Unintended Injuries Research Articles

Validation in the Greek Language of the Patients' Perception of the Surgical Safety Questionnaire.

Introduction Adverse events in the operating room are considered unintended injuries or harm caused by healthcare rather than the patient's disease, leading to death, disability, or prolonged hospital stays. Methods A cross-sectional design was conducted following the random sampling method, on 200 surgical patients. A self-completed questionnaire was used, translated, and adapted into the Greek language. Results Most of the sample (57%) was male. The mean age was 67 years, and52% were elementary school graduates. Uponanalysis, significant correlations were observed between the two-administration (p<0.001) facts (intraclass correlation coefficient= 0.567), which reveal that the scale is stable through time.In addition, Cronbach's alpha had a value of 0.824 suggesting good internal consistency of the scale. Regarding the subscale, the first factor "safety regarding surgical procedure" was found 0.847, the second factor "effective communication and understanding" was 0.792, and finally the third factor "emotional security" was 0.506. A statistically significant difference found between the dimensions of safety in the operating room and the age of the patients was in the factor of emotional security, revealing that patients aged more than 70 were feeling more secure compared to younger patients (198) = 2.374, p=0.019. Conclusions The internal consistency of the Patients' Perspectives of Surgical Safety Scale (PPSS), weighted in a sample of the Greek population, is deemed satisfactory. The safety perceptions of surgical patients are at high levels.

Unintended Home Injuries in Under-5 Children in Sohag Governorate

Unintended Home Injuries in Under-5 Children in Sohag Governorate

Assessing a Medication Safety and Disposal Educational Program using the Health Belief Model.

Background: Self-medication practices continue to grow due to reclassification of prescription to OTC status and self-care information on the internet, however unintended injuries and inappropriate use of medications continue to challenge healthcare providers during the provision of patient care. Pharmacists have an integral role in pharmacovigilance and patient education activities to ensure safe medication use, storage, and disposal practices. Objectives: The objective of this medication safety and disposal educational program was to provide comprehensive informational support to the community coupled with an assessment using the Health Belief Model (HBM) to gauge participants' perceived behavior change. Methods: The HBM was selected to assess the understanding of the community members' benefits and barriers to safe medication practices. The HBM posits that health behaviors are influenced by perceptions of a diseases' severity, perceived susceptibility, perceived barriers to health practices, perceived benefits of health practices, self-efficacy, and cues to action. An 8 item pre/post survey following the HBM constructs was developed which used a 5 point Likert scale. Results: A total of 25 senior participants attended the educational program. Twenty-three pre/post surveys were completed (RR=92%). Five items revealed a statistically significant change from pre to post-educational content including understanding risk of herbal/OTC products (p=0.021), improved awareness of medication disposal methods (p=0.044), comprehension of OTC 'Drug Facts' information (p=0.004), understanding OTC label information to prevent medication interactions and side effects (p=0.008), and routinely reviewing expiration dates on medications and disposing of these properly (p=0.019). Conclusion: This study suggests a comprehensive approach which covers a wide range of medication safety topics and disposal practices can successfully improve the knowledge and skill of community participants and potentially improve medication harm reduction practices.

Frequency, Type, and Degree of Potential Harm of Adverse Safety Events among Pediatric Emergency Medical Services Encounters

