Pub Date : 2024-11-16DOI: 10.1016/j.pcorm.2024.100446
Panop Limratana , Wiriya Maisat , Lee Ferguson , Christopher W. Baird , Koichi Yuki
Early recovery from surgery for congenital heart disease (CHD) is becoming a trend. Tetralogy of Fallot/pulmonary stenosis (TOF/PS) is the most common cyanotic CHD with excellent long-term outcomes. We examined potential factors associated with early extubation in 249 patients who underwent TOF/PS complete repair in a tertiary pediatric medical center from January 2015 to December 2022. Patient demographics, preoperative characteristics, intraoperative variables, postoperative outcomes, surgical type, surgical duration, cardiopulmonary bypass (CPB) time, cross-clamp time, and blood product volumes were acquired from the electronic medical records. Valve sparing repair (VSR) tends to demonstrate earlier recovery profiles than transannular patch repair (TAP) irrelevant of the presence of monocusp valve (P < 0.0001) and the degree of right ventricular outflow pressure drop was significantly correlated with post-operative recovery profile (p = 0.0204). Because of intracardiac shunts and PaO2/FiO2 ratios being poor indicators of lung injury, Brixia scores were also used. Our data suggested that Brixia score could be an excellent alternative to evaluate post-operative lung status.
{"title":"Postoperative mechanical ventilation after corrective Tetralogy of Fallot surgery in infants: Assessment of perioperative factors and radiographic severity scores","authors":"Panop Limratana , Wiriya Maisat , Lee Ferguson , Christopher W. Baird , Koichi Yuki","doi":"10.1016/j.pcorm.2024.100446","DOIUrl":"10.1016/j.pcorm.2024.100446","url":null,"abstract":"<div><div>Early recovery from surgery for congenital heart disease (CHD) is becoming a trend. Tetralogy of Fallot/pulmonary stenosis (TOF/PS) is the most common cyanotic CHD with excellent long-term outcomes. We examined potential factors associated with early extubation in 249 patients who underwent TOF/PS complete repair in a tertiary pediatric medical center from January 2015 to December 2022. Patient demographics, preoperative characteristics, intraoperative variables, postoperative outcomes, surgical type, surgical duration, cardiopulmonary bypass (CPB) time, cross-clamp time, and blood product volumes were acquired from the electronic medical records. Valve sparing repair (VSR) tends to demonstrate earlier recovery profiles than transannular patch repair (TAP) irrelevant of the presence of monocusp valve (<em>P</em> < 0.0001) and the degree of right ventricular outflow pressure drop was significantly correlated with post-operative recovery profile (<em>p</em> = 0.0204). Because of intracardiac shunts and PaO<sub>2</sub>/FiO<sub>2</sub> ratios being poor indicators of lung injury, Brixia scores were also used. Our data suggested that Brixia score could be an excellent alternative to evaluate post-operative lung status.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100446"},"PeriodicalIF":0.0,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The post-anesthesia care unit (PACU) is a critical care unit where postoperative patients are monitored and cared for until full recovery. Evaluating standards in different domains is crucial for providing quality care. This study aims to assess the compliance of design, equipment, drugs, and staff performance standards in PACUs of teaching hospitals of Alborz Province, Iran.
Methods
This cross-sectional study was conducted between January 2023 and September 2023. Data were gathered using a 40-item checklist covering physical structure, equipment/drugs, and staff performance. For the latter, a 360-degree appraisal (self-assessment, internal evaluator, external evaluator) was done.
Results
Among the three standard domains, performance had the highest average compliance at 80.72 %, followed by equipment/drugs at 75.33 %. Design/structure had the lowest compliance at 54 %.
Conclusion
Given the lack of full compliance in PACU design, equipment, and certain aspects of patient care, healthcare managers and policymakers must prioritize improving post-anesthesia care unit infrastructure, equipment provision, and staff training. Implementing continuous education programs with effective teaching methods is crucial for enhancing care quality and preparing future healthcare professionals in these teaching hospitals.
