Surgical Department Research Articles

The Impact of Surgical Training on Residents’ Relationships and Life Choices

Our study investigated the effects of surgical training on residents' personal relationships. It aimed to address the gaps in understanding of how the surgical training commitment can influence relationship stability, decision-making, and life planning within this unique professional group. We used cross-sectional survey methodology to gather data on the intricacies of relationship dynamics amid the rigors of surgical training. The survey focused on marital status, relationship dynamics, personal life choices, the challenges and rewards of dual-healthcare relationships, and the support networks that individuals and couples rely on. All surgical departments at The Johns Hopkins Hospital. The study comprised 111 participants, including residents, fellows, and attending surgeons. Of those reporting sex, 56/105 (53%) were female, and the predominant age category was 25 to 34 years, making up 61/104 (59%) of respondents. The majority (73/105, 70%) of respondents were or had been married, and 50/96 (52%) had partners in the medical field. Among those in a dual-healthcare relationship, 38/46 (83%) reported that their relationship was strengthened through understanding and empathy, yet 37/46 (80%) acknowledged complications in work-life balance. However, women were significantly more likely than men to report at least one negative effect of a dual-healthcare relationship (84% [16/19] versus 22% [6/27], p = .003). Among those with partners outside medicine, 39/46 (85%) acknowledged that their partner had to adjust their lifestyle significantly. A considerable number (73/92, 79%) postponed life events such as starting a family, and 57/85 (67%) experienced relationship strain due to long working hours. Residents in dual-healthcare couples derived support from their relationships, but surgical training placed a significant strain on residents' personal relationships and often prompted residents to postpone major life events such as starting a family. Enhanced support systems and targeted interventions are needed to assist surgical professionals in navigating the complexities of balancing a demanding career with personal life.

Trajectories of perioperative nutritional status in patients with pancreatic tumor after surgery in six months

PurposeTo characterize subgroups with similar nutritional status trajectories during the 6-month period after pancreatectomy and to identify demographic and clinical characteristics influencing changes in nutritional status in each subgroup. MethodsThis longitudinal prospective study recruited 112 patients with newly diagnosed pancreatic tumor from an outpatient pancreatic surgical department of a medical center in northern Taiwan between September 2016 and April 2019. Patients completed a demographic and clinical characteristics form, the Mini Nutritional Assessment scale, and the Symptom Severity Scale prior to surgery (T0), 3 months after surgery (T1), and 6 months after surgery (T2). Latent class growth analysis was used to investigate the trajectories of nutritional status. Generalized estimating equations were used to identify significant factors influencing each trajectory. ResultsTwo latent groups of nutritional status trajectories were identified. Among 112 patients, 74.11% and 25.89% were classified as having high and low nutritional status trajectories, respectively. High nutritional status was significantly negatively correlated with changes in symptom severity. Low nutritional status was significantly negatively correlated with older age, surgical complications, and changes in symptom severity. ConclusionsSymptom severity has the most significant negative effect on perioperative nutritional status. Older age and surgical complications exert negative effects on perioperative nutritional status among patients with low nutritional status. These findings emphasize the need for nurses to identify at-risk individuals and provide individualized nutritional care to improve nutritional status in this population. Clinical trials registrationThis study was registered on ClinicalTrials.gov (trial registration number: NCT02900677; approved date: September 14th, 2016). Link: https://clinicaltrials.gov/ct2/show/NCT02900677.

Integrating Complaint Analysis into Hospital Management: A Comparative Study of Surgical and Non-Surgical Complaints.

Aims/Background: In an era where patient-centred care is paramount, effectively managing and analyzing hospital complaints is crucial for improving service quality and patient satisfaction. This study examines hospital complaints to enhance management practices by differentiating between surgery-related and non-surgery-related grievances. By identifying patterns in complaint types and outcomes, we aim to inform targeted quality improvement strategies that address specific patient concerns and boost operational efficiency. Methods: The study utilized data from an internal complaint management system over one year. Complaints were categorized as either surgery-related or non-surgery-related. Descriptive statistics and cross-tabulation analysis were employed to examine the data. The sample comprised 132 complaints, with 67 being surgery-related and 65 non-surgery-related. Results: The analysis revealed that surgery-related complaints frequently involved issues with 'Patient Communication' and 'Surgical Error', while non-surgery-related complaints were primarily about the 'Medical Treatment Process'. The Surgery Department received the highest number of complaints, indicating a critical area for intervention. Additionally, the correlation between complaint types and outcomes provided insights into potential areas for improvement. Conclusion: The findings highlight the need for targeted communication training and procedural enhancements in surgical departments. Non-surgical departments should focus on improving treatment protocols and transparency. These strategies can reduce complaints and improve patient satisfaction. Future research should develop and test interventions based on these insights to further enhance healthcare quality.

