Incidence Of Type Research Articles

Incision techniques for trigger thumb release: a comparison of outcomes of four types of skin incision.

Although trigger thumb release is commonly performed, there is no consensus on the optimal skin incision. This study aimed to compare outcomes of four incision techniques, including V-shaped, oblique, transverse and longitudinal incisions. Outcomes included the Michigan Hand Outcomes Questionnaire, satisfaction with the treatment and postoperative complications. The results of 875 patients who underwent trigger thumb release were assessed. All groups demonstrated improvement in self-reported hand function (range of 10-14 points), pain (25-27 points) and aesthetics (4-7 points) from baseline to 3 months postoperatively with no differences between incision techniques. Of the patients, 76% reported good or excellent satisfaction with the outcome of treatment. Satisfaction and complication rates of the different incision techniques were similar. These findings imply that there is no clear benefit of one type of incision over another for trigger thumb release, suggesting that surgeons may use the technique of their preference.Level of evidence: III.

Scalp incision technique for decompressive hemicraniectomy: comparative systematic review and meta-analysis of the reverse question mark versus alternative retroauricular and Kempe incision techniques

Decompressive hemicraniectomy (DHC) is a critical procedure used to alleviate elevated intracranial pressure (ICP) in emergent situations. It is typically performed to create space for the swelling brain and to prevent dangerous and potentially fatal increases in ICP. DHC is indicated for pathologies ranging from MCA stroke to traumatic subarachnoid hemorrhage—essentially any cause of refractory brain swelling and elevated ICPs. Scalp incisions for opening and closing the soft tissues during DHC are crucial to achieve optimal outcomes by promoting proper wound healing and minimizing surgical site infections (SSIs). Though the reverse question mark (RQM) scalp incision has gained significant traction within neurosurgical practice, alternatives—including the retroauricular (RA) and Kempe incisions—have been proposed. As choice of technique can impact postoperative outcomes and complications, we sought to compare outcomes associated with different scalp incision techniques used during DHC. We queried three databases according to PRISMA guidelines in order to identify studies comparing outcomes between the RQM versus “alternative” scalp incision techniques for DHC. Our primary outcome of interest in the present study was postoperative wound infection rates according to scalp incision type. Secondary outcomes included estimated blood loss (EBL) and operative duration. We identified seven studies eligible for inclusion in the formal meta-analysis. The traditional RQM technique shortened operative times by 36.56 min, on average. Additionally, mean EBL was significantly lower when the RQM scalp incision was used. Postoperatively, there was no significant association between DHC incision type and mean intensive care unit (ICU) length of stay (LOS), nor was there a significant difference in predisposition to developing wound complications or infections between the RQM and retroauricular/Kempe incision cohorts. Superficial temporal artery (STA) preservation and reoperation rates were collected but could not be analyzed due to insufficient number of studies reporting these outcomes. Our meta-analysis suggests that there is no significant difference between scalp incision techniques as they relate to surgical site infection and wound complications. At present, it appears that outcomes following DHC can be improved by ensuring that the bone flap is large enough to enable sufficient cerebral expansion and decompression of the temporal lobe, the latter of which is of particular importance. Although previous studies have suggested that there are several advantages to performing alternative scalp incision techniques during DHC, the present study (which is to our knowledge the first to meta-analyze the literature on outcomes in DHC by scalp incision type) does not support these findings. As such, further investigations in the form of prospective trials with high statistical power are merited.

Impact of Vertical and Horizontal Skin Incisions on Outcome Measures in Tracheostomies.

