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Cureus May 2024Introduction The World Health Organization (WHO) Safe Surgery Checklist significantly decreases morbidity and mortality in regular operating room cases. However,...
Adaptation of the World Health Organization (WHO) Safe Surgery Checklist for Use With Cesarean Sections: Implementation and Outcomes With the Safe Cesarean Section Checklist.
Introduction The World Health Organization (WHO) Safe Surgery Checklist significantly decreases morbidity and mortality in regular operating room cases. However, significant differences in workflow and processes exist between regular operating room cases and cesarean sections performed on the labor and delivery unit. The aim of this study is to adapt the WHO Safe Surgery Checklist for the labor and delivery unit and cesarean sections to improve communication and patient safety. Methods A multidisciplinary team consisting of all major stakeholders reviewed and revised the WHO Safe Surgery Checklist making it more applicable to cesarean section operations. The new Safe Cesarean Section Checklist was tested and then integrated into the electronic medical record and utilized on the labor and delivery unit. A specific cesarean section safety attitudes questionnaire was developed, validated, and administered prior to and one year after implementation. Results Usage of the Safe Cesarean Section Checklist was greater than 95% after initial implementation. Significant improvements were reported by the staff on the cesarean section attitudes questionnaire for several key areas including the feeling that all necessary information was available at the beginning of the procedure, decreases in communication breakdowns and delays, and fewer issues related to not knowing who was in charge during the procedure. Discussion Implementation of the Safe Cesarean Section Checklist was successfully adopted by the staff, and improvements in staff perceptions of several key safety issues on our unit were demonstrated. Additional studies should be undertaken to determine if clinical outcomes from this intervention are comparable to those seen with the use of the WHO Safe Surgery Checklist.
PubMed: 38947575
DOI: 10.7759/cureus.61330 -
Heliyon Jun 2024This work aimed to investigate the adoption value of blood lactic acid (BLA) combined with the National Early Warning Score (NEWS) in the early screening of sepsis...
This work aimed to investigate the adoption value of blood lactic acid (BLA) combined with the National Early Warning Score (NEWS) in the early screening of sepsis patients and assessing their severity. The data and materials utilized in this work were obtained from the electronic medical record system of 537 anonymized sepsis patients who received emergency rescue in the emergency rescue area of Liuzhou People's Hospital, Guangxi, from July 1, 2020, to December 26, 2020. Based on the 28-day outcomes of sepsis patients, the medical records were rolled into Group S (407 survival cases) and Group D (130 dead cases). Basic information such as the mode of hospital admission, initial management, use of emergency ventilator within 24 h of admission, NEWS score, arterial oxygen pressure/alveolar oxygen pressure ratio (PaO/PAO), alveolar-arterial oxygen difference (A-aDO), serum creatinine (SCr), blood urea nitrogen (BUN), oxygenation index (OI), Glasgow Coma Scale (GCS), D-dimer, use of vasoactive drugs within 24 h of admission, C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), N-terminal pro-B-type natriuretic peptide (NT-proBNP), quick Sequential Organ Failure Assessment (qSOFA) score, SOFA score, BLA level, NEWS with lactate (NEWS-L) score, SOFA score including lactate level (SOFA-L) score, Intensive Care Unit (ICU) length of stay, total hospital stay, ICU stay/total hospital stay, and septic shock condition were compared between groups. Logistic regression analysis was performed to assess the impact of various predictive factors on prognosis and to plot the receiver operating characteristic (ROC) curve. The results suggested