Patients In Surgical Departments Research Articles

IMPACT OF STAPHYLOCOCCUS SPP. ON OCCURRENCE OF INFECTIOUS INFLAMMATORY PROCESSES IN SURGICAL PATIENTS: A BACTERIOLOGICAL STUDY

Introduction. Staphylococci are well-known pathogens associated with purulent-inflammatory processes at various body sites. However, the specific contributions of different microorganisms within microbial communities remain poorly understood. Notably, these diverse microbes can exhibit distinct antibiotic susceptibility profiles due to their varying taxonomic classifications.
 The purpose of this study is to analyze the results of bacteriological examination of pathological material taken from patients in surgical department and to assess the contribution of S. aureus and coagulase-negative staphylococci in the form of mono- and mixed infection in the cases of infectious pathology.
 Results and discussion. 123 samples were obtained from patients in the surgical department; cultures of Staphylococcus bacteria were isolated in 37 cases, which accounted for 30.1% of all studies. Staphylococcus aureus was identified in 18 cultures (14.6%), with 11 isolates (8.9%) found as single infections (monoculture) and 7 isolates (5.7%) identified within mixed microbial communities. Additionally, 19 isolates (15.4%) were identified as coagulase-negative staphylococci. These microbial communities comprised 2 to 4 different types of microorganisms.
 Conclusion. Staphylococcus spp. were isolated from 30.1% of patients in the surgical department. Among these isolates, Staphylococcus aureus was present in 38.9% of mixed microbial cultures, while coagulase-negative staphylococci were found in 33.3% of Staphylococcus isolations. Notably, S. aureus and coagulase-negative staphylococci were never co-isolated within the same mixed culture.

Surgery Is in Itself a Risk Factor for the Patient

(1) Background: Adverse events (AE) affect about 1 in 10 hospitalised patients, and almost half are related to surgical care. The aim of this study is to determine the prevalence of AE in operated and non-operated patients in surgical departments in order to determine whether surgical treatment is a risk factor for AE. (2) Methods: A cross-sectional design that included 3123 patients of 34 public hospitals in the Community of Madrid determining the prevalence of AEs in operated and non-operated patients in surgical departments. (3) Results: The prevalence of AE in non-operated patients was 8.7% and in those operated was 15.8%. The frequency of AE was higher in emergency surgery (20.6% vs. 12.4%). The 48.3% of AEs led to an increase in hospital stay, and surgery was involved in 92.4% of cases. The most frequent AEs were related to hospital-acquired infection (42.63%), followed by those related to a procedure (37.72%). In the multivariate analysis, being operated on represented 2.3 times the risk of developing an AE. (4) Conclusions: Surgical sites are particularly vulnerable to AE. Surgical intervention alone is a risk factor for AE, and we must continue to work to improve the safety of both patient care and the working environment of surgical professionals.

Possibilities of diagnostic scales in patients with acute appendicitis in the conditions of an infectious hospital

Currently, diagnostic scales are being actively developed to help doctors diagnose and make decisions regarding the treatment tactics of certain diseases. In particular, there are diagnostic scales for acute appendicitis. However, we found no publications describing the results of assessing the sensitivity of diagnostic scales for acute appendicitis in relation to patients admitted to infectious diseases hospitals, as well as the results of comparing the sensitivity of these scales in patients in general surgery and infectious diseases hospitals. Thus, based on the sufficient clinical material, we have analyzed the results of comparing the sensitivity of some diagnostic scales of acute appendicitis in relation to patients in general surgical hospitals and patients being treated in hospitals with an infectious profile. The results of the study show that the sensitivity of diagnostic scales in relation to acute appendicitis in patients treated in infectious diseases wards is lower than in patients in surgical departments of the general profile. The following result may be explained by masked course of acute appendicitis (when simulating the symptoms of acute intestinal infection), as well as the blurred clinical picture of acute appendicitis in patients with acute and chronic infectious diseases.

