Scheduling Procedure Research Articles

Surgical scheduling via optimization and machine learning with long-tailed data : Health care management science, in press.

Using data from cardiovascular surgery patients with long and highly variable post-surgical lengths of stay (LOS), we develop a modeling framework to reduce recovery unit congestion. We estimate the LOS and its probability distribution using machine learning models, schedule procedures on a rolling basis using a variety of optimization models, and estimate performance with simulation. The machine learning models achieved only modest LOS prediction accuracy, despite access to a very rich set of patient characteristics. Compared to the current paper-based system used in the hospital, most optimization models failed to reduce congestion without increasing wait times for surgery. A conservative stochastic optimization with sufficient sampling to capture the long tail of the LOS distribution outperformed the current manual process and other stochastic and robust optimization approaches. These results highlight the perils of using oversimplified distributional models of LOS for scheduling procedures and the importance of using optimization methods well-suited to dealing with long-tailed behavior.

The impact of a preanesthesia assessment clinic on scheduled elective case cancelations at a Thai university hospital.

Elective surgical case cancelations negatively impact healthcare systems and patient dissatisfaction. Preanesthesia assessment clinics (PACs) have been established in many countries to facilitate preoperative medical optimization. However, their benefits for elective procedure cancelations in Thailand have not been formally assessed. This study evaluated the impact of a PAC on scheduled elective surgical case cancelations at a Thai university hospital. A retrospective cross-sectional study was conducted for the period covering from May 2016 to April 2017. We included all scheduled elective surgical cases at Siriraj Hospital, Thailand, canceled on the day of surgery. The cancelation incidences of patients attending and not attending the PAC were compared. Cancellation reasons were categorized as "patient issue," "hospital-facility issue," "surgeon issue," "anesthesiologist issue," "medical condition," and "miscellaneous." The PAC patients' reasons were rigorously explored to determine their preventability. There were 30,351 scheduled elective procedures during the study period. The case-cancelation incidences were 0.9% (95% confidence interval [CI], 0.7-1.2%) for patients visiting the PAC and 5.9% (95% CI, 5.6-6.3%) for those who did not. Medical conditions were the most common reason for cancelation for non-PAC patients (27.3%), whereas hospital-facility issues were the most frequent for PAC patients (43.8%). The cancelation rate for patient issues was significantly lower in the PAC group (4.2% vs 20.7%; P < .05). Thirty-one (64.6%) of the PAC patients' cancelations were potentially preventable. Of the 15 PAC patient cancelations related to medical conditions, 12 were for patients with a history of acute illness and were determined to be nonpreventable. Visiting the PAC was significantly associated with a decreased elective-case cancelation rate. Cancellations were most frequently related to hospital-facility issues for patients visiting the PAC and medical conditions for those who did not. Some PAC patient cancelations for medical conditions involved unpreventable acute patient illnesses. Clinical Trials.gov (NCT02816281).

Evaluation of the agreement between lingual and thoracic limb noninvasive blood pressure with invasive blood pressure measurements in anaesthetized horses

ObjectiveTo evaluate the agreement between noninvasive arterial blood pressure (NIBP) measured from the tongue and thoracic limb with invasive blood pressure (IBP), and to compare NIBP measured from the tongue and thoracic limb in anaesthetized horses. Study designProspective clinical study. AnimalsA group of eight client-owned healthy horses anaesthetized for scheduled procedures, American Society of Anesthesiologists classification I–II, weighing (mean ± standard deviation) 498 ± 91 kg and aged 7.8 ± 6.75 years. MethodsAnimals were premedicated with intravenous (IV) romifidine (0.04–0.08 mg kg–1) and methadone (0.1 mg kg–1). General anaesthesia was induced IV with ketamine (2.5 mg kg–1) and midazolam (0.05 mg kg–1) and maintained with isoflurane. The facial artery was catheterized for IBP measurements. Systolic (SAP), mean (MAP) and diastolic (DAP) arterial pressures were recorded from the NIBPtongue, NIBPlimb and IBP every 20 minutes during the procedure. Agreement between NIBP and IBP was evaluated based on the American College of Veterinary Internal Medicine criteria and American Association for Medical Instrumentation criteria using the Bland–Altman method. ResultsThe mean bias and precision between IBP and NIBP measured from the tongue met the standards for all pressure ranges (< 10 mmHg and < 15 mmHg, respectively). NIBP measurements from the tongue and thoracic limb tended to underestimate IBP measurements. During hypotension, MAPtongue and DAPtongue overestimated IBP, but both precision and accuracy met the criteria. The overall accuracy and precision of NIBPlimb was poorer than NIBPtongue. The percentage of NIBPtongue that differed from IBP by < 10 mmHg was higher than that recorded with NIBPlimb for SAP (46% versus 25%), MAP (77% versus 28%) and DAP (79% versus 19%). Conclusions and clinical relevanceThe tongue is a clinically suitable alternative for assessing arterial blood pressure compared with the thoracic limb and can reliably detect hypotension in healthy anaesthetized horses.