{"title":"Compliance evaluation in post-anesthesia care units at teaching hospitals in Alborz Province, Iran","authors":"Leila Sadati , Mohsen Khalilnejad , Dorrin Nikbakht , Sahar Karami , Fatemeh Tavakoli , Rana Abjar","doi":"10.1016/j.pcorm.2024.100445","DOIUrl":"10.1016/j.pcorm.2024.100445","url":null,"abstract":"<div><h3>Background</h3><div>The post-anesthesia care unit (PACU) is a critical care unit where postoperative patients are monitored and cared for until full recovery. Evaluating standards in different domains is crucial for providing quality care. This study aims to assess the compliance of design, equipment, drugs, and staff performance standards in PACUs of teaching hospitals of Alborz Province, Iran.</div></div><div><h3>Methods</h3><div>This cross-sectional study was conducted between January 2023 and September 2023. Data were gathered using a 40-item checklist covering physical structure, equipment/drugs, and staff performance. For the latter, a 360-degree appraisal (self-assessment, internal evaluator, external evaluator) was done.</div></div><div><h3>Results</h3><div>Among the three standard domains, performance had the highest average compliance at 80.72 %, followed by equipment/drugs at 75.33 %. Design/structure had the lowest compliance at 54 %.</div></div><div><h3>Conclusion</h3><div>Given the lack of full compliance in PACU design, equipment, and certain aspects of patient care, healthcare managers and policymakers must prioritize improving post-anesthesia care unit infrastructure, equipment provision, and staff training. Implementing continuous education programs with effective teaching methods is crucial for enhancing care quality and preparing future healthcare professionals in these teaching hospitals.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100445"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-02DOI: 10.1016/j.pcorm.2024.100443
Shilpa A Naik, Prathvi B, Ranjan R K, Angela Abraham
Pregnancy complicated with preeclampsia, pleural effusion and lung infection presents unique challenges to the anaesthesiologist. An enlarged uterus in pregnant women, particularly in the third trimester restricts diaphragmatic movement, raising pleural fluid pressure and facilitating the development of pleural effusion. We present the safe and successful conduct of an emergency lower segment cesarean section (LSCS) in a severe pre-eclamptic patient, with bilateral pleural effusions and collapse and consolidation of the lungs. This was performed under spinal anaesthesia as a valuable alternative to general anaesthesia in the setting of numerous infrastructure constraints.
{"title":"Anaesthetic management of caesarean section in a primigravida with pre-eclampsia, pleural effusion, consolidation, and lung collapse – a case report","authors":"Shilpa A Naik, Prathvi B, Ranjan R K, Angela Abraham","doi":"10.1016/j.pcorm.2024.100443","DOIUrl":"10.1016/j.pcorm.2024.100443","url":null,"abstract":"<div><div>Pregnancy complicated with preeclampsia, pleural effusion and lung infection presents unique challenges to the anaesthesiologist. An enlarged uterus in pregnant women, particularly in the third trimester restricts diaphragmatic movement, raising pleural fluid pressure and facilitating the development of pleural effusion. We present the safe and successful conduct of an emergency lower segment cesarean section (LSCS) in a severe pre-eclamptic patient, with bilateral pleural effusions and collapse and consolidation of the lungs. This was performed under spinal anaesthesia as a valuable alternative to general anaesthesia in the setting of numerous infrastructure constraints.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100443"},"PeriodicalIF":0.0,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142662594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1016/j.pcorm.2024.100442
Derya Esenkaya , Emine İyigün
Amaç: Bu araştırma, cerrahi dumanın ameliyathane sahipleri üzerinde mevcutlukları, risklere karşı tutumlarını ve para harcamanlarını planlama amacıyla tanımlama olarak yapılmıştır. Gereç ve Yöntem: Kesitsel kalitede bu çalışma, Türkiye'de bir hastanenin ameliyathane ünitesinde Nisan-Mayıs 2022′de kayıtlı süre boyunca devam etmektedir. Araştırmanın boyutları, dahil edilme kriterlerini karşılayan 73 ameliyathane çalışanından oluşuyordu. Araştırmanın verileri Kişisel Bilgi Formu, AORN (Peri-Operatif Kayıtlı Hemşireler Derneği) rehberleri ve ilgili kaynaklarla kırsal Cerrahi Dumanın Ameliyathane Çalışanları Üzerindeki Etkileri, Risklere Yönelik Tutumlar ve Önleyici Tedbirlerin Uygulanması Anketi ile toplanmıştır. Bulgular: Ameliyathane çalışanlarının %91,8′i (n = 67) son beş yıl içerisinde cerrahi dumanla ilgili herhangi bir eğitime katılmadığını belirtti. Bunların %75,3′ü cerrahi dumana maruz kaldıklarını bildirdi. Ameliyathane