Background Only 5–10% of emergency medical services (EMS) patients are children, and most pediatric encounters are low-acuity. EMS chart review has been used to identify adverse safety events (ASEs) in high-acuity and high-risk pediatric encounters. The objective of this work was to evaluate the frequency, type, and potential harm of ASEs in varied acuity pediatric EMS encounters. Methods This cross-sectional study evaluated pediatric (ages 0–18 years) prehospital records from 15 EMS agencies among three states (Colorado, Connecticut, and Rhode Island) between November 2019 and October 2021. Research associates used a previously validated tool to analyze electronic EMS and hospital records. Adverse safety events were recorded in six care categories, grouped into four levels for analysis: assessment/diagnosis/clinical decision-making, procedures, medication administration (including O2), and fluid administration, and defined across five types of ASEs: Unintended injuries or consequences, Near misses, Suboptimal actions, Errors, and Management complications (UNSEMs). Type and frequency of ASEs in each category were rated in three harm severities: Harm Unlikely, Mild/Temporary, or Permanent/Severe. Three physicians verified ASEs determined by research associates. Frequency of ASEs and harm likelihood are reported. Results Records for 508 EMS patients were reviewed, with 63 (12.4%) transported using lights and sirens. At least one clinical intervention beyond assessment/diagnosis/clinical decision-making was documented for 183 (36.1%, 95% CI: 31.8, 40.4) patients. A total of 162 ASEs were identified for 112 patients (22.1%, 95% CI: 18.5, 25.7). Suboptimal actions were the most frequent UNSEM (n = 66, 40.7%; 95% CI: 33.1, 48.3). For ASEs, (n = 162), the most frequent associations were with procedures 39.5% (95% CI: 32.0, 47.0) or assessment/diagnosis/clinical decision making, 32.1%, (95% CI: 24.9, 39.3). Among care categories, fluid administration was associated with significantly more UNSEMs (58.1%, 95% CI:53.8, 62.4). Most ASEs were determined to be ‘Harm Unlikely’ 62.4% (95% CI: 54.4, 70.4), with assessment/diagnosis/clinical decision making having significantly fewer ASEs with documented harm (22.4%, 95% CI: 10.7, 34.1) compared to other care categories. Conclusion Over 20% of pediatric EMS encounters had an identified ASE, and most were unlikely to cause harm. Most frequent ASEs were likely to be associated with procedures and assessment/diagnosis/clinical decision-making.

STUDY ON KNOWLEDGE ABOUT RASHTRIYA KISHOR SWASTHYA KARYAKRAM (RKSK) AMONG ADOLESCENTS ATTENDING HEALTH CENTRE IN DELHI.

Background: Adolescents are susceptible to several preventable and treatable health problems like nutritional disorders, substance abuse, mental health concerns, early and unintended pregnancy, unsafe sex, injuries and violence. To ensure holistic development of the adolescent population, the Ministry of Health and Family Welfare launched Rashtriya Kishor Swasthya Karyakram (RKSK) programme. This study aimed to assess the knowledge regarding Rashtriya Kishor Swasthya Karyakram (RKSK) among adolescents attending the health centre in Delhi. Methods: Acrosssectional study conducted among 100 adolescents belonging to age group of 10-19 years, who were attending the urban and rural health training centres in Delhi. Data was collected with the help of the predesigned and pretested questionnaire. Data was collected regarding socio-demographic details and knowledge regarding different adolescent health services provided under the programme. Results: Out of 100 adolescents, 18.0 % participants had adequate knowledge about RKSK. Knowledge about IFA supplementation, transmission and prevention of Sexually Transmitted Infection and common mental health problems was 52.0%,36.0% and 24.0% respectively. Knowledge regarding adverse effects and consequences of tobacco, alcohol and drug abuse and risk factors for non-communicable diseases was 46.0% and 42.0% respectively. 12.0% participants had awareness about Adolescent Friendly Health Clinics and 8.0% had registered themselves at these clinics. 44.0% participants had knowledge about Adolescent Health Days. 71.4% of adolescent girls had awareness regarding good menstrual hygiene. Conclusions: The knowledge regarding RKSK programme is low amongst the adolescents Awareness need to be spread regarding the various services provided under the programme through social media, local newspapers and television channels so that more number of adolescents avail these services

Advances in Management of Respiratory Failure in Children.

Providing the right respiratory support is an essential skill, vital for anyone treating sick children. Recent advances in respiratory support include developments in both non-invasive and invasive ventilatory strategies. In non-invasive ventilation, newer modalities are being developed, in an attempt to decrease the need for invasive ventilation. This include newer techniques like Heated humidified high-flow nasal cannula (HHHFNC) and improvements in existing modes. The success of Continuous positive airway pressure (CPAP) and other non-invasive modes depend to a large extent on choosing and maintaining a suitable interface. When it comes to invasive ventilation, recent advances are focussing on increasing automation, improving patient comfort and minimising lung injury. Concepts like mechanical power are attempts at understanding the mechanisms of unintended injuries resulting from respiratory support and newer monitoring methods like transpulmonary pressure, thoracic impedance tomography are attempts at measuring potential markers of lung injury. Using the vast arrays of available ventilatory options judiciously, considering their advantages and drawbacks in every individual case will be the prime responsibility of clinicians in the future. Simultaneously, efforts have been made to identify potential drugs that can favourably modify the pathophysiology of acute respiratory distress syndrome (ARDS). Unfortunately, though eagerly awaited, most pharmaceutical agents tried in pediatric ARDS have not shown definite benefit. Pulmonary local drug and gene therapy using liquid ventilation strategies may revolutionize our future understanding and management of lung diseases.