Tracheostomy is a life-saving procedure in which an opening is created in the anterior wall of the trachea. Different skin incision types are administered in tracheostomy procedures, predominantly vertical and horizontal. Various literature on the skin incision types in tracheostomy had contradictory findings, with different studies observing that one skin incision type had better outcomes than its counterpart.Hence the objective of this study was to compare the outcomes associated with vertical and horizontal skin incisions in patients undergoing tracheostomy. Method The present study assessed the outcome measures between the two incision types (vertical and horizontal) in tracheostomy. A prospective longitudinal study was done based on an academic tertiary hospital in Bhopal, Madhya Pradesh. Participants above 18 years who underwent tracheostomy were enrolled in the study and followed up over six months during intraoperative, immediate, within seven days, and long-term periods. Result In intraoperative complications, bleeding was most common (n = 15, 16.7%), followed by passage of tube into false tract (n = 6, 6.7%) and saturation drop (n = 2, 2.2%). Immediate complications comprised T-tube blockage (n = 4, 4.4%) and bleeding (n = 1, 1.1%). Complications within seven days occurred only in the horizontal group in which stomal site ulceration (n = 4, 6.7%) and delayed bleeding (n = 2, 3.3%) was seen, and one participant had unintended decannulation. In the long term, complications observed were stomal granulation (n = 9, 19.1%), dysphagia (n = 7, 14.9%), and unintended decannulation (n = 4, 8.5%). Conclusion In the current study, the most common intraoperative complication was bleeding, the immediate complication was tube dislodgement, and tracheostomy site ulcer was the most common complication within seven days, similar to the literature findings.

Revealing Orbital Tumors: A 2-Year Evaluation in Clinical Profile, Histopathological Features and Surgical Technique

Abstract
 Introduction & Objectives : Incidence of orbital tumors is relatively low, but the delay in diagnosis, even if benign, can lead to vision loss and deformity. This study aims to review clinical and demographic information of orbital tumors in Sardjito General Hospital, Yogyakarta.
 Methods : We retrospectively reviewed clinical data of 138 patients who diagnosed with orbital tumors during July 2021 - March 2023. Data extracted included clinical characteristics, operative procedures, and histopathologic characteristics of orbital tumors.
 Results : There were 138 orbital tumors managed at hospital during a 2-year period. Among 138 patients, 82 patients (59%) were female and 56 patients (40%) were male. Twenty-one patients (15%) were in childhood age and 117 patients (84.8%) were in adulthood age. The common clinical manifestations were proptosis (83.3%) and decreased vision (10.4%). The main procedure used was anterior orbitotomy (54.34%). Eighty-eight patients (63.7%) have primary tumors and 51.4% of the orbital tumors were malignant. The most common orbital tumor in childhood age was a cyst (15%). On the other hand, in adult patients, the most common orbital tumor was meningioma (18%) and Non- Hodgkin Lymphoma (15.7%). There was an overall 8% complication rate after orbitotomy tumor removal, including decrease in vision (3.3%), ptosis (2.6%), and strabismus (1.3%).
 Conclusion : Orbital tumors are challenging group of tumors with proptosis become the most frequent clinical characteristic that found. The orbital tumors in childhood and adulthood differ significantly in their incidence and tumor type with the percentage of malignant tumors increasing with age.

REVEALING ORBITAL TUMORS: 2-YEAR EVALUATION IN CLINICAL PROFILE, HISTOPATHOLOGICAL FEATURES AND SURGICAL TECHNIQUE

Introduction: Incidence of orbital tumors is relatively low, but the delay in diagnosis, even if benign, can lead to vision loss and deformity. Purposes: This study aims to review clinical and demographic information of orbital tumors in Sardjito General Hospital, Yogyakarta. Method: We retrospectively reviewed clinical data of 138 patients who diagnosed with orbital tumors during July 2021 - March 2023. Data extracted included clinical characteristics, operative procedures, and histopathologic characteristics of orbital tumor. Result: There were 138 orbital tumors managed at hospital during 2-year period. Among 138 patients, 82 patients (59%) were female and 56 patients (40%) were male. Twenty-one patients (15%) were in childhood age and 117 patients (84.8%) were in adulthood age. The common clinical manifestations were proptosis (83.3%) and decreased vision (10.4%). The main procedure used was anterior orbitotomy (54.34%). Eighty-eight patients (63.7%) have primary tumors and 51.4% of the orbital tumors were malignant. The most cases in children were benign tumors (61.9%) meanwhile in adults were malignant (54.7%). The main orbital tumor in childhood age was a Non-Hodgkin Lymphoma (NHL) (19%) and cyst (14.3%). On the other hand, in adult patient, the most common orbital tumor was meningioma (18%) and NHL (15.7%). Conclusion: Orbital tumors are challenging group of tumors with proptosis become the most frequent clinical characteristic that found. The orbital tumors in childhood and adulthood differ significantly in their incidence and tumor type with the percentage of malignant tumors increasing with age.