çalışanlarının yaklaşık %50,7′si (n = 37) lazer dumanı tahliyesi için herhangi bir cihazın kullanılmadığını belirtirken, %39,7′si (n = 29) tahliye dumanı için kullanılan cihazlar hakkında bilgisinin olmadığını belirtti. Ameliyathane çalışanlarının %65,8′inin (n = 48) iş yerlerinde cerrahi dumanla ilgili herhangi bir protokolden haber yoktu. Cerrahi dumana maruz kalmanın sağlık üzerindeki etkilerine, maruziyete dayanıklına süt verdiklerini bildirdiler: sızıntı (%65,8), göz tahrişi (%65,8), gözlerde sulanma (%63,0), göz kuruluğu (%65,8)), uyku bozuklukları (%49,3) %), solunum problemleri (%37,0) ve baş ağrısı (%35,6). Araştırmada ameliyathane çalışanlarının elde edebilecekleri cerrahi dumandan korunmak için kişisel koruyucu önlemlerin alınması. Cerrahi maske (%100), aspirasyon sondası (%60,3), önlük (%41,1) ve gözlük (%35,6) belirlendi. Sağlık çalışanlarının cerrahi dumanın potansiyel tehlikelerine karşı tutumları değerlendirildi. Diğer sağlık çalışanlarının ameliyathane çalışanlarına göre daha fazla kaygı yaşadıkları belirlendi. Sonuç: Araştırmanın düzenine göre ameliyathane çalışanlarının sağlıklı duman tehlikelerine yönelik ilerlemeye yönelik tutumlarını geliştirecek yöntemlerin benimsenmesinin esasları. Ayrıca vakum dumanıyla ilgili tamamlayıcıları önlemek için politikalar ve kılavuzlar iletilmeli ve yöneticilerden uygun ekipman ve destek eğitimi.
{"title":"The effect of surgical smoke on operating room workers, attitudes towards risks, and the implementation of preventive measures","authors":"Derya Esenkaya , Emine İyigün","doi":"10.1016/j.pcorm.2024.100442","DOIUrl":"10.1016/j.pcorm.2024.100442","url":null,"abstract":"<div><div>Amaç: Bu araştırma, cerrahi dumanın ameliyathane sahipleri üzerinde mevcutlukları, risklere karşı tutumlarını ve para harcamanlarını planlama amacıyla tanımlama olarak yapılmıştır. Gereç ve Yöntem: Kesitsel kalitede bu çalışma, Türkiye'de bir hastanenin ameliyathane ünitesinde Nisan-Mayıs 2022′de kayıtlı süre boyunca devam etmektedir. Araştırmanın boyutları, dahil edilme kriterlerini karşılayan 73 ameliyathane çalışanından oluşuyordu. Araştırmanın verileri Kişisel Bilgi Formu, AORN (Peri-Operatif Kayıtlı Hemşireler Derneği) rehberleri ve ilgili kaynaklarla kırsal Cerrahi Dumanın Ameliyathane Çalışanları Üzerindeki Etkileri, Risklere Yönelik Tutumlar ve Önleyici Tedbirlerin Uygulanması Anketi ile toplanmıştır. Bulgular: Ameliyathane çalışanlarının %91,8′i (<em>n</em> = 67) son beş yıl içerisinde cerrahi dumanla ilgili herhangi bir eğitime katılmadığını belirtti. Bunların %75,3′ü cerrahi dumana maruz kaldıklarını bildirdi. Ameliyathane çalışanlarının yaklaşık %50,7′si (<em>n</em> = 37) lazer dumanı tahliyesi için herhangi bir cihazın kullanılmadığını belirtirken, %39,7′si (<em>n</em> = 29) tahliye dumanı için kullanılan cihazlar hakkında bilgisinin olmadığını belirtti. Ameliyathane çalışanlarının %65,8′inin (<em>n</em> = 48) iş yerlerinde cerrahi dumanla ilgili herhangi bir protokolden haber yoktu. Cerrahi dumana maruz kalmanın sağlık üzerindeki etkilerine, maruziyete dayanıklına süt verdiklerini bildirdiler: sızıntı (%65,8), göz tahrişi (%65,8), gözlerde sulanma (%63,0), göz kuruluğu (%65,8)), uyku bozuklukları (%49,3) %), solunum problemleri (%37,0) ve baş ağrısı (%35,6). Araştırmada ameliyathane çalışanlarının elde edebilecekleri cerrahi dumandan korunmak için kişisel koruyucu önlemlerin alınması. Cerrahi maske (%100), aspirasyon sondası (%60,3), önlük (%41,1) ve gözlük (%35,6) belirlendi. Sağlık çalışanlarının cerrahi dumanın potansiyel tehlikelerine karşı tutumları değerlendirildi. Diğer sağlık çalışanlarının ameliyathane çalışanlarına göre daha fazla kaygı yaşadıkları belirlendi. Sonuç: Araştırmanın düzenine göre ameliyathane çalışanlarının sağlıklı duman tehlikelerine yönelik ilerlemeye yönelik tutumlarını geliştirecek yöntemlerin benimsenmesinin esasları. Ayrıca vakum dumanıyla ilgili tamamlayıcıları önlemek için politikalar ve kılavuzlar iletilmeli ve yöneticilerden uygun ekipman ve destek eğitimi.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100442"},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142662593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-24DOI: 10.1016/j.pcorm.2024.100441
Franklin Dexter , Bradley J. Hindman , Richard H. Epstein , Andrea Vannucci , Rashmi N. Mueller
Background
Anesthesia departments may benefit from automated computerized methods to monitor the clinical performance of individual anesthesia practitioners. Hospital admission (>1 night stay) after ambulatory surgery may be a suitable metric, with higher incidences potentially being associated with poor clinical performance. If valid, there should be a small but statistically significant association of postoperative admission with previously validated measures of quality of intraoperative anesthesia care.