Source Control and Antibiotics in Intra-Abdominal Infections.

Intra-abdominal infections (IAIs) account for a major cause of morbidity and mortality, representing the second most common sepsis-related death with a hospital mortality of 23-38%. Prompt identification of sepsis source, appropriate resuscitation, and early treatment with the shortest delay possible are the cornerstones of management of IAIs and are associated with a more favorable clinical outcome. The aim of source control is to reduce microbial load by removing the infection source and it is achievable by using a wide range of procedures, such as definitive surgical removal of anatomic infectious foci, percutaneous drainage and toilette of infected collections, decompression, and debridement of infected and necrotic tissue or device removal, providing for the restoration of anatomy and function. Damage control surgery may be an option in selected septic patients. Intra-abdominal infections can be classified as uncomplicated or complicated causing localized or diffuse peritonitis. Early clinical evaluation is mandatory in order to optimize diagnostic testing and establish a therapeutic plan. Prognostic scores could serve as helpful tools in medical settings for evaluating both the seriousness and future outlook of a condition. The patient's conditions and the potential progression of the disease determine when to initiate source control. Patients can be classified into three groups based on disease severity, the origin of infection, and the patient's overall physical health, as well as any existing comorbidities. In recent decades, antibiotic resistance has become a global health threat caused by inappropriate antibiotic regimens, inadequate control measures, and infection prevention. The sepsis prevention and infection control protocols combined with optimizing antibiotic administration are crucial to improve outcome and should be encouraged in surgical departments. Antibiotic and antifungal regimens in patients with IAIs should be based on the resistance epidemiology, clinical conditions, and risk for multidrug resistance (MDR) and Candida spp. infections. Several challenges still exist regarding the effectiveness, timing, and patient stratification, as well as the procedures for source control. Antibiotic choice, optimal dosing, and duration of therapy are essential to achieve the best treatment. Promoting standard of care in the management of IAIs improves clinical outcomes worldwide. Further trials and stronger evidence are required to achieve optimal management with the least morbidity in the clinical care of critically ill patients with intra-abdominal sepsis.

Palliative care case management in a surgical department for patients with gastrointestinal cancer—a register-based cohort study

BackgroundThe effectiveness of generalist palliative care interventions in hospitals is unknown.AimThis study aimed to explore the impact of a palliative care case management intervention for patients with gastrointestinal cancer (PalMaGiC) on hospital admissions, healthcare use, and place of death.DesignThis was a register-based cohort study analyzing data from the Danish Register on Causes of Death, the Danish National Patient Register, and the Danish Palliative Database.Setting/participantsDeceased patients with gastrointestinal cancer from 2010 to 2020 exposed to PalMaGiC were compared over three periods of time to patients receiving standard care.ResultsA total of 43,969 patients with gastrointestinal cancers were included in the study, of whom 1518 were exposed to PalMaGiC. In the last 30 days of life, exposed patients were significantly more likely to be hospitalized (OR of 1.62 (95% CI 1.26–2.01)), spend more days at the hospital, estimate of 1.21 (95% CI 1.02–1.44), and have a higher number of hospital admissions (RR of 1.13 (95% CI 1.01–1.27)), and were more likely to die at the hospital (OR of 1.94 (95% CI 1.55–2.44)) with an increasing trend over time. No differences were found for hospital healthcare use.ConclusionPatients exposed to the PalMaGiC intervention had a greater likelihood of hospitalizations and death at the hospital compared to unexposed patients, despite the opposite intention. Sensitivity analyses show that regional differences may hold some of the explanation for this. Future development of generalist palliative care in hospitals should focus on integrating a home-based approach, community care, and PC physician involvement.