A COMPARATIVE ANALYSIS OF INFORMATION SECURITY INCIDENTS IN PUBLIC ADMINISTRATION IN SELECTED EUROPEAN UNION COUNTRIES

The article presents the issue of information security incident management in public administration. The goal of security incident management is to minimize the negative impact of incidents and ensure the continuity of the organization's operations. It is critical to know what the threats are, including the number and types of incidents reported. The article outlines key incident management and legal issues related to the topic of security incidents and the work of computer incident response teams. Examples of incidents that took place recently in public administration units in Poland were also presented. This was followed by an analysis of statistical data on reported incidents in Poland in the years 2020-2022, and the results were compared with the number of incidents reported in selected European Union countries. The results of the study show that the dominant type of incidents is fraud (mainly phishing), and public administration is one of the main targets of cybercriminals' attacks. Difficulties in conducting such comparative analysis have also been demonstrated.

Molecular prevalence and associated risk factors of Cryptosporidium spp. infection in dairy cattle in Khon Kaen, Thailand

Background and Aim: Cryptosporidium spp. are important parasites in the small intestines of humans and animals, particularly cattle. The aim of this study was to estimate the molecular prevalence and associated risk factors of Cryptosporidium infection in dairy cattle in five districts of Khon Kaen province, Thailand, and to identify Cryptosporidium spp. Materials and Methods: From July 2020 to October 2021, 296 fecal samples were collected from three groups of dairy cattle: Calves aged <3 months, calves aged 3 months–1 year, and calves aged >1 year. Cryptosporidium spp. were detected by polymerase chain reaction (PCR) amplifying the 18s RNA gene. Both genus-specific and species-specific primers were used to identify Cryptosporidium confirmed by DNA sequencing. Age, house floor type, and water trough type were evaluated as risk factors. We analyzed all associated risk factor information using the logistic regression test in the Statistical Package for the Social Sciences. Results: PCR results showed that 40 (13.51%) out of 296 samples were positive for Cryptosporidium spp., including Cryptosporidium bovis (57.50%) and Cryptosporidium ryanae (2.50%). There was a significant association between Cryptosporidium incidence, cattle age, and house floor type (p = 0.05). National Center for Biotechnology Information Basic Local Alignment Search Tool displayed 99.48%–100% nucleotide similarity of each Cryptosporidium spp. isolate with references recorded on GenBank. Conclusion: C. bovis and C. ryanae are commonly found in dairy cattle, especially calves, in Khon Kaen, Thailand, and the incidence was associated with age and house floor type. A molecular technique may be influential for species identification. The results of the present study would provide useful information for veterinarians and animal owners to understand better Cryptosporidium spp. and how to manage farms properly. Keywords: bovine cryptosporidiosis, Cryptosporidium, dairy cattle, molecular prevalence.

Validation of Urostomy Parastomal Herniation Incisional Prevention Strategies

ObjectiveTo evaluate simulated parastomal herniation forces in in vitro abdominal fascial models. Our group previously illustrated how incision type may play a consequential role in bowel herniation force generated across an incision using several abdominal fascia models. We sought to 1)Confirm findings in fresh human tissue 2)Assess correlation between herniation force and incision size 3)Determine whether incision type impacts drainage in a simulated ex vivo ileal conduit. Materials and MethodsAxial tension force(N) of herniation was measured using our previously published protocol, pulling a Foley catheter balloon 3.8cm diameter affixed to a dynamometer through silicone/fascial incisions ranging 3cm-5.8cm. We simulated ileal conduits using bovine small intestine with stoma matured through human fascia using 3.0 cm linear or cruciate incisions. The conduit’s caudal end was catheterized and filled at 20mL/minute. Drainage was measured by pad weight change. Two-sided α<0.05 was used to reject the null hypothesis. ResultsMean(±SD) herniation forces in fresh human fascia varied significantly across linear longitudinal, linear transverse, and cruciate incisions (20.9±3.7, 23.3±8.8, and 8.9±3.8N, respectively[p=0.011]). Fresh human fascial linear incisions 3cm in diameter had a herniation force of 22.1±6.3 vs 3.5±0.7N for 5.8cm incisions when herniating a 3.8cm balloon(p=0.002). All observations were similar in silicone. In simulated ileal conduit, mean drainage: 70.8±3.6 vs 82.1±9.7mL (linear vs cruciate) after 100mL instilled, respectively(p=0.05). ConclusionsThis ex-vivo study further suggests incision type has predictable influence on herniation force. These data support standardization of urostomy construction techniques and evaluating the clinical impact of stomal maturation techniques on parastomal hernia rates.

