Ward Procedures Research Articles

Harnessing Patient Complaints to Systematically Monitoring Healthcare Concerns through Disproportionality Analysis.

Staff observations are the most common source of data for driving improvements in care. However, the patient perspective should also be considered, and healthcare complaints offer concrete details that health organizations might otherwise overlook and that can highlight areas for learning and improvement in the healthcare system. However, because of the diverse nature of patient complaints, systematic analyses can be challenging. This study aimed to identify and prioritize areas for improvement using a data-driven approach to analysing patient complaints. The Danish version of the Healthcare Complaints Analysis Tool was used to categorize the content of complaint letters. All complaints managed by the national complaints authority, compensation claims to the Patient Compensation Association, and locally managed complaints that were filed directly at Odense University Hospital from 2017 to 2021 were included. Proportional reporting ratios (PRRs) were used to measure and display the top five signals of disproportionality and rank them by excess complaints at the hospital level and when divided into department types. The study included 6366 complaints containing 13 156 problems (on average, 2.1 problems mentioned per complaint letter). Surgical departments had the highest number of complaints (3818), followed by medical (1059), service (439), and emergency departments (239). Signal 1 of disproportionality, relating to quality problems during ward procedures, had the highest excess reporting of 1043 complaints at the hospital level, a PRR of 1.61, and was present in all department types. Signal 2, relating to safety problems during the examination and diagnosis stage, had excess reporting of 699 problems, a PRR of 1.86, and was also present in all department types. Signal 3, relating to institutional problems during admission, had the highest PRR of 3.54 and was found in most department types. Signals 4 and 5, relating to environmental problems during ward procedures and care on the ward, respectively, had PRRs of 1.5 and 1.84 and were present in most department types. The study found that analysing patient complaints can identify potential areas for hospital improvement. The study identified recurring issues in multiple departments, including quality problems during ward procedures, safety problems during the examination, institutional problems during admission, and environmental problems on the ward. The study highlights disproportionality analysis of complaints as a valuable tool to monitor patient concerns systematically.

Sedative and analgesic effects of propofol–ketamine versus propofol–fentanyl for emergency department procedures

Background:To manage and reduce painful procedures in the emergency wards, procedural sedation as well as analgesia can be used. Propofol combinations are the most common short‐acting intravenous sedative drugs in the field of emergency medicine.Objectives:This research aimed to compare the effectiveness, safety, and complications of intravenous infusion of ketofol with fentofol in painful emergency procedures.Methods:This study was a randomized, double‐blind clinical trial. Sampling was simple and used random assignment; 196 participants were randomly assigned to two groups of 98 patients each. In each group, injection was done with fentanyl–propofol or ketamine–propofol. For data gathering, pre‐procedure, and procedure, modified Aldrete's scoring checklist was used. In order to determine the levels of sedation, we used the Ramsay Sedation Scale. Data analysis was performed via SPSS Version 20 using statistical tests such as mean ± standard division, t‐test, chi‐square test, and analysis of variance.Results:Among the participants in this study, shoulder procedure was performed more than other procedures (56.6%). The mean of recovery time was significantly different in the two groups (ketofol: 5.65 ± 0.35 vs fentofol: 9.33 ± 0.78); the recovery time in group B (fentofol) was longer than that in group A (ketofol) (p = 0.001). Drug complications were statistically significant in the two groups, and complications by ketofol were less than those by fentofol (p = 0.001). “Hypotension and bradycardia” were observed with fentofol and “tachycardia” was observed with ketofol. The performance of these two drugs was not the same when subject to various procedures.Conclusion:Results of this study revealed that ketofol provided better analgesia and sedation, faster recovery time, lesser complications and adverse events, and reduced bradycardia and hypotension.

