Surgery Room Research Articles

The Value of Refined Nursing Management for Surgical Efficiency, Postoperative Recovery, and Stress Response in Laparoscopic General Surgery.

The study aimed to explore the impact of refined nursing management in the operating room on surgical efficiency, postoperative recovery, and stress responses in patients undergoing laparoscopic general surgery. A retrospective analysis was conducted on 100 patients who underwent laparoscopic surgery at Zhongnan Hospital of Wuhan University between March 2023 and March 2024. The control group comprised 48 cases receiving conventional operating room nursing, while the observation group comprised 52 cases receiving refined nursing management in the operating room in addition to the conventional care. Comparisons were conducted between the two groups regarding surgical efficiency, postoperative recovery, postoperative stress indicators, psychological status before and after nursing, overall treatment comfort, perioperative complications, and nursing satisfaction. The observation group showed statistically significant improvements in surgical efficiency, postoperative recovery, and stress indicators compared to the control group. After the intervention, the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores of both groups significantly decreased compared to pre-nursing levels (p < 0.05), while such decrease was notably higher in the observation group (p < 0.05). Patients in the observation group reported significantly higher post-nursing comfort levels (p < 0.05) and exhibited significantly fewer perioperative complications (p < 0.05) compared to the control group. Furthermore, the nurses indicated significantly higher satisfaction with patient care in the observation group (p < 0.05). Implementing refined nursing in the operating room for laparoscopic general surgery can facilitate the recovery of gastrointestinal function, reduce postoperative recovery time, prevent complications, improve patients' psychological state, and enhance their quality of life.

Short-Cycle Autoclave Sterilization of Instruments in Same-Day Ophthalmic Surgeries

What Is the Issue? The volume of ophthalmic surgeries is increasingly high, with cataract surgery being 1 of the most performed surgeries in Canada. Infections following ophthalmic surgeries, while rare, can cause severe complications that may lead to irreversible vision loss. Reducing postsurgery infections is a high priority in clinical practice. Running a full wrapped, terminal steam sterilization cycle for ophthalmic instruments in autoclaves may be inefficient for ophthalmic surgeries and may cause unnecessary heavy economic and environmental burdens due to high surgical volumes. Using instruments sterilized on a short cycle between sequential same-day ophthalmic surgeries may help improve efficiency and reduce resources used. These instruments are generally processed using autoclaves (i.e., steam sterilizers); the effectiveness of a shorter-cycle method of sterilization is unclear. What Did We Do? To inform decisions regarding the use of autoclaves for short-cycle sterilization for sequential same-day instrument use in ophthalmic surgery, we sought to identify and summarize evidence comparing this method to full-cycle sterilization of wrapped instruments and identify any relevant recommendations. We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since 2012. One reviewer screened articles for inclusion based on predefined criteria. What Did We Find? In a laboratory setting to simulate sequential same-day procedures, short-cycle sterilization with interrupted dry time for unwrapped ophthalmic instruments is feasibly as effective as full-cycle sterilization for wrapped instruments using the STATIM autoclave. Similarly, short-cycle sterilization with interrupted dry time for contained ophthalmic instruments is feasibly as effective as full-cycle sterilization for contained instruments using the AMSCO autoclave. For sequential same-day ophthalmic procedures, wet instruments sterilized by a short-cycle process with an interrupted dry time can remain sterile for at least 3 minutes if kept in a covered sterilizer containment device. One guideline recommends that wrapped or unwrapped ophthalmic instruments sterilized by a short-cycle process without full drying should be stored in a covered containment device until retrieved by staff wearing sterile gloves and gowns in the operating room for the subsequent surgery after a short delay. Phaco handpieces should be immediately primed with a balanced salt solution and remain wet as they sit on the sterile instrument table. We did not identify any clinical setting evidence from studies or autoclave manufacturers. It is unclear if clinical outcomes differ between patients undergoing sequential same-day ophthalmic surgeries using short-cycle sterilized instruments and those undergoing surgery using full-cycle sterilized instruments. What Does This Mean? Preliminary laboratory evidence and guideline recommendations supporting the use of autoclaves for short-cycle sterilization of instruments for sequential same-day ophthalmic surgeries are available. However, there is no clinical effectiveness evidence available on this process in patient settings. Future research is necessary to understand the clinical safety of using instruments sterilized by short cycles for sequential same-day use for patients undergoing ophthalmic surgeries. In addition to the evidence and recommendations identified, other factors, such as environmental influence, may be useful considerations when making decisions about short-cycle sterilization for sequential same-day instrument use for ophthalmic surgery.