Correlation between type of surgery and incidence of postoperative venous thromboembolism (VTE)

Venous thromboembolism (VTE) is a significant complication in patients after undergoing major surgery. The type of surgery is believed correlated with the incidence of VTE. This study aimed to evaluate the correlation between type of surgery and incidence of VTE among patients who underwent major surgery. It was a retrospective study conducted in Dr. Sardjito General Hospital, Yogyakarta using medical record data of patients who underwent major surgery and were diagnosed with VTE between 2016 and 2020. Patients were grouped by surgery type, and length of stay (LoS). All caused deaths were also analyzed. Among 29,120 patients who underwent major surgery, 76 (0.26%) experienced VTE with females patients accounting for 75%. The mean age of the patients was 55 yr. All VTE cases had the mean LoS of 25 d. The highest proportion of patients who experienced VTE were patients who underwent tumor removal (67.0%) followed by trauma patients (18.4%). A significant difference in the incidence of mortality between the surgical groups was reported (p = 0.02). Post-cardiology had the highest risk of mortality (OR=7.46; 95% CI: 0.322 - 172.61) while age had the lowest risk of mortality (OR=1.01; 95% CI: 0.953 - 1.071). In conclusion, surgery type is correlated with the incidence of VTE. Surgery due to cancer and trauma has a higher risk of VTE compared to the others.

Optimization of the cosmetic appearance of skin scar after caesarean section - part II physiotherapy practice.

Scar formation is a natural part of the healing process after CS. This process, lasting up to two years, depends on the number of factors including type of incision, wound size, the person's age, body weight, health condition, and many others. Abnormal scarring should not be treated only as a cosmetic defect or superficial tissue defects. Functional and anatomical considerations must also be considered. Large varieties of non-invasive treatment modalities have been used to enhance wound healing and scar treatment. The article proposes a comprehensive approach to scar prevention and remodeling. The role of manual techniques, dry needling, cupping therapy, compression therapy, Kinesio taping, and physical agents is highlighted.

Meta-analysis of risk factors for posttraumatic stress disorder in myocardial infarction.

The aim of this study was to identify the risk factors for posttraumatic stress disorder in patients with myocardial infarction. Cohort, case-control, and cross-sectional studies on posttraumatic stress disorder (PTSD) in patients with myocardial infarction were searched from PubMed, Embase, Cochrane Library, Web of Science, China Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and Technology Journal database. The Newcastle-Ottawa Quality Assessment Scale was used to score the quality of the included literature in the cohort and case-control studies, and the cross-sectional studies were scored using the American Agency for Health Care Quality and Research cross-sectional study quality evaluation criteria. The literature was screened independently by 2 researchers, and if there was no consensus, the inclusion was decided by a third party. The extraction content included first author, publication year, sample size, PTSD assessment tool, PTSD assessment time, PTSD incidence, influencing factors, and study type. Meta-analysis of data was performed using Stata17.0 software. Ten studies were included, including 2 cohort studies, 7 cross-sectional studies, and 1 case-control study, with a total sample size of 2371 patients, including 26 influencing factors. The results of meta-analysis showed that the prevalence of PTSD in patients with myocardial infarction was 21.2%. Statistically significant influencing factors were gender (odd ratio [OR] = 3.124), neuroticism score (OR = 2.069), and age (OR = 0.913). The prevalence of PTSD in patients with myocardial infarction in China is higher than that in other countries. Female and neurotic personality are risk factors for developing PTSD in patients with myocardial infarction, and old age is protective factor for developing PTSD in patients with myocardial infarction. Targeted measures should be taken to prevent and reduce the occurrence and development of PTSD in patients with myocardial infarction in the future.

