to septic events.
CONCLUSIONS
Establishing a new LVAD program can be successful also with small- and medium-size programs. With careful and meticulous planning LVAD implantation can be extended to more centers thus offering an excellent solution for advanced heart failure patients.
Topics: Humans; Heart-Assist Devices; Heart Failure; Male; Middle Aged; Female; Adult; Patient Selection; Program Development; Treatment Outcome
PubMed: 38884307
DOI: No ID Found -
MethodsX Jun 2024Follicle culture is a process of dividing follicle unit structures from ovaries for continued culture in an incubator, which simulates the environment. Alginate gel is...
Follicle culture is a process of dividing follicle unit structures from ovaries for continued culture in an incubator, which simulates the environment. Alginate gel is the most stable and most convenient 3D material currently used in follicle culture. We performed follicle culture following the standard operating procedure recommended by the Follicle Handbook and we have summarized our experience and skills in details. Through several experiments, we found only follicles tightly surrounded by theca cells can grow healthily until the preovulatory stage. In addition, the hardness of alginate gel is crucial for constructing the 3D culture system, and selecting appropriate tools can reduce damage to the alginate gel and shorten the time follicles are exposed to room temperature. Our detailed operation improves bioavailability and provides a more natural environment for the entire process of follicular growth.•Alginate gel is still the most suitable 3D material used for follicle culture.•Follicle integrity and the hardness of alginate gel are the keys for culture.•Detailed operation steps better protect the follicular microenvironment and improve bioavailability.
PubMed: 38883585
DOI: 10.1016/j.mex.2024.102756 -
American Journal of Translational... 2024To evaluate the effect of thermal insulation nursing in the operating room on preventing hypothermia during laparoscopic radical resection of colorectal cancer.
OBJECTIVE
To evaluate the effect of thermal insulation nursing in the operating room on preventing hypothermia during laparoscopic radical resection of colorectal cancer.
METHODS
Sixty colorectal cancer patients undergoing laparoscopic radical resection from June 2022 to August 2023 were included. The research group received thermal insulation nursing interventions using medical heaters and infusion heaters, while the control group received routine nursing measures. Clinical data including vital signs, intraoperative and postoperative complications, recovery time, nursing satisfaction, and psychological and sleep status were compared between the two groups.
RESULTS
Thirty minutes after skin incision, both groups showed decreased body temperature, and systolic and diastolic blood pressure compared to pre-surgery levels, with no significant difference between groups (P > 0.05). However, the research group exhibited lower rates of intraoperative hypothermia, postoperative infection, and other complications, as well as shorter postoperative recovery times, hospital stays, anxiety, and depression scores compared to the control group (P < 0.05). Additionally, the research group demonstrated higher comfort scores, shorter sleep latency, longer actual sleep time, and higher nursing satisfaction rate (P < 0.05).
CONCLUSION
Thermal insulation nursing intervention in the operating room during laparoscopic radical resection of colorectal cancer contributes to maintaining vital signs, preventing intraoperative hypothermia, reducing postoperative complications, expediting recovery, and improving psychological well-being and sleep quality. This intervention enhances patient comfort and nursing satisfaction in perioperative care.
PubMed: 38883388
DOI: 10.62347/BKBY6649 -
Cureus May 2024Medical research aims to improve patient safety and efficiency in the perioperative setting. One critical aspect of patient safety is the intrahospital transfer of...
BACKGROUND
Medical research aims to improve patient safety and efficiency in the perioperative setting. One critical aspect of patient safety is the intrahospital transfer of patients. Also, reliable monitoring of vital signs is crucial to support the medical staff. This study was conducted to assess two monitoring systems in terms of the handover time and staff satisfaction.
METHODS
To assess several aspects, two monitoring systems were compared: an organizational unit-related monitoring system that needs to be changed and brought back to the initial organizational unit after the patient transfer and a patient-specific monitoring system that accompanies the patient during the whole perioperative process.