Birth in the Operating Room for Immediate Cardiac Surgery: A Rare but Effective Strategy.

Background: With significant advancements in fetal cardiac imaging, patients with complex congenital heart disease (CHD) carrying a high risk for postnatal demise are now being diagnosed earlier. We sought to assess an interdisciplinary strategy for delivering these children in an operating room (OR) adjacent to a cardiac OR for immediate surgery or stabilization. Methods: All children prenatally diagnosed with CHD at risk for immediate postnatal hemodynamic instability and cardiogenic shock who were delivered in the operating room (OR) between 2012 and 2023 in which the senior author was consulted were included. Results: Eight patients were identified. Six (75%) patients were operated on day-of-life zero, all requiring obstructed total anomalous pulmonary venous return (TAPVR) repair. Of these six patients, 2 (33%) required a simultaneous Norwood procedure, 2 (33%) required pulmonary artery unifocalization and modified Blalock-Taussig-Thomas shunt, and 2 (33%) patients had repair of obstructed mixed TAPVR. The remaining 2 patients potentially planned for immediate surgery had nonimmune hydrops fetalis and went into cardiogenic shock at 12 and 72 hours postnatally, requiring a novel Norwood procedure with left-ventricular exclusion for severe aortic/mitral valve insufficiency. The median ventilation and inpatient durations were 19 [IQR: 11-26] days and 41 [IQR: 32-128] days, respectively. Three(38%) patients required one or more in-hospital reoperations. Subsequent staged procedures included Glenn (n = 5), Fontan (n = 3), biventricular repair (n = 2), ventricular assist device placement (n = 1), and heart transplant (n = 1). Median follow-up was 5.7 [IQR:1.3-7.8] years. The five-year postoperative survival was 88% (n = 7/8). Conclusion: While children with these diagnoses have historically had poor survival, the strategy of birth in the OR adjacent to a cardiac OR where emergent surgery is planned is a potentially promising strategy with excellent clinical outcomes. However, this is a high-resource strategy whose feasibility in any program requires thoughtful assessment.

One-Stage Burr Hole Surgery and Middle Meningeal Arterial Embolization for Treating Chronic Subdural Hematoma in a Hybrid Operative Angiography Suite

BackgroundChronic subdural hematoma (CSDH) is a prevalent neurosurgical condition that is known to recur and that leads to unfavorable clinical outcomes. Middle meningeal artery embolization (MMAE) has emerged as an alternative treatment to prevent recurrence. This study investigated the efficacy of combined two therapies in a hybrid operative suite for high-risk patients. MethodsThis retrospective review provides evidence for the indications and benefits of one-stage combined therapy in a hybrid neurovascular operative suite. The procedures include burr hole craniostomy, irrigation, and drainage followed by adjuvant MMAE at the lesion site. Subsequently, routine cone beam computed tomography is conducted after the whole process. ResultsFive patients with symptomatic CSDH and mass effect were enrolled in this study. Among them, three patients had undergone burr hole surgery previously but experienced hematoma recurrence. Two patients presented with a history of recent cardiac stent placement due to coronary artery disease, precluding the cessation of antiplatelet or anticoagulant therapy. All patients experienced symptom resolution and demonstrated no evidence of CSDH recurrence during the follow-up period. ConclusionIn our initial case experiences, one-stage burr hole surgery and adjuvant MMAE for treating chronic subdural hematoma in a hybrid operative angiography suite could be a feasible and effective treatment modality.

Hypothermia and the Global War on Terror: 18 Years of Minimal Progress.