Risks of legionella pneumonia in patients receiving immunosuppressive therapy

The legionellosis infection associated with medical care is usually registered for patients with reduced immunity, including those receiving immunosuppressive therapy. Prevention of nosocomial legionellosis in patients is essential due to high mortality. The aim . Analyze of the potential risks of legionellosis infection in patients of surgical departments. Materials and methods . Isolation of Legionella pneumophila from water supply systems in Moscow hospitals and serotyping of the isolated microorganism was performed using bacteriological, molecular genetic and enzyme immunoassay methods. Results and discussion . The study showed that there are potential risks of disease in surgical departments of hospitals that provide medical care, including immunocompromised patients. The content of Legionella pneumophila in water reached 10 5 CFU/l. The share of Legionella pneumophila SG 1, which causes up to 80 % of cases of legionellosis in the world, is 13 % in the water of the surveyed hospitals. The only action prevention of legionellosis is the biological safety of water. Conclusion . Due to the presence of potential risks, prevention of legionellosis is a necessary component of ensuring the safety of the treatment process for patients with immunosuppression.

Molecular Characterization of Candida parapsilosis by Microsatellite Typing and Emergence of Clonal Antifungal Drug Resistant Strains in a Multicenter Surveillance in China.

Candida parapsilosis is an important species causing invasive candidiasis (IC) in China. The present survey was a national multicenter study of the molecular epidemiology and antifungal susceptibility profiles of C. parapsilosis. Non-duplicate C. parapsilosis isolates were collected from 10 hospitals across China in the CHIF-NET program 2016–2017. Isolates were genotyped using four highly polymorphic microsatellite markers, and susceptibility profiles determined using Sensititre YeastOneTM YO10. A total of 319 C. parapsilosis from separate patients with IC were studied; 49.2, 17.9, and 10.3% isolates were from patients in surgical departments, general intensive care units (ICUs) and neonatal ICUs (NICU), respectively. C. parapsilosis showed good susceptibility to nine antifungal drugs. Microsatellite analysis identified 122 microsatellite (MT) types. Most MT types had sporadic distribution. However, we identified 32 clusters across 10 hospitals; seven clusters were caused by seven endemic genotypes involving five or more isolates in hospitals designated as H01, H02, H06, and H10. These clusters mainly affected surgical departments and ICUs, except for genotype MT42 which was seen in 22 patients from NICU (hospital H06). Of 16 fluconazole-resistant isolates, seven from hospital H02 shared the same genotype MT70, and three from hospital H04 were of genotype MT47. For 37 isolates with non-wild type MICs to 5-flucytosine, 29 were from hospital H01 (genotype MT48). Here we present the first nationwide molecular epidemiology study of C. parapsilosis in China, identified several previously unrecognized clusters, which included antifungal drug resistant isolates. These findings provide important data for control of IC in China.

Evaluation of hepatitis C virus infection based on big data of hospital

Objective: To evaluate the feasibility of hepatitis C virus (HCV) infection by survey methods based on big data of hospital. Methods: Inpatients data of anti-HCV was collected in 2016 and 2011. Patient's data related to Department of Liver Diseases were excluded. The research population was divided into Surgical and Non-surgical Department. The characteristics of the two groups were analyzed and the changing trends of anti -HCV positive rate in different years was compared and analyzed. Results: Patients in the surgical and non-surgical department of hospital were equally distributed across gender, urban and rural areas, and region, but the distribution of patients in surgical departments were relatively equal in all age groups. The positive rate of anti -HCV in hospitalized patients in 2016 was 0.82%, and anti -HCV positive rate was 0.58% in surgical department of 1~55 years old. Among them, anti-HCV was positive in 0.06% who underwent surgical procedure at the age of ≤25 (born after 1993 and screened for hepatitis C antibody), which was significantly lower than those in other age groups were. The anti -HCV positive rate of patients (all age groups) was lower in 2016 than that in 2011(0.75% vs. 0.97%). The anti-HCV positive rates of surgical department in both years had a decreasing trend with age. Conclusion: The prevalence rate of anti-HCV, among patients population of operation departments, might reflect the prevalence rate of HCV infection among general population. Using the convenience of hospital data acquisition, we might dynamically understand the change of HCV infection.

