Minor Surgical Interventions Research Articles

The endocrinologist gap: Managing diabetes patients in absence of a specialist.

The treatment of pediatric patients with diabetes is frequently orchestrated within a multidisciplinary framework at tertiary, specialized institutions. Insituations where emergent surgery is indicated or when a procedure is scheduled in a facility devoid of an endocrinology service, the onus of managing perioperative glycemic levels may rest with the attending anesthesiologist. The objective of this review is to furnish a comprehensive examination of the anesthetic considerations and perioperative governance of pediatric patients with diabetes. Furthermore, this paper delineates a streamlined protocol for perioperative glycemic control, tailored to both major and minor surgical interventions.

Diagnostic Value of the Pediatric Bleeding Questionnaire in Prediction of Bleeding in Minor Surgery.

Preoperative coagulation tests have not been shown to be effective in predicting bleeding complications. The Pediatric Bleeding Questionnaire (PBQ) is a proven and sensitive tool for diagnosing children with a predisposition to bleeding. The aim of this study was to evaluate the usefulness of PBQ as a preoperative screening tool for the prediction of bleeding after minor surgical interventions. Preoperative coagulation tests and PBQ were performed in all patients who underwent minor surgery. The postoperative bleeding status was evaluated and then compared with the coagulation tests and PBQ of the patients. Evaluation was made of a total of 706 patients, comprising 91.2% males and 8.8% females, with a mean age of 4.8 years (median: 4y, QR: 1 to 7y). Prolongation in coagulation tests was observed in 131 (18.5%) patients. Repeated tests in 116 patients were within the normal range, and 5 patients received treatment. Postoperative bleeding occurred in 4 (0.5%) patients. The relationship between coagulation tests and postoperative bleeding was not significant. PBQ was found to be ≥2 in 14 patients, but none of these patients had postoperative bleeding. No significant relationship was found between postoperative bleeding status and PBQ ( p :0.77). The sensitivity, specificity, positive predictive, and negative predictive values of PBQ were 0%, 98%, 0%, and 97.4%, respectively. The results of this study demonstrated that neither coagulation tests nor PBQ will be sufficient to predict bleeding after minor surgery, that prolongation in coagulation tests does not always indicate a bleeding tendency, and that bleeding history should also be recorded in detail.

Newborn hip screening experience in Türkiye

In this review article, newborn hip screening experience in Türkiye was summarized. The nationwide newborn hip screening program was officially initiated in 2013. The program currently includes the ultrasonographic examination of the hips of almost all newborns within the first two months of life. The rate of minor surgical interventions (closed/open reduction and casting) was 0.47 per 1,000 live births in 2015 and was 0.89 per 1,000 live births in 2020. Thus, an increase of 89% in the rate of minor surgical interventions was observed. The rate of major surgical interventions (pelvic/femoral osteotomies) was 0.74 per 1,000 live births in 2015 and was 0.21 per 1,000 live births in 2020. Thus, a decrease of 72% in the rate of major surgical interventions was observed between 2015 and 2020. While minor surgical interventions constituted about 39% of the overall surgical interventions in 2015, this ratio raised to 81% in 2020. Based on the experiences in Türkiye universal newborn ultrasonography (US) hip screening is advocated to lessen the rate of extensive surgeries in developmental dysplasia of the hip (DDH) during childhood and adulthood and to have as many as possible functional hips in the long-term follow-up of patients with DDH.

OBSERVATIONAL STUDY OF COSTS AND APPROPRIATENESS OF USE OF HEMOSTATIC DEVICES AND DRUGS IN DIFFERENT TYPES OF BLEEDING

OBSERVATIONAL STUDY OF COSTS AND APPROPRIATENESS OF USE OF HEMOSTATIC DEVICES AND DRUGS IN DIFFERENT TYPES OF BLEEDING

Six years of experience with the nationwide newborn ultrasonographic hip screening program in Turkey: a considerable change in the type of surgical interventions in developmental dysplasia of the hip.