The association between hypothermia, coagulopathy, and acidosis in trauma is well described. Hypothermia mitigation starts in the prehospital setting; however, it is often a secondary focus after other life-saving interventions. The deployed environment further compounds the problem due to prolonged evacuation times in rotary wing aircraft, resource limitations, and competing priorities. This analysis evaluates hypothermia in combat casualties and the relationship to resuscitation strategy with blood products. Using the data from the Department of Defense Joint Trauma Registry from 2003 to 2021, a retrospective analysis was conducted on adult trauma patients. Inclusion criteria was arrival at the first military treatment facility (MTF) hypothermic (<95ºF). Study variables included: mortality, year, demographics, battle vs non-battle injury, mechanism, theater of operation, vitals, and labs. Subgroup analysis was performed on severely injured (15 < ISS < 75) hypothermic trauma patients resuscitated with whole blood (WB) vs only component therapy. Of the 69,364 patients included, 908 (1.3%) arrived hypothermic; the vast majority of whom (N = 847, 93.3%) arrived mildly hypothermic (90-94.9°F). Overall mortality rate was 14.8%. Rates of hypothermia varied by year from 0.7% in 2003 to 3.9% in 2014 (P <0.005). On subgroup analysis, mortality rates were similar between patients resuscitated with WB vs only component therapy; though base deficit values were higher in the WB cohort (-10 vs -6, P < 0.001). Despite nearly 20 years of combat operations, hypothermia continues to be a challenge in military trauma and is associated with a high mortality rate. Mortality was similar between hypothermic trauma patients resuscitated with WB vs component therapy, despite greater physiologic derangements on arrival in patients who received WB. As the military has the potential to conduct missions in environments where the risk of hypothermia is high, further research into hypothermia mitigation techniques and resuscitation strategies in the deployed setting is warranted.

Contribution of Coordination Theories to the Determination of Human Factors Associated With Operating Room Perceived Performance.

The efficient and fluid organization of surgical interventions in an operating room (OR) and operating suite (OS) is important as these are among the most expensive units to run in medical-surgical facilities. The complexity of OS organization requires careful coordination, defined here as the directing of individuals' efforts toward achieving common and explicitly recognized goals. There is currently sparse literature on OS coordination, especially in the French context. This study aimed to respond to this gap by reporting on the coordination mechanisms associated with the perceived performance of OS across 4 facilities in an urban setting in France. We used a qualitative comparative case study based on ethnographic methodology to explore 4 facilities (2 teaching, 1 general, and 1 private). Several investigation techniques were used for data collection (semistructured interviews, participant and nonparticipant observations, and informal interviews) in the OR, the OS, the regulation council (dedicated to adapting the necessary resources to specific procedures and patients' health status), and the OS council (dedicated to strategic and operational OS transformations and adaptations, and responsible for finding solutions to organizational problems). Analysis was guided by Okhuysen and Bachky's theoretical framework on coordination and multi-team systems theory. Data were compared across the 4 facilities and triangulated using the different techniques to ensure coherence and accuracy. Overall, 48 interviews with health care providers and hospital managers and 200 hours of direct observations were performed. The OR exhibited a high degree of coordination, whereas improved perception of performance in the OS depended on managerial competency, trust, and authority. Perceived performance in the regulation council and OS council, on the other hand, depended on the identification of formal objectives by all stakeholders and the development of common understanding (developing agreement, direct information sharing, creating common perspective, substitution, bringing groups together, and storing of knowledge). Based on existing literature on multi-team systems (as represented in the OS organization), this study identifies success factors influencing OS coordination. These include the OS manager's leadership skills; the identification of formal system objectives; and professional differentiation between stakeholders (absence/decrease of a sense of belonging to a multi-team system). This differentiation was related to the high degree of specialization within OS teams, each bringing different norms, cultures, and contingencies that induce dissonance in organization and task performance. Interventions targeting these success factors might improve coordination, and thus performance, in the OS.

Interventions to Reduce Surgical Waste Burden: A Systematic Review.