Frequency of Radial Nerve Palsy in Patients with Closed Traumatic Humeral Shaft Fracture in High Energy Trauma Cases

Background: Different pattern of the fractures of the humerus shaft usually result in radial nerve injury. The frequent injury of radial nerve is because of its close proximity to the humeral shaft in the radial groove. Objective: Determining the incidence of Radial Nerve Injuries in Patients with Closed type of Humeral Shaft Fractures in high-energy trauma cases. Material and Methods:Department of Orthopedics conducted this study at Ghurki Trust & Teaching Hospital, Lahore from January 2021 to December 2021, including all patients regardless of gender, aged between 20-60 years with closed fractures at the level of shaft of humerus. All the patients were thoroughly investigated with detailed history, clinical and radiological examination. The patients were originally managed according to standard ward procedures, fracture stabilization with U-slab and analgesic requirements. All of the patients were clinically examined to rule out radial nerve damage. The data accumulated after completion was analyzed using the relative software SPSS version 26.0. Results: This study included 80 patients with radiologically confirmed humeral shaft fractures. There were 55 (68.5%) men and 25 (31.25%) women having this type of fracture pattern. The participants ages were inbetween 20 to 60 years, with men and women having mean ages of 31.62 ±8.35 years and 38.43±5.06 years, respectively, and overall mean age of 38.93± 6.19 years. Spiral fractures accounted for 32 (40%) of the cases, while transverse fractures17 (21.25%), communited fractures16 (20%) and segmental fractures 15(18.75%). In 7 (or 8.75 percent) out of the 80 patients, radial nerve injury was observed. 4 (57.1%) cases of radial nerve damage were found in patients with spiral closed midshaft humerus fractures, 1 (14.3%) reported case in transverse closed humerus shaft fractures, 1 (14.3%) case in comminuted closed midshaft humerus fractures, and 1 (14.3%) case in segmental fractures. Conclusion: This study highlighted the frequency of radial nerve palsy among the patients with humeral shaft fractures at spiral goove . Radial nerve palsy was found in 8.75% of cases presented to our setup.Most of these cases reported in patients with spiral type of fracture of humerus midshaft. These findings are helpful to the surgeons during the pre operative counseling of patients, who suffered radial nerve damage due to a humerus shaft fracture at radial groove. Keywords:Radial Nerve Injury, Closed fracture of the humerus, Radial groove ,Humerus Shaft

Five-Year Analysis of Surgical Site Infections in Three Orthopaedics and Trauma Wards under HAI-Net from the South of Poland in 2014-2018 Considering the Standardized Infection Ratio.

Background and Objectives: Surgical site infections (SSIs) are the most common healthcare-associated infections (HAIs) in surgical wards. The highest risk of developing SSI is carried by operations involving implants, such as: hip prosthesis (HPRO), knee prosthesis (KPRO), open reduction of fracture (FX), and closed reduction of fracture with internal fixation (CR). Objectives. The objective of the study was to assess the incidence of SSI in patients subjected to HPRO, KPRO, FX, and CR procedures in orthopaedics and trauma wards in 2014–2018 considering risk factors included in the SIR index. Materials and Methods: The study included 6261 patients who were subjected to orthopaedic surgery in 2014–2018. The investigation covered three hospitals with orthopaedics and trauma wards. The research was conducted in the framework of the national HAI surveillance programme according to the methodology of the HAI-Net, ECDC. Results: A total of 6261 surgeries were investigated, of which 111 cases of SSI were detected. The incidence was 1.8%; HPRO (incidence 2.1%, median (Me) surgery duration 90 min, and standardized infection ratio (SIR) above 1 in all units tested); KPRO (incidence 2.0%, Me 103 min, and SIR above 1 for all units tested); FX (incidence 1.9%, Me 70 min, and SIR above 1 for two units tested and below 1 in one unit); CR (incidence 1.0%, Me 55 min, and SIR—not calculated). The etiological agents that were most frequently isolated from patients with SSI were Staphylococcus aureus, coagulase-negative Staphylococcus, and Klebsiella pneumoniae. Conclusions: HPRO, KPRO, and FX operations performed in the studied wards carried a higher risk of developing SSI than that predicted by SIR. SSIs accounted for a significant percentage of the overall infection pool in CR surgeries. Actions should be undertaken to reduce the incidence of SSI in these surgeries. There should be a hospital network which facilitates cooperation in order to better monitor and analyse the incidence of SSI.