MANEJO DE LAS HERIDAS QUIRÚRGICAS, DESDE EL TIPO, TÉCNICA E INSUMOS UTILIZADOS EN UNA IPS”. ARMENIA, QUINDÍO, 2014

Este artículo surge de la investigación “Manejo de las heridas quirúrgicas, desde el tipo, técnica e insumos utilizados en una ips. Armenia, Quindío, 2014, financiado por la Vicerrectoría de Investigaciones de la Universidad del Quindío. La investigación describe los métodos que son manejados para el cuidado de las heridas por parte del personal de enfermería que realiza dicho procedimiento, con el fin de conocer con detalle la técnica, o técnicas, y los procesos utilizados en el procedimiento, materiales, pasos, asepsia, entre otros; contrasta lo observado con los avances científicos-tecnológicos en este campo y determina el cuidado de enfermería brindado a los pacientes adultos hospitalizados con heridas de diferente etiología. La investigación fue de tipo Descriptiva-Transversal, con enfoque cuantitativo. La muestra se obtuvo a través de un muestreo intencional, para este caso, pacientes con herida quirúrgica hospitalizados en los servicios quirúrgicos, que ingresaron durante un trimestre por cirugía programada, complicaciones quirúrgicas o por cirugía de urgencia, en una IPS de tercer nivel de atención de Armenia, y quien es eligieron voluntariamente su participación. La técnica para la recolección de la información fue a través de la filmación del procedimiento. Posteriormente, se diligenciaron los instrumentos diseñados para los fines de la investigación; los datos fueron ingresados a Bases de Datos construidas y procesadas en SPSS.

Pain assessment and post-operative pain management in orthopedic patients

Abstract Aims A fast-track based surgical treatment reduces morbidity and hospital stay by providing early mobilization. Sufficient postoperative pain management is mandatory for early mobilization and optimal utilization of rehabilitation measures. Insufficient postoperative pain management is however a widespread problem. Lack of knowledge about pain and pain treatment among health care professionals and general community has been considered as a major potential contributor in insufficient pain management. It has been suggested that severe postoperative pain might imply a potential risk of developing chronic pain. The purpose of this study was to examine this problem in acute and elective surgical patients in department of orthopedic surgery at Bispebjerg Hospital in order to identify obstacles and possibilities for future improvement. Methods Questionnaires were developed and distributed to patients consisted of 10 acute admitted and 10 elective orthopedic patients. The patients’ pain scores were recorded with a 0–10 NRS scale. The scores were obtained for current pain in rest, current pain in activity, and the highest and lowest pain intensity for the last 24 hours. Data were handled using descriptive statistics. Results The goal for sufficient pain treatment was patients with pain score at ≤ 3 NRS at rest and ≤ 5 in activity. For pain at rest 45% of the patients were within the goal range and 55% for the current pain in activity. For the mildest pain experienced in the last 24 h, 75% and for the worst pain experienced 30% of the patients reached the goal. Conclusions Corresponding to similar studies, half of the patients received a sufficient pain treatment at the time of examination. The consequences for insufficient pain management would be reduced effect of the physiotherapy, reduced ability to handle every day activity, sleep disturbances, and potential risk of developing chronic pain.

Emergence of the Uncommon Clone ST944/ST78 Carrying blaOXA-40-like and blaCTX-M-like Genes Among Carbapenem-Nonsusceptible Acinetobacter baumannii in Moscow, Russia.

Carbapenem-nonsusceptible (Carba-NS) Acinetobacter baumannii has emerged as an important cause of nosocomial infections. In the present study, we characterized 91 Carba-NS A. baumannii isolates collected from patients of surgical departments and intensive care units at three hospitals in Moscow in 2012-2015. Multilocus sequence typing (MLST) using the Oxford (Oxf) scheme identified 16 sequence types (STs) of three clonal complexes (CCs), including CC92Oxf (67%), CC109Oxf (1%), CC944Oxf (29%), and the singleton ST1100Oxf (3%). CC944Oxf was composed of ST944Oxf (n = 16) and two of its newly described single locus variants ST1103Oxf (n = 3) and ST1104Oxf (n = 7); all the three STs were identical to the Pasteur (Pas) MLST scheme ST78. All CC944Oxf/ST78Pas isolates were blaOXA-40-like positive and all but one isolate harbored a blaCTX-M-like gene. ST944Oxf was the only ST found in each of the three study hospitals. Biofilm growth capacity was similar among Carba-NS and nonclonal carbapenem-susceptible isolates. Our data demonstrate the predominance of two clonal lineages among Carba-NS A. baumannii. One of these, the uncommon blaOXA-40-like/blaCTX-M-like-positive clone of CC944Oxf/ST78Pas, seems to be endemic in Russia.