RESULTS
In total, 243 patients were included, and 375 transfers were examined to analyze economic factors, including differences in handover times and user-friendliness. To this end, 30 employees of the Heidelberg University Hospital were asked about their satisfaction with the two monitoring systems based on a systematic questionnaire. It could be shown that, especially during transfers from the operating theater to the intensive care unit or the recovery room, the time from arrival to fully centralized monitoring and the total handover time were significantly shorter with the patient-specific monitoring system (p < 0.001). Furthermore, the staff was more satisfied with the patient-specific monitor system in terms of flexibility, cleanability and usability.
CONCLUSION
The increased employee satisfaction and significant time benefits during intrahospital transports may increase patient safety and efficiency of patient care, reduce employee workload, and reduce costs in the overall context of patient care.
PubMed: 38883109
DOI: 10.7759/cureus.60481 -
Cureus May 2024Suboptimal teamwork in the operating room (OR) is a contributing factor in a significant proportion of preventable complications for surgical patients. Specifying... (Review)
Review
Suboptimal teamwork in the operating room (OR) is a contributing factor in a significant proportion of preventable complications for surgical patients. Specifying behaviour is fundamental to closing evidence-practice gaps in healthcare. Current teamwork interventions, however, have yet to be synthesized in this way. This scoping review aimed to identify actionable strategies for use during surgery by mapping the existing literature according to the Action, Actor, Context, Target, Time (AACTT) framework. The databases MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), Cochrane, Scopus, and PsycINFO were searched from inception to April 5, 2022. Screening and data extraction were conducted in duplicate by pairs of independent reviewers. The search identified 9,289 references after the removal of duplicates. Across 249 studies deemed eligible for inclusion, eight types of teamwork interventions could be mapped according to the AACTT framework: bundle/checklists, protocols, audit and feedback, clinical practice guidelines, environmental change, cognitive aid, education, and other), yet many were ambiguous regarding the actors and actions involved. The 101 included protocol interventions appeared to be among the most actionable for the OR based on the clear specification of ACCTT elements, and their effectiveness should be evaluated and compared in future work.
PubMed: 38883070
DOI: 10.7759/cureus.60522 -
Heliyon Jun 2024To develop and evaluate a nomogram prediction model for recurrence of acute ischemic stroke (AIS) within one year.
OBJECTIVE
To develop and evaluate a nomogram prediction model for recurrence of acute ischemic stroke (AIS) within one year.
METHOD
Patients with AIS treated at the second affiliated hospital of Xuzhou Medical University from August 2017 to July 2019 were enrolled. Clinical data such as demographic data, risk factors, laboratory tests, TOAST etiological types, MRI features, and treatment methods were collected. Cox regression analysis was done to determine the parameters for entering the nomogram model. The performance of the model was estimated by receiver operating characteristic curves, decision curve analysis, calibration curves, and C-index.
RESULT
A total of 645 patients were enrolled in this study. Side of hemisphere (SOH, Bilateral, HR = 0.35, 95 % CI = 0.15-0.84, p = 0.018), homocysteine (HCY, HR = 1.38, 95 % CI = 1.29-1.47, p < 0.001), c-reactive protein (CRP, HR = 1.04, 95 % CI = 1.01-1.07, p = 0.013) and stroke severity (SS, HR = 3.66, 95 % CI = 2.04-6.57, p < 0.001) were independent risk factors. The C-index of the nomogram model was 0.872 (se = 0.016). The area under the receiver operating characteristic (ROC)curve at one-year recurrence was 0.900. Calibration curve, decision curve analysis showed good performance of the nomogram. The cutoff value for low or high risk of recurrence score was 1.73.
CONCLUSION
The nomogram model for stroke recurrence within one year developed in this study performed well. This useful tool can be used in clinical practice to provide important guidance to healthcare professionals.
PubMed: 38882377
DOI: 10.1016/j.heliyon.2024.e32176