Feasibility of a multidisciplinary group videoconferencing approach for chronic low back pain: a randomized, open-label, controlled, pilot clinical trial (EN-FORMA)

BackgroundLow back pain is a common condition that becomes even more prevalent with aging. A non-pharmacological multidisciplinary approach for chronic non-specific low back pain (CNSLBP) has been recommended, but integrating different healthcare professionals is challenging. A multidisciplinary group videoconferencing approach (MGVA) can be helpful. Our aim was to provide evidence on MGVA's feasibility in managing CNSLBP and its impact on clinical practice.MethodsWe conducted an open-label, randomized, controlled, parallel-group pilot clinical trial with CNSLBP patients irresponsive to conservative treatment. Patients between 18 and 67 years of age were randomly assigned (1:1) to either Standard-of-Care + MGVA (experimental group) or Standard-of-Care alone (control group). MGVA consisted of integrated sessions for physical rehabilitation/physiotherapy, psychology, and social work treatments. The control group received standard clinical practice treatment.The feasibility was assessed by the number of study procedures completed to at least 80% as planned. The impact on clinical practice was evaluated by the number of patients who changed their status from "candidate" to "non-candidate" to low back surgery as the treatment of choice for CNSLBP. The SF–36, Oswestry Disability Index, and TMMS–24 questionnaires were used. We performed a whole population-based descriptive analysis.ResultsWe included 20 patients, but only 18 were randomized (2 withdrew consent before randomization). The mean (SD) age was 53.1 (5.9) years, and mostly women (13/18); 7 were actively employed.In the experimental group, 6/9 (67%, 95%CI:35–88%) patients attended at least 80% of the scheduled procedures, while in the control group, 8/9 (89%, 95%CI:57–98%) did. Additionally, 1 out of 4 (25%) patients in the experimental group changed their status from "candidate" for low back surgery to "non-candidate". None of the 2 patients in the control group did so. We found differences between groups in the SF-36 mental health component (p-value:0.061), Oswestry Disability Index (p-value:0.032), and TMMS-24 Repair component (p-value:0.014) at the end of the trial favoring MGVA.ConclusionsThe multidisciplinary group videoconferencing approach to managing chronic non-specific low back pain was feasible, suggesting overall beneficial effects on patients’ health and could play a role in changing a patient's status from “candidate” to “non-candidate” for surgery.Trial registrationNCT05093543 (ClinicalTrials.gov), first registered in 26/10/2021.

Toward Sustainable Manufacturing Facilities: Utilization of Solar Energy for Efficient Scheduling of Manufacturing Processes

Abstract The utilization of solar energy as a renewable energy source has been a subject of interest for researchers in recent years. Despite recent advances in promoting solar energy, its intermittent and unpredictable nature limits its widespread utilization in manufacturing facilities. This research paper focuses on utilizing solar energy for efficient scheduling of manufacturing processes while keeping friendly environmental conditions for the workers. The work proposes an energy-aware dynamic scheduling procedure to minimize production and building costs by optimizing the utilization of an onsite photovoltaic (PV) system energy generation. The proposed method considers various factors such as the availability of solar energy, energy consumption of different manufacturing processes, and thermal requirements of the building. A stochastic energy prediction algorithm is developed to forecast the hourly one-day-ahead solar resources based on year-long solar radiation observations collected from an outdoor solar test facility in Qatar. This study shows that using the forecasted PV output improves the overall efficiency of manufacturing processes and building thermal requirements, thus achieving up to a 20% reduction in energy costs. These findings help the development of sustainable manufacturing systems and decrease the negative environmental impacts from industries.

