Operative Procedures Research Articles

Navigating hernia sac management in minimally invasive inguinal hernia repair: to abandon or to reduce? An updated systematic review and meta-analysis.

Minimally invasive inguinal hernia repair has become increasingly accepted, demonstrating superior outcomes over open procedures in postoperative complications. However, certain postoperative complications, such as seroma, remain a dilemma, with many attributing it to the management of the hernia sac. We aimed to perform a systematic review and meta-analysis comparing the reduction versus abandonment of the hernia sac during laparoscopic inguinal hernia repair. Cochrane, Scopus, SciELO, and PubMed were searched for studies comparing reduction and abandonment of the hernia sac. Our primary outcome was seroma. Secondary outcomes were overall complications, postoperative pain, surgical site infection, recurrence, hospital length of stay (LOS), and operative time. We performed a subgroup analysis of transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques. Statistical analysis was performed with R Studio. 2388 studies were screened, and seven studies were included, comprising 3153 patients, of which 916 (29%) were in the abandonment group. We found higher seroma rates for the abandonment group (RR 1.52; 95% CI 1.22 to 1.89; P < 0.001). No differences were found in overall complications (RR 0.88; 95% CI 0.55 to 1.42; P = 0.61), postoperative pain (RR 1.15; 95% CI 0.46 to 2.87; P = 0.76), recurrence (RR 2.67; 95% CI 0.51 to 14.05; P = 0.25), operative time (MD -4.45 min; 95% CI -12.77 to 3.86; P = 0.29), and LOS (MD -0.06 days; 95% CI -0.14 to 0.02; P = 0.14) between both groups. Subgroup analysis of seroma showed no differences between the groups when analyzing TAPP (19.3% vs. 13%; RR 1.65; 95% CI 0.91 to 2.99; P = 0.1) and TEP (9% vs. 4.3%; RR 1.69; 95% CI 0.62 to 4.6; P = 0.3) procedures. Our systematic review and meta-analysis support that hernia sac abandonment may be associated with increased early seroma rates following laparoscopic inguinal hernia repair, but limited data are available for technique-specific analyses.

Technology Adoption and Digital Transformation in Small Businesses: Trends, Challenges, and Opportunities

Small and medium-sized enterprises (SMEs) are at the forefront of digital transformation and technology adoption, which entails the integration of digital technologies to transform operational procedures, elevate customer satisfaction, foster innovation, and increase competitiveness. Notwithstanding the presence of distinct obstacles such as limited technological knowledge, inadequate financial resources, inadequate digital infrastructure, and shortages of skilled personnel, small and medium-sized enterprises (SMEs) have the potential to accrue considerable advantages from digital transformation. Digital transformation empowers small and medium-sized enterprises (SMEs) to achieve sustainability, competitiveness, and customization in their offerings (Philbin et al., 2022). The incorporation of digital technologies is imperative in order to attain sustainable development, which encompasses social, environmental, and economic dimensions. Adoption, nevertheless, is frequently impeded by a dearth of comprehension and strategic direction (Philbin et al., 2022).

Use of Standard Operating Procedures for Supporting Cross-Organizational Emergency Management: Challenges and Opportunities Identified from a Tabletop Exercise

AbstractThis study investigated the crucial role of formulating and applying standard operating procedures (SOPs) in the context of emergency planning and response. The effective application of SOPs during operations is essential in order to address challenges that surpass individual organizational capacities. A specific focus on fostering efficient information sharing and executing specified actions maximizes the prospect of success. To explore the collective functionality of SOPs across organizations, we conducted a comprehensive tabletop exercise involving 10 organizations spanning tactical, operational, and strategic levels. Our analysis identified six key challenges, primarily related to the structures for information sharing, communication pathways, and the complex integration and application of common SOPs within these diverse organizational contexts. This research contributes insights into the use of SOPs in large-scale, cross-organizational scenarios.