Exploring thirst incidence and risk factors in patients undergoing general anesthesia after extubation based on ERAS principles: a cross sectional study

BackgroundThis study aims to comprehend the levels of dry mouth and thirst in patients after general anesthesia, and to identify the factors influencing them.MethodsThe study included all patients transferred to the Post Anesthesia Care Unit (PACU) at the Second Affiliated Hospital of Dalian Medical University between August 2021 and November 2021 after undergoing general anesthesia. A thirst numeric rating scale was utilized to conduct surveys, enabling the assessment of thirst incidence and intensity. Statistical analysis was performed to explore patient thirst levels and the associated factors.ResultsThe study revealed a thirst incidence rate of 50.8%. Among the thirst intensity ratings, 71.4% of patients experienced mild thirst, 23.0% reported moderate thirst, and 5.6% expressed severe thirst. Single-factor statistical analysis of potential risk factors among the enrolled cases indicated that gender, history of coronary heart disease, surgical duration, intraoperative fluid volume, intraoperative blood loss, intraoperative urine output, and different surgical departments were linked to post-anesthetic thirst in patients undergoing general anesthesia. Multifactorial Logistic regression analysis highlighted age, gender, history of coronary heart disease, fasting duration, and intraoperative fluid volume as independent risk factors for post-anesthetic thirst in patients undergoing general anesthesia. Moreover, age, gender, history of coronary heart disease, and intraoperative fluid volume were also identified as risk factors for varying degrees of thirst.ConclusionThe incidence and intensity of post-anesthetic thirst after general anesthesia are relatively high. Their occurrence is closely associated with age, gender, history of coronary heart disease, fasting duration, and intraoperative fluid volume.

Quality of life with diverticular disease: translation and validation of the German version of the diverticulitis quality of life questionnaire (DV-QOL).

The DV-QoL is a 17-item questionnaire measuring health-related quality of life in patients affected by symptomatic diverticular disease, covering four domains: physical symptoms, concerns, feelings, and behavioral changes. Given the lack of a diverticulitis-specific questionnaire to be used for German-speaking patients, we prospectively validated the German version of the DV-QoL. German-speaking patients with CT-confirmed history of recurrent diverticular disease admitted to a Swiss surgical department completed the German version of the DV-QoL, along with short form-36 (SF-36) and the Gastrointestinal Quality of Life Index (GIQLI). Reliability was examined using exploratory and confirmatory factor analysis, a Martin-Loef test, and Cronbach's alpha. For convergent validity testing, correlations were calculated with the GIQLI and SF-36. Discriminant validity tests included age and gender. We included 121 patients, of whom 77 were admissions for elective surgery and 44 presented with acute diverticulitis treated conservatively. The DV-QoL's total score showed good correlations with the GIQLI (r = -0.77) and its subscales (r = -0.76 to -0.45), as well as with the SF-36's subscales (r = -0.30 to -0.57). No relationships were found with age or gender (p < 0.05). The Cronbach's alpha coefficient was 0.89 over all items and 0.69, 0.90, 0.78, and 0.77 for the four separated domains (physical symptoms, cognitions/concerns, feelings, and behavioral changes, respectively). A nonsignificant Martin-Loef test indicated unidimensionality (p = 1), further supported by the exploratory factor analysis, which showed an item information sharing of 65%. The German DV-QoL questionnaire can be used as a valid and reliable disease-specific measure for quality of life in patients with recurrent diverticular disease.

Effects of rural hospital closures on nurse staffing levels and health care utilization at nearby hospitals.

Our study examines the causal effect of rural hospital closures on nearby hospitals' nurse staffing levels and health care utilization. We use data from the 2014-2019 American Hospital AssociationSurvey on nurse staffing level outcomes including licensed practical or vocational nurses (LPNs), registered nurses (RNs), and advanced practice nurses (APNs); and health care utilization outcomes, including inpatient and outpatient surgical operations and emergency department (ED) visits. Using propensity score matchingand difference-in-differences (DID) methods, we find that rural hospital closures lead to an average increase of 37.3% in the number of nurses in nearby rural hospitals during the 4years following the closure. This increase is found across all categories of nurses, including LPNs, RNs, and APNs. We also find a substantial increase in the provision of inpatient and outpatient surgical operations but there is no change in ED visits. We do not find any effects for nearby urban hospitals. Our study suggests that a large proportion of the nursing workforce relocates to nearby hospitals after a rural hospital closure, which mitigates the negative consequences of such closures and allows these nearby hospitals to provide a larger volume of highly profitable services.