The Effect of Aerobic and Resistance Exercise after Bariatric Surgery: A Systematic Review

Understanding the optimal time, length, intensity, and type of exercise program for bariatric surgery patients is crucial due to increased obesity prevalence and the number of performed bariatric procedures. Our aim for this review is to identify the effects of exercise on all aspects of health regarding the most recent and randomized studies. A total of 120 articles were reviewed through PubMed. As a result of the research, 11 studies that met the inclusion criteria were included. A quality analysis and a risk of bias assessment of the trials included in this systematic review were performed using the Physiotherapy Evidence Database (PEDro) scoring and classification system. Narrative syntheses were given for this systematic review. The articles’ intervention description, outcomes, and results are given in detail in the Results Section. Most exercise interventions were carried out in the post-op stage in bariatric surgery patients. Only two studies were conducted before the scheduled procedure. Overall, aerobic training (AT) and resistance training (RT) combined exercise programs effectively improved clinical parameters, including cardiac function, lower extremity function, muscle strength and endurance, cardiovascular parameters, and functionality. Exercise training caused no additional effects on inflammation and endothelial dysfunction biomarkers. In the literature, no research identifies the effects of only AT on bariatric surgery patients. Therefore, this aspect should be considered when interpreting all the studies’ results. In conclusion, there is a need for research to examine only AT in bariatric surgery patients and for general exercise training studies, including better randomization and quality.

Put it in the bag: Order fulfillment with a pocket sorter system

AbstractDue to high real estate costs in urban areas, shop floor space is scarce in most brick‐and‐mortar stores. Maneuvering newly arrived merchandise through narrow aisles during shelf replenishment is time‐consuming for the sales staff and impedes customers. Therefore, many retail chains nowadays aim for store‐friendly shipments (SFS). By mirroring the layout of a store in the buildup of its dedicated shipments, the need for a zigzag movement through the store when replenishing shelves can be avoided. On the negative side, however, additional effort arises in the distribution centers. A suitable warehousing system to assemble SFS without excessive effort is a pocket (or pouch or bag) sorter, where each item is put into its separate bag. These bags, filled with items, are automatically transported while hanging from an overhead conveyor and can be sorted into any sequence before being delivered to the workstations that build SFS. This article investigates the assembly of SFS with a pocket sorter and presents scheduling procedures to enhance the efficiency of this process for a given set of store orders. We demonstrate that, despite its notorious complexity, the problem can be solved by simple decision rules with good performance. In a case study, we show that this approach can dramatically reduce the completion times of store orders, resulting in savings of more than 60% of the total working hours compared to a simple real‐world policy. Another 30% of reduction can be obtained by standardized store layouts.

Programming High-Speed and Sprint Running Exposure in Football: Beliefs and Practices of More Than 100 Practitioners Worldwide.

To gain knowledge on the beliefs and practices of football practitioners applying high-speed and sprint running exposure programming strategies. One hundred two football practitioners from 22 different countries participated in a study consisting of a survey including 5 domains: demographic and professional characteristics (Who); importance of high-speed and sprint running exposure for physical-capability development, preparation for competition, and injury-prevention strategies (Why); exposure timing (When); methodological procedures for exposure monitoring and training scheduling (What); and effectiveness of common training practices (How). Data were analyzed using a combination of descriptive statistics, generalized mixed effects, and multinomial logistic regression models. Data revealed 5 main findings: (1)overall agreement on the importance of exposure for physical-capability development, preparation for competition, and injury-prevention strategies; (2)different exposure timing and selective training scheduling for starting and nonstarting players across typical and congested weeks; (3)lack of consensus on the conceptual constructs defining high-speed and sprint running metrics and the methodological procedures used for monitoring; (4)a probable association between match-related outcomes and exposure strategies used in training; and (5)a broad range of training methods considered effective to elicit exposure. This study provides actionable insights into the planning, implementing, and monitoring strategies for high-speed and sprint running exposure in football. While some conform with the evidence on high-speed and sprint running training in football, further research and professional debate are warranted to develop empirical knowledge and provide pragmatic recommendations to help practitioners in adopting evidence-informed decisions.