This study aims to assess whether or not the nationwide newborn ultrasonographic hip screening program has influenced the rate of different types of surgical interventions performed in developmental dysplasia of the hip (DDH) in children in Turkey. A retrospective analysis of the nationwide data obtained from the National Registry System between January 1, 2015, and December 31, 2020, was carried out. The rate of minor and major surgical interventions was calculated by dividing the total number of primary closed/open reductions with or without tenotomies and the total number of primary pelvic or periacetabular osteotomies with or without femoral osteotomies by the total number of live births in the country per year, respectively. The rates of primary minor surgical interventions were found to be 0.47/1000 in 2015, 0.71/1000 in 2016, 1.07/1000 in 2017, 1.00/1000 in 2018, 1.06/1000 in 2019, and 0.89/1000 in 2020. The rates of primary major surgical intervention were found to be 0.74/1000 in 2015, 0.40/1000 in 2016, 0.33/1000 in 2017, 0.31/1000 in 2018, 0.32/1000 in 2019, and 0.21/1000 in 2020. The introduction of the nationwide newborn hip screening program has significantly changed the surgical treatment modalities in children with DDH. A nearly twofold increase in the rate of primary closed/open reduction and hip spica casting and nearly three quarters decrease in the rate of primary bony procedures were observed within 6 years.

Microbial Prevalence and Outcome of Diabetic Foot Ulcers in Patient’s Candidates for Minor Surgical Interventions

Background: Diabetes mellitus is a progressive disease with chronic complications such as diabetic foot infection, a significant difficulty that inevitably leads to gangrene and amputations.
 
 Objective: This study aims to determine microbial prevalence in diabetic foot infections, identify the significance of aggressive surgical therapy and minor amputations in limb salvage and the prevention of more proximal amputations, and identify predicting factors affecting the outcome of these surgical processes.
 
 Methods: In this cohort study, microbiological samples were collected from 62 patients with diabetic foot lesions who underwent debridement or minor amputations to determine the prevalence of microorganisms in diabetic foot infections. Then, they were followed up to determine the rate of saved limbs and the factors that affect the outcomes and rate of complications.
 
 Results: infections were mainly caused by aerobic Gram-positive bacteria (S. aureus) 53.5%, and aerobic Gram-negative bacteria of enterobacter species 40.4%. Regarding the outcome of surgical intervention, we found an 80.65% success rate of saving the limb with a 30.6% complication rate. Risk factors such as high levels of inflammatory markers and parameters of the severity of peripheral arterial disease showed significant association with the rate of complications and poor outcomes.
 
 Conclusions: Debridement and minor surgical amputations effectively prevent more proximal amputations in diabetic foot infections with a high chance of good results. At the same time, the common microorganism in our local population was S. aureus, followed by P. mirabilis, E. coli, and Klebsiella species in diabetic foot infections.

The association between the distance from the epicenter of the Haiti earthquake (2021) and medical diagnoses: A report from the field

Background: Following the earthquake of August 2021 in Haiti, humanitarian agencies provided support to the local population. NATAN, a voluntary based non-governmental organization, had arrived in the field five days after the earthquake and provided medical support based on a mobile clinic in seven villages close to the epicenter of the earthquake. Methods: We conducted a cross-sectional study on data collected from 331 persons of concern, as part of ‘good clinical practice’. They received basic treatment such as antibiotics and minor surgical interventions following a diagnosis. The main variables that were collected in this intervention included demographic data, main diagnoses, and main treatments. We also examined the distance from the earthquake epicenter (DfE) and its effects on the diagnoses and treatments. Results: Several interesting findings were observed. A significant association between the DfE and the diagnoses was found, where within the group closest to the epicenter, the most prevalent diagnosis was internal medicine problems (40.3%). Conclusions: It is possible that since five days had passed since the earthquake, the expected diagnoses of traumatic injuries were reduced, leaving sub-acute problems to be diagnosed and treated. Finally, mental health symptoms and stress levels should be assessed systematically and with validated measures.

Bacillus Calmette-Guérin Vaccine-Related Osteomyelitis in Immunocompetent Children in Saudi Arabia: A Narrative Review.