On-site detection of OTA and AFB1 based on branched hybridization chain reaction coupled with lateral flow assay

Mycotoxins are widely prevalent in various agricultural commodities, whose excessive consumption can pose significant risks to human health. In this study, we developed a facile mycotoxin detection platform based on branched hybridization chain reaction coupled with lateral flow assay. Ochratoxin A/Aflatoxin B1 bind to aptamers triggering the release of initiators, which leads to bHCR amplification and forms three-dimensional dendritic DNA nanostructures. Using the functionalized quantum dots as a fluorescent label, by leveraging smartphones and handheld ultraviolet lamps, the qualitative and quantitative detection of OTA and AFB1 can be achieved with a significantly enhanced sensitivity level, surpassing that of commercial test strips by 2–3 orders of magnitude. The visual detection limits for OTA and AFB1 were 30 pg/mL and 4 pg/mL, respectively. This approach eliminates the necessity for enzyme catalysis or the preparation and purification of antibodies and/or hapten, thereby reducing testing expenses and streamlining operational procedures. Moreover, substituting aptamer and nucleic acid sequences can effectively expand the scope of detection targets. Consequently, the as-proposed strategy exhibits great potential as a versatile technique, suitable for various analytical scenarios due to its sensitivity, accuracy, simplicity, and portability.

The COMPARE Study: Comparing Perioperative Outcomes of Oncologic Minimally Invasive Laparoscopic, Da Vinci Robotic, and Open Procedures: A Systematic Review and meta-analysis of The Evidence.

To assess 30-day outcomes of da Vinci robotic-assisted (dV-RAS) versus laparoscopic/thoracoscopic (lap/VATS) or open oncologic surgery. Complex procedures in deep/narrow spaces especially benefit from dV-RAS. Prior procedure-specific comparisons are not generalizable. PubMed, Scopus and EMBASE were systematically searched (latest: 11/17/2023) following PRISMA and PROSPERO (Reg#CRD42023466759). Randomized, prospective, and database studies were pooled as odds ratios (OR) or mean differences (MD) in R using fixed-effect or random-effects (heterogeneity significant). ROBINS-I/RoB 2 were used to assess bias. Of 56,314 unique references over 12 years from 22 countries, 230 studies (34 randomized, 74 prospective, 122 database) comparing dV-RAS to lap/VATS or open surgery across 7 procedures, 4 specialties, representing 1,194,559 dV-RAS; 1,095,936 lap/VATS and 1,625,320 open cases were included. Operative time for dV-RAS was longer than lap/VATS (MD:17.73min [9.80,25.67], P<0.01) and open surgery (MD:40.92min [28.83,53.00], P<0.01), whereas hospital stay was shorter (lap/VATS MD:-0.51d [-0.64,-0.38], P<0.01; open MD:-1.85d [-2.09,-1.62], P<0.01) and blood loss was less versus open (MD:-293.44ml [-359.53,-227.35]). There were fewer dV-RAS conversions (OR:0.44 [0.40,0.49], P<0.01), transfusions (OR:0.79 [0.72,0.88], P<0.01), postoperative complications (OR:0.90 [0.84,0.96], P<0.01), readmissions (OR:0.91 [0.83,0.99], P=0.04), and deaths (OR:0.86 [0.81,0.92], P<0.01) versus lap/VATS, and fewer transfusions (OR:0.25 [0.21,0.30], P<0.01), postoperative complications (OR:0.56 [0.52,0.61], P<0.01), readmissions (OR:0.71 [0.63,0.81], P<0.01), reoperations (OR:0.89 [0.81,0.97], P<0.01), and deaths (OR:0.54 [0.47,0.63], P<0.01) versus open surgery. Blood loss (MD:-12.26mL [-29.44,4.91], P=0.16) and reoperations (OR:1.03 [0.95,1.11], P=0.48) were similar for dV-RAS and lap/VATS. There was significant heterogeneity. Da Vinci-RAS confers benefits across oncological procedures and study designs. These results provide clinical evidence to multi-specialty-care decision-makers considering dV-RAS.

THE ROLE OF ARTIFICIAL INTELLIGENCE IN TRANSFORMING INTERNAL CONTROL WORKFLOWS

Internal control systems rely heavily on well-defined workflows and procedures in business operations. The fundamental components of internal control systems encompass policies, procedures, and workflows, impacting various aspects such as the accurate establishment of internal controls, employees' adeptness in their application, defining authorities correctly, and ensuring business sustainability. This significance is further underscored by incorporating these elements into internal control standards and relevant legislation. The absence of documented internal control flows directly contributes to audit findings in numerous public institutions and private organizations. Therefore, this research highlights the critical role of policies, procedures, and workflows in internal control. It aims to explore the attributes of artificial intelligence applications across multiple dimensions to emphasize their potential in bolstering internal control systems. This study underscores the significance of internal control processes, emphasizing their crucial role in daily operations and the potential benefits of artificial intelligence in streamlining these processes, thereby making the audience feel the importance of their work.