The effect of COVID-19 on nuclear medicine and radiopharmacy activities: A global survey

Globally, COVID-19 affected radiopharmaceutical laboratories. This study sought to determine the economic, service, and research impacts of COVID-19 on radiopharmacy. This online survey was conducted with the participation of employees from nuclear medicine and radiopharmaceutical companies. The socioeconomic status of the individuals was collected. The study was participated by 145 medical professionals from 25 different countries. From this work, it is evident that 2-deoxy-2-[18F]fluoro-D-glucose (2-[18F]FDG), and 99mTc-labeled macro aggregated albumin 99mTc-MAA were necessary radiopharmaceuticals used by 57% (83/145and 34% (49/145;) respondents, respectively for determining how COVID infections affect a patient’s body. The normal scheduling procedure for the radiopharmacy laboratory was reduced by more than half (65%; 94/145). In COVID-19, 70% (102/145) of respondents followed the regulations established by the local departments. Throughout the pandemic, there was a 97% (141/145) decrease in all staffing recruitment efforts. The field of nuclear medicine research, as well as the radiopharmaceutical industry, were both adversely affected by COVID-19.

Losing weight to achieve joint or hernia surgery: is the intragastric balloon the answer?

Obesity is an epidemic, with its accompanying medical conditions putting patients at increased risk of postoperative complications. For patients undergoing elective surgery, preoperative weight loss provides an opportunity to decrease complications. We sought to evaluate the safety and efficacy of an intragastric balloon in achieving a body mass index (BMI) < 35kg/m2 prior to elective joint replacement or hernia repair. Retrospective review of all patients who had intragastric balloon placement at a level 1A VA medical center from 1/2019 to 1/2023. Patients who had a scheduled qualifying procedure (knee/hip replacement or hernia repair) and had a BMI > 35kg/m2 were offered intragastric balloon placement to achieve 30-50lbs (13-28kg) weight loss prior to surgery. Participation in a standardized weight loss program for 12months was required. Balloons were removed 6months after placement, preferentially concomitant with the qualifying procedure. Baseline demographics, duration of balloon therapy, weight loss and progression to qualifying procedure were recorded. Twenty patients completed intragastric balloon therapy and had balloon removal. Mean age 54 (34-71years), majority (95%) male. Mean balloon duration was 200 ± 37days. Mean weight loss was 30.8 ± 17.7lbs (14.0 ± 8.0kg) with an average BMI reduction of 4.4 ± 2.9. Seventeen (85%) patients were successful, 15 (75%) underwent elective surgery and 2 (10%) were no longer symptomatic after weight loss. Three patients (15%) did not lose sufficient weight to qualify or were too ill to undergo surgery. Nausea was the most frequent side effect. One (5%) patient was readmitted within 30days for pneumonia. Intragastric balloon placement resulted in an average 30lbs (14kg) weight loss over 6months allowing more than 75% of patients to undergo joint replacement or hernia repair at an optimal weight. Intragastric balloons should be considered in patients requiring 30-50lbs (13-28kg) weight loss prior to elective surgery. More study is needed to determine the long-term benefit of preoperative weight loss prior to elective surgery.

A DRL based approach for adaptive scheduling of one-of-a-kind production

Adaptive scheduling is an efficient strategy for one-of-a-kind production (OKP) widespread in heavy industries to address its challenges of the high degree of customization and frequent interference. However, the scheduling procedure meets the problems of complex constraints and short decision time. To address these issues, this study aims to develop a reinforcement learning-based algorithm to solve the adaptive scheduling problem of OKP. The objective is to minimize the makespan. Firstly, the OKP adaptive scheduling problem is modeled as a Markov decision process, and a reinforcement learning algorithm is used to train the scheduling agent offline. Then, the trained agent can make scheduling decisions adaptively according to the production state in a short time. To evaluate the effectiveness of the proposed algorithm, a large number of numerical experiments are performed on the benchmark datasets and a practical engineering case. The results show that the proposed algorithm is competitive in static testing. And it can also achieve the balance between scheduling performance and computation time during adaptive scheduling.

Is Faster Better? Relationships of Cesarean Acuity with Risk of Low Apgar Scores and Fetal Acidemia.