The completeness of routine registration of the counterpart in deliberate interpersonal violence in an urban emergency department

Most studies of violence from the health care system lack reliable information about the counterpart, which is important for distinguishing between different types of violence. Since 2014, the emergency department at Odense University Hospital in Denmark has routinely registered information about the counterpart. The purpose of this study was to evaluate the completeness of registering information about the counterpart during routine registration of victims of interpersonal violence in the emergency department. We included 11,200 victims treated at the emergency department 2014–2021. Using the patient registration data, we estimated the proportion of missing information on the counterpart, stratified by age group and gender of the victim as well as type of incident and severity of injury. Information about the counterpart was registered in 91.5 % of all cases. In 43.1 % (CI: 42.2–44.0) of the cases, the counterpart was unknown to the victim, in 24.3 % (CI: 23.5–25.1) the counterpart was an acquaintance, in 10.5 % (CI: 10.0–11.1) the counterpart was a partner, and in 4.2 % (CI: 3.8–4.5) the counterpart was another family member. The proportion of cases with no information about the counterpart varied with gender, age group, time of violence, place of violence, weapon use, and severity of injury. Half of the victims injured with firearms (46.2 %, CI: 30.1–62.8) and one-fourth of the victims injured with knives (25.9 %, CI: 21.9–30.2) did not reveal information about the counterpart. The majority of the victims revealed information about the counterpart, making it possible to analyse different types of violence separately.

Cesarean section prior to 28 weeks’ gestation: which type of uterine incision is optimal?

Objective The purpose of this study was to determine the factors that influence physician preference for type of hysterotomy incisions in gravidas with a singleton or twin pregnancy undergoing cesarean section under 28 weeks, and to assess factors that result in delivery complications, defined as either intraoperative dystocia or hysterotomy extension. We hypothesized that compared to those with non-cephalic presentations, gravidas with a presenting fetus in cephalic presentation would have higher rates of low-transverse cesarean section, and reduced rates of delivery complications with low-transverse hysterotomy. Methods This was a retrospective cohort chart analysis of 128 gravidas between 23 0/7 and 27 6/7 weeks undergoing cesarean section at a single academic institution between August 2010 and December 2022. Data was abstracted for factors that might influence the decision for hysterotomy incision type, as well as for documentation of difficulty with delivery of the fetus or need for hysterotomy extension to affect delivery. Results There was a total of 128 subjects, 113 with a singleton gestation and 15 with twins. The presenting fetus was in cephalic presentation in 43 (33.6%), breech presentation in 71 (55.5%), transverse/oblique lie in 13 (10.2%), and not documented in 1 (0.8%). Sixty-eight (53.1%) had a low-transverse cesarean section (LTCS), 53 (41.4%) had a Classical, 5 (3.9%) had a low-vertical hysterotomy and 2 (1.6%) had a mid-transverse incision. There was a significantly higher rate of LTCS among gravidas with the presenting fetus in cephalic presentation (30/43, 69.8%) compared to those with breech (31/71, 43.7%) or transverse/oblique presentations (7/13, 53.8%), p = .03. No other significant associations were related to hysterotomy incision, including nulliparity, racially or ethnically minoritized status, plurality, indication for cesarean delivery, or pre-cesarean labor. Twenty (15.6%) subjects experienced either an intraoperative dystocia or hysterotomy extension. For the entire cohort, there was a greater median cervical dilatation in those with delivery complications (4.0 cm, IQR .5 - 10 cm) compared to those without complications (1.5, IQR 0 – 4.0), p = .03, but no significant association between delivery complications and fetal presentation, hysterotomy type, plurality, or other demographic/obstetrical factors. However, among gravidas undergoing low-transverse cesarean section, only 2/30 (6.7%) with cephalic presentations had a delivery complication, compared to 9/31 (29.0%) with breech presentations and 3/7 (42.9%) with a transverse/oblique lie, p = .03. Conclusion In pregnancies under 28 weeks, the performance of a low-transverse cesarean section was significantly associated only with presentation of the presenting fetus. Among those with cephalic presentations, the rate of intrapartum dystocia or hysterotomy extension was low after a low-transverse hysterotomy, suggesting that in this subgroup, a low-transverse cesarean section should be considered.