The Bacillus Calmette-Guérin (BCG) vaccine is the most frequently used live-attenuated vaccine worldwide. Since 2002, two BCG vaccination strains, Pasteur 1173 P2 and Tokyo 172-1, have been the mainstay of Saudi Arabian healthcare. In 2005, the Danish 1331 strain was first used as the principal strain in clinical trials. Children can develop osteomyelitis 4-24 months after immunization with the BCG vaccine, an uncommon but serious side effect in immunocompetent children. We conducted this study to review the epidemiology, diagnosis, clinical symptoms, laboratory analyses, imaging features, and management of BCG osteomyelitis in immunocompetent children. Long bone metaphyses and epiphyses are more frequently affected. The diagnosis of BCG osteomyelitis is difficult because the symptoms are vague and subtle, and the duration between presentation and vaccination may range from a few months to a year. Radiography and computed tomography scans for BCG osteomyelitis typically show a devastating lesion with an associated periosteal response. Magnetic resonance imaging frequently reveals a large interosseous abscess indicative of osteomyelitis. There are no current treatment guidelines for BCG osteomyelitis in Saudi Arabia, but antituberculous regimens, particularly isoniazid and rifampicin, have been found to be very effective in previous studies. Although older studies did not favor surgical intervention because of the risk of complications, a few studies performed minor surgical interventions and had good outcomes. As BCG osteomyelitis is an infrequent complication, especially in immunocompetent children, its diagnosis is time-consuming. Therefore, it is critical to inform healthcare workers of this possible complication to make the diagnosis more straightforward and avoid confusion with pyogenic osteomyelitis. As only a few cases have been reported, further studies in Saudi Arabia are required for evidence-based guidelines applicable to actual practice to be established.

Comparison of culture-positive and culture-negative severe infectious keratitis leading to hospitalization: a tertiary referral center experience

Aim: To compare the predisposing factors, surgical interventions, length of hospital stay (LOHS), and treatment outcomes of culture-positive (CP) versus culture-negative (CN) severe infectious keratitis (IK) resulting in hospitalization in a tertiary referral clinic. 
 Material and Method: We retrospectively reviewed the medical and microbiological records of 287 patients clinically diagnosed with severe keratitis over a 4-year period. 
 Results: Of 287 study participants, 141 (49.1%) had positive CP results. The most common ocular risk factor was a previous ocular surgery (45.6%), and keratoplasty was the first among these ocular surgeries (90.8%). Staphylococcus epidermidis (22.7%) was the most commonly isolated microorganism followed by fungi (17.7%). The initial and final visual acuities did not differ significantly between the CP and CN groups. Major and minor surgical interventions did not significantly differ between the groups (p=0.05). The rates of clear corneal graft in the CP group (p =0.002) were significantly higher than the rates of graft failure in the CN group (p=0.033). No significant difference was noted in the mean LOHS between groups (p=0.66). Logistic regression analyses showed that surgery during admission, S. epidermidis infection, and connective tissue diseases were independent risk factors for a prolonged hospital stay. 
 Conclusion: The initial and final visual acuities, surgical interventions, and LOHS were similar between the CP and CN groups. However, graft failure rates were significantly higher in patients with CN keratitis than in those with CP keratitis.

Efficacy and safety of von Willebrand factor concentrate almost devoid of factor VIII (Wilfactin®) in paediatric patients under 6 years of age with severe von Willebrand disease.

Plasma-derived von Willebrand factor (VWF) (Wilfactin®, LFB, France) was developed for prophylaxis and treatment of haemorrhages in both adults and adolescents with von Willebrand disease (VWD). Replacement therapy in paediatric patients is a key element of the clinical trial programme. Patients aged <6 years with severe VWD were enrolled in a multinational, open-label study to evaluate the in vivo recovery for Wilfactin®, and its efficacy in preventing and treating bleeding episodes and during surgery. Overall haemostatic efficacy based on a 4-point scale was assessed by investigators. The treatment period ≥18 months investigated the long-term safety. Nine patients, including 7 with type 3 VWD were exposed to treatment with Wilfactin® for up to 4.2 years. Recovery of VWF in 7 patients (n=5 type 3, n=1 type 2, n=1 type 1) was 1.8±0.4 IU/dL per IU/kg. Of the 62 bleeds, 89% were controlled with one (73%) or two (16%) infusions of Wilfactin®. The median dose per infusion was 54 IU/kg. A factor VIII dose was co-administered in 1.6% of bleeds. "Excellent"/"Good" haemostatic efficacy was achieved in 90.3% of episodes. Six patients underwent 11 minor surgical interventions. Treatment duration was 1 day (range: 1-6 days) with a dose administered 30-60 minutes before procedure of 56 IU/kg (range: 41-106 IU/kg). Haemostasis was rated as "Excellent" in all surgeries. During 4-year prophylactic treatment in one patient, breakthrough bleeds were reported in 2.2% of infusions. No VWF inhibitors, thromboembolic events or allergic/anaphylactic-type reactions were observed following a total exposure of 770 days. The results show that Wilfactin® provides a safe and effective treatment in patients <6 years of age with severe VWD.