A multifaceted intervention to reduce drug-related complications in surgical patients.

The P-REVIEW study was a prospective, multicenter, open intervention study, designed to determine whether a multifaceted intervention of educating the prescriber combined with medication review and pharmaceutical visits to the ward by the hospital pharmacist could lead to a reduction in drug-related complications among surgical patients. A total of 6780 admissions of 5940 patients to surgical, urological and orthopaedic wards during the usual care period and 6484 admissions of 5711 patients during the intervention period were included. An educational programme covering pain management, antithrombotics, fluid and electrolyte management, prescription in case of renal insufficiency and antibiotics was developed. National and local hospital guidelines were included. Hospital pharmacists performed medication safety consultations, combining medication review of high-risk patients and a visit to the physician on the ward. A significantly lower proportion of admissions with one or more clinically relevant, potentially preventable, drug-related problems (including death, temporary or sustained disability, increased length of hospital stay or readmission within 30 days) occurred in the intervention period (1.1% (73/6484) compared to the usual care period [1.6% (106/6780)] (P=0.029). The relative risk (RR) was 0.72 (95% CI 0.53-0.97). Several types of drug-related problems occurred less frequently. Costs incurred as result of time spent on study-related activities were not different before and after the intervention. The P-REVIEW study shows that education and support of the prescribing physician with respect to high-risk patients in surgical departments leads to a significant, clinically relevant benefit for patients without generating additional costs.

Analysis of the effect of whole seamless nursing in operating room nursing and its influence on prognosis of patients

Objective To explore the application effect of whole seamless nursing in operating room nursing and its influence on prognosis of patients. Methods 126 cases of surgical patients in department of general surgery in our hospital were collected as the subject investigated,all were divided into observation group and control group by random number table, 63 cases in each group.The control group received conventional operating room nursing, the observation group received whole seamless nursing,the nursing effect and prognosis of patients in the two groups were compared. Results The Visual Analogue Scale (VAS) score of observation group was (3.6±0.5) points,the heart rate was (70.9±1.2) beats/min, SBP was (120.3±3.2) mmHg (1 mmHg=0.133 kPa), DBP was(83.2±3.1)mmHg, cortisol was (501.2±182.3) ng/L; the VAS score of control group was (5.0±1.2) points,the heart rate was (78.9±1.5) beats/min, SBP was (143.6±3.5) mmHg,DBP was (91.4±4.6) mmHg, cortisol was (578.6±189.5) ng/L,the differences between the two groups were statistically significant (t=2.336-38.997, P < 0.05); The incidence of complications and nursing satisfaction in the observation group was3.17%(2/63), 95.24% (60/63),and it was 14.29% (9/63) and 80.95% (51/63) in the control group, the differences between the two groups were statistically significant (P < 0.05); The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores in observation group were (45.3±4.2) points and (46.2±1.3) points, the recovery time of gastrointestinal motility and first ambulation time were (2.1±0.3) d and (3.6±0.8) d; The SAS and SDS scores in control group were (53.2±2.6) points and(56.4±1.8)points, the recovery time of gastrointestinal motility and first ambulation time were (4.4±0.6) d and (6.3±0.7) d, the differences between the two groups were statistically significant (t=12.694-36.463, P < 0.05). Conclusions The application of whole seamless nursing in operating room nursing can improve the prognosis of patients, improve postoperative mental state of patients, reduce the incidence of complications and improve the quality of clinical nursing. Key words: Whole seamless nursing; Operating room nursing; Prognosis

Are physician-patient communication practices slowly changing in Croatia? – a cross-sectional questionnaire study

AimTo explore physician-patient communication practices during the process of obtaining informed consent in a hospital setting in Croatia.MethodsTwo hundred and fifty patients (response rate 78%) from five tertiary level hospitals in Zagreb, Croatia, anonymously filled in the questionnaire on informed consent and communication practices by Nemcekova et al in the period from April to December 2011.ResultsEighty five percent of patients received complete, understandable information, presented in a considerate manner. Patients in surgical departments received a higher level of information than those in internal medicine departments. Patients were informed about health risks of the proposed treatments (in 74% of cases) and procedures (76%), health consequences of refusing a medical intervention (69%), and other methods of treatment (46%). However, patients pointed out a number of problems in physician-patient communication.ConclusionCommunication practices during informed consent-obtaining process in hospitals in Zagreb are based on a model of shared decision-making, but paternalistic physician-patient relationship is still present. Our results indicate that Croatia is undergoing a transition in the physician-patient relationship and communication.