Physical and autonomic functionality in women with breast cancer pre and post chemotherapy: a case control study

BackgroundBreast cancer (BC) is one of the most incident types of cancer among women in the world. Although chemotherapy is an effective way to treat several types of cancer, it may also cause serious complications, including cardiotoxicity. This study aimed to identify the impact of chemotherapy on functional capacity, muscle strength and autonomic function.MethodsTen breast cancer patients in therapeutic follow-up (TG) and ten women without comorbidities (CG) participated in the study (46±8.87 years old). Both groups were evaluated at two time points, before and 20 weeks after the start of chemotherapy. Functional capacity and muscle strength were assessed by 6-minute walk test (6MWT) and handgrip test, respectively. Autonomic function was assessed by heart rate variability analysis.ResultsTG presented greater reductions in the handgrip test for the non-dominant hand (TG ↓15.2%; CG: ↑1.1%, p<0.05) compared to GC. However, no significant differences were found regarding VO2max (p>0.05) and 6MWT total distance (p>0.05). Regarding the heart rate variability variables before and after follow-up period, rMSSD (CG= 39.15±37.66; TG= 14.89±8.28, p= 0.01) and SDNN (CG= 55.77±40.03; TG= 26.30±10.37, p= 0.02) showed effect in the group and time interaction, whereas the LF/HF ratio presented significant difference only in the time analysis (CG= 2.24±2.30; TG= 2.84±1.82, p= 0.04).ConclusionChemotherapy used in the treatment of breast cancer patients resulted in decreased muscle strength and autonomic imbalance. The data suggests that chemotherapy may carry the risk of developing cardiovascular disease.Trial registrationRegistration not required.

ASSESSMENT OF INTEROBSERVER RELIABILITY FOR THE LETOURNEL AND JUDET CLASSIFICATION.

The Judet and Letournel classification is the most widely used classification system for acetabular fractures. Some complex fractures couldn't be classified according to this classification. The main purpose of this study was to evaluate the reliability of the Letournel and Judet classification system for acetabular fractures. 10 acetabular fractures were analyzed among 17 orthopedic surgeons. The surgeons were asked to classify the fractures according to the Judet and Letournel classification. Their experience, the number of surgeries, and the incision type that the surgeon uses for the anterior part of the acetabulum were recorded. The overall interobserver agreement for the Letournel classification was found to be poor, with a Kappa value of 0.287. The Kappa value for interobserver agreement was 0.224 for plain radiographs, 0.293 for 2D-CT, and 0.321 for 3D-CT scans. There was no significant difference between the incision types used by the surgeons. The highest reliability was determined among the surgeons who operate on 10-20 acetabular fractures per year, with a Kappa value of 0.309. This results revealed that the Judet and Letournel Judet classification is not sufficient to classify acetabular fractures because of unclassified fractures and the complex algorithm of the system. Level of Evidence III; Comparative Retrospective Study.

Minimum data set harmonization in the management of cross-border Multi Casualty Incidents. Modified Delphi (VALKYRIES-H2020 project).

There is a need to develop harmonized procedures and a Minimum Data Set (MDS) for cross-border Multi Casualty Incidents (MCI) in medical emergency scenarios to ensure appropriate management of such incidents, regardless of place, language and internal processes of the institutions involved. That information should be capable of real-time communication to the command-and-control chain. It is crucial that the models adopted are interoperable between countries so that the rights of patients to cross-border healthcare are fully respected. To optimize management of cross-border Multi Casualty Incidents through a Minimum Data Set collected and communicated in real time to the chain of command and control for each incident. To determine the degree of agreement among experts. We used the modified Delphi method supplemented with the Utstein technique to reach consensus among experts. In the first phase, the minimum requirements of the project, the profile of the experts who were to participate, the basic requirements of each variable chosen and the way of collecting the data were defined by providing bibliography on the subject. In the second phase, the preliminary variables were grouped into 6 clusters, the objectives, the characteristics of the variables and the logistics of the work were approved. Several meetings were held to reach a consensus to choose the MDS variables using a Modified Delphi technique. Each expert had to score each variable from 1 to 10. Non-voting variables were eliminated, and the round of voting ended. In the third phase, the Utstein Style was applied to discuss each group of variables and choose the ones with the highest consensus. After several rounds of discussion, it was agreed to eliminate the variables with a score of less than 5 points. In phase four, the researchers submitted the variables to the external experts for final assessment and validation before their use in the simulations. Data were analysed with SPSS Statistics (IBM, version 2) software. Six data entities with 31 sub-entities were defined, generating 127 items representing the final MDS regarded as essential for incident management. The level of consensus for the choice of items was very high and was highest for the category 'Incident' with an overall kappa of 0.7401 (95% CI 0.1265-0.5812, p 0.000), a good level of consensus in the Landis and Koch model. The items with the greatest degree of consensus at ten were those relating to location, type of incident, date, time and identification of the incident. All items met the criteria set, such as digital collection and real-time transmission to the chain of command and control. This study documents the development of a MDS through consensus with a high degree of agreement among a group of experts of different nationalities working in different fields. All items in the MDS were digitally collected and forwarded in real time to the chain of command and control. This tool has demonstrated its validity in four large cross-border simulations involving more than eight countries and their emergency services.