Clinical and Mycological Features of Fungal Keratitis: A Retrospective Single-Center Study (2012-2018)

Objectives:To present the demographic, etiological, clinical, and mycological characteristics and treatment results of fungal keratitis patients admitted to our clinic.Materials and Methods:The medical records of patients diagnosed with fungal keratitis between October 2012 and 2018 were reviewed. The diagnosis of fungal keratitis was confirmed mycologically and/or cytologically. Treatment response was defined as complete infiltrate resolution and re-epithelization with medical treatment and minor surgical interventions. Patients who underwent penetrating keratoplasty or evisceration due to clinical deterioration despite treatment were classified as treatment nonresponders and were compared with responders in terms of demographic, etiological, and clinical characteristics.Results:Seventy-two (12.8%) of 559 patients diagnosed with microbial keratitis in the 6-year period were fungal keratitis. Of these, 38 cases (38 eyes) without polymicrobial etiology were included in the study. The patients’ mean age was 44.9±19.0 years (range: 2-80) and males predominated (14 females [36.8%], 24 males [63.2%]). Trauma (63.6%) was the most common predisposing factor in patients younger than 40 years old, whereas pathologies impairing ocular surface immunity were the leading risk factor (48.1%) in patients older than 40 years. Filamentous fungi were detected in 34 (89.5%) cases, while yeasts were found in 4 (10.5%) cases. Among 26 cases with positive cultures, Aspergillus species were the most common pathogens (42.3%). Infiltrate size before treatment was larger in nonresponders (14/38, 36.8%) compared to treatment responders (19/38, 50%) (p=0.049). In addition, rates of treatment response were higher in cases in which the infiltrate was located paracentrally compared to other cases (p=0.036).Conclusion:Fungal keratitis is an important public health problem in our region. Ocular trauma is a leading etiology in men under the age of 40 years. In the 6-year period, we observed that the main causes of fungal keratitis were filamentous fungi, and most commonly Aspergillus species. In cases presenting with large and central lesions, aggressive treatment options should be considered and these patients should be followed up more closely.

The Role of the Laser Photobiomodulation (PBM) in the Management of Patients at Risk or Affected by MRONJ

Medication-Related Osteo-Necrosis of the Jaws (MRONJ) is a severe painful complication of the long-lasting administration of bisphosphonates and anti-resorptive and anti-angiogenetic drugs in neoplastic and dysmetabolic patients, secondary to minor surgical oral interventions or chronic epithelial decubitus ulcers. Its pathogenesis is still largely unknown even if the activity change of the osteoclasts plays a relevant role in bone remodeling. The management of these patients aims to prevent the onset of the pathology or to reduce the pain and remove the necrotic bone, promoting the healing of the pathological area. Photobiomodulation therapy (PBMT), the therapeutic application of low-energy laser or LED lights, was recently introduced in the management of this condition. Thanks to its therapeutic and biomodulating action on the irradiated tissues, PBM can be used alone or in combination with antibiotic and antibacterial therapies as a preventive, antalgic or palliative tool, and in support of surgery in a combined multi-protocol that leads to a positive and better resolution and healing of the pathologic process, with great improvement of the Quality of Life (QoL) of the patients. In this narrative review, a wide analysis of the various applications of PBM in MRONJ patients’ management is analyzed, emphasizing its role as supportive care for this condition.

Evaluation of vapocoolant spray effect on pain reduction during digital nerve block: A randomized clinical trial.

The digital nerve block is an effective method of anesthesia before minor surgical interventions on the fingers. However, patients may experience a lot of pain and anxiety during this procedure. The efficacy of topical vapocoolant spray during minor procedures has been demonstrated in previous studies. we aimed to evaluate the effectiveness of topical vapocoolant spray in reducing pain during digital nerve block. This prospective, randomized clinical study was conducted to evaluate the effectiveness of vapocoolant spray application in reducing pain during digital block. The patients were categorized into 2 groups as spray-treated and control group. A routine digital block process was applied to the control group. Spray application was performed in two groups of 50 each, in a manner of bilateral and unilateral to the finger. Demographic data of the patients, such as gender, age, dominant hand, injury patterns, injection site and injury sites, were recorded. After the application, the patients' visual analog scale (VAS) was evaluated. Of the participants, 100 were randomly assigned to the vapocoolant spray-treated group, and 50 were included in the control group. The VAS pain score during penetration in both spray groups was significantly lower than the control group (p < 0.001). Pain change during penetration was found to be significantly lower in the bilateral spray-treated group compared to the control group (p < 0.001). Pain change during infiltration was significantly lower in both spray groups compared to the control group (p < 0.001). Spray application prior to digital nerve blocking can be used to reduce needle penetration pain associated with this procedure and pain associated with local anesthetic infiltration.