Моніторинг умовно-патогенних і патогенних мікроорганізмів у лікарняних відділеннях хірургічного профілю м. Дніпродзержинськ

The paper presents monitoring results of the spread of opportunistic and pathogenic microorganisms in patients of surgical departments of the Dniprodzerzhynsk city hospital No 7. 1464 strains of bacteria isolated from biological material of the patients from January to December 2012 were studied. Relevant standard methods of research and data interpretation in accordance with the regulatory guidelines were used. The microorganisms’ sensitivity to antibiotics was determined by the disk diffusion method. Assessment of the resistance of isolated microorganisms to antibiotics was made with the software Whonet 5.1. At the first stage of investigation sampling biological material and inoculation in the culture medium were made. The discharges of wounds, throat, nose, ears, vagina and urethra, and also urine from patients of surgical departments were sampled for bacteriological analysis. The main substratum was 5% blood agar. There may additionally be used the selective growth media (yolk-salt agar, Endo, and Saburo). At the second stage we identify microorganisms with bacterioscopic, bacteriological and biochemical methods. Identifying microorganisms of the genus Staphylococcus was made by the reaction of lecithinase presence, plasma-coagulation reaction and the mannitol oxidation reaction. For the identification of bacteria of the family Streptococcaceae the growth pattern in 0.5% sugar medium was used. It was differentiated from bacteria of the genus Enterococcus by plating onto egg yolk agar base and milk with 0.1% methylene blue. Identification of bacteria of the Enterobacteriaceae family was made by studying their colonies on dense differential diagnostic media. Suspicious colonies were transferred on a combined medium for primary identification (Olkenitsky's medium). Then the biochemical signs of enterobacteria were studied in the minimum number of tests. The third phase of the study included the determination of the sensitivity of microorganisms to antibiotics. To do that, we use the disc diffusion method. The antibiogram tests of isolated bacterial strains used Mueller-Hinton agar. According to the data obtained we assign of microorganisms to certain category of sensitivity: sensitive, moderately resistant or resistant. Monitoring of prevalent microorganisms showed that 61% (893 of 1464) isolates were gram-positive bacteria, 696 strains of them are staphylococci. 477 of these are identified as S. aureus, representing 68.5% of all Staphylococcus. We found coagulase negative staphylococci in 192 patients, and the strains of S. haemolyticus are dominated. Strains of the family Streptococcaceae isolated from 197 patients. Among them the E. faecalis accounted for 66% of the total number of Streptococcus. Gram negative bacteria were presented by the families Enterobacteriaceae and Pseudomonaceae. Enterobacteriaceae accounted for 90.7% (518 of 571). E. coli plays the leading role and accounted for 42% of all Enterobacteriaceae. The strains of P. aeruginosa were identified in 53 patients. S. haemolyticus has played an important role as a pathogen as well as S. aureus. Its resistance to antibiotics is much higher than that of S. aureus. Although S. haemolyticus is opportunistic coagulase negative, it can be isolated from patients not only with chronic, but with acute infection. Thus nowadays the strains of S. haemolyticus gained high pathogenic and virulent properties.