Robotic stray energy with constant-voltage versus constant-power regulating electrosurgical generators.

Stray energy from surgical energy instruments can cause unintended thermal injuries. There are no published data regarding electrosurgical generators and their influence on stray energy transfer during robotic surgery. There are two approved generators for the DaVinci Xi robotic platform: a constant-voltage regulating generator (cVRG) and a constant-power regulating generator (cPRG). The purpose of this study was to quantify and compare stray energy transfer in the robotic Xi platform using a cVRG versus a cPRG. An ex vivo bovine model was used to simulate a standard multiport robotic surgery. The DaVinci Xi (Intuitive Surgical, Sunnyvale, CA) robotic platform was attached to a trainer box using robotic ports. A 5s, open-air activation of the monopolar scissors was done with commonly used electrosurgical settings using a cPRG (ForceTriad, Covidien-Medtronic, Boulder, CO) or cVRG (ERBE VIO 300 dV 2.0, ERBE USA, Marietta, GA). Stray energy transfer was quantified as the change in tissue temperature (°C) nearest the tip of the assistance grasper (which was not in direct contact with the active monopolar scissors). Stray energy transfer occurred with both generators. Utilizing common, comparable settings for standard coagulation, significantly less stray energy was transferred with the cVRG versus cPRG (4.4 ± 1.6°C vs. 41.1 ± 13.0°C, p < 0.001). Similarly, less stray energy was transferred using cut modes with the cVRG compared to the cPRG (5.61 ± 1.79°C vs. 33.9 ± 18.4°C, p < 0.001). Stray energy transfer increases tissue temperatures more than 45C in the DaVinci Xi robotic platform. Low voltage modalities, such as cut or blend; as well as a cVRG generator, significantly reduces stray energy. Robotic surgeons can minimize the risk of stray energy injuries by using these low risk modes and/or generator.

Deep Epicardial Laceration after Cardiopulmonary Resuscitation: A Case Report.

Effective chest compressions have been proven to be a key element in a successful cardiopulmonary resuscitation (CPR). However, unintended injuries have been described in the medical literature for decades, including major intrathoracic injuries. We present a case of an 80-year-old man after a successful CPR who was later diagnosed with deep epicardial laceration as a result of effective chest compressions.

Population-scale identification of differential adverse events before and during a pandemic

Adverse patient safety events, unintended injuries resulting from medical therapy, were associated with 110,000 deaths in the United States in 2019. A nationwide pandemic (such as COVID-19) further challenges the ability of healthcare systems to ensure safe medication use and the pandemic’s effects on safety events remain poorly understood. Here, we investigate drug safety events across demographic groups before and during a pandemic using a dataset of 1,425,371 reports involving 2,821 drugs and 7,761 adverse events. Among 64 adverse events identified by our analyses, we find 54 increased in frequency during the pandemic, despite a 4.4% decrease in the total number of reports. Out of 53 adverse events with a pre-pandemic gender gap, 33 have seen their gap increase with the pandemic onset. We find that the number of adverse events with an increased reporting ratio is higher in adults (by 16.8%) than in older patients. Our findings have implications for safe medication use and preventable healthcare inequality in public health emergencies.