Trauma-informed care in geriatric inpatient units to improve staff skills and reduce patient distress: a co-designed study protocol

BackgroundGeriatric hospital wards are highly medicalised environments with limited opportunities for choice and control, and can be distressing for older survivors of psychological trauma. While trauma-informed models of care (TIC) are effectively applied across mental health and other settings, the utility of these models in aged care settings has not been assessed. The objective of this study was to examine whether TIC can reduce responsive behaviour, chemical restraint, and improve staff skills and patient experiences in inpatient geriatric settings.MethodsFour wards participated in this type I hybrid implementation-effectiveness study across southern Adelaide, Australia, including 79 beds. Using a co-design method, the principles of TIC were transformed into an implementation strategy including staff training, establishment of highly trained ‘champions’ on each ward, screening for trauma-related needs, and amending ward policies and procedures. Primary outcomes will be examined using an interrupted time-series design and are monthly incidence of responsive behaviour incidents and use of chemical restraint. Process evaluation will be used to examine secondary, implementation outcomes including the acceptability, feasibility, and fidelity to the implementation strategy.DiscussionTrauma-informed care has potential to improve the safety and accessibility of hospital wards for older people who have survived psychologically traumatic events and has an extensive evidence base supporting its effectiveness in other settings. Identifying trauma-related needs and amending care to reduce the risk of re-traumatisation and distress may also reduce the incidence of responsive behaviour change, which has a significant impact on the quality of life of hospital patients and staff and is very costly. The inclusion of a process evaluation will allow us to identify and report changes made on each ward and make recommendations for future implementation efforts.

A NOVEL TECHNIQUE OF RYLE’S TUBE FIXATION (PARTHA’S TECHNIQUE) FOR CONVENIENT INTRAOPERATIVE USE

Dear sir,
 Nasogastric tube (Ryle’s tube) insertion is one of the commonest ward procedures done for different indications. During selected surgical procedures, the insertion of such tubes is done in the preoperative ward. There are lot of reported difficulties during insertion in the intraoperative period.1 The Ryle’s tube is inserted in the classical manner but usually adjusted to enable the surgeon to do the gut surgery. The tube is usually fixed to the nose by a plaster wound round the tube. This technique is usually difficult to unwound if there is a need to reposition. In surgical and medical wards, the necessity for repositioning is not very significant. But during the intraoperative period, the surgeons always prefer to move the tube here and there to make the operative field better. This in turn causes much discomfort to the attending anaesthesiologist if the plaster is stuck in a traditional way. Hence, we propose a novel technique of fixation wherein we get the advantages of avoiding accidental removal but with the ease of frequent positional adjustment. A sixty-five-year-old male came for upper Gastro-intestinal surgery. The Ryle’s tube was inserted in the ward and fixed as given in fig 1. To adjust the position after removal of the plaster becomes a herculean task. Its more difficult to adjust the plaster with gloved hands. The plaster was removed before induction and fixed as described below. The first plaster (P1 in fig 2) was vertical and fixed the tube to the nose in a vertical fashion. The portion of the plaster which sticks to the tube should be around 50 % of the plaster length. Usually there is a small gap between the attachment of the tube and the nose. The next or the second plaster (P2 in fig 2) was transverse which fixed the vertical plaster to the nose. The transverse plaster never touched the Ryle’s tube. (Fig 2) If we need to adjust the position, the plasters can be easily loosened to adjust and fix again. The portion of the plaster in the gap can be lifted to loosen. There is no need for changing the plasters. Many a time, the surgeons may ask for repeated changes of position during the surgery. Hence this Partha’s technique of fixation suits repeated unfastening and regluing. There are reports of lost Ryle’s tubes2 after fixation in the wards. Lorente3 in his study of intensive care patients, found an incidence of accidental removal of Ryle’s tube as 4.48%. A single plaster use may be a cause of malposition. An extensive search of the literature did not reveal fixation techniques with their pros and cons. We have been using this technique for many years so far with minimal problems. This report is limited to the fact that it is not used much with no comparative studies to know its advantages and disadvantages.

Recusa de procedimentos em Hospital de Reabilitação: análise bioética

Do ponto de vista bioético é importante analisar as causas de conflitos na recusa da realização de procedimentos durante a internação de pacientes em Hospital de Reabilitação. Objetiva-se descrever a recusa dos procedimentos em Hospital de Reabilitação e analise à luz da bioética. Questionários foram aplicados a enfermeiros sobre o motivo da recusa de procedimentos e as consequências no atendimento. De 190 internações durante um mês, 20 recusaram procedimentos na enfermaria, 55% mulheres, 61 anos de idade, 75% com grau de escolaridade até o ensino médio, 75% apresentavam comorbidades, 65% com indicação cirúrgica. O tempo de internação foi em média de 27,5 dias, 10% recusaram procedimentos, entre estes de locomoção e de enfermagem, obteve-se consenso em 50%, houve consequências no atendimento em 55% destes. Os profissionais de saúde estão cientes de que não é possível realizar cuidados sem o consentimento do paciente, todavia isso pode gerar impacto nos cuidados ao paciente. É importante que o paciente entenda as informações que lhe foram prestadas e as repercussões das suas decisões sobre o seu atendimento e tratamento, especialmente em reabilitação, que exigem cuidados duradouros ou permanentes, a depender do grau de dependência física e psíquica.