Operating suites are significant drivers of waste, pollution, and costs. Surgeons can help fight the climate crisis by implementing innovative strategies aimed at mitigating the environmental impact of surgical procedures and decreasing operational costs, and moving toward a more sustainable healthcare system. This study aims to review the literature describing interventions that reduce surgical waste. PubMed, Cochrane, and Embase were searched. Studies reporting interventions to reduce operative waste, including emissions, energy, trash, and other, were included. Case reports, opinion-based reports, reviews, and meta-analyses were excluded. Study quality was rated using MINORS and Jadad scales. Data were extracted from each study to calculate waste on a per case basis. Narrative review of studies was performed rather than meta-analysis. The search yielded 675 unique hits, of which 13 (level of evidence: I-III) met inclusion criteria. Included studies were categorized by intervention type in relation to the operating and procedure room. Three studies evaluated provider education initiatives, three evaluated setup of instruments, two evaluated single-use items, four evaluated technique changes, and one evaluated surgical venue. Seven studies reported significant reductions in disposable surgical waste throughput, and seven reported significant reductions in cost. The results of this systemic review demonstrated the effectiveness of surgical waste reduction initiatives in reducing waste volume, cost, and carbon emissions. Within plastic surgery, minimal surgical packs resulted in reduced gross waste and cost while promoting patient satisfaction in hand surgery, supporting the continued development and implementation of such initiatives in a surgical context.

Propagation and evaporation of contaminated droplets, emission and exposure in surgery environments revealed by laser visualization and numerical characterization

The contaminated liquid mixture containing mucosalivary fluid and blood would be aerosolized during medical procedures, resulting in higher-risk exposures. The novelty of this research is integrating laser visualization and numerical characterization to assess the propagation and evaporation of contaminated droplets, and the interactive effects of humidity and temperature on exposure risks will be numerically evaluated in surgery environments. The numerical model evidenced by experiments can predict the mass balance of ejection droplets, the minimum required fallow time (FT) between appointments, and the disinfection region of greatest concern. Around 98.4 % of the ejection droplet mass will be removed after the cessation of ultrasonic scaling, while the initial droplet size smaller than 72.6μm will dehydrate and become airborne. The FT recommendation of 30 min is not over-cautious, and the extended FT (range of 28–37 min) should be instituted for low temperature (20.5 °C) and high humidity levels (60 %RH). The variation of the temperature and humidity in the range for human thermal comfort has little influence on the area of the disinfection region (0.15m2) and the cut-off size (72.6μm) of droplet deposition and suspension. This research can provide scientific evidence for the guidelines of environmental conditions in surgery rooms.

Energy and economic analysis of energy efficiency actions in surgery rooms: A dynamic analysis

This research proposes several measures designed for reducing the primary energy consumption of operating rooms, but at the same time complying with the stringent regulations governing operating rooms. In particular, this study proposes a novel control strategy for the air handling unit serving the surgery rooms, along with two innovative layouts designed for decreasing the thermal energy demand. Note that the two proposed novel layout involves the adoption of a round-around-coil and a recovery heat pump, in order to recover the waste heat of the air stream leaving the user. The simulation model of the operating room and of its heat, ventilation, and air conditioning systems plant are developed using the TRNSYS18 environment. The performance of the air handling unit and heat pumps are calibrated against the manufactured data. The case study consists of a real surgery theatre including three operating rooms. This facility is located in Naples, south of Italy. The operating room is served by a dedicated air handling unit, integrated with a heat pump providing heating and cooling energy, as well as a humidifier. All proposed layouts demonstrated high performance, reducing primary energy consumption by roughly 22–26%, with a simple payback period lower than one year. All the proposed layouts are able to significantly reduce the specific primary energy consumption of the selected operating rooms. In fact, the specific energy consumption decreases from 1.883 kWh/m2 to 1.452–1.383 kWh/m2.