Timely response to obstetrical emergencies is highly desired. The recommendation for decision-to-incision (DTI) time in cesarean delivery (CD) of not more than 30 minutes was issued to prevent neonatal hypoxic-ischemic morbidities. We analyzed the efficiency with which an institutional-specific CD acuity classification system (emergent case: target DTI ≤ 15 minutes; urgent case: target DTI ≤ 30 minutes) reflected in the actual DTI time, Apgar scores, and newborn acid-base status. Data on all 610 cesarean sections (CSs) performed over a 14-month period at a tertiary medical center were retrospectively extracted. Cases grouped by target DTI time categories were compared for proportions in low Agar scores and fetal acidosis. Multivariable regression was used to identify clinical variables associated with the need for neonatal resuscitation. During the study period, 60 (10%) of CSs were emergent, 296 (49%) urgent, and 254 (41%) elective. The target DTI ≤ 15 minutes was achieved in 68% of emergent CSs with 93% having a DTI ≤ 30 minutes. Among urgent surgeries, the target DTI ≤ 30 minutes was reached in 48% of cases with 83% having DTI ≤ 45 minutes. Compared with both urgent and scheduled procedures the incidence of newborn acidosis and Apgar scores ≤4 and ≤7 was the highest among emergent CSs. The proportion of moderate and severe acidosis for deliveries with DTI ≤ 15 minutes was significantly higher compared with procedures with DTI 16 to 30 and >30 minutes. The need for neonatal resuscitation, including intubation, was independently associated with fetal acidosis, low gestational age, surgery acuity level, general anesthesia, but not with the actual DTI time. Adherence to tight DTI time targets is pragmatically difficult. The need for neonatal resuscitation varies with the acuity of the procedure but not with the actual DTI interval, implying that within certain time limits, the indication for surgery plays a greater role in the status of the newborn than the speed of the CS. · Adherence to prespecified DTI times for cesarean is pragmatically difficult.. · Emergent CS had the highest proportion of newborns with acidosis and low Apgar scores despite shorter DTI.. · The need for neonatal resuscitation associated with fetal acidemia, prematurity and general anesthesia..

Molecular effect of holding equine oocytes: a road to cytoplasmic maturation?

The quality of oocytes has a direct effect on the outcome of in vitro embryo production (IVP). For successful IVP, oocytes need to undergo maturation, which requires coordinated nuclear (NM) and cytoplasmic maturation (CM). The lack of adequate cytoplasmic maturation has been proposed to be associated with a lower developmental competence of the oocyte. The improvement of in vitro techniques relies upon mirroring in vivo conditions. Therefore, acquiring a deeper knowledge of the process involved in CM and pathways leading to germinal vesicle breakdown and maturation can provide the necessary foundation to improve IVP results. Holding oocytes in commercial embryo holding media for 24hrs at room temperature has become a routine procedure for oocyte shipment and laboratory scheduling. However, the effects of this procedure on oocyte CM remain unresolved. In this study, we analyzed the changes induced by the holding period on the transcriptome of equine oocytes (OC) and the surrounding cumulus cells (CC). Cumulus-oocyte-complexes (COCs) were collected from six mares using transvaginal aspiration. Only non-expanded, non-degenerated COCs were randomly allocated to one of two groups: no holding (NH) or 24hrs holding (H). The COCs were denuded, and each single OC and CC were stored individually in RNAlater® at -20°C until further processing. RNA was extracted from 24 samples (NH/CC=6; NH/OC=6; H/CC=6; H/OC=6), followed by librarypreparation and sequencing (150 pb-PE). Reads were trimmed and mapped to the equine reference genome (Ecab 3.0). Mapped reads were quantified using featureCount and analysis of differentially expressed genes (DEGs) was performed using DESeq2 (FDR< 0.1 and log fold change >2). Overall, there were 26,077 genes expressed in CCs and 17,930 in OCs. When compared by holding time, there were 660 DEGs between the CCs (NH vs. H) and 205 between the OCs. In CC, 74 genes had a higher expression and 586 had a lower expression in H than NH groups. In OC, 7 genes were upregulated, and 198 were downregulated in H compared to NH group. Gene ontology analysis showed changes in genes related to glutathione (GSH) synthesis, AP-1 transcription factor complex and mitogen-activated protein kinase (MAPK) pathway in CC. In OC, DEGs were involved in α-tubulin detyrosination and tight junction proteins involved in magnesium transport. Overall, our results suggest modification in processes related to CM, including post-translational changes in tubulin, GSH composition, and activation of MAPK pathways during oocyte holding. Meanwhile, genes considered markers of NM and meiotic resumption remained unchanged, suggesting pre-maturation like changes occur prior to germinal vesicle breakdown. Further studies to understand the implications of this pre-maturation step in the developmental competence of oocytes can help improve the outcome of equine IVP. Funding: Center for Equine Health

“Call Vascular”: Vascular Surgery an Indispensable Service in a Highly Functional Complex Hospital System