Minor Sphincter Sparing Surgery for Successful Closure of Perianal Fistulas in Patients with Crohn's Disease.

The purpose of this study is to demonstrate that repetitive minor surgical procedures allow for a high rate of permanent closure of perianal fistulas in patients with Crohn’s disease (CD). Patients with perianal fistulizing CD (PFCD) who underwent perianal surgery at the University Hospital of Muenster between 2003 and 2018 were assessed for fistula characteristics and surgical procedures. We included 45 patients (m:f = 28:17) with a mean age of 27 years at first fistula appearance. Of these, 49% suffered from a complex fistula. An average of 4.2 (1–14) procedures were performed, abscess incisions and fistula seton drainages included. Draining setons were left in place for 5 (1–54) months, until fistula closure. Final surgical techniques were fistulotomy (31.1%), seton removal with sustained biological therapy (26.7%), Anal Fistula Plug (AFP) (17.8%), Over-The Scope-Clip proctology (OTSC) (11.1%), and mucosa advancement flap (4.4%). In 8.9% of cases, the seton was kept as permanent therapy. The time from first to last surgery was 18 (0–182) months and the median follow-up time after the last surgery was 90 (15–200) months. The recurrence rate was 15.5% after 45 (17–111) months. Recurrent fistulas healed after another 1.86 (1–2) surgical re-interventions. The final success rate was 80%. Despite biological treatment, PFCD management remains challenging. However, by repeating minor surgical interventions over a prolonged period of time, high permanent healing rates can be achieved.

COVID-19 and the ethical challenges of management in Private Dental Clinics in Egypt.

Background: One of the challenges that face effective dental and oral surgical treatment is reducing transmission of infectious diseases. This study assessed the challenges and the changes in management of patients in private dental clinics in Egypt in view of rapid spread of SARS-COVID-19. Methods: Six private dental clinics in Egypt were enrolled in this study. Changes in the management protocols were recorded and evaluated. Data were collected about the changes in clinic policies and in infection control practices. The modifications in patient management and the number and types of treatment approaches either surgical or non-surgical for dental and oral conditions were recorded and evaluated. Results: The most commonly followed guidelines were wearing gloves followed by wearing masks and using disposable products. Remote consultations and shortage of personal protective equipment were recorded by all clinics. Management approaches included conservative endodontic management for periapical lesions and fistulae. Aerosols and minor surgical interventions could not be avoided in many cases. Conclusion: Conservative approaches were effective and could be considered during pandemic spread. Dental personnel should be more aware and more prepared for any pandemic spread. Management modifications and strict precautions should be followed

Возможность применения тилетамин-золазепама для седации при пероральном введении у собак и кошек: обзор литературы