PELATIHAN PEMIKIRAN BERBASIS RISIKO MENGGUNAKAN TEKNOLOGI KOMPUTER UNTUK MENINGKATKAN AKUNTABILITAS KANTOR DISTRIK NAVIGASI PALEMBANG

With its strategic role, the Palembang Navigation District Office has made substantial efforts to improve the quality of its services, particularly by conducting initiatives to develop Standard Operating Procedures for the many types of services it offers. One of the main activities in this series of activities is providing training entitled Risk-Based Thinking - Identifying Risk Aspects in Processes that can support Accounting and Management Information Systems. The author explains to the participants using three methods: the Lecture Method, the Question-and-Answer Method, and the Case Study Discussion Method, all of which are conducted face-to-face and divided into five sessions, beginning with the opening session, material presentation session, illustration session, question and answer session, and closing session. It is hoped that by participating in this training activity, participants will gain a better understanding of the concept and application of risk-based thinking, as well as skills in using various types of tools, techniques and computer technology commonly used in risk management, which will be integrated into the process of developing the new service procedures. According to the results of the post-activity interview, the Head of the Palembang Navigation Office was satisfied with the training results and his team's absorption of the content.

The Chilean COVID-19 Genomics Network Biorepository: A Resource for Multi-Omics Studies of COVID-19 and Long COVID in a Latin American Population

Although a lack of diversity in genetic studies is an acknowledged obstacle for personalized medicine and precision public health, Latin American populations remain particularly understudied despite their heterogeneity and mixed ancestry. This gap extends to COVID-19 despite its variability in susceptibility and clinical course, where ethnic background appears to influence disease severity, with non-Europeans facing higher hospitalization rates. In addition, access to high-quality samples and data is a critical issue for personalized and precision medicine, and it has become clear that the solution lies in biobanks. The creation of the Chilean COVID-19 Biorepository reported here addresses these gaps, representing the first nationwide multicentric Chilean initiative. It operates under rigorous biobanking standards and serves as one of South America’s largest COVID cohorts. A centralized harmonization strategy was chosen and included unified standard operating procedures, a sampling coding system, and biobanking staff training. Adults with confirmed SARS-CoV-2 infection provided broad informed consent. Samples were collected to preserve blood, plasma, buffy coat, and DNA. Quality controls included adherence to the standard preanalytical code, incident reporting, and DNA concentration and absorbance ratio 260/280 assessments. Detailed sociodemographic, health, medication, and preexisting condition data were gathered. In five months, 2262 participants were enrolled, pseudonymized, and sorted by disease severity. The average Amerindian ancestry considering all participant was 44.0% [SD 15.5%], and this value increased to 61.2% [SD 19.5%] among those who self-identified as Native South Americans. Notably, 279 participants self-identified with one of 12 ethnic groups. High compliance (&gt;90%) in all assessed quality controls was achieved. Looking ahead, our team founded the COVID-19 Genomics Network (C19-GenoNet) focused on identifying genetic factors influencing SARS-CoV-2 outcomes. In conclusion, this bottom-up collaborative effort aims to promote the integration of Latin American populations into global genetic research and welcomes collaborations supporting this endeavor. Interested parties are invited to explore collaboration opportunities through our catalog, accessible online.

Transcending failure: A study on the “failed domestication” of online news for young visually impaired people in China

Drawing on the triple articulation framework, this study explores the “failed domestication” of online news consumption among young visually impaired people (YVIP), focusing on technological objects, symbolic environments, and individual texts. The findings suggest that “failed domestication” is not merely a consequence of limitations in technical design or social contexts but rather the result of “negotiation” between individuals and media. YVIP develop unique media usage strategies by simplifying operational procedures, foregoing updates, filtering out news irrelevant to their daily lives, and personalizing their interpretation of texts. In contrast to the notion of “failure” rooted in ableism, these behaviors reflect a deep understanding by the visually impaired of their capabilities and specific needs, constituting a form of “alternative success.” The use of digital media by people with disabilities is a process of autonomous choice rather than the “enforcing normalcy.” Therefore, this study advocates for creating a more flexible and human-centric media ecosystem that enables people with disabilities to choose appropriate media usage patterns based on their individual needs and preferences, thus promoting genuine digital inclusivity.