CONSIDERATION OF MORPHOLOGICAL-FUNCTIONAL CHANGES IN THE COMPONENTS OF CALOT’S TRIANGLE IN ACUTE CHOLECYSTITIS AND THEIR INFLUENCE ON THE SPECIFIC LAPAROSCOPIC CHOLECYSTECTOMY TECHNIQUE IN PATIENTS WITH ACUTE CHOLECYSTITIS

From 2018 to 2023, a study was conducted on 89 (100%) patients operated on for acute cholecystitis in the surgical department of the Storozhynets Multidisciplinary Hospital for Intensive Care.The goal is to study the clinical features of acute cholecystitis based on the results of surgical treatment in the general surgery department of a multidisciplinary district hospital for intensive care.Materials and methods. From 2018 to 2023, 89 patients who underwent surgery for acute cholecystitis were studied in the surgical department of the Storozhynets Multidisciplinary Hospital for Intensive Care. Clinical, laboratory, instrumental examinations, and surgical treatment were performed on 89 patients of various age groups (from 18 to 74 years) with manifestations of acute cholecystitis. The patients were divided into two groups. The diagnosis was confirmed clinically, laboratory, by instrumental methods, intraoperative examination, and histological study of the removed specimens. The state of changes in peripheral blood was assessed: the number of erythrocytes, hemoglobin content, number of leukocytes, leukocyte formula, erythrocyte sedimentation rate, and leukocyte intoxication index according to the Kalf-Kalif formula. Statistical processing of the material was performed using the t-test with the determination of the probability corresponding to the Student's t-criterion. When performing statistical processing, the arithmetic mean (M) and the reliability of differences in study results (p) relative to the indicators of different groups were calculated. The results were considered reliable when the confidence coefficient was less than or equal to 0.05.Results. The results of our laparoscopic cholecystectomies for grade I and II (moderate) severity of acute cholecystitis (according to the International Classification) showed a quantitative advantage in prioritizing the laparoscopic method of surgical intervention. However, in the presence of a purulent-inflammatory process in the hepatobiliary zone, priority is given to performing cholecystectomy by the "open method," involving highly experienced surgeons in the surgical team. This option of cholecystectomy is advisable mainly for severe acute cholecystitis (stage III of the pathological process) with a purulent-necrotic process in the hepatobiliary zone detected at the preoperative stage and in the case of peritonitis. Contraindications for laparoscopic cholecystectomy include chronic duodenal obstruction, gangrenous-perforative cholecystitis, and diffuse peritonitis. Considering the features of surgical tactics for treating acute cholecystitis confirms the need for its differentiated determination based on already developed tactical and therapeutic recommendations, the effectiveness of which is evidenced by the accumulated experience of the international school of surgeons and confirmed by our clinical results.Conclusions. 1. Laparoscopic cholecystectomy is currently performed for both chronic and acute cholecystitis. 2. The most optimal time for performing "laparoscopic cholecystectomy" is the first two days from the onset of the inflammatory process in the gallbladder. 3. Performing laparoscopic cholecystectomy considering anatomical landmarks according to the recommendations for "safe cholecystectomy" by Steven Strasberg (1992, 1995 - SVS) and Gary G. Wind (1999) is an effective component of successful laparoscopic cholecystectomy for chronic cholecystitis and in the early stages of acute inflammatory processes in the gallbladder. 4. For acute destructive cholecystitis, the "elephant trunk" technique is practically preferred.