The Effect of a Hand Massage on the Physiological Changes Induced by Intravenous Line Insertion in Children Aged Three to Six: A Clinical Trial

Background: The insertion of intravenous (IV) line is one of the most painful procedures in pediatric wards, which can lead to complications such as changes in the physiological parameters of the patient. Objectives: The purpose of this study was to determine the impact of a hand massage on controlling changes in the physiological parameters caused by inserting IV line in children. Methods: This clinical trial was conducted in the Surgery Ward of a teaching pediatric hospital in Tabriz between 2016 and 2017. A total of 70 qualified children were enrolled and randomly assigned to the experimental and control groups. The experimental group underwent massage therapy five minutes before venipuncture until it was completed. Physiological responses of both groups were measured and recorded before and immediately after the intervention. Eventually, the data were analyzed in SPSS version 24 using descriptive (mean and standard deviation) and analytical (independent and paired t-tests) statistics. Results: The results of statistical analysis revealed that the increase in heart rate in response to the pain caused by venipuncture is significantly lower in the massage group than in the control group (P = 0.001). Conclusions: A hand massage is an easy, inexpensive, and practical technique that could be administered along with other pharmaceutical or non-pharmaceutical methods to control physiological responses of pain due to IV line insertion in children.

Evaluation of mobile learning for the clinical practicum in nursing education: application of the FRAME model

This paper presents an evaluation of mobile learning practice for the clinical practicum in nursing education. Nursing students need to practise nursing skills and follow specific clinical procedures in wards. In this study, they were provided with a mobile device for learning purposes, with mobile apps preinstalled for watching nursing videos and conducting clinical assessments. The evaluation was conducted following the Framework for the Rational Analysis of Mobile Education (FRAME). It included a questionnaire survey involving 265 nursing students and focus group interviews with 20 nursing students, the course coordinator of the clinical practicum and the instructional designer of the mobile apps. The participants shared their views, perceptions and experiences of mobile learning for studying nursing skills and conducting clinical assessment in the practicum context. The results showed the participants’ overall satisfaction with the mobile learning practice. They gave positive feedback on the use of the mobile apps in terms of enabling ubiquitous access to materials for situated learning in wards, and offering effective support for teachers to keep track of students’ learning progress. They also suggested areas for improvements, which emphasised the hardware capacity of devices, training on the use of apps and institutional support for the maintenance of devices. The results of factor analysis showed a composition of underlying factors different from that of the original FRAME model, which suggests contextual variation in the application of the model.

Intrapartum Procedures for Prevention of Infections and Complications in Mothers During Childbirth.

Multiple factors can cause infection and other pathological conditions in mothers during childbirth. These risk factors and diseases/complications can be prevented or timely detected through the implementation of special protocols/procedures. The aim of this paper is to identify the implementation of procedures/measures for the prevention and detection of infections and risk factors for morbidity and mortality in four hospitals in the Republic of Macedonia, before and during childbirth. A retrospective study was conducted in four hospitals in R. Macedonia, in December 2016, on certain days according to the same principle of selection in all institutions. The questionnaire used contained relevant and specific questions related to the application of procedures and protocols at the maternity clinic at the time of admission to the birthplace and immediately prior to delivery. The study analyzes the performed procedures from 137 obstetric histories. Cardiotocograph was taken after the admission in a hospital in 86% of the mothers; a temperature was measured at only 47.5%, and arterial tension at 89.8%. Immediately before delivery, the color and odor of the vaginal discharge in 98.5% of the mothers was checked, urine was analyzed only in 8% of the mothers, and the analysis of the time of rupture of the mammalian sheaths in 98.6% of the mothers. The study showed that part of the analyzed procedures was not sufficiently implemented, and the percentage distribution varied between hospitals. There is a need for introduction of organized programs with standard procedures in maternity wards in order to protect against infections and other pathological conditions during childbirth.