marked differences between Group S and Group D in terms of mean age ( = -5.620; OR = -9.96, 95 % CI: -13.44∼-6.47; < 0.001). Group S showed drastic differences in terms of mode of hospital admission (χ = 9.618, < 0.01), method of initial management (χ = 51.766, < 0.001), use of emergency ventilator within 24 h of admission (χ = 98.564, < 0.001), incidence of septic shock (χ = 77.545, < 0.001), use of vasoactive drugs within 24 h of admission (χ = 102.453, < 0.001), heart rate ( = -4.063, < 0.001), respiratory rate ( = -4.758, < 0.001), oxygenation status (χ = 20.547, < 0.001), NEWS score ( = -6.120, < 0.001), PaO/PAO ratio ( = 2.625, < 0.01), A-aDO value ( = -3.581, < 0.001), OI value ( = -3.106, < 0.01), PLT value ( = -2.305, < 0.05), SCr value ( = -3.510, < 0.001), BUN value ( = -3.170, < 0.01), D-dimer ( = -4.621, < 0.001), CRP level ( = -4.057, < 0.001), PCT value ( = -2.783, < 0.01), IL-6 level ( = -2.904, < 0.001), length of hospital stay ( = -4.138, < 0.001), total hospital stay ( = -8.488, < 0.001), CCU/total hospital stay ( = -9.118, < 0.001), NEWS score ( = -6.120, < 0.001), SOFA score ( = -6.961, < 0.001), SOFA-L score ( = -4.609, < 0.001), NEWS-L score ( = -5.845, < 0.001), BLA level ( = -6.557, < 0.001), and GCS score ( = 6.909, < 0.001) when compared to Group D. The use of ventilators, septic shock, PCT, NEWS score, GCS score, SOFA score, SOFA-L score, NEWS-L score, and BLA level were identified as independent risk factors for predicting the prognosis of sepsis patients ( < 0.001). The areas under ROC curve (AUC) of blood lactic acid, PCT, NEWS, NEWS-L, GCS, SOFA, and SOFA-L were 0.695, 0.665, 0.692, 0.698, 0.477, 0.700, and 0.653, respectively. These findings indicate that the combination of BLA with NEWS (NEWS-L) score and SOFA score has certain advantages in assessing the prognosis of sepsis.
PubMed: 38947447
DOI: 10.1016/j.heliyon.2024.e31907 -
European Review For Medical and... Jun 2024The mini-fluid challenge (MFC), which assesses the change in stroke volume index (SVI) following the administration of 100 mL of crystalloids, and the short-time low... (Observational Study)
Observational Study Comparative Study
Comparison of the ability of short time low PEEP challenge and mini fluid challenge to predict fluid responsiveness in patients undergoing open pancreaticoduodenectomy: an observational cohort study.
OBJECTIVE
The mini-fluid challenge (MFC), which assesses the change in stroke volume index (SVI) following the administration of 100 mL of crystalloids, and the short-time low positive end-expiratory pressure (PEEP) challenge (SLPC), which evaluates the temporary reduction in SVI due to a PEEP increment, are two functional hemodynamic tests used to predict fluid responsiveness in the operating room. However, SLPC has not been assessed in patients undergoing abdominal surgery, and there is no study comparing these two methods during laparotomy. Therefore, we aimed to compare the SLPC and MFC in patients undergoing open pancreaticoduodenectomy.
PATIENTS AND METHODS
All patients received a standard hemodynamic management. The study protocol evaluated the percentage change in SVI following the application of an additional 5 cmH2O PEEP (SVIΔ%-SLPC) and the infusion of 100 mL crystalloid (SVIΔ%-MFC). Challenges that resulted in an increase of more than 15% in SVI after the 500 ml of fluid loading were classified as positive challenges (PC). Areas under the receiver operating characteristics curves (ROC AUCs) were used for the comparison of the methods.
RESULTS
Thirty-three patients completed the study with 94 challenges. Fifty-five (58.5%) of them were PCs. The ROC AUC of SVIΔ%-MFC was observed to be significantly higher than that of SVIΔ%-SLPC (0.97 vs. 0.64, p < 0.001). The best cut-off value for SVIΔ%-MFC was 5.6%. If we had stopped the bolus fluid administration when SVIΔ%-MFC ≤ 5% was observed (lower limit of the gray zone), we would have postponed the fluid loading in 35 (89.7%) of 39 negative challenges. The amount of fluid deferred would have corresponded to up to 40% of the total fluid given.