Prognostic value of 24-hour cultivation of peritoneal fluid to distinguish complicated from uncomplicated acute appendicitis: a prospective cohort study

BackgroundThe distinction between complicated and uncomplicated acute appendicitis (AA) is important as it guides postoperative antibiotic treatment. A diagnosis based on intraoperative findings is imprecise and standard cultivation of peritoneal fluid is generally time-consuming with little clinical benefit. The aim of this study was to examine if cultivation of peritoneal fluid in acute appendicitis could reliably detect bacteria within 24 h.MethodsPatients older than 18 years undergoing laparoscopic appendectomy were prospectively enrolled at two surgical departments after informed consent was obtained. Periappendicular fluid was collected prior to appendectomy and sent for cultivation. Sensitivity, specificity and positive and negative predictive values were calculated with 95% confidence intervals (CIs) using 72-hour cultivation results as the gold standard. Patients with complicated AA as determined by the surgeon, received a three-day course of oral antibiotics. Postoperative infectious complications within 30 days after surgery were registered.ResultsFrom July 2020 to January 2021, 101 patients were included. The intraoperative diagnosis was complicated AA in 34 cases. Of these patients, six (17.6%) had bacteria cultured within 24 h after surgery, leading to a sensitivity of 60% and a specificity of 100%. The positive and negative predictive values were 1.00 and 0.96, respectively. Seven patients developed a postoperative infection (five superficial wound infections and two intra-abdominal abscess). In all cases with a positive cultivation result, the intraoperative diagnosis was complicated appendicitis and a postoperative course of antibiotics prescribed.ConclusionTwenty-four-hour cultivation of the peritoneal fluid in acute appendicitis is a valid indicator for peritoneal bacterial contamination. Randomized studies are necessary to determine if this approach is suitable for targeting postoperative antibiotic treatment as a means to prevent overtreatment without increasing the risk of infectious complications.

2349 How to provide a cost-effective geriatric peri-operative service within general surgery in line with NELA BPT

Abstract Introduction More than 50% of patients undergoing emergency general surgery are &amp;gt;65 years. The Emergency Laparotomy and Frailty (ELF) study showed strong associations between frailty (CFS ≥ 5) and increased mortality, risks of complications, and length of hospital stay. Methods For nearly 10 years, we have had geriatric liaison input for general surgery and colorectal patients in a tertiary teaching centre. This has transformed into a fully embedded service involving consultant geriatrician, registrars and senior house offices, providing 3-day a week medical input. NELA best practice tariff (BPT) April 2023 emphasises perioperative Geriatric team involvement in frail patients aged 65 and above. The main metrics include CFS, an MDT-based risk assessment, treatment escalation decision making and perioperative geriatrician involvement. Results The service has previously demonstrated significant improvement in patient care and holistic management including reducing the length of stay in hospital (average decrease of 5.5 days). Simple job planning, use of current resources and efficiency can mean Trusts can incorporate geriatricians with essential skills to improve patient management and reach NELA BPT. Conclusion Changes in NELA BPT emphasise the importance of comprehensive geriatric assessment in the management of older laparotomy patients. Introducing a multidisciplinary geriatric liaison service into the general surgical department can achieve high levels of compliance with national guidelines, resulting in better outcomes for patients as well as financial benefits for Trusts. This is particularly pertinent given the financial constraints on many services across the NHS, this is an opportunity to increase revenue and build a geriatric workforce.

Short-term outcomes and inflammatory stress response following laparoscopy or robotic-assisted transabdominal preperitoneal inguinal hernia repair (TAPP): study protocol for a prospective, randomized trial (ROLAIS)