PENGARUH KOMPETENSI TERHADAP KINERJA PERAWAT BANGSAL RAWAT INAP DI RSUD dr. SOEHADI PRIJONEGORO SRAGEN

Introduction: Human resources are the most important determining factor in achieving the strategic goals of an organization, especially in the healthcare industry. Based on the results of a preliminary study, inpatient ward nurses have education ranging from third diploma to bachelor's degree to postgraduate degree, and inpatient indicators meet the ten standards set by the Indonesian Ministry of Health. The competence of nurses in terms of knowledge and skills in nursing is very important to know how good the performance of nurses is in achieving good health goals in accordance with the duties and authority, code of ethics and applicable standard operating procedures. Objectives: The purpose of this study was to determine the effect of competence on the performance of inpatient ward nurses at RSUD Dr. Soehadi Prijonegoro Sragen Methods: This study used a quantitative paradigm with a cross-sectional design to test the hypothesis. The study population consisted of all nurses (N = 158) in 11 inpatient wards. The study sample consisted of 121 nurses selected using proportional random sampling technique. The predictor variable was competence and the criterion variable was nursing performance. The analysis used univariate and bivariate analysis (simple linear regression analysis). Results: Based on univariate analysis, competence and performance are in the "good" category, with the percentage of competence of 95.87% and nurse performance of 92.56%. Based on bivariate analysis, the significance value is 0.000 &lt;0.05 and t count is 8.796&gt; t table 1.980. The results of the study indicate that competence has a positive influence on the performance of nursing staff. Conclusions: The conclusion is that competence has a positive effect on the performance of the inpatient ward hospital Dr. Soehadi Prijonegoro Sragen Regional Hospital.

Surgical Options for Retained Gallstones After Cholecystectomy.

Retained gallstones are the most common cause of postcholecystectomy pain. They may be in a long remnant cystic duct (CD), the common bile duct (CBD), or within a remnant gallbladder (GB) post subtotal cholecystectomy. Although endoscopic management is often attempted, occasionally surgical clearance is required. Rates of preoperative surgery to remove stones in a remnant GB are rising due to the increased practice of subtotal cholecystectomy during a problematic laparoscopic cholecystectomy. This study aims to review the surgical management of symptomatic retained stones at a tertiary hepatobiliary referral center in Sydney, Australia. This retrospective analysis of prospectively collected data was performed on patients who underwent an operation for retained stones after a previous cholecystectomy over 18 years (2004-2022). All of the patients with residual CBD stones had failed endoscopic retrograde cholangiopancreatogram (ERCP) attempts or could not have an ERCP because of prior foregut surgery. All patients underwent a systematic preoperative workup confirming the biliary anatomy and pathology. Fourteen patients had surgical intervention for retained stones. All cases were attempted laparoscopically and were successful in 11/14 patients (78%). Retained stones were found within a remnant GB (29%, n=4), a remnant CD (36%, n=5), or the CBD (36%, n=5). Conversion to an open procedure in 3 patients was for dense fibrosis associated with a long low-insertion of the CD, necessitating a hepatico-jejunostomy, failure to delineate the biliary anatomy, and inability to clear CBD stones, respectively. One patient developed a minor postoperative complication (superficial wound infection), and all patients were free of symptoms at a median follow-up of 33.5 months. This study demonstrates favorable outcomes in patients undergoing laparoscopic intervention for retained gallstones. A systematic approach to the workup and surgical management of patients with retained stones is essential.

Surgical Management of Penetrating Carotid Artery Injury: Preoperative Level of Consciousness Does Matter.