Musculoskeletal and skin considerations in children with medical complexity: Common themes and approaches to management

The term "children with medical complexity" (CMC) describes a population of heterogeneous genetic and metabolic disorders with multi-system involvement, with shared common abnormalities within the musculoskeletal system. Disorders that affect the central nervous system (CNS) result in abnormal muscular tone, ranging from dystonia and spasticity, to hypotonia, to combinations of both (axial hypotonia with appendicular hypertonia). Abnormal tone can impair movement and function and contribute to development of contractures, progressive scoliosis and hip dislocation. Impaired mobility, chronic illness and polypharmacy can result in fragile bones and increased risk of fracture, which can be difficult to diagnose and associated with pain. Additionally, CMC with impaired ability to communicate, total dependence on caregivers and frequent use of support devices can develop unintended skin injuries. There are a variety of treatments available for CMC with musculoskeletal disorders ranging from physical supports to pharmacologic treatments to surgeries. Medical and surgical treatments can promote changes in tone and support bone health to improve comfort, hygiene and proper positioning. These therapies may also carry significant risk in medically fragile patients. It is important for CMC to have a care team with a good understanding of the patient's overall health and goals of care and that can advocate for the patient to balance optimization of function and reduction of pain while also minimizing risk.

Overview of Environmental Health in Latin American: Information for joint action between countries and Promoting Environmental Health and Equity

BACKGROUND AND AIM: According to WHO 25% of global deaths and 28% of deaths among children under five are due to modifiable environmental factors. Ischemic heart diseases, chronic respiratory diseases, cancers and unintended injuries top the list. People in low- and middle-income countries bear the greatest burden of disease. Several cities are experiencing similar situations, but seek individualized discussions and solutions. AIM: To survey, analyze and present sources and reports made available by various institutions on environmental health aspects in Latin American countries. METHODS: Official sources from various Latin American countries were surveyed, as well as general reports from regional and international institutions such as: Economic Commission for Latin America and the Caribbean - ECLAC, PAHO, Global Burden of disease, CIDACS, Atlas HDI - United Nations Organization. We considered here 43 countries. The period of the reports considered was from 2017 to 2019. RESULTS:We found 30 regional reports - LAC and 132 data sources / reports for the total of countries. Brazil was the country that presented the largest data coverage. Various institutions produce data, national information on sanitation, air pollution, climate change. Few address greenspaces. The data show that countries are different, and point to all countries: 38% of the population in Latin America and the Caribbean is vulnerable. 80% of the population lives in urban areas. Only 37% of all legislators and senior officials are women. 40% of people living in the region feel safe. GDP spending at LAC ranges from 11.7% (Cuba) to 1.2% (Venezuela). A total of 15.5 million people still defecate in the open CONCLUSIONS:Stimulating research activities and debating public policies in the countries of Latin America jointly can contribute to positive impacts on quality of life. The ISEE Latin American and Caribbean chapter can enrich these actions. KEYWORDS: Policy and practice,Socio-economic factors,Environmental epidemiology

Prevalence and Correlates of Unintentional Injuries among In-School Adolescents in Ghana.

Injuries among adolescents pose significant public health problems. Unintentional injuries are the leading cause of adolescents’ mortality and disability with the largest burden in low-and middle-income countries. Yet, there is paucity of data in Ghana on adolescent injuries. The present study aimed to determine the prevalence and correlates of unintentional injuries among in-school adolescents in Ghana using data from the Global School-Based Health Survey. Cross-sectional data on 2058 adolescents in junior and senior high schools who randomly participated in the 2012 Global School-Based Health Survey were analyzed. Descriptive statistics were performed to determine the prevalence of unintentional injuriesacross the background characteristics of in-school adolescents. Binary logistic regression was employed to determine the factors associated with unintentional injuries. The results were presented as crude and adjusted odds ratios at a 95% confidence interval. The prevalence of one or more serious injuries in the past 12 months was 57.0%. The most commonly reported type and cause of injuries were “I had a cut or stab wound” (15.2%) and “I fell” (13.1%), respectively. In the adjusted regression, in-school adolescents aged 14–16 (aOR = 1.60, CI = 1.12–2.28) were more likely to report one or more serious injuries compared to their counterparts aged 13 or younger. In-school adolescents who participated in physical education (aOR = 1.27, CI = 1.03–1.58) had higher odds of reporting one or more serious injuries. The odds of being injured was higher among adolescents who were truant at school compared to those who were not truant (aOR = 1.42, CI = 1.14–1.77) In-school adolescents who were bullied were more likely to report being injured one or multiple times compared to their counterparts who were not bullied (aOR = 2.16, CI = 1.75–2.65). In addition, the odds of being injured once or multiple times were higher among adolescents who were physically attacked (aOR = 2.21, CI = 1.78–2.75), those that engaged in physical fighting (aOR = 1.94, CI = 1.54–2.45), and those who reported high psychological distress (aOR = 2.00, CI = 1.52–2.63) compared to their counterparts who were not. Conversely, adolescents in senior high schools were 39% less likely to be injured once or multiple times compared to those in junior high schools (aOR = 0.61, CI = 0.47–0.79). A relatively high prevalence of unintentional injuries was found among in-school adolescents in the study. The numerous factors identified in this study could be integrated into health promotion and injury prevention activities to help reduce the occurrence of injuries among in-school adolescents. Moreover, students who are susceptible to unintended injuries such as older adolescents, victims of bullying, those who participate in physical education, those who are often involved in fights, truants, and those who have psychological distress should be sensitized to take measures that will reduce their level of susceptibility. First aid treatment services should also be made available in schools to treat victims of unintended injuries.