Evaluation of Nursing Staffs' Documentation Standard Related to Nursing Procedures at Medical Wards in Al-Najaf Al-Ashraf Governorate

Background: A patient medical record ( chart ) is a legal document which may be used in court as evidence, so it is important that every chart and record must have clear, simple and an accurate language.Objective of study: The study aims to evaluating of nursing staffs documentation standard in medical and, finding out the association between nursing staffs documentation and sociodemographic characteristic of (age, gender, education level , and years of experience).Methodology: A descriptive study was carried out to evaluation of nursing staffs' documentation standard related to nursing procedures in medical wards. A purposive sample of (71) nurses was selected from medical wards of hospitals (Al-Sadder Medical City, Al-Manathra General Hospital, Al-Forat General Hospital, Al-Haydaria General Hospital, Al-Sagaad General Hospital and Al-Hakeem General Hospital) in Al Najaf governorate, direct interviewing with participant. The data collection started from first of October 2014 to first of September 2015. The constructed instrument used is compromised of two sections: section one includes the nurses demographic characteristic, section two is the documentation tool which consists of 4 parts including (vital signs form, nursing observation flow sheet, intake-output fluid flow sheet and insulin chart).Descriptive and inferential statistical methods were used to analyze the data. Reliability of the instrument was done for the tool parts and flow sheets through test and retest, also a panel of experts determined the validity of the tool. data was analyzed by using descriptive and dataResult: The study showed that the majority of nurses were male, with age group (30-39), they graduated from the school of nursing (50.7%), they had (1-4) years of experience in medical wards (22.5%). Most of the study sample had sharing in training sessions related to documenting in nursing (80.3%).Conclusion: Overall evaluation for the documentation of the nursing staffs is moderate.Recommendations: the study recommended to- Applying the modified documentation system to all Iraqi medical wards.KUFA JOURNAL FOR NURSING SCIENCES Vol. 6 No. 3 Sep. through Dec. 201620-Training sessions should be conducted for nurses to act as a unique challenge for showing the importance of documentation and documenting nursing activities.

Improving efficiency in the endoscopy unit

The demand for endoscopic services is increasing rapidly, and this necessitates optimal efficiency in the endoscopy unit. Aim: To assess the efficiency of an endoscopy unit, concentrating in the delay pre-and post-procedure. Patients: Outpatient/day ward procedures. Methods: We examined the delay in endoscopic procedures between 19 and 30 May 2014. The procedure process was examined at three different stages: stage 1 is from when the ‘patients arrives to pre-procedure ward’ to ‘ready for procedure’; stage 2 is from ‘where the patient is ready and waiting to be called’ to ‘when the endoscopy procedure commences’; and stage 3 is from ‘when the ward is contacted to collect patient post procedure’ to ‘when the patient is discharged from the ward’. Results: The pathways for 238 endoscopic procedures were assessed. In total, 249 episodes of delay were documented. Stage 1 accounts for 28% of the delays; there is 1.1–1.6 hours of a delay per patient at this stage. Stage 2 accounts for 53% of the delays; there is a delay of 2.5–2.75 hours per patient at this stage. Stage 3 accounts for 19% of the delays; there is a delay of 1.75 – 2 hours per patient at this stage. Conclusion: Delays were a major factor affecting optimal use of available day ward/endoscopy resources. Significant delay can occur pre-and post-procedure. Strategies to reduce peri-procedural delays could have a favourable impact on day ward capacity and the volume of procedures performed in the endoscopy unit.

Assessment of indoor and outdoor airborne fungi in an Educational, Research and Treatment Center

Hospital environments contain different types of microorganisms. Airborne fungal are one of these microbes and the major sources of hospitals indoor contamination that will be able to cause airborne fungal diseases. The total count and diversity of the airborne filamentous and yeasts fungi were investigated in indoor and outdoor air of selective wards of Emam Reza Educational, Research and Treatment Center. This cross-sectional study was performed during the fall season. One hundred and ninety-two environmental samples of indoor and outdoor air from hematology, infectious diseases, Ear, Nose and Throat (ENT) and Neonatal Intensive Care Unit (NICU) wards were collected by open plate technique (on Sabouraud dextrose agar media) once a week. The cultures were then examined and evaluated according to macroscopic and microscopic examination criteria. In this study, 67 (62.03%) of indoor samples and 81 (96.42%) of outdoor samples were positive for fungi. The most isolated fungi were yeast species (17.12%), <em>Penicillium</em> spp. (16.34%), <em>Alternaria</em> spp. (14.39%), <em>A.</em> <em>niger</em> (11.28%), <em>A</em>. <em>flavus</em> (8.95%), respectively. Almost all of the wards showed high rates of contamination by various fungi. However, the analysis of the data showed that indoor air of hematology ward had the highest fungal pollution. In contrast, the outdoor air of ENT had the highest fungal pollution. Thus, these results demonstrated that the cleansing and disinfection procedures in the hospital wards should be improved yet.