CONCLUSIONS
SVIΔ%-MFC predicts fluid responsiveness with high diagnostic performance and is better than SVIΔ%-SLPC in patients undergoing open pancreatoduodenectomy. Additionally, the use of SVIΔ%-MFC has the potential to defer up to 40% of the total fluid given.
CLINICALTRIALS
gov: NCT05419570.
Topics: Humans; Pancreaticoduodenectomy; Fluid Therapy; Male; Female; Aged; Positive-Pressure Respiration; Middle Aged; Cohort Studies; Crystalloid Solutions; Stroke Volume
PubMed: 38946384
DOI: 10.26355/eurrev_202406_36463 -
European Review For Medical and... Jun 2024The use of scoring systems contributes to the faster identification of septic patients, especially those at a high risk of a fatal outcome. The best scoring system does... (Observational Study)
Observational Study
OBJECTIVE
The use of scoring systems contributes to the faster identification of septic patients, especially those at a high risk of a fatal outcome. The best scoring system does not exist, so the search for the optimal one is always current. The aim of this study is to estimate the prognostic value of the six scoring systems in predicting 24-hour mortality among septic patients presented at the emergency department.
PATIENTS AND METHODS
An observational retrospective study was conducted in the Emergency Triage Room (ETR) of the Emergency Center (EC) at the University Clinical Center of Serbia (UCCS) in Belgrade. Consecutive septic patients, according to the Sepsis-3 definition, with or without shock, presented to the ETR and then hospitalized in Intensive Care Units were included in the study. Mortality data within 24 h and on the 28th day were extracted from the Hospital information system or the National mortality database. Scoring systems including sequential organ failure assessment (SOFA), quick sequential organ failure assessment (qSOFA), systemic inflammatory response syndrome (SIRS), National early warning score (NEWS), sepsis patient evaluation in the emergency department (SPEED), and mortality in emergency department sepsis (MEDS) were analyzed for all patients utilizing the available data. The primary outcome of this study was death within 24 hours of triage. Receiver operating characteristic (ROC) analysis was used to determine the most effective scoring system. Lactate was then added to this system to enhance its predictive accuracy.
RESULTS
Nineteen out of 120 patients included in the study (15.8%) experienced death within 24 hours of triage. The twenty-eight-day mortality rate was 55%. SOFA score demonstrated the highest predictive value for 24-hour mortality but was only moderately predictive overall, with an area under the receiver operating curve (AUC) of 0.755 (95% CI 0.625-0.885). SPEED, MEDS, and NEVS exhibited modest discriminatory power [0.673 (95% CI 0.543-0.803), 0.665 (95% CI 0.536-0.794), 0.630 (95% CI 0.528-0.724)], while SIRS and qSOFA remained insignificant in predicting 24-hour mortality. The predictive value of the SOFA score was increased by the addition of lactate (AUC 0.865, 95% CI 0.736-0.995; p=0.0081). All scores demonstrated better and satisfactory predictive power for 28-day mortality.
CONCLUSIONS
SOFA, with the addition of lactate, is a complex but reliable tool for the early stratification of septic patients who are presenting at an emergency department.
Topics: Humans; Sepsis; Retrospective Studies; Prognosis; Male; Female; Middle Aged; Organ Dysfunction Scores; Emergency Service, Hospital; Aged; Hospital Mortality; Triage; Intensive Care Units; ROC Curve
PubMed: 38946383
DOI: 10.26355/eurrev_202406_36462 -
International Journal of Surgery Case... Jun 2024The surgical removal of unexploded mortar shells is rarely documented in the literature. Since most cases occur within war or conflict regions, reporting such instances...
INTRODUCTION AND SIGNIFICANCE
The surgical removal of unexploded mortar shells is rarely documented in the literature. Since most cases occur within war or conflict regions, reporting such instances is vital for optimizing and enhancing surgical practices, particularly in low-resource settings.