The optimal surgical management of penetrating carotid artery injuries (PCAI) remains controversial. This study aimed to examine the association between operative techniques for PCAI and the incidence of stroke. This retrospective cohort study used the American College of Surgeons Trauma Quality Improvement Program (2016-2021) database. We included patients (≥16 years old) with severe penetrating injuries to the common or internal carotid arteries (CCA/ICA) who underwent one of the following operative procedures: primary suture repair, ligation, and arterial reconstruction with a graft. Multivariate logistic regression analysis with cluster-adjusted robust standard errors was performed to estimate the adjusted odds ratio (AOR) for postoperative stroke stratified by the initial Glasgow Coma Scale (GCS). A total of 429 patients were included (329 underwent primary suture repair, 82 underwent ligation, and 81 underwent arterial reconstruction with a graft). The median age was 31 years (interquartile range [IQR]: 24-43) and median GCS on arrival was 11 (IQR: 3-15). On multivariate analysis after adjusting for potential confounders, ligation of CCA/ICA was significantly associated with increased odds of stroke in patients with initial GCS ≥9 (AOR: 4.40, 95% confidence interval [CI]: 1.16-16.58, p=0.029), whereas there was no significant association in patients with GCS <9 (AOR: 0.77, 95% CI: 0.28-2.11, p=0.37). No significant association was identified between arterial reconstruction with a graft and stroke, irrespective of the initial GCS. The study findings suggest that the preoperative level of consciousness may help in planning operative strategies for PCAI. In patients with an initial GCS ≥ 9, definitive repair of the CCA/ICA, including arterial reconstruction with a graft, should be pursued instead of ligation.

Minimally Invasive Pauli Parastomal Hernia Repair.

Although originally described as an open procedure, the application in the setting of minimally invasive surgery of the Pauli technique for parastomal hernia repair is gaining interest among surgeons owing to encouraging early results. We aimed at combining and analyzing the results of minimally invasive Pauli repair by assessing the available evidence. A literature search in Pubmed, Embase, and Web of Science was undertaken to include all articles reporting on minimally invasive repair of parastomal hernias using the Pauli technique. Data regarding a total of 75 patients across 11 articles published between 2019 and 2023 were included. Patients received surgery either by a laparoscopic (27%) or robotic (73%) approach. A transabdominal route was chosen in 62 patients (83%), while an extraperitoneal technique was employed in the remaining 13 patients. The rate of postoperative morbidity was 34%, with 10% being the incidence of grade >II complications. The reported overall rate of recurrence was 7% at a median follow-up of 1 to 43 months. The available evidence derived from a growing number of centers suggests that minimally invasive Pauli repair is a viable option to treat parastomal hernias. Despite robust, high-level data still lacking, preliminary experiences indicate promising results.

Magnetic Resonance Imaging - Derived Psoas Muscle Area and Survival in Patients Treated Invasively for Peripheral Arterial Disease.

Psoas muscle parameters estimated from computed tomography images, as surrogates for sarcopenia, have been found to be associated with post-interventional outcomes after a wide range of cardiovascular procedures. The pre-interventional assessment in patients undergoing invasive treatment for peripheral arterial disease is increasingly often carried out with magnetic resonance imaging (MRI), and we therefore sought to investigate the predictive potential of MRI-derived psoas muscle area in this cohort. A total of 899 patients with available sufficient quality pre-interventional MRI conducted within 6 months prior to treatment undergoing open, endovascular, or hybrid revascularization procedures for claudication and/or limb-threatening ischemia at Tampere University hospital between 2010 and 2020 were retrospectively studied in this single-center cohort study. The follow-up lasted until 17 June 2021. Psoas muscle areas were measured from the magnetic resonance images at the L4 level, and the reliability of muscle parameter measurements was tested with intraclass correlation coefficient analysis. The average psoas muscle area values (mean of left and right psoas surface areas) were z-scored and analyzed separately for men and women. The median follow-up time was 5.9 years (interquartile range (IQR) = 2.7-7.8), and the overall mortality count was 259 (28.8%) (29.5% n = 168/569 for men and 27.6% n = 91/330 for women). The intraclass correlation coefficient analysis showed excellent interrater reliability for psoas muscle measurements. The muscle surface areas were larger in men (mean = 7.58 cm2) compared to women (mean = 5.27 cm2) (p < 0.001). Higher psoas muscle area was associated with better survival in women (p = 0.003, hazard ratio (HR) = 0.71, 95% confidence interval (CI) = 0.6-0.9 per 1 SD), whereas in men, an independent association of the muscle parameter with mortality was not found. MRI-derived psoas muscle area may be a prognostic factor for clinical use.