The review presents the results of three studies of the use of tiletamine-zolazepam for sedation during oral administration in dogs and cats.&#x0D; Study 1. Objective: to study the sedative effect of the combination of tiletamine-zolazepam-acepromazine (TZA) or ketamine-flunitrazepam (CF) in dogs with oral administration, as well as to evaluate the effectiveness of the capsule form of TZA in stray dogs. In a pilot study, 6 dogs were administered a liquid form of TZA (20 mg/kg tiletamine-zolazepam and 2 mg/kg acepromazine) or a liquid form of CF (50 mg/kg ketamine and 2 mg/kg flunitrazepam) orally. Sedation was evaluated in points. On average, the time interval from the introduction of MAL to the adoption of the animal side position was: protocol 1 (infusion of the drug into the mouth) — 47.5 (35...80) minutes (67 % of dogs); protocol 2 (addition of the capsule form to the canned food) — 30 (15...65) minutes (83 %), protocol 3 (addition of the liquid form of the drug in gravy) — 75 (45...110) minutes (100 %). None of the dogs in the CF group in protocols 2 and 3 took a side position. Based on these results, 20 stray dogs received encapsulated MAL: TZ (20 mg/kg) and acepromazine (2 mg/kg). Overall, 63 % of the stray dogs in the experiment were caught after eating a double dose of MAL. Oral administration of encapsulated MAL added to the canned food allows you to catch stray dogs, but it may require the use of additional drugs. The time from the introduction of TZA to the development of sedation in animals and the taste of the drug affect the percentage of capture.&#x0D; Study 2. The purpose of the study is to study the possibility of oral administration of the drug «Zoletil» to cats. 8 healthy cats, females and males, aged from 2 to 4 years, were selected. «Zoletil-50» was used in the form of a sterile lyophilizate prepared in the form of a solution with water for injection in doses from 15 to 25 mg/kg. After administration of the drug, hemodynamic parameters, sedation, and the possibility of endotrachial intubation were evaluated. After oral administration, the effect of sedation developed quite quickly. When administered at a dose of 25 mg/kg, intubation and minor surgical interventions were possible. A dose of 15 mg / kg caused only sedation. It is advisable to use «Zoletil» in the form of a powder with a pleasant taste.&#x0D; Study 3. Objective: to assess the quality of sedation, changes in SAD, heart rate and BH in TB administration of TK to healthy cats. Healthy, sterilized European shorthair cats (n=7; 3 males, 4 females) were included in a randomized, blind, cross-sectional study. Each cat received two doses of tiletamine-diazepam TB: 5 mg / kg (LD) and 7.5 mg/kg (HD) of each drug. TB administration of tiletamine-zolazepam in the studied doses is a simple and effective method of pharmacological fixation of cats, while LD has less effect on SAD and BH than HD.

Influence of general anesthesia for tonsillotomy and adenotomy to cognitive functions in children

Background. Surgery under general anesthesia can affect the patients neurocognitive outcome. This problem is of particular relevance in pediatric surgical practice.&#x0D; Goal. The aim of this study is to determine the spectrum of clinical manifestations and the frequency of cognitive dysfunction symptom development in children after adenotomy and/or tonsillotomy performed under general anesthesia.&#x0D; Methods. This prospective study included 30 children aged 3 7 years (average age 4.9 1.3 years) who underwent adenotomy and/or tonsillotomy under general, combined, balanced anesthesia. In the preoperative period and a day after the operation, neuropsychological testing was performed: The Raven test, mechanical and associative memory test, Mini-Mental State Examination (MMSE) scale adapted for children from 3 years old, and the Bourdon test. A 20% decrease in function compared with the initial level was considered clinically significant.&#x0D; Results. One day after surgery, 10% of patients had a clinically significant decrease in attention productivity, 10% had a decrease in attention accuracy, 13.3% had a decrease in attention index, and 16.7% had a decrease in overall productivity and the attention index according to the Bourdon test. Also, 13.3% showed a decrease in attention, 30% had a decrease in memory on the MMSE scale, 20% showed a decrease in mechanical memory, and 10% had a decrease in test results on the Raven test.&#x0D; Conclusion. Conducting even minor surgical interventions with general anesthesia leads to an impairment of various cognitive functions in 10%30% of children aged 3 to 7 years.

Essential Emergency Surgical Care in Remote Hilly Districts of Karnali - A Cross-Sectional Survey

Background: Remote hilly areas of Karnali Province has one in all the very best burdens of surgically treatable conditions within the world and therefore, the highest unmet need. The first objective of our study was to gauge the capacity of first-referral health facilities in remote districts of Karnali Province to perform basic surgical procedures. The aim is to assess the status of Essential Emergency Surgical Care in remote hilly districts of Karnali region of Nepal.&#x0D; Method: The screening Tool was Situational Analysis to Assess Emergency and Essential Surgical Care, to spot the health facility’s capacity to perform basic surgical (including obstetrics and trauma) and anesthetic procedures by investigating four categories of data: human resources, infrastructure, equipment and interventions available. The tool interrogated the supply of eight sorts of care providers, 35 surgical interventions and 67 items of apparatus.&#x0D; Results: on the average, 72.83% of all admissions required either minor or major surgical interventions. Oxygen supplies, electrical power backup, running water, blood bank, hospital guidelines were inconsistent. Only 1 Hospital have trained Surgeons, Anesthesiologist and Obstetrician/Gynecologist. Only 1 hospital can perform around 97.1% of procedures.&#x0D; Conclusion: The capacity for essential surgery is severely limited in Karnali region of Nepal. Limitations was seen in basic equipment, human resources, infrastructure, and supplies.