CASE PRESENTATION
We report the case of a 35-year-old man who sustained an injury from a 60 mm unexploded mortar shell, penetrating the patient's right posterior chest in the right paravertebral region of the 4th thoracic vertebra, causing intrathoracic injuries, multiple rib fractures, and a right pneumothorax. The patient was immediately resuscitated and transferred to the operating room. The projectile was removed without direct contact with metal instruments. A right chest tube was then inserted and the injured area was repaired, resulting in an uneventful postoperative recovery.
CLINICAL DISCUSSION
Unexploded mortar shell injuries are infrequently documented in the literature. These injuries are seen within war and conflict regions, that have limited accessibility or availability of experienced explosive ordnance disposal (EOD) teams, transporting personnel, and equipped and separated operating theaters.
CONCLUSION
Unexploded ordnance and munitions represent an underrecognized and underreported health risk to patients, healthcare providers, and healthcare facilities. These injuries are commonly encountered within regions that lack experienced transport and EOD staff. The need for the establishment of such experienced teams along with providing adequate training for healthcare providers is necessary.
PubMed: 38943933
DOI: 10.1016/j.ijscr.2024.109967 -
Nigerian Journal of Clinical Practice Jun 2024Surgical procedures cause a certain level of anxiety in the relatives of the patients, it has been observed that heart surgeries cause more anxiety. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Surgical procedures cause a certain level of anxiety in the relatives of the patients, it has been observed that heart surgeries cause more anxiety.
AIM
To determine the effects of informing patients' relatives with short messages on anxiety levels during cardiovascular surgery.
METHODS
The study was conducted as a randomized controlled research investigation from October 1, 2015, to December 31, 2022, at the cardiovascular surgery operating room of a university hospital and included 84 patient relatives (42 experimental and 42 control group). The Patient Relatives Information Form and the State and Trait Anxiety Inventory were used to collect the study data. The patients' relatives in the experimental group were informed by short messages (preparations for surgery have begun, your relative's surgery has started, your relative's surgery is still ongoing, and your relative's surgery is completed) during the surgery. State Anxiety Inventory was re-administered to all patients' relatives after cardiovascular surgery. The study was registered with ClinicalTrials.gov (NCT05157789).
RESULTS
It was found that the postoperative State Anxiety Inventory score of the experimental group was significantly lower than that of the control group (P < 0.001). The difference between preoperative and postoperative state anxiety scores was significantly higher in the experimental group (P < 0.001).
CONCLUSION
Informing the patients' relatives with a short message during cardiovascular surgery significantly reduced the level of anxiety.
Topics: Humans; Male; Female; Anxiety; Middle Aged; Family; Cardiovascular Surgical Procedures; Adult; Turkey; Aged
PubMed: 38943294
DOI: 10.4103/njcp.njcp_607_23 -
Alternative Therapies in Health and... Jun 2024The nursing work in the operating room is heavy, intensive, and irregular, and the quality of nursing work can directly affect the surgical effect and patient prognosis....
BACKGROUND
The nursing work in the operating room is heavy, intensive, and irregular, and the quality of nursing work can directly affect the surgical effect and patient prognosis. Therefore, nursing management in the operating room should be strengthened to protect patients' life safety effectively.
OBJECTIVE
To assess the effectiveness of applying the 6S management model in operating room nursing.
DESIGN
This was a retrospective study.
SETTING
This study was conducted at the Department of Anesthesia Surgery, Nanfang Hospital, Southern Medical University.
PARTICIPANTS
The research included 100 operating room nurses on duty between January 2020 and December 2022.
INTERVENTION
From January 2020 to June 2021, the hospital conducted routine training programs for nurses in the operating room. From July 2021 to December 2022, the hospital adopted the 6S management model for overseeing nursing work in the operating room.
PRIMARY OUTCOME MEASURES
(1) nursing quality score (2) nursing staff safety awareness (3) nursing disputes and complaints (4) incidence of adverse reactions (5) patient satisfaction with the quality of nursing care.
RESULTS
Following the adoption of the 6S management model, there was a noticeable improvement in the nursing quality scores, the nursing staff's awareness of safety, and the satisfaction levels of patients with the quality of care provided by operation nurses (P < .05). Additionally, the incidence of nursing disputes, complaints, and adverse events among patients decreased significantly compared to before the implementation of 6S (P = .01).