Digitalisation of information and management optimisation in Multiple Victim Incidents. Analytical study.

Triage is a crucial tool for managing a Multiple Victim Incident (MVI). One particularly problematic issue is the communication of results to the chain of command and control. Favourable data exists to suggest that digital triage can improve some features of analogue triage. Within this context we have witnessed the emergence of the Valkyries Project, which is working to develop strategies to respond to MVIs, and especially cross-border incidents. To that end, an IT platform called "SIGRUN" has been created which distributes, in real time, all the information to optimise MVI management. A full-scale simulation, held on the Spain-Portugal border and featuring contributions from different institutions on both sides of the border, put to the test the role of information digitalisation in this type of incidents. To evaluate the impact of the synchronous digitalisation of information on the optimal management of Multiple Victim Incidents. Clinical evaluation study carried out on a cross-border simulation between Spain and Portugal. A Minimum Data Set (MDS) was established by means of a modified Delphi by a group of experts. The digital platform "SIGRUN" integrated all the information, relaying it in real time to the chain of command and control. Each country assigned two teams that would carry out digital and analogue triage synchronously. Analogue triage variables were gathered by observers accompanying the first responders. Digital triage times were recorded automatically. Each case was evaluated and classified simultaneously by the two participating teams, to carry out a reliability study in a real time scenario. The total duration of the managing of the incident in the A group of countries involved compared to the B group was 72.5 minutes as opposed to 73 minutes. The total digital assistance triage (AT) time was 37.5 seconds in the digital group, as opposed to 32 minutes in the analogue group. Total evacuation (ET) time was 28 minutes in the digital group compared with 65 minutes in the analogue group. The average differences in total times between the analogue and the digital system, both for primary and secondary evaluation, were statistically significant: p = 0.048 and p = 0.000 respectively. For the "red" category, AT obtained a sensitivity of 100%, also for ET, while with regard to AT safety it obtained a PPV of 61.54% and an NPV of 100%, and for ET it obtained a PPV of 83.33% and an NPV of 100%. For the analogue group, for AT it obtained a sensitivity of 62.50%, for ET, 70%, for AT safety it obtained a PPV of 45.45% and an NPV of 92.31%, while for ET it obtained a PPV of 70% and an NPV of 92.50%. The gap analysis obtained a Kappa index of 0.7674. The triage system using the developed digital tool demonstrated its validity compared to the analogue tool, as a result of which its use is recommended.

A Novel Approach for Conservative Management of Placenta Accreta Spectrum Disorder Cases: Experience of a Single Surgeon: PAS Disorders and Conservative Management.