BackgroundInguinal hernia repair is a frequently performed surgical procedure, with laparoscopic repair emerging as the preferred approach due to its lower complication rate and faster recovery compared to open repair. Mesh-based tension-free repair is the gold standard for both methods. In recent years, robotic hernia repair has been introduced as an alternative to laparoscopic repair, offering advantages such as decreased postoperative pain and improved ergonomics.This study aims to compare the short- and long-term outcomes, including the surgical stress response, postoperative complications, quality of life, and sexual function, between robotic-assisted transabdominal preperitoneal (rTAPP) and laparoscopic TAPP inguinal hernia repairs.MethodsThis randomized controlled trial will involve 150 patients from the Surgical Department of the University Hospital of Southern Denmark, randomized to undergo either rTAPP or laparoscopic TAPP. Surgical stress will be quantified by measuring C-reactive protein (CRP) and cytokine levels. Secondary outcomes include complication rates, quality of life, sexual function, and operative times. Data analysis will adhere to the intention-to-treat principle and will be conducted once all patient data are collected, with outcomes assessed at various postoperative intervals.DiscussionThis study holds significance in evaluating the potential advantages of robotic-assisted surgery in the context of inguinal hernia repairs.It is hypothesized that rTAPP will result in a lower surgical stress response and potentially lower the risk of postoperative complications compared to conventional laparoscopic TAPP. The implications of this research could influence future surgical practices and guidelines, with a focus on patient recovery and healthcare costs. The findings of this study will contribute to the ongoing discourse surrounding the utilization of robotic systems in surgery, potentially advocating for their broader implementation if the benefits are substantiated.Trial registrationClinicalTrials.gov NCT05839587. Retrospectively registered on 28 February 2023.

Empowering mind-body wellness: effect of bundling seated exercises and psychoeducational rehabilitation using the teach-back approach on fatigue and coping of women postmastectomy

BackgroundBeing diagnosed with Breast Cancer (BC) is a crisis that throws the patient’s life out of balance. Cancer-related fatigue is a debilitating sign experienced by women during and after BC treatment. Regular physical exercise may help mitigate patients’ fatigue, enhance coping abilities, improve their quality of life, and overall well-being. In parallel, psychological interventions are geared toward normalizing the lived painful experiences among oncology patients.Objectiveto examine the effect of bundling seated exercises and psychoeducational rehabilitation using the teach-back approach on fatigue and coping of women postmastectomy.MethodsA quasi-experimental study was conducted in the Oncology Surgical Department and chemotherapy unit at the Alexandria Main University Hospital, Egypt. A total of 60 women were randomly allocated to either to the study or the control groups. Women in the study group practiced seated exercises and psychological rehabilitation interventions, including mindfulness breathing, problem-solving training, cognitive reframing technique, and thought stopping while the control group received the routine care.ResultsThe study revealed a significant decline in the fatigue mean scores among participants in the intervention group from 136.10 ± 27.76 to 98.43 ± 25.99 (p < 0.001). Similarly, there was a significant decrease in the patients’ mean scores of maladaptive coping, helplessness/ hopelessness (p = 0.014), and anxious preoccupation (p = 0.008). In contrast, there is a noticeable increment in the scores of adaptive coping, such as fighting spirit (p = 0.012), cognitive avoidance (p = 0.002), and fatalism (p = 0.009).ConclusionBundling seated exercises and psychological rehabilitation interventions using the teach-back approach have been proven to be simple and inexpensive non-pharmacological methods of reducing cancer-related fatigue and improving coping skills among women post-mastectomy.Trial registration numberNCT06360276, ClinicalTrails.gov, Retrospectively registered (April 8th, 2024), URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT06360276.

Analysis of clinical manifestations, course and results of treatment of acute pancreatitis in patients of an emergency surgical hospital

Background. Over the past 10–15 years, there has been a clear trend towards improving the diagnosis and treatment of acute pancreatitis. However, even at the current stage of technology development, a number of difficulties arise in making an accurate diagnosis, in determining the volume and timing of surgical intervention, in organizing measures to prevent complications, treatment and further recovery of patients after acute pancreatitis. Aim. To analyze the structure of morbidity and treatment outcomes of patients with acute pancreatitis in an emergency surgical hospital. Materials and methods. We analyzed the structure of pathology and incidence of acute pancreatitis in patients of the 5th and 6th surgical departments. The sample consisted of 2033 patients diagnosed with acute pancreatitis. Of these, 973 people are patients of the 5th surgical department, 1060 people are patients of the 6th surgical department. The work used standard mathematical and statistical methods of data processing. Results. The results indicate that in the structure of surgical pathology, the predominant diagnoses are acute pancreatitis, unspecified, and other acute pancreatitis. At the same time, these are also those forms of the disease that are characterized by high mortality. On average, 1 patient takes 9–10 bed days, which indicates the high medical and social significance of these forms of pathology. All the data obtained confirm the fact that many patients require emergency surgical care, even at a stage when the diagnosis has not yet been definitively confirmed. As a rule, indications for emergency surgical intervention appear already at the first stages of diagnosis, according to the main ultrasound criteria. The mortality rate averages 3–4%. Conclusion. The data obtained are approximately comparable with data obtained by other authors. In general, the literature notes that among all patients with pancreatitis, the acute form of the disease predominates. However, in terms of mortality, the results we obtained were slightly lower compared to the results for the country as a whole.