1276 Creating Safer Theatres. Tackling Religious Headwear Discrimination Nationally

Abstract Aim To identify and challenge discriminatory EDI practices. To improve adoption of national policies on surgical headwear in theatre. Method Freedom of information requests were sent to 124 hospitals with emergency general surgery theatres. Data requested included total staff number, BAME staff percentage, theatre staff percentage, Muslim theatre staff (including ODPs, porters, medical, nursing staff, surgeons, junior doctors), female Muslim staff number, and copies of uniform policies, especially on religious headwear. Two senior trainees reviewed policies. Results 100 of 124 trusts responded to the FOI request. Percentage of BAME staff ranged from 5% to 47%. 12 trusts had no BAME members of staff working in theatres or could not release this data for risk of their few personal being identified. 97 policies were reviewed. 80% of the policies reviewed adhered or replicated the national guidance. Potentially discriminatory practices included necessitating disposable head wear be always worn, lack of specific guidance on the wearing of hijabs, and one policy which appeared to request they would not be worn. Conclusions This project highlights significant disparities in EDI policies within hospital theatre teams, especially regarding religious headwear. The lack of specific accommodations for religious garments creates an exclusionary environment. This can lead to increased stress and lower sense of belonging amongst minority staff. The findings emphasise the need for hospitals to re-evaluate and reform their policies, those with poor practices have been contacted. We aim to foster a more inclusive, equitable workplace.

Isolation of bacteria in the aseptic surgery and neonatology rooms of the Ngaliema Clinic and the King Beaudoin I Hospital of Masina in Kinshasa, DRC

Les salles de chirurgie et de néonatologie doivent être exemptes de toute biotamination. La présence des bactéries pathogènes dans l’environnement de ces salles pourrait conduire à l’infection des patients avec comme conséquence une augmentation de la morbidité et de la mortalité. L’objectif de l’étude était de vérifier la présence des bactéries pathogènes résistantes aux antibiotiques dans les salles de chirurgie et de néonatologie de la Clinique Ngaliema et de l’Hôpital Roi Beaudoin Ier de Masina. L’analyse de l’air intérieur des salles et l’écouvillonnage des surfaces des couveuses, des lits opératoires et des poignets des portes ainsi que des blouses des infirmiers ont été réalisés. La sensibilité aux antibiotiques des bactéries isolées par les méthodes classiques de microbiologie a été réalisée par la méthode de diffusion en milieu gélosé de Mueller Hinton. 21 écouvillons des surfaces et 34 prélèvements de l’air ont été réalisés. 63 souches bactériennes ont été isolées dont 30 à la clinique Ngaliema et 33 à l’Hôpital Roi Beaudoin Ier. Les bactéries isolées étaient Staphylococcus aureus (34,9%), Staphylococcus spp (30,2%), Bacillus spp (12,7%), Klebsiella pneumoniae (9,5%), Pseudomonas spp (7,90%), Klebsiella ozaenae (1,6%), Providencia alcalifaciens (1,6%) et Acinetobacter spp (1,6%). 52,2 % de souches étaient multi-résistantes à la majorité des antibiotiques testés. Les résultats de la présente étude montrent que des bactéries multi-résistantes circulent dans les salles de néonatologie et de chirurgie aseptique de ces hôpitaux. Les mesures de prévention et des contrôles des infections doivent être envisagées. Mots clés : Bactéries pathogènes, Résistance aux antibiotiques, Salle de chirurgie aseptique, Salle de Néonatologie

Recommendations on the use of the flash continuous glucose monitoring system in hospitalized patients with diabetes in Latin America

BackgroundContinuous glucose monitoring can improve glycemic control for hospitalized patients with diabetes, according to current evidence. However, there is a lack of consensus-established recommendations for the management of hospitalized patients with diabetes using flash continuous glucose monitoring system (fCGM) in Latin America. Therefore, this expert consensus exercise aimed to establish guidelines on the implementation of fCGM in the management of hospitalized patients with diabetes in Latin America.MethodsThe modified Delphi method was applied on a panel of nine specialists, establishing consensus at 80%. A twenty-two-question instrument was developed to establish recommendations on the use of fCGM in hospitalized patients living with diabetes.ResultsBased on consensus, experts recommend the use of fCGM in hospitalized patients with diabetes starting at admission or whenever hyperglycemia (> 180 mg/dl) is confirmed and continue monitoring throughout the entire hospital stay. The recommended frequency of fCGM scans varies depending on the patient's age and diabetes type: ten scans per day for pediatric patients with type 1 and 2 diabetes, adult patients with type 1 diabetes and pregnant patients, and seven scans for adult patients with type 2 diabetes. Different hospital services can benefit from fCGM, including the emergency room, internal medicine departments, intensive care units, surgery rooms, and surgery wards.ConclusionsThe use of fCGM is recommended for patients with diabetes starting at the time of admission in hospitals in Latin America, whenever the necessary resources (devices, education, personnel) are available.