With the maturation of vascular surgery as an independent specialty, vascular surgeons have become an essential resource in any hospital system. Not only do vascular surgeons provide the breadth of open and endovascular treatment to patients with vascular disease, but they are also an important resource for other surgical subspecialties, providing open exposure, control of life-threatening hemorrhage, repair and reconstruction of blood vessels, using both open and endovascular techniques. We conducted a retrospective review of the concurrent intraoperative involvement of vascular surgery with another surgical service at tertiary care, level 1 trauma designated academic medical center over a ten-year period in which vascular surgery was consulted to assist another surgical service. The consults were classified as intraoperative, emergent in which vascular surgery was consulted prior to surgery either in the emergency department or in the hospital and electively scheduled procedures. We identified 362 cases in which vascular surgery was consulted for operative assistance by another surgical service from August 2012 to May 2022. This equates to approximately three consults per month. The majority (57%) were trauma cases. Of the nontrauma-related cases, 33% were intraoperative consults, 35% emergent, and 32% were electively scheduled procedures. Of the trauma cases, 50% were intraoperative consults and 50% emergent consults (Table I). The most common reason for a vascular surgery consult on a trauma patient was limb ischemia (65%), followed by assistance with uncontrolled hemorrhage (25%). The most common reason for a vascular surgery consult on a nontrauma patient was for assistance with exposure (52%) followed by uncontrolled hemorrhage (21%) (Table II). The specialties requiring vascular assistance included trauma surgery, general surgery, urology, orthopedic surgery, plastic surgery, obstetrics/gynecology, neurosurgery, cardiothoracic surgery, transplant surgery, surgical oncology, orthopedic oncology, pediatric surgery, ENT, and cardiology. Vascular surgery provides operative support to and collaboration with every other surgical specialty. In the majority of cases, vascular surgery is consulted either intraoperatively or emergently. In addition to providing care to patients with vascular disease, vascular surgeons assist other specialists in providing care to their patients. Vascular surgeons are a crucial resource for a hospital, and it is essential for hospitals to have full-time vascular surgery availability.Table IType of consultNontraumaTraumaAll cases regardless of trauma statusIntraoperative consults51103154 (43%)Emergent consults54105159 (44%)Elective consults49049 (13%)Total154 (43%)208 (57%)362 (100%) Open table in a new tab Table IIReason for vascular consultNon-traumaTraumaAll cases regardless of trauma statusUncontrolled hemorrhage335184 (23%)Limb ischemia31135166 (46%)Organ ischemia10212 (3%)Exposure8020100 (28%)Total154 (43%)208 (57%)362 (100%) Open table in a new tab

V-044 CASE REPORT: RECURRENT AND INCARCERATED VENTRAL HERNIA. ETEP APPROACH

Abstract Aim The eTEP approach for ventral hernia is becoming a promising treatment option for obese patients as a scheduled procedure, in specialized high volumen centers. Is it feasible also in emergency surgey? M&amp;M We present a case of a 73 year old female patient with an incarcerated ventral hernia, presenting itself as a bowel obstruction on the early postoperative period after a prosthetic knee surgery. The patient had a previous midline laparotomy (Cesarian), two onlay ventral hernia repairs, and body mass index of 32. The CT imaging findings revealed a bowel obstruction close to incarcerated ventral hernia. We performed an endoscopic retromuscular sac exploration, reduced the incarcerated hernia, ruled out bowel damage, completed intraperitoneal adhesiolysis and followed through with an eTEP procedure, closing anterior and posterior rectus sheat running sutures. We began closing supraumbilical abdominal wall using inferior trocars and finished closing infraumbilical part using superior trocars. Then we introduced and deployed a polypropylene 26×15 cm mesh. No mesh fixation or drains were used. Results Bowel obstruction was solved after surgery. Oral liquids intake started on the second postoperative day. Despite of knee pain, sedentary lifestyle, depressive disorder and obesity, the patient started walking, assisted by physiotherapist also on second postoperative day. Intravenous naproxen and acetaminophen were used as painkillers. Discharged on postoperative day 10 because of knee wound celulitis. Conclusions eTEP approach seams feasible also in emergency surgeries in specialized centers.