Coercion in psychiatry: the importance of extramural factors

Background: Mechanical restraints and forced procedures in psychiatric wards are of major concern in Denmark and there is a desire to reduce these procedures to a minimum. So far, focus has primarily been on identifying and changing internal (intramural) factors when seeking to reduce coercion.Aim: To identify possible external (extramural) factors that may increase the risk of coercion during admission to a closed psychiatric ward.Method: Using a retrospective case-controlled design, 235 patients admitted to a closed ward during 2011–2013 were randomly selected. Coercion comprised belt restraint, physical restraint, and forced medication. The data source was the electronic patient records, which include statutory information on all forced measures. Multiple logistic regression analyses were applied to calculate the risk (odds ratio, OR (95% confidence interval)) of forced measures being used.Results: Out of the 235 patients, 66 (28%) were subject to coercion. The time of forced procedures was predominately during the first hours after admission. The risk of forced measures being applied was significantly higher if patients were involuntarily admitted (OR = 6.4 (3.4–11.9)), or were acutely intoxicated by substances at the time of admission (OR = 3.7 (1.7–8.2)).Conclusion: Extramural factors should be included when mental health authorities plan efforts to reduce coercion during admission to psychiatric wards. A reduced threshold for admission and improved integrated effort between mental health services and treatment for substance abuse could improve the course of disease for this group of patients and reduce the need for involuntary admissions and subsequently coercion.

Source-case investigation of Mycobacterium wolinskyi cardiac surgical site infection

The non-tuberculous mycobacteria (NTM) Mycobacterium wolinskyi caused bacteraemia and massive colonization of an aortic prosthesis in a patient 16 days after cardiac surgery, necessitating repeat surgery and targeted antimicrobial chemotherapy. The infection control team investigated the source and conditions of infection. Peri-operative management of the patient complied with recommendations. The environmental investigation showed that although M.wolinskyi was not recovered, diverse NTM species were present in water from point-of-use taps and heater-cooler units for extracorporeal circulation. This case and increasing evidence of emerging NTM infections in cardiac surgery led to the implementation of infection control procedures in cardiac surgery wards.

Iatrogenic bile duct injuries – clinical problems

Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures in surgical wards. Iatrogenic bile duct injuries (IBDI) incurred during the procedures are among postoperative complications that are most difficult to treat. The risk of bile duct injury is 0.2-0.4%, and their consequences are unpleasant both for the surgeon and for the patient. The aim of the study was analysis of iatrogenic bile duct injuries and methods of their repair, taking into consideration the circumstances, under which the injuries occur. The study group consisted of 16 patients who had suffered IBDI during surgery. The analysed parameters included sex, age, indications for surgery, the setting of the surgical procedure and the type of bile duct injury. Additionally, the time of injury diagnosis, type of repair and treatment outcome were assessed. The IBDI analysis used the EAES classification of injuries. The time of IBDI repair was defined as immediate, early or late,depending on the time that had passed from the injury. The analysis included complications seen after bile duct repair. The study group consisted of 10 women and 6 men, aged 29-84. Patients underwent 6 classic cholecystectomies, 8 laparoscopic cholecystectomies, one gastrotomy to remove oesophageal prosthesis and one laparotomy due to peptic ulcer. IBDI was diagnosed intraoperatively in 4 patients. In 12 patients IBDI was diagnosed within 1-7 days. The diagnosis was based on endoscopic retrograde cholangiopancreatography and the results of biochemistry tests. According to the EAES classification, the injuries were of type 1 (4 patients), type 2 (8 patients), type 5 (3 patients) and type 6 (1 patients). Reconstruction procedures were performed during the same anaesthesia session in 3 patients, and in the early period in 13 patients. The main procedure was Roux-en-Y anastomosis (12 patients), with the remaining including bile-duct suturing over a T-tube (3 patients) and underpinning of an accessory bile duct in the pocket left after gallbladder removal (1 patient). The most common reconstruction complications included bile leak (3 patients), recurrent cholangitis (3 patients) and bile duct stricture (2 patients). Mortality in the study group was 12.5%. The procedures of laparoscopic and classic cholecystectomy are associated with a risk of IBDI, especially in the presence of inflammatory state of the gall-bladder. IBDI is a complex complication: its treatment poses a challenge for the operating surgeon, and even the most careful treatment adversely affects the patient's lifedue to complications.