Surgical correction of posttraumatic triphalangeal joint flexion contractures of the fingers (systematic literature review)

Introduction Triphalangeal joint flexion contracture of the fingers is a common and challeging posttraumatic hand condition. The goal of surgical treatment is to correct finger deformity and increase interphalangeal range of motion.The objective was to systematize data on the causes of post-traumatic triphalangeal joint flexion contracture of the fingers and methods of surgical correction.Material and methods The original literature search was conducted on key resources including Scientific Electronic Library (www.elibrary.ru), the National Library of Medicine (www.pubmed.org), ScienceDirect, Google Scholar, Ovid databases according to PRISMA recommendations. Literature searches included both Russian and English studies, with one or more cases of post-traumatic triphalangeal joint flexion contracture of the fingers with the deformity surgically corrected. Cases of non-traumatic flexion contractures were excluded. Etiological factors of flexion contractures, heterogeneity of definitions and methods for recording the range of motion in the joint, anatomical features, surgical correction of flexion contractures and postoperative complications were reviewed.Results Common causes of flexion contractures included burns (32.3 %), dislocations and fracturedislocations of the finger joints (23.5 %). The median postoperative follow-up period was 13.5 months after surgical treatment. Surgical correction was produced with external fixation device (EFD) in 40 % of cases, open procedures performed in 50 % and a combined technique employed in one case (10 %). Based on calculations of the odds ratios of postoperative complications, a weak positive linear relationship was revealed between EFD and pain syndrome, and a weak negative linear relationship was observed between the open procedure and pain.Discussion There is heterogeneity of approaches regarding methods for correcting flexion contractures, surgical approaches, techniques for mobilizing joints and releasing the anatomical structures of the finger with open procedures, the distraction rate with EFD, methods for repair of soft tissue defects following the treatment of flexion contractures of interphalangeal joint of a finger.Conclusion Open procedures are commonly used for precise elimination of all components of flexion contracture of the joint and repair of soft tissue defects of the finger. A weak positive linear relationship was revealed between EF and pain syndrome. There was no significant correlation between open techniques and complications. There were no correlations between the treatment method and the contracture type; there are no treatment regimens for patients with this pathology.

Prediction method of surface subsidence induced by block caving method based on UAV oblique photogrammetry

Unmanned Aerial Vehicle (UAV) oblique photogrammetry has been extensively employed in mining, albeit predominantly for reconstructing three-dimensional scenes and detecting changes within mining sites, lacking predictive capabilities. Leveraging 3D real scene model data, this study presents a two-stage prediction model, merging the probabilistic integral method with recurrent neural network (PIMF-RNN), to mitigate the impact of internal and external factors on surface subsidence, thereby enhancing predictive accuracy. Building upon this framework, a methodology was developed to forecast the maximum surface subsidence height and affected area under the block caving method, offering crucial data support for mitigating hazards associated with this mining technique. Analysis of surface data from Pulang copper mine during 2018–2020 demonstrates a prediction accuracy of 91.47% for maximum surface subsidence height and 87.52% for subsidence area. This research expands the potential applications of UAV oblique photogrammetry techniques within mining contexts. Furthermore, it establishes a cost-effective and efficient operational procedure for predicting mine surface subsidence.

National Trends in Laryngeal Laser Surgery: Comparison of Operative Versus Office-Based Procedures.