Cost factor "outpatient wound care" in the emergency department : Cost-revenue deficit of outpatient wound treatment in a German university hospital

HintergrundDie Erstversorgung von Wunden und kleinere chirurgische Eingriffe gehören neben der hochspezialisierten Medizin zu den allgemein notwendigen Grundleistungen der Notfallversorgung in den Kliniken. Die Vergütung der ambulanten Notfallleistungen für gesetzlich Versicherte erfolgt derzeit nach dem Einheitlichen Bewertungsmaßstab (EBM), welchem die betriebswirtschaftliche Aufwandserfassung des niedergelassenen Sektors als Kalkulationsgrundlage dient. Krankenhäuser haben im Vergleich zu Arztpraxen wesentlich höhere Vorhaltungskosten.Ziel der ArbeitIn dieser Arbeit wird das entstehende Kosten-Erlös-Verhältnis der ambulanten Wundversorgung in einer Notaufnahme durch die Vergütung nach EBM analysiert.Material und MethodenDie Daten wurden in der Notaufnahme des Universitätsklinikums Frankfurt am Main über 12 Monate erhoben. Eingeschlossen wurden alle Patienten, die in diesem Zeitraum eine Wundversorgung mittels Naht erhielten. Die Kosten wurden der Abrechnung nach EBM 01210 (bzw. 01212) mit der Zusatzpauschale für kleinchirurgische Eingriffe EBM 02301 gegenübergestellt.ErgebnisseIm Beobachtungszeitraum wurden 1548 Patienten versorgt; das entspricht 19,52 % aller unfallchirurgischen Fälle. Den Kosten einer Standardwundversorgung in Höhe von 45,40 € steht eine Vergütung von 31,83 € gegenüber. Die Berechnung des Gesamterlöses weist einen Defizitbetrag von 13,57 € pro ambulantem Fall auf; dies entspricht einem Jahresdefizit von 21.006,36 €.DiskussionEs konnte gezeigt werden, dass ohne Betrachtung der relevanten Vorhaltekosten in keinem Fall eine Kostendeckung erreicht werden kann.Die bisherige Vergütung der ambulanten Wundversorgung nach EBM erscheint unzureichend. Eine Anpassung bzw. Zusatzvergütung scheint notwendig, um eine ausreichende Versorgungsqualität in Zukunft sicherstellen zu können.

TRANSDERMAL FENTANYL PATCH FOR ACUTE PAIN CONTROL AFTER SHORT INTRAHOSPITAL STAY

Transdermal fentanyl patch (TFP) is used for alleviation of chronic pain, while scientific evidence regarding its use for acute pain is insufficient. Purpose. To compare the effects of pain control by non-steroidal anti-inflammatory drug (NSAID) and TFP and the restrictions in daily activities in patients following elective minor surgical interventions. Patients and methods. Prospective, randomised, casecontrolled study included patients aged ≥18 years who underwent elective cholecystectomy, gastric fundoplication or inguinal hernia repair. All randomised patients (fentanyl prescription group, FG, and control group, CG, 62 cases each) were administered dressing plasters for the first three post-operative days; the FG patients received 50mcg/h TFP under the plaster. Within the 4 post-operative days, the patients of both groups received diclofenac on demand. Post-operative pain at rest and during movement was evaluated using the Visual Analogue Scale on the 1st, 2nd, 3rd, 4th post-operative days. Daily activities using the Functional Activity Score were scored as 0 – no limitations, 1 – some limitations, 2 – severe limitations. Results. Pain both at rest and during movement on the first three post-operative days was lower in the FG; CG patients received 5 times more doses of diclofenac on demand on the 1st day after the surgery, with the higher need of NSAID during the next two days (p&lt;0.05). The total number of NSAID doses per patient administered on demand was 3.11±0.59 in the CG and 0.73±0.16 in the FG (p&lt;0.05). The influence of pain on daily activities on the 2nd post-operative day was scored as 0 by 92% patients and as 1 by 8% patients of the FG, versus 60% and 40% patients of the CG (p&lt;0.05). Conclusion. Patients with TFP experienced significantly more effective pain control leading to less restricted daily activities and used less doses of NSAID within the first few post-operative days. Plain Language Summary. Could a single long-lasting dose of transdermal fentanyl patch serve as an alternative to uncontrolled consumption of non-steroid anti-inflammatory drugs when dealing with early post-operative pain in patients following a hospital discharge after an elective minor surgery? Our conclusion suggests that the answer is “yes”, if the riskbenefits balance is evaluated.