Background: This study is aimed at evaluating the conservative surgical treatment of patients with placenta accreta spectrum (PAS) disorder and at presenting the experience of a single surgeon. Materials and Methods: This retrospective study included 245 patients with placenta previa accompanied by PAS disorders operated at a university hospital between June 2013 and December 2023. The diagnosis of PAS was made by a single perinatologist using a combination of transvaginal and transabdominal ultrasonography. All patients were operated with conservative surgical technique by the same surgeon. The demographic and clinical characteristics of the patients, the anesthesia and incision types used, and the details of the surgical technique were evaluated. Results: Of the patients, 165 were operated on at the scheduled time, 80 were operated on under emergency conditions, and 232 (94.69%) of them were operated on under spinal anesthesia. All patients were operated on with a Pfannenstiel incision followed by a transverse incision to the upper border of the placenta to enter into the uterus. An average of 0.52 units of red blood cells per patient was transfused to all patients. Spontaneous intra-abdominal bleeding developed in five patients, and surgical complications occurred in eight patients. No cesarean hysterectomy was performed, and no maternal mortality was detected in any of the cases. The mean time duration of surgery was 54.44 ± 11.37 (30-90) min, and the mean length of hospital stay was 1.71 ± 1.30 (1-9) days. Conclusions: We recommend this procedure as a novel technique and a robust and safe alternative to peripartum hysterectomy and other conservative surgical management procedures for cases with complete PP accompanied with PAS. This technique preserves the uterus as well as reduces blood loss, and transfusion requirement, and thus maternal morbidity and mortality in PAS cases.

Intracorporeal versus extracorporeal anastomosis in minimally invasive right hemicolectomy: systematic review and meta-analysis of randomized controlled trials.

Compared with extracorporeal anastomosis (ECA), intracorporeal anastomosis (ICA) is expected to provide some benefits, including a shorter operation time and less intraoperative bleeding. Nevertheless, the benefits of ICA have mainly been evaluated in nonrandomized studies. Owing to the recent update of randomized controlled trials (RCTs) for minimally invasive surgery (MIS) of right hemicolectomy (RHC), the need to measure the actual effect by synthesizing the outcomes of these studies has emerged. We performed a comprehensive search of the PubMed, Embase, and Cochrane databases (from inception to January 30, 2023) for studies that applied ICA and ECA for RHC with MIS. We included 7 RCTs. The operation time, intraoperative blood loss, conversion rate, length of incision, and postoperative outcomes such as ileus, anastomosis leakage, length of hospitalization, and postoperative pain were compared between ICA and ECA. A total of 740 patients were included in the study. Among them, 377 and 373 underwent ICA and ECA, respectively. There were significant differences in age (P = 0.003) and incision type (P < 0.001) between ICA and ECA. ICA was associated with a significantly longer operation time (P = 0.033). Although the postoperative pain associated with ICA was significantly lower than that associated with ECA on postoperative day 2 (POD 2) (P = 0.003), it was not different on POD 3 between the groups. Other perioperative outcomes were similar between the 2 groups. In this meta-analysis, ICA did not significantly improve short-term outcomes compared to ECA; other advantages to overcome ICA's longer operation time are not clear.

Oblique versus Straight skin incision: The impact of incision type on postoperative outcomes in distal radiocephalic arteriovenous fistula creation

Aim: The type of skin incision utilized in arteriovenous (AV) fistula creation may significantly influence the patency, maturation, and overall outcomes of the fistulas. An oblique skin incision may offer distinct advantages in preventing early AV fistula failure by reducing skin tension and minimizing pressure on the newly formed anastomosis. This study aims to compare the postoperative early period outcomes of oblique versus straight skin incision techniques, with a focus on their impact on AV fistula success. Material and Methods: 2020 to 2023, all patients with created AV fistula via distal antebrachial vessels with oblique and straight skin incisions were enrolled. Retrospectively, the patients’ demographics, comorbidities were collated from the hospital data. All patients were operated with local anesthesia for radiocephalic AV fistula creation. The characteristics of the vessels were determined through preoperative Doppler ultrasonography mapping. Evaluations were conducted on primary patency, early maturation, and the incidence of early thrombosis. Results: In Total, 182 patients were operated for AV fistula creation. The mean age was 57±17 years and there was a male predominance with %68. We performed 74 patients AVF creation via straight skin incision and 108 via oblique skin incision. Despite there being no differences in comorbidities and demographic characteristics between the two groups, the group with a straight skin incision exhibited a higher incidence of early thrombosis (p=0.03), a lower maturation rate (p=0.03), and reduced primary patency (p=0.01). Conclusion: Oblique skin incision could be a feasible alternative to conventional straight incision with a higher early AVF patency and lower thrombosis rates. Reducing the pressure on and keeping the incision away from the new anastomosis may be crucial for achieving better outcomes.