Acute healing outcomes in paediatric partial thickness burns using Epiprotect® and Biobrane®: A retrospective comparative study

To compare the acute healing outcomes of Biobrane® and Epiprotect® in paediatric partial thickness (PT) burns. All paediatric patients (age <18 years) with PT burns managed using either Biobrane® or Epiprotect® over a 5-year period at our burns unit were included. The primary outcome was time to complete healing. Secondary outcomes included adherence, infection rates, length of hospital stay, duration of acute follow-up and return to the theatre. Among the 99 patients included, 38 received Epiprotect® and 61 received Biobrane®. The mean total body surface area (TBSA) was 6% (range 1%-15%) and median age was 21 months (range 5-169 months). Median time to healing in the Epiprotect® group was 19.5 days and 16 days in the Biobrane® group (P=.14). The median hospitalisation length was the same for both products (2 days, P=.85). Infection rate was lower in the Epiprotect® group (2.6% vs 16.4%, P=.048). There was no difference in adherence rate. These trends were preserved when depth sub-groups were analysed. Adherence and infection rates were not affected by post-operative antibiotics (P>.99 and P=.65, respectively) in either group. The rate of return to the theatre for further surgery was 13.2% for both products (P> .99). Our findings demonstrate that acute healing outcomes with Epiprotect® in paediatric PT burns are comparable to those with Biobrane®, with significantly lower infection rates for Epiprotect®. These results suggest that Epiprotect® is a viable alternative to Biobrane®. Nevertheless, further prospective randomised studies are required to investigate the short- and long-term outcomes.

The Role of Magnesium Sulfate to Facilitate Classical LMA Insertion, in Spontaneous Breathing Anesthesia

Background: Laryngeal Mask Airway (LMA) is a noninvasive supraglottic device that requires Smooth insertion and correct positioning of an LMA requires adequate through mouth opening and sufficient depth of anesthesia to prevent complications such as gagging, coughing, swallowing, head and limb movements and laryngospasm. Propofol is consider the induction agent of choice for LMA insertion but when used alone it provides less than satisfactory LMA insertion conditions. Aim of the study: Is to find The role Of Magnesium Sulfate to facilitate classical LMA insertion ,in spontaneous breathing anesthesia. Patients and method: A prospective randomizes clinical trial study was carried out in General Surgery theatres of Baghdad Teaching Hospital. A 40 patients where included and they were undergoing minor elective surgery, divided into two groups equally, magnesium group (M group, n=16) and control group (C group, n=18), 6 cases were dropped from the study(2 from C group and 4 from M group). All patients were premeditated with Ranitidine 50mg, Metoclopramide 10mg and Dexamethasone 8mg. Then patient would receive either a 100ml of (0.09% N/S) for the C group, or 30mg/Kg of Magnesium Sulfate in 100ml of (0.09% N/S) for the M group. Results: that there were no significant differences between M group (n=16) and C group (n=18) in the age, weight and duration of surgery where p value was (0.571, 0.791 and 0.351 respectively). Also there was no improvement in LMA insertion condition in M group in compares to C group regarding number of insertion attempt where p value was non-significant(0.498),nor did it influence the easiness of LMA grading were P value was found to be(1,0.112 and 0.471 for grades I,II and III respectively),but an accidental finding that M group had a shorter time duration from skin closure until LMA removal which was significant (p=0.021). Conclusion: We concluded that giving magnesium sulfate infusion at 30 mg/Kg prior to induction, does not improve LMA insertion condition in spontaneous breathing anesthesia.