Assessing of Veterinary and Sanitary Measures against Glanders and the risk of disease introduction into Republic of Kazakhstan

A possible revised sentence could be: "Veterinary and sanitary measures against glanders consist of preventing the introduction of the pathogen into the country, systematically monitoring the welfare of the horse population, preventing the spread of the disease, and implementing timely eradication or control measures in the event of an outbreak.&#x0D; This article presents the results of an analysis of veterinary and sanitary measures currently implemented against glanders in the Republic of Kazakhstan, as well as the results of epizootological forecasting. Special measures for preventing glanders in horses in the territory of veterinary and sanitary well-being, which is Kazakhstan, include basic requirements such as quarantine, clinical examination, and negative malleinization test results for imported animals. Local veterinary services systematically monitor the well-being of the horse population and conduct annual scheduled allergy testing procedures, such as eye malleinization&#x0D; Outbreaks of glanders have not been recorded in the Republic since 1939, indicating the effectiveness of annual veterinary and sanitary measures. However, due to the intensive development of horse breeding and close economic ties of Kazakhstan with neighboring regions and countries where glanders is prevalent or endemic, the risk of introducing the pathogen into the Republic remains. Therefore, it is necessary to conduct ongoing epizootological monitoring, including short-term and long-term forecasting of glanders outbreaks, as well as analysis of veterinary and sanitary measures against the disease.

Rectus Sheath Block Improves Patient Recovery Following Open Aortic Surgery

Postoperative pain management remains a barrier to recovery following aortic surgery. Although epidural catheters help in adjunctive pain management, less is known about the use of rectus sheath blocks. We compared patient recovery following open abdominal aortic surgery (OAS) with and without adjunctive rectus block. Adult patients undergoing open abdominal aortic aneurysm repair and aortobifemoral or aortoiliac bypass for occlusive disease were identified and stratified by use of general anesthesia alone (GA) versus adjunctive use of a rectus sheath block (GA+RB). A small number of patients with GA and concomitant epidural analgesia, along with patients that had retroperitoneal repairs, were not included in further analysis. Outcomes included time to extubation, intraoperative and postoperative morphine milligram equivalents (MME) utilization, length of stay, discharge MME, and postoperative complications. Categorial data were compared with Person Chi-Square tests or Fisher's exact tests. Continuous data were tested with independent t-tests or Mann-Whitney U-tests. From January 2017 to April 2022, there were 106 patients who underwent open aortic surgery, 55 patients with GA alone, 39 with GA+RB, and 12 patients who had a GA with concomitant epidural analgesia. Between GA and GA+RB, patients were comparable in both groups in terms of age, BMI (body mass index), smoking history, hypertension, diabetes, CAD (coronary artery disease), COPD (chronic obstructive pulmonary disease), and ASA (American Society of Anesthesiologists) class and prior opioid use. Patients with GA+RB were more likely to have scheduled elective procedures (80% GA cohort vs. 94.9% RB, P=0.040), and a lower incidence of retroperitoneal exposure (14.5% GA cohort vs. 0% RB, P=0.019). Patients with GA+RB had shorter time to extubation than GA (84.6%<12hr vs. 44.4%, P<0.001), greater rate of procedural ketamine usage (GA+RB: 61.5% vs. GA: 40.0%, P=0.049), lower MME at first postoperative day (median MME GA+RB: 25.0 vs. GA: 67.5, P=0.002), lower discharge MME (median MME GA+RB: 142.5 vs. GA: 225.0, P=0.036), and overall shorter length of stay (median stay GA+RB: 5 vs. GA: 6days, P=0.006). Postoperative complications were similar between groups. Similar findings were found in the comparison between elective-only GA and GA+RB patients and after exclusion of patients who only had a single shot of regional anesthesia. Patients that receive adjunctive rectus sheath blocks for pain control following OAS utilize fewer opioid medications during hospital stay and at discharge. Rectus sheath blocks represent an alternative option to other periprocedural analgesia following open aortic surgery.

Incorporation of pharmacist pre-surgical calls to improve medication history completion rates.