End-digit preference and related factors in blood pressure measurement among inpatients

Objective To investigate the end-digit preference and related factors in blood pressure measurement among inpatients. Methods A cross-sectional study was conducted on the end digits of blood pressure measurement during the admission of patients in a tertiary general hospital of shanghai in 2010, and the related factors were analyzed with the logistic regression. Results The average blood pressure in records of 2276 patients was (125±14) mm Hg(1 mm Hg=0.133 kPa) in systolic and (77±9) mm Hg in diastolic. End-digital zero preference accounted for 1874 records (82.3%) of systolic and 1859 records (81.7%) of diastolic readings, which were significant different to the expected frequency of 20% (P<0.001). Logistic analysis showed that admission of patients not in winter (OR=1.270, OR=1.270), patients in surgical department (OR=1.619, OR=2.045), patients with no history of hypertension (OR=1.432, OR=1.310) were the risk factors of end-digital zero preference in systolic and diastolic pressure measurement. Non-elderly patients(OR=1.288)and patients with normal heart rate(OR=1.823)were related to zero preference diastolic pressure measurement. Conclusions Blood pressure measurement of inpatient displays marked zero end-digit preference. Doctors tend to end in zero when taking blood pressure in some special types of patients. Key words: Blood pressure; Cross-sectional studies; Regression analysis

Analysis of incidence and risk factor in hospitalized patients with acute kidney injury

To investigate the epidemiology and the risk factors of acute kidney injury (AKI) in hospitalized patients in order to help clinicians better understand and prevent AKI. All patients hospitalized in Renji Hospital of Shanghai Jiao Tong University, which is a three-level General Hospital in Shanghai, during January to December of 2008 were screened by Lab Administration Network. Study group was comprised of the patients with full clinical data of AKI, as defined by Acute Kidney Injury Network (AKIN). The incidence, etiology and distribution characteristics of hospitalized patients with AKI were retrospectively analyzed. Logistic regression analysis was used to investigate the risk factors in severity of AKI. Nine hundred and thirty-four patients suffering from AKI for 1 001 episodes were enrolled. The incidence of AKI in hospitalized patients was 2.4% (934/38 734). The ratio of male to female was 1.88:1. The mean age was (60.82 ± 16.94) years old. Higher incidence was seen with an increase in age. Three hundred and thirty-one(35.4%) patients with AKI were found in medical department, 592(63.4%) patients in surgical department and 11(1.2%) patients in department of gynecologic and obstetrics. Analysis of the causes of AKI showed that pre-AKI accounted for 52.0%, followed by renal parenchyma AKI (44.7%) and postrenal AKI (3.3%). The most common reason for AKI was acute tubular necrosis (ATN, 37.5%), followed by absolute (33.6%) and relative inadequacy of blood volume (13.4%). Multivariate logistic regression analysis showed that chronic kidney disease (CKD) [odds ratio (OR)=2.085, 95% confidence interval (95%CI): 1.536-2.830,P<0.01], renal injurious drugs (OR=1.438, 95%CI: 1.087-1.901 ,P<0.05), and failure of organs other than kidney (OR=1.327, 95%CI: 1.014-1.737,P<0.05) were independent risk factors for stage II-III AKI. AKI is one of the most common clinical syndromes in hospitalized patients. With the increase of age, the incidence increases gradually. The most common reasons for hospitalized AKI are pre-AKI and ATN. CKD, renal injurious drugs and failure of other organs are independent risk factors of medium to serious AKI.

Diagnosis and Treatment of Pulmonary Tuberculosis in Hospitalized Patients Are Affected by Physician Specialty and Experience

IntroductionHealthcare system delays in the diagnosis of tuberculosis can increase the risk of its nosocomial transmission. We aimed to determine whether different physicians’ specialties and experience influenced this diagnostic delay. MethodsWe retrospectively reviewed the cases of 167 patients with smear-positive pulmonary tuberculosis who were hospitalized from September, 2004, to August, 2006, for 5 components of healthcare system delays according to the World Health Organization definitions and analyzed the impact of physicians’ specialties and their experience (annual number of patients treated for tuberculosis) on these delays. ResultsThe median suspicion delay was significantly longer for patients in surgical departments than those in medical departments (4days versus 1day, P=0.001) and for patients treated by nontuberculosis specialists than those treated by tuberculosis specialists (including pulmonologists, infectious diseases specialists and thoracic surgeons; 3days versus 1day, P < 0.001). Both were independent factors related to suspicion delay examined by multivariate analysis. The annual number of tuberculosis patients in each department had a significant negative correlation with suspicion delay (r=−0.303, P < 0.001). ConclusionsPatients treated by surgeons and nontuberculosis specialists who were inexperienced in treating tuberculosis experienced a longer suspicion delay. Enhancing knowledge about tuberculosis among all physicians in the hospital, encouraging staff to consult tuberculosis specialists to confirm a diagnosis and implementing early alarm systems are crucial to improving the correct diagnosis of tuberculosis and to reducing delays in treatment.