#2189 Percutaneous peritoneal dialysis catheter implantation

Abstract Background and Aims There are three main techniques to implant a peritoneal dialysis catheter (PDC): percutaneously, laparoscopically or through open surgery; and current guidelines recommend individualising according to previous abdominal surgeries and anaesthetic risk. Recent metanalysis show the percutaneous technique to be safe, non-inferior in catheter survival, and with an equal incidence in mechanic complications (within &amp;lt;3 months after implantation) and infectious complications (within &amp;lt;1 month after implantation) to laparoscopic technique. On the other side, as the percutaneous PDC implantation is a minimal intervention that requires neither surgery room nor over 24h hospitalisation, it allows for a lower waiting time to PDC implantation, a shorter period until usage, and it's economically efficient. Considering these benefits and its non-inferiority described in the literature, our centre started using this technique since 2018. In this study we analyse our results. Method This is an observational retrospective unicentric study, which included the first PDC implantation in adult patients between January 2019 and August 2023, were we analysed the mechanical and infectious complications associated with the implantation technique. All PDC were double-cuff straight Tenckhoff, placed using Seldinger technique with radioscopy. A single dose of prophylactic antibiotic was used. We considered as mechanic complication all those non-infectious incidences that required repositioning or replacement of the PDC within 3 months of implantation (excluding those patients whose catheter was removed because of kidney transplantation, death by other reasons non related to the procedure, or trespass to haemodialysis); and we considered as infectious complications all those peritonitis diagnosed the first month after implantation. Results We analysed a total of 147 patients, 71.4% were male, mean age was 61 years old, and mean kidney function at implantation time was 11.5 ml/min/1.73 m2. We found a total of 8.1% of mechanical complications (33% required repositioning and 66% required replacement) and 5.4% infectious complications. There were no deaths related to percutaneous PDC technique. Conclusion In this study we observe that mechanic or infectious complications associated with percutaneous PDC technique are similar to those published in the literature: ISPD guidelines recommend the incidence of peritonitis associated to catheter implantation to be less than 5%. And though there is no clear percentage of mechanical complications that are considered acceptable or unavoidable, many studies report a survival of 76-86% PDC at 90 days of implantation in percutaneous and laparoscopic procedures, without significant differences between them.

Antibiotic prophylaxis for preventing surgical site infections after abdominal surgery

Surgical site infections (SSIs) pose severe burden in healthcare, specially in laparoscopic surgeries. It,s the leading cause of morbidity, mortality, and healthcare costs. The reason to improve this strategy is to enhance SAP practices for laparoscopic surgery by evaluating different antibiotics prophylaxis. Conducting a thorough examination on the basis of vast studies results in effective SAP implications to rule out laparoscopic surgeries leading to reduce SSI effort and safety of patient. Our research put great significance on customized approaches to SAP. In addition to SAP,various factors such as the kind of procedure, patient-specific risks, antimicrobial resistance and other preventive measures,such as surgical site antiseptics and glycemic control, RCS is also important in preventing SSIs. In addition to SAP, surgical techniques, postoperative care, and stewardship after administration outside the operative suite are needed. High-quality studies in diverse populations and development of standardized SAP protocols are warranted to optimize patient outcomes. To sum up this discussion , this chronological review gives esteemed awareness into improving SAP procedures for laparoscopic surgery. By amalgamating evidence-based guidelines and promoting effective antibiotic management , physicians and surgeons can contribute to reducing SSIs and ameliorate patient safety worldwide.

The use of healthcare services and disabling chronic pain: results from the cross-sectional population-based Andalusian Health Survey.