The Impact of a Care Bundle on the Prevention of Post-cesarean Surgical Site Infection

Background: The most common complication in the first 10 days after a cesarean section is surgical site infection (SSI), leading to poorer health outcomes, financial consequences, and maternal mortality. However, about 40 to 60% of such complications are preventable. Objectives: The present study aimed to examine the effect of a care bundle on the prevention of post-cesarean surgical site infection. Methods: This clinical trial was conducted on pregnant women undergoing cesarean section at Ali Ibne Abitalib Hospital, Zahedan, in the summer of 2022. A total of 60 full-term pregnant women who were candidates for cesarean section were selected using convenience sampling based on the inclusion criteria and were divided into two groups (each with 30 members) using random permuted blocks. The patients in the intervention group received preoperative, intraoperative, and postoperative care using an infection prevention care bundle, while the patients in the control group received routine care in the surgical department and operating room. The participants’ demographic, pregnancy, and surgical data were collected through interviews with the patients and by reviewing their medical files and were recorded in a checklist. The surgical incision was checked using the wound assessment checklist and the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) Scale, 24 hours after surgery and on the 10th and 30th days after surgery to confirm or reject wound infection. A score greater than 6 confirmed a surgical site infection. The data were analyzed with SPSS-21 software using independent samples t-test and chi-square test. The level of significance in this study was set at P &lt; 0.05. Results: The data in this study showed that the patients in the two groups did not have statistically significant differences in terms of demographic, pregnancy, and surgical variables, except for the history of infection (P &gt; 0.05). The mean REEDA scores for the patients in the intervention group 24 hours after surgery and on the 10th and 30th days after surgery were 2.52 ± 4.6, 1.3 ± 2.7, and 0, respectively. The corresponding values for the patients in the control group were 3.64 ± 5.26, 1.7 ± 3.07, and 0.08 ± 0.3, respectively. The independent samples t-test showed that the mean REEDA scores in the intervention and control groups 24 hours after surgery and on the 10th and 30th days after surgery did not have a statistically significant difference (P &gt; 0.05). Moreover, 2 patients (6.67%) in the intervention group and 5 patients (16.67%) in the control group showed signs and symptoms of SSI, but the chi-square test did not show a significant intergroup difference (P &gt; 0.05). Conclusions: The findings suggested that the care bundle was not effective in the prevention of cesarean wound infection, but we cannot deny the positive effects of care bundles on the prevention of surgical site infections. Thus, the components of the care bundle should be carefully examined, and any potential issues need to be more carefully analyzed in subsequent studies, especially intraoperative interventions that should be performed with extensive collaboration between surgical and operating room nurses and technicians.

Auxetic Biomedical Metamaterials for Orthopedic Surgery Applications: A Comprehensive Review.

Poisson's ratio in auxetic materials shifts from typically positive to negative, causing lateral expansion during axial tension. This scale-independent characteristic, originating from tailored architectures, exhibits specific physical properties, including energy adsorption, shear resistance, and fracture resistance. These metamaterials demonstrate exotic mechanical properties with potential applications in several engineering fields, but biomedical applications seem to be one of the most relevant, with an increasing number of articles published in recent years, which present opportunities ranging from cellular repair to organ reconstruction with outstanding mechanical performance, mechanical conduction, and biological activity compared with traditional biomedical metamaterials. Therefore, focusing on understanding the potential of these structures and promoting theoretical and experimental investigations into the benefits of their unique mechanical properties is necessary for achieving high-performance biomedical applications. Considering the demand for advanced biomaterial implants in surgical technology and the profound advancement of additive manufacturing technology that are particularly relevant to fabricating complex and customizable auxetic mechanical metamaterials, this review focuses on the fundamental geometric configuration and unique physical properties of negative Poisson's ratio materials, then categorizes and summarizes auxetic material applications across some surgical departments, revealing efficacy in joint surgery, spinal surgery, trauma surgery, and sports medicine contexts. Additionally, it emphasizes the substantial potential of auxetic materials as innovative biomedical solutions in orthopedics and demonstrates the significant potential for comprehensive surgical application in the future.