Characterization of Efficacy and Animal Safety across Four Caprine Disbudding Methodologies.

Simple SummaryDisbudding of dairy goat kids is a routine, necessary, but painful husbandry procedure. Heat cautery disbudding is the industry standard since it is effective and can be rapidly performed by lay personnel on large numbers of kids. Efforts to improve welfare associated with heat cautery disbudding commonly focus on adjunct anesthesia and analgesia but there are often technical, legal, and safety barriers to routine use of these adjunct therapies in production settings. This project explores four alternative methods to heat cautery disbudding for safety, efficacy, and vocal evidence of duress during the procedure. We found that heat cautery was the most effective, was similar to the sham procedure for vocalization count during the procedure, and did not cause any serious or lasting complications. Clove oil injection, short-term topical application of caustic paste, and two cryosurgical methods were not consistently effective; additionally, the latter two created significantly more vocalization efforts. Clove oil injection was associated with several unexpected and severe complications including unintended tissue necrosis, temporary paresis, skull defects, meningitis, and death. Collectively, we did not find that any of the alternative methods of disbudding provided a feasible option over heat cautery to improve welfare associated with the disbudding process.There is a strong industry demand for technically simple and highly efficacious alternatives to heat cautery disbudding in goat kids that can be performed as a stand-alone procedure without adjunct anesthesia, and that result in improved overall welfare through reduced acute pain, reduced tissues healing interval, and a consistent safety record. The objective of this study was to consider the net effect of disbudding techniques on goat welfare by examining vocalization frequency, long-term efficacy and animal safety associated with four alternative caprine disbudding methods against sham-disbudded and heat-cautery controls. Sixty-five commercial male dairy kids were disbudded at 3–10 days of age with one of six disbudding treatments (clove oil injection, caustic paste, two cryosurgical methods, heat-cautery, and sham procedure). Heat cautery was 91% effective, caustic paste was 55% effective, and the other treatments were ineffective. Heat cautery and sham procedures resulted in similar vocalization efforts; freezing with a liquid-nitrogen cooled iron resulted in significantly greater vocalization numbers. No unintended paste transfer injuries were observed with short-term application of the caustic paste. Heat cautery resulted in numerous superficial infections but no permanent injury. Clove oil injection was associated with several unexpected and severe complications including unintended tissue necrosis, temporary paresis, skull defects, meningitis, and death. Collectively, we did not find that any of the alternative methods of disbudding provided a feasible option over heat cautery to improve welfare.

Mapping the robotic hysterectomy learning curve and re-establishing surgical training metrics.

ObjectiveCommon robotic training curricula in the US entail completion of an online module followed by lab training with standardized exercises, such as manipulating needles with robotic needle drivers. Assessments are generally limited to elapsed time and subjective proficiency. We sought to test the feasibility of a simulation-based robotic hysterectomy curriculum to collect objective measurements of trainee progress, map the trainee learning curve and provide a system for trainee-specific evaluation.MethodsAn observational cohort study of a single institutions' residency members participating in a procedural hysterectomy simulation performed every 4 months. Each simulation episode had one-on-one teaching. The robotic platform was used to measure all movements within cartesian coordinates, the number of clutches, instrument collisions, time to complete the simulated hysterectomy, and unintended injuries during the procedure.ResultsVoluntary participation was high. Objective metrics were successfully recorded at each session and improved nearly universally. More senior residents demonstrated superior capabilities compared to junior residents as expected. The majority of residents (29/31) were able to complete an entire simulated hysterectomy in the allotted 30-minute training session period by the end of the year.ConclusionsThis program establishes learning curves based on objective data points using a risk-free simulation platform. The curves can then be used to evaluate trainee skill level and tailor teaching to specific objective competencies. The pilot curriculum can be tailored to the unique needs of each surgical discipline's residency training.