To analyze national trends in the prevalence of office-based laryngeal ablative procedures and compare those with traditional operative excisional procedures utilizing direct laryngoscopy. For years 2013-2022, the US Medicare Part B claims database was searched for Current Procedural Terminology (CPT) codes 31572 (flexible laryngoscopy with laser ablation of lesion), 31540 (operative direct laryngoscopy with excision of lesion), 31541 (operative direct microlaryngoscopy with excision of lesion), and 31545 (operative direct microlaryngoscopy with excision of lesion and local tissue flap reconstruction). For each CPT code, the total number of charges billed to the Medicare database in each calendar year was recorded and annual trends were analyzed. Biopsy procedures were not included. The annual number of office-based laser procedures (CPT 31572) remained relatively constant since the CPT code was introduced in 2017 (range: 18887-25241 procedures annually, trendline slope = +16, R2:0.02). Office-based laser procedures comprised a small portion of total laryngeal excisional procedures (range: 8.4%-12.1%). The total number of operative laryngeal excisions, billed by CPT 31540 and 31541, declined over the studied time frame (Trendline slope = -132, R2:0.93; Trendline slope = -950, R2: 0.93 respectively). Office-based laser procedures comprise a small fraction of procedures to remove laryngeal lesions. The number of office-based laser procedures has been relatively stable over the last 5 years. This finding contrasts with the prevailing health care trend toward office-based procedures. Further research is needed to understand the decrease in operative laryngeal lesion excision procedures observed over the last 10 years. 4 Laryngoscope, 2024.

Efforts to Prevent Recurrence of Stroke in Stroke Patients

Stroke is a major health problem for modern society today. A person who has had a stroke has a greater tendency to have a recurrence of stroke. This study aims to analyze efforts to prevent the occurrence of recurrent stroke in stroke patients at the Neurological Poly of Muhammdiyah Gresik Hospital. This type of research is correlational analysis, which is looking for a relationship between two variables, with a cross sectional approach between independent and dependent variables. The population in this study is all stroke patients at the Neurological Poly. The sample was taken by purposive sampling technique obtained by 48 respondents. The test results showed that the significance of the overall count results was less than 0.05 which meant that there was a significant relationship between prevention efforts, namely blood pressure control, bloodsugar control, obesity, medication adherence, family support and stress to the occurrence of recurrent strokes. Based on the results of the study, it is hoped that health workers can make efforts to prevent recurrent stroke as an important step in handling stroke patients and provide education about it to patients and their families. The hospital should make standard operational procedures or other forms of policies regarding efforts to prevent recurrent strokes. Keywords : Efforts to Prevent Recurrent Stroke, Recurrent Stroke Incidence

Training and education of operating room nurses in robot-assisted surgery: a systematic review.

With the introduction of robot-assisted surgery, the role and responsibility of the operating room nurses have been expanded. The surgical team for robotic-assisted surgery depends on the ability of the operating room nurses to operate and handle the robotic system before, during, and after procedures. However, operating room nurses must acquire the necessary competencies for robotic-assisted surgery. We performed a systematic review using the databases MEDLINE and EMBASE to review the evidence on educating and training operating room nurses in robot-assisted surgery. Studies describing operating room nurses' training and team-training with operating room nurses for robot-assisted surgery were included. The Medical Education Research Study Quality Instrument (MERSQI) and the Newcastle-Ottawa Scale-Education (NOS-E) were used to evaluate the quality of the included studies. We identified 3351 potential studies and included 16 in the final synthesis. Nine studies focused on team-training in robot-assisted surgery: four focused solely on training for operating room nurses, and only three on operating room nurses as first assistants in robot-assisted surgery. Most studies examined team-training in RAS, including OR nurses, focused on emergency situations and conversion to an open procedure. Only a few studies addressed other competencies relevant to OR nurses in RAS. No randomized controlled trials were identified. Only a few studies used pre- and post-testing, and only one examined clinical outcomes. The quality assessment of the included studies was moderate to low, with a median MERSQI score of 10.3 and a median NOS-E score of 2. There is sparse research on the education of operating room nurses in robot-assisted surgery, and the literature emphasizes the training of surgeons. More research is needed to develop evidence-based training for operating room nurses in robot-assisted surgery.

Stump Appendicitis: An Update on Current Management: A Narrative Review Article

Stump appendicitis is a rare complication that occurs after an appendectomy and the diagnosis of this condition is usually delayed. The diagnosis is confirmed by either an ultrasound or computerized tomography. The management of stump appendicitis is by performing a completion appendectomy, which can be done as an open or laparoscopic procedure. The delay in diagnosis can often lead to complications like perforation and abscess formation. We have conducted this review article to look at the diagnosis and management of stump appendicitis. The method of stump closure is also discussed by looking at the various methods that are employed.