Descriptive analysis of work and trends in anaesthesiology from 2005 to 2006: Quantitative and qualitative aspects of effects and evaluation of anaesthesia

In anaesthesiology, economic aspects have been insufficiently studied. The aim of this paper was the assessment of rational choice of the anaesthesiological services based on the analysis of the scope, distribution, trend and cost. The costs of anaesthesiological services were counted based on "unit" prices from the Republic Health Insurance Fund. Data were analysed by methods of descriptive statistics and statistical significance was tested by Student's t-test and chi2-test. The number of general anaesthesia was higher and average time of general anaesthesia was shorter, without statistical significance (t-test, p = 0.436) during 2006 compared to the previous year. Local anaesthesia was significantly higher (chi2-test, p = 0.001) in relation to planned operation in emergency surgery. The analysis of total anaesthesiological procedures revealed that a number of procedures significantly increased in ENT and MFH surgery, and ophthalmology, while some reduction was observed in general surgery, orthopaedics and trauma surgery and cardiovascular surgery (chi2-test, p = 0.000). The number of analgesia was higher than other procedures (chi2-test, p = 0.000). The structure of the cost was 24% in neurosurgery, 16% in digestive (general) surgery,14% in gynaecology and obstetrics, 13% in cardiovascular surgery and 9% in emergency room. Anaesthesiological services costs were the highest in neurosurgery, due to the length anaesthesia, and digestive surgery due to the total number of general anaesthesia performed. It is important to implement pharmacoeconomic studies in all departments, and to separate the anaesthesia services for emergency and planned operations. Disproportions between the number of anaesthesia, surgery interventions and the number of patients in surgical departments gives reason to design relation database.

Nutrition support of the critically ill patients in surgical department

营养支持是危重患者治疗的重要措施之一,合理、有效的营养支持可降低应激状况下机体的分解代谢反应,改善机体重要脏器和免疫功能,降低并发症的发生率,缩短住ICU时间和总住院时间,提高危重患者的救治成功率.目前,临床上危重患者接受营养支持的比例较低,不合理的营养支持仍十分普遍.因此,如何进行合理的营养支持依然是危重患者治疗中值得关注的问题。

50th Field Romanian Hospital - Surgical Department Activity in Somalia Campaign 1993-1994

We present the surgical activity of 50th Romanian Field Hospital, during UNOSOM II mission In Somalia 1993-1994. The mission was profoundly humanitarian, being the first across borders campaign for a Romanian hospital. The hospital structure included 3 sections (surgery, intensive care, internal medicine) and a triage unit with ambulatory of various medical specialties. Mostly the medical activity was for the Somali civil population and also for military and civilian members of UNOSOM II mission. Between 1993-1994, 1118 patients were admitted in Romanian Hospital, with 781 patients in surgical department and 356 war casualties. The treatment was biphasic, first resuscitation and secondly surgical treatment. The overall mortality was 7.81%.

The quality and suitability of written educational materials for patients*

In this study, the quality and suitability of written educational materials being used for the education of patients in surgical departments of hospitals were studied. In the literature, it is stated that most of the educational materials for patients are not suitable from the aspects of contents, structure, design, composition and language. In this descriptive type study, which was carried out between March and May 2006, 59 examples of written educational material used for patient education at 138 surgical clinics were evaluated for quality and suitability. The written educational materials obtained were evaluated independently by researchers from the aspect of quality and suitability. The DISCERN measuring instrument was used in the evaluation of the reliability of the written educational materials and the Evaluation of the Suitability of Written Materials form was used in the evaluation of suitability. It was determined that the educational materials received low scores for reliability and information quality. It was determined that the total scores for the written educational materials were average for suitability. It was determined that there were no written educational materials in more than half of the surgical units included in the study. It was also found that the educational materials had serious deficiencies. This study showed that there was no adequate written patient educational material at the clinics. This deficiency in written educational materials could be eliminated by having them prepared by health professionals in accordance with guidebooks and taking the target group into account.