Navigating Improper Care Settings: Nurses' Experiences Assisting Oncological Patients at the End of Life in Surgical Departments.

Despite the growing preference for end-of-life care at home, numerous oncological patients continue to spend their final moments in surgical wards. This incongruity in settings may contribute to "dysthanasia," unnecessarily prolonging futile treatments and resulting in undue suffering. As frontline caregivers, nurses frequently bear the brunt of these challenging situations for patients and their families. To investigate the experiences of nurses providing care to terminally ill oncological patients inappropriately admitted to surgical departments. We adopted a phenomenological descriptive study. Nurses purposefully selected from 7 distinct surgical units at a University Hospital in Northeast Italy were recruited. Data collection took place through open-ended semistructured interviews. The interview content was analyzed using Colaizzi's framework. The study with 26 participants revealed emotional challenges, especially for less-experienced nurses. Diverse perspectives among nurses emphasized the need for better palliative care knowledge. Despite the commitment to quality care, collaboration challenges and discordant goals with physicians impacted comprehensive care delivery. Dysthanasia relates to participants' challenges in caring for oncological patients in inappropriate settings, hindering transparent communication and exacerbating discordance with doctors. Communication and collaboration among healthcare professionals, particularly nurses, and surgeons are crucial. Ongoing education in end-of-life care, coupled with advance care planning, empowers patients, aligns treatment choices, and prevents dysthanasia across diverse healthcare settings.

Patient Experience Quality Improvement Project at WKBH Surgical Department

Patient Experience Quality Improvement Project at WKBH Surgical Department

Ability of nursing professionals and nursing directors to manage conflict situations and professional stress

The problem of conflicts and stress in teams continues to be relevant and is the focus of attention of many domestic and foreign scientists, theorists and practitioners, representatives of various scientific schools and directions. Applied aspects — the theory and practice of conflict resolution and stress relief — are becoming increasingly impor tant. Target. To study the ability of nursing specialists and managers of nursing services in therapeutic and surgical depar tments to manage conflict situations and professional stress. Results. An assessment was made of the level of conflict and professional stress of nursing staff in therapeutic and surgical departments, the ability of specialists and managers of nursing services to find effective solutions in conflict situations and opportunities to overcome stress was studied, and the level of need for nursing specialists to receive psychological help was assessed. Conclusion. The professional activity of nursing specialists involves emotional intensity and the presence of factors that cause stress. With the intense rhythm of work, the intensification of the work of nursing staff often leads to increased stress, the emergence of emotional burnout syndrome, in which there are disturbances in relationships with other people and excessive conflict.

Optimizing patient-controlled analgesia: a narrative review based on a single center audit process.

Intravenous patient-controlled analgesia (PCA) is valuable for delivering opioids in a flexible and timely manner. Although it is designed to offer personalized analgesia driven by the patients themselves, users often report insufficient pain relief, which can be addressed by optimizing its settings and multimodal analgesia. We adopted a systematic approach to modify PCA protocols by utilizing a serial audit process based on institutional PCA data. This review retrospectively examined the process, encompassing data from 13,230 patients who had used PCA devices. The two modifications to the fentanyl-based PCA protocols resulted in three distinct phases. In the first phase, high opioid consumption and unintended PCA withdrawal were the common issues. These were addressed in the second phase by omitting the routine use of basal infusion. However, this led to increased delivery-to-demand ratios, mitigated in the third phase by increasing the bolus dose from 15 μg to 20 μg. These serial protocol changes have produced varied outcomes across different surgical departments, underscoring the need for careful and gradual adjustments and thorough impact assessments. Drawing insights from this audit process, we incorporated findings from the literature on PCA settings and multimodal analgesic approaches. This review underscores the significance of iterative feedback and refinement of analgesic protocols to achieve optimal postoperative pain management. Additionally, it discusses critical considerations regarding the postoperative audit processes.