Deep Learning for US Image Quality Assessment Based on Femoral Cartilage Boundary Detection in Autonomous Knee Arthroscopy.

Knee arthroscopy is a complex minimally invasive surgery that can cause unintended injuries to femoral cartilage or postoperative complications, or both. Autonomous robotic systems using real-time volumetric ultrasound (US) imaging guidance hold potential for reducing significantly these issues and for improving patient outcomes. To enable the robotic system to navigate autonomously in the knee joint, the imaging system should provide the robot with a real-time comprehensive map of the surgical site. To this end, the first step is automatic image quality assessment, to ensure that the boundaries of the relevant knee structures are defined well enough to be detected, outlined, and then tracked. In this article, a recently developed one-class classifier deep learning algorithm was used to discriminate among the US images acquired in a simulated surgical scenario on which the femoral cartilage either could or could not be outlined. A total of 38 656 2-D US images were extracted from 151 3-D US volumes, collected from six volunteers, and were labeled as "1" or as "0" when an expert was or was not able to outline the cartilage on the image, respectively. The algorithm was evaluated using the expert labels as ground truth with a fivefold cross validation, where each fold was trained and tested on average with 15 640 and 6246 labeled images, respectively. The algorithm reached a mean accuracy of 78.4% ± 5.0, mean specificity of 72.5% ± 9.4, mean sensitivity of 82.8% ± 5.8, and mean area under the curve of 85% ± 4.4. In addition, interobserver and intraobserver tests involving two experts were performed on an image subset of 1536 2-D US images. Percent agreement values of 0.89 and 0.93 were achieved between two experts (i.e., interobserver) and by each expert (i.e., intraobserver), respectively. These results show the feasibility of the first essential step in the development of automatic US image acquisition and interpretation systems for autonomous robotic knee arthroscopy.

Cervical traction suture technique during large loop excision of the transformation zone increases complete lesion excision

PurposeA surgical technique was developed in the past by our group to reduce the rate of inadvertent complications. It was then seemed that it also increased the rate of complete lesion excision. The objective of the study was to evaluate the effectiveness of a cervical traction suture technique in increasing the prevalence of complete lesion excisions and reducing the incidence of unintended injuries to adjacent tissues during large loop excision of the transformation zone (LLETZ). Basic proceduresA retrospective cohort study, including all consecutive patients who underwent LLETZ between January 2016 and June 2018, at the outpatient Colposcopy clinic of a general hospital in Galilee Medical Center. We divided patients into two groups based on whether their LLETZ utilized the cervical traction suture technique. We compared these two groups using an independent-samples t test, and we compared the study-specific proportions to those reported in the literature using the proportion test. Main findingsA total of 66 patients were included in the analysis; 33 had undergone LLETZ with a traction suture, and 33 had undergone LLETZ without a traction suture. The prevalence of complete lesion excision was 93.3 % among patients undergoing LLETZ with a traction suture and 72.7 % among those without a traction suture (p = 0.04). The incidence of unintentional injuries to adjacent organs was 12.1 % in women with a traction suture and 18.2 % in women without a traction suture (p = 0.73). Principal conclusionsUsing a cervical traction suture along with LLETZ can increase the rate of complete lesion excision and may reduce the prevalence of unintended injuries.