The accuracy and timeliness of documenting a medication history is an important aspect to ensure appropriate medication reconciliation during transitions of care. Surgical patients often have their medication history recorded just moments before surgery which may be rushed, incomplete or missed entirely. Between January and May 2020, 76.7% of surgical patients admitted to our institution had a medication history completed by a pharmacist prior to surgery. The objective of this work is to improve the pharmacist medication history completion rates for pre-surgical patients before surgery by integrating pharmacist-led medication histories into the pre-operative pathway. Through interdisciplinary collaboration, the pre-operative pathway for surgical patients was evaluated for opportunities to complete medication histories days prior to their scheduled procedure. Plan-Do-Study-Act (PDSA) cycles were utilized to make incremental improvements in practice. Through an iterative process, the pathway for cardiovascular surgery (CVS) patients was modified to include a scheduled pharmacist phone appointment in the days leading up to their surgical procedure. Utilizing these phone appointments, pharmacists complete patient medication history reviews and share a feedback loop to cardiovascular and peri-operative health care providers. The iterative PDSA cycles revealed challenges to completing pre-surgical medication history calls without advance notice. Patient responsiveness to pre-surgical medication history calls improved with the incorporation of scheduled phone appointments. Between January 18 and May 31, 2021, pharmacists completed 359 of 376 scheduled CVS appointments (95.5%), improving the medication history completion rates for cardiovascular surgery patients from 84.8 to 93.0% (p = 0.000025). The completion rate for all surgical patients also improved from 76.7 to 85.1% (p<0.00001). Incorporating scheduled pharmacist medication history appointments as a part of the pre-operative pathway was shown to expand the capacity for pharmacists to complete medication histories for patients prior to surgery. By reducing pharmacist workload on the morning of surgery, fewer patients were admitted to surgery without having their medication history reviewed by pharmacy. Future investigation should be considered to evaluate the impact on patient outcomes.

British Society for Haematology guideline for anticoagulantmanagement of pregnant individuals with mechanical heart valves.

British Society for Haematology guideline for anticoagulantmanagement of pregnant individuals with mechanical heart valves.

MP19-12 THE TELEMED VASECTOMY CONSULT IS A SAFE ALTERNATIVE TO IN PERSON CONSULTS: A RETROSPECTIVE STUDY IN A HIGH VOLUME CENTER

You have accessJournal of UrologyCME1 Apr 2023MP19-12 THE TELEMED VASECTOMY CONSULT IS A SAFE ALTERNATIVE TO IN PERSON CONSULTS: A RETROSPECTIVE STUDY IN A HIGH VOLUME CENTER Phillip Westbrook and Richard Schoor Phillip WestbrookPhillip Westbrook More articles by this author and Richard SchoorRichard Schoor More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In March of 2020, telemedicine health care delivery catapulted from rare to ubiquitous in utilization and since then has been shown to be a safe method of health care delivery for a variety of illnesses. Some debate remains as to whether or not virtual consults can safely be done for pre-operative patients. In January 2021, our office, for reasons of scheduling efficiency, decided to offer men the option of scheduling elective sterilization consults as a telemedicine/virtual-visit, at the men’s own discretion. The present study investigated whether outcomes for elective sterilization were the same or different in men that chose telemedicine consults versus the more traditional in-person consult option. METHODS: Using a CPT code search feature on our electronic health record, completed vasectomy procedures between 12/1/2021 and 8/30/2022 were identified and flagged for chart review. Manual chart review was then undertaken to see if the consult was done in-person (IP) or as a telemedicine (TM) only consult. We then ascertained if the procedure was not attempted (NA), attempted and aborted (AA), or completed (C), and whether or not there were adverse events (AE) following the vasectomies, as defined using the Clavien-Dindo classification system. RESULTS: A total of 253 vasectomy procedures were done by one surgeon during the study period. 113 (45%) had IP consults prior to the vasectomy and 140 (55%) had TM consults prior to the vasectomy. All 253 were completed and none were either NA or AA from either the IP or TM groups. All 253 procedures were done under local anesthetic only. There were no adverse events that reached even a class 1 on the Clavien-Dindo scale from either group. A deeper dive into the data revealed that all vasectomies performed in December 2021 were IP and 15 of the vasectomies done in January were scheduled prior to the policy change. As such, after the policy change was fully implemented, men were ∼2.5 times more likely to opt for TM consults over IP ones (140 TM vs 56 IP). On a side note, 7% of men in the TM group called the office in the immediate post-op period to report a concern, compared to 16% in the IP consult group. One can only speculate on the reasons for this discrepancy. CONCLUSIONS: Telemedicine consults are a safe alternative to in-person consults for men who desire elective sterilization. In the hands of a skilled vasectomist, an IP consult can safely be bypassed. Men that elect to choose the TM consult can expect that they will be able to have their vasectomies completed on the day of the scheduled procedure and will have the same outcomes as men that elect to have in-person consults. The data suggest that Long Island men overwhelmingly prefer TM consults. Offices that are contemplating adopting a TM vasectomy consult policy can do so with confidence. Source of Funding: No funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e270 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Phillip Westbrook More articles by this author Richard Schoor More articles by this author Expand All Advertisement PDF downloadLoading ...