Several factors seem to be related to the use of healthcare services, and chronic pain (CP) is among these characteristics. The objective is to describe the number of visits to a doctor's surgery or emergency rooms, and the periods of hospitalization; to identify characteristics associated with frequent healthcare use, including disabling chronic pain (DCP) and non-disabling chronic pain (n-DCP). Representative population-based cross-sectional study of 6569 people older than 16 years from southern Spain was collected. The frequency of visits to a doctor's surgery or emergency rooms and periods of hospitalization were defined as at or above the 90th percentile. Binary logistic regression analyses were conducted separately on women and men to identify characteristics associated with being frequent visitors. People with DCP are more frequent visitors to a doctor's surgery and emergency rooms and endure longer periods of hospitalization compared to people with n-DCP and without pain. In logistic regression models, people with DCP are twice as likely to over-visit a doctor's surgery; to endure longer periods of hospitalization and more visits to an emergency room service. No relationship was found in n-DCP. Disability seems to modulate a greater use of health services among the population with CP, doubling it when compared to n-DCP and n-CP, both in women and men. Understanding the role of disability in the use of healthcare services for individuals with CP allows for the identification of needs and strategies to optimize resources.

An Efficient Design of 2-BIT Arithmetic Logical Unit in Quantum Dot Cellular Automata

For the past two decades, CMOS technology has reigned supreme in the world of Very Large Scale Integration (VLSI). But Quantum Dot Cellular Automata (QCA) is stepping into the spotlight, offering a fresh solution to the growing challenges of CMOS. This paper delves into the potential of QCA circuits by presenting a 2-bit Arithmetic Logic Unit (ALU) crafted with this groundbreaking technology, while also benchmarking it against conventional CMOS designs. The proposed QCA-based ALU delivers a trifecta of benefits: streamlined circuit design, exceptional space efficiency, and reduced quantum cost—all while keeping performance sharp in terms of latency and area usage. This 2-bit ALU encompasses a suite of operations: addition, subtraction, multiplication, division, bitwise AND, OR, XOR, and XNOR. QCA technology addresses some of CMOS's major pain points, like slow switching speeds, and doesn't require additional power sources, making it both efficient and environmentally friendly. This is not just an incremental improvement; it's a bold leap into the future of circuit design

Cost Evaluation for Capacity Planning Based on Patients’ Pathways via Semi-Markov Reward Modelling

In the present paper, we develop a non-homogeneous semi-Markov reward model, deriving expressions for a healthcare system’s expected structure along with the expected costs generated by medical services and patients’ holding times in the states. We provide a novel definition and investigation for states’ availability, which is critical for capacity planning based on service demand in an environment of limited resources. The study is based on patients’ mobility through hospital care, where each patient spends an amount of time in every state of the hospital (emergency room, short-term acute care, hospitalization, surgery room, and intensive care unit). Multiple outcomes, such as discharge or death, can also be taken into account. We envisage a situation where any discharges are immediately replaced by a number of new admissions that carry on the pathways of the patients who exit. By assuming an expanding system, the new idea of states’ inflows is considered due to new patients who create pathways through hospital care, along with internal entrances. The theoretical results are illustrated numerically with simulated hospital data informed by aggregated public data of the Greek public health sector. The framework can be used for both strategic planning and cost evaluation purposes for hospital resources.

Stratified Noncommutative Geometry

We introduce a theory of stratifications of noncommutative stacks (i.e., presentable stable ∞ \infty -categories), and we prove a reconstruction theorem that expresses them in terms of their strata and gluing data. This reconstruction theorem is compatible with symmetric monoidal structures, and with more general operadic structures such as E n \mathbb {E}_n -monoidal structures. We also provide a suite of fundamental operations for constructing new stratifications from old ones: restriction, pullback, quotient, pushforward, and refinement. Moreover, we establish a dual form of reconstruction; this is closely related to Verdier duality and reflection functors, and gives a categorification of Möbius inversion. Our main application is to equivariant stable homotopy theory: for any compact Lie group G G , we give a symmetric monoidal stratification of genuine G G -spectra. In the case that G G is finite, this expresses genuine G G -spectra in terms of their geometric fixedpoints (as homotopy-equivariant spectra) and gluing data therebetween (which are given by proper Tate constructions). We also prove an adelic reconstruction theorem; this applies not just to ordinary schemes but in the more general context of tensor-triangular geometry, where we obtain a symmetric monoidal stratification over the Balmer spectrum. We discuss the particular example of chromatic homotopy theory.