Unintended Injuries Evaluated in theEmergency Room of a Third Level PediatricHospital in Dominican Republic

Introduction: The term unintended injury is defined as that injury not caused in a premeditated manner; being one of the most frequent causes of death among children of all ages. Material and Methods : A descriptive, cross-sectional analysis and retrospective data collection study was conducted in the emergency database of a third level pediatric hospital from the Dominican Republic, with the objective of Determine the prevalence of unintended injuries. Results : The total prevalence of unintended injuries was 12.1%. The most frequent sex was male with 61.6%, most frequent age range 1-14 years with 29.2%. According to the diagnosis, trauma is in the first place with 94.1%, highlighting that this is the main diagnosis in order of frequency in both sexes. Conclusions: The total prevalence of unintended injuries was 12.1%. The most frequent sex was male. In all unintended injuries identified, the most affected age range was 1-4 years.

Laser safety: the need for protocols.

Lasers are being used in ever-expanding roles in dermatology. As our understanding of laser energy grew, the need for safety guidelines became apparent. The US Food and Drug Administration (FDA) published the first safety guidelines in 1984, which are updated on a regular basis. However, these are just guidelines, and their implementation is voluntary by the laser practitioner. In this article, we discuss the 4 regulatory entities for laser safety in the United States, laser principles in general, ocular hazards, laser-generated airborne contaminants (LGACs), fires, and unintended laser beam injuries. We also review the use of checklists in reducing adverse outcomes and the need for safety protocols for laser practitioners. We provide a modifiable checklist, which pertains specifically to lasers and can be customized to meet the needs of the individual laser practitioner.

Stray energy transfer in single-incision robotic surgery.

Stray energy transfer from surgical monopolar radiofrequency energy instruments can cause unintended thermal injuries during laparoscopic surgery. Single-incision laparoscopic surgery transfers more stray energy than traditional laparoscopic surgery. There is paucity of published data concerning stray energy during single-incision robotic surgery. The purpose of this study was to quantify stray energy transfer during traditional, multiport robotic surgery (TRS) compared to single-incision robotic surgery (SIRS). An in vivo porcine model was used to simulate a multiport or single-incision robotic cholecystectomy (DaVinci Si, Intuitive Surgical, Sunnyvale, CA). A 5s, open air activation of the monopolar scissors was done on 30W and 60W coag mode (ForceTriad, Covidien-Medtronic, Boulder, CO) and Swift Coag effect 3, max power 180W (VIO 300D, ERBE USA, Marietta, GA). Temperature of the tissue (°C) adjacent to the tip of the assistant grasper or the camera was measured with a thermal camera (E95, FLIR Systems, Wilsonville, OR) to quantify stray energy transfer. Stray energy transfer was greater in the SIRS setup compared to TRS setup at the assistant grasper (11.6 ± 3.3°C vs. 8.4 ± 1.6°C, p = 0.013). Reducing power from 60 to 30W significantly reduced stray energy transfer in SIRS (15.3 ± 3.4°C vs. 11.6 ± 3.3°C, p = 0.023), but not significantly for TRS (9.4 ± 2.5°C vs. 8.4 ± 1.6°C, p = 0.278). The use of a constant voltage regulating generator also minimized stray energy transfer for both SIRS (0.7 ± 0.4°C, p < 0.001) and TRS (0.7 ± 0.4°C, p < 0.001). More stray energy transfer occurs during single-incision robotic surgery than multiport robotic surgery. Utilizing a constant voltage regulating generator minimized stray energy transfer for both setups. These data can be used to guide robotic surgeons in their use of safe, surgical energy.

Incidence of adverse events after discharge from a secondary hospital in northern Ghana

Background: Adverse events involve unintended injuries or complications resulting in death, disability, harm or prolonged hospital stay that arise from health care management. This paper aims at giving insight into the incidence, types and severity of adverse events after hospital discharge in the context of the management/care patients received from the hospital.Methods: A descriptive cohort study design was used in a secondary hospital in Ghana. The study population involved patients discharged from the medical, surgical and emergency wards of the Hospital. A total of 206 patients were recruited through a consecutive sampling technique.Results: The findings revealed an adverse events rate of 25.7%. The study also identified adverse events related to medications to be the leading type of adverse events recorded after discharge from the hospital. There were 3.9% death rate among participants 21 days after discharge from the hospital. The study revealed that adverse events usually occur after discharge from the hospitals which differ in several forms and in severity.Conclusions: These, therefore offer nurses and other service providers an opportunity to target the areas for improvement of services.