Early maternal separation: a rodent model of depression and a prevailing human condition

The early life of most mammals is spent in close contact with the mother, and for the neonate, early maternal separation is a traumatic event that, depending on various conditions, may shape its behavioral and neurochemical phenotype in adulthood. Studies on rodents demonstrated that a very brief separation followed by increased maternal care may positively affect the development of the offspring but that prolonged separation causes significant amounts of stress. The consequences of this stress (particularly the hyperreactivity of the HPA (hypothalamic–pituitary–adrenal) axis are expressed in adulthood and persist for life. Maternal separation in rodents, particularly rats, was used as a model for various psychotic conditions, especially depression. The most popular separation procedure of a 3-h daily separation from the second to the 12th postpartum day yields a depression model of high construct and predictive validity. The results of studies on maternal separation in rats and monkeys prompt a discussion of the consequences of traditional procedures in the maternity wards of developed countries where attention is focused on the hygiene of the neonates and not on their psychological needs. This alternate focus results in a drastic limitation of mother-infant contact and prolonged periods of separation. It is tempting to speculate that differences in the course and severity of various mental disorders, which are usually less prevalent in underdeveloped countries than in developed countries (as noted by Kraepelin), may be related to different modes of infant care. Only recently has so-called kangaroo mother care (establishing mother-infant skin-to-skin contact immediately after birth) become popular in developed countries. In addition to its instant benefits for the neonates, this procedure may also be beneficial for the mental health of the offspring in adulthood.

PM.34 Immune Thrombocytopenia in Pregnancy

Immune thrombocytopenia (ITP) is the most common cause of thrombocytopenia in the first half of pregnancy and occurs in one or two per thousand pregnancies. The management of these pregnancies...

Opportunities for medical students to perform four common ward procedures in a Malaysian teaching hospital

Assoc Prof Dr Lum Siew Kheong, Head of Department of Surgery, International Medical University, Jalan Rasah,70300 Seremban, MALAYSIA Email: siewkheong_lum@imu.edu.my Opportunities for medical students to perform four common ward procedures in a Malaysian teaching hospital Siew Kheong Lum1, Wei Rong Lee2, Syn Dee Ch’ng2, Navin Raj a/l Balachandran2, Chee Kit Tee2 Original Article IeJSME 2013 7(1): 10-14

Oxygen therapy multicentric study—A nationwide audit to oxygen therapy procedures in Internal Medicine wards

Oxygen therapy is a common and important treatment in Internal Medicine wards, however, several studies report that it is not provided accordingly with the best of care. The goal of this work was to evaluate oxygen therapy procedures in Portuguese Internal Medicine wards, comparing them to the standards established by the British Thoracic Society (BTS) in its consensus statement “BTS guideline for emergency oxygen use in adult patients”.Between September 3rd and 23rd 2010, each one of the 24 enrolled hospitals audited the oxygen therapy procedures for one randomly chosen day. All Internal Medicine inpatients under oxygen therapy or with oxygen prescription were included. Data was collected regarding oxygen prescription, administration and monitoring.Of the 1549 inpatients, 773 met inclusion criteria. There was an oxygen prescription in 93.4%. Most prescriptions were by a fixed dose (82.4%), but only 11.6% of those stated all the required parameters. Absence of oxygen therapy duration and monitoring were the most frequent errors.Oxygen was administered to only 77.0% of the patients with fixed dose prescriptions. FiO2 or flow rate and the delivery device were the same as prescribed in 70.9 and 89.2% of the patients, respectively. Out of the 127 patients with oxygen therapy prescriptions by target SatO2 range, 82.7% were on the prescribed SatO2 objective range.Several errors were found in oxygen therapy procedures, particularly regarding fixed dose prescriptions, jeopardizing the patients. Although recommended by BTS, oxygen therapy prescriptions by target SatO2 range are still a minority.