CONCLUSION
Implementing 6S management with a focus on the work of operation room nurses enhanced the competence of the nursing staff and improved management effectiveness, ultimately leading to increased patient satisfaction.
PubMed: 38940802
DOI: No ID Found -
Health Care Science Dec 2023This study aims to develop and validate a Structured Training Effectiveness Evaluation (STEE) tool based on the Kirkpatrick model for newly graduated registered nurses...
BACKGROUND
This study aims to develop and validate a Structured Training Effectiveness Evaluation (STEE) tool based on the Kirkpatrick model for newly graduated registered nurses in the operating room in China.
METHODS
The first phase will involve focus group and individual interviews with nursing educators and newly graduated registered nurses selected using purposive sampling. The data will be analyzed thematically to identify key components necessary to develop the STEE tool. The second phase will develop and validate the STEE tool through a panel of experts using the Delphi method. The item weights will be determined with the analytic hierarchy process technique. The third phase will involve implementation and evaluation of the STEE tool with an exploratory, nonexperimental, and comparative analysis. Descriptive and inferential statistical analyses will be performed with SPSS version 23.
RESULTS
The STEE tool for newly graduated registered nurses in the operating room will be useful for evaluating training effectiveness during standardized training. The results obtained with this tool will clarify the effectiveness of training, thereby helping transform nursing students into competent nurses.
CONCLUSION
In this way, this study will provide practical guidance for improving standardized training programs and help newly graduated nurses manage their transition to the clinical work environment and remain in their posts.
PubMed: 38938624
DOI: 10.1002/hcs2.75 -
BMC Urology Jun 2024TIP is the most common preformed type of Urethroplasty. The intermediate barrier is used as a waterproofing layer to prevent fistula formation. Many tissues have been... (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVE
TIP is the most common preformed type of Urethroplasty. The intermediate barrier is used as a waterproofing layer to prevent fistula formation. Many tissues have been utilized as a barrier layer, with varying success rates. The search for a better intermediate layer will continue. In this study, we aim to evaluate the role of Buck's Fascia as a covering for the neo-urethra to prevent fistula formation in patients who underwent Snodgrass Urethroplasty.
METHODS
This prospective study was conducted between 2018 and 2022. Patients were randomly assigned to either Group 'A' or Group 'B'. Group A included patients who underwent the Snodgrass procedure with a Buck's Fascia cover, while Group B included patients whose neo-urethra was covered with the dartos flap. These patients were closely monitored for the development of short- and long-term complications in both groups, and the results were recorded.
RESULTS
The study involved 164 patients, who underwent midpenile and distal hypospadias repair using the Snodgrass technique. In Group 'A' (84 patients), the neo-urethra was covered with Buck's Fascia, while in Group 'B' (80 patients), the neo-urethra was covered with the dartos flap. The mean age of the children was (23.06 ± 16.12) months in group 'A' & (26.06 ± 14.07) months in group 'B'. mean operating time was (40 ± 11.43) minutes, in Group 'A', and (70 ± 17.43) minutes, in Group 'B'. Meatal stenosis occurred in 3.57% of children in Group 'A' and 10% of patients in Group 'B'. Urethral fistulas were encountered in 2.35% of cases in Group 'A'and 10% in Group 'B'. The difference between the groups was statistically significant.
Topics: Humans; Male; Urologic Surgical Procedures, Male; Prospective Studies; Hypospadias; Urethra; Infant; Treatment Outcome; Child, Preschool; Fascia; Surgical Flaps; Postoperative Complications
PubMed: 38937743
DOI: 10.1186/s12894-024-01468-x -
Deutsches Arzteblatt International May 2024
Topics: Humans; Urologic Surgical Procedures; Operating Rooms; Elective Surgical Procedures; Germany
PubMed: 38934070
DOI: 10.3238/arztebl.m2024.0025