Methods
This retrospective cohort study used eight fiscal years of data from one hospital with daily assessments of two different measures of quality of anesthesia clinical care. One variable was anesthesiologists’ clinical supervision evaluated by trainees, principally residents. The second independent variable was nurse anesthetists’ work habits, evaluated by anesthesiologists. These independent variables were binary, the proportions of rater-leniency-adjusted evaluations with maximum performance for all items, calculated annually. The dependent variable was the proportion of ratees’ cases (anesthesiologist or nurse anesthetist) with postoperative length of stay ≤ 1 day, adjusted for surgical suite and procedure category. Thus, for both independent and dependent variables, larger (positive logits) were “good” and smaller (negative logits) were “bad.”
Results
There were no significant associations for either supervision (P =0.14, N=561 anesthesiologist-years) or work habits (P =0.74, N=598 nurse anesthetist-years). Estimated signs of the slopes were for increases in the logits of the quality of clinical supervision to be associated with non-significant decreases in the logits of the probabilities of the patients having lengths of stay ≤1 day. Similarly, increases in the logits of nurse anesthetists’ work habits had negative-signed non-significant associations with the logits of the probabilities of the patients having lengths of stay ≤1 day.
Conclusions
The results show with substantial certainty that higher-performing anesthesia practitioners do not have briefer lengths of stay. Anesthesiologists and nurse anesthetists should not be compared among one another based on whether their patients have a greater than predicted risk of procedure-adjusted hospital admission after ambulatory surgery.
{"title":"Procedure-adjusted incidences of postoperative hospital admissions are not associated with differences in the quality of anesthesiologists’ clinical supervision or nurse anesthetists’ work habits","authors":"Franklin Dexter , Bradley J. Hindman , Richard H. Epstein , Andrea Vannucci , Rashmi N. Mueller","doi":"10.1016/j.pcorm.2024.100441","DOIUrl":"10.1016/j.pcorm.2024.100441","url":null,"abstract":"<div><h3>Background</h3><div>Anesthesia departments may benefit from automated computerized methods to monitor the clinical performance of individual anesthesia practitioners. Hospital admission (>1 night stay) after ambulatory surgery may be a suitable metric, with higher incidences potentially being associated with poor clinical performance. If valid, there should be a small but statistically significant association of postoperative admission with previously validated measures of quality of intraoperative anesthesia care.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used eight fiscal years of data from one hospital with daily assessments of two different measures of quality of anesthesia clinical care. One variable was anesthesiologists’ clinical supervision evaluated by trainees, principally residents. The second independent variable was nurse anesthetists’ work habits, evaluated by anesthesiologists. These independent variables were binary, the proportions of rater-leniency-adjusted evaluations with maximum performance for all items, calculated annually. The dependent variable was the proportion of ratees’ cases (anesthesiologist or nurse anesthetist) with postoperative length of stay ≤ 1 day, adjusted for surgical suite and procedure category. Thus, for both independent and dependent variables, larger (positive logits) were “good” and smaller (negative logits) were “bad.”</div></div><div><h3>Results</h3><div>There were no significant associations for either supervision (P =0.14, N=561 anesthesiologist-years) or work habits (P =0.74, N=598 nurse anesthetist-years). Estimated signs of the slopes were for increases in the logits of the quality of clinical supervision to be associated with non-significant <u>decreases</u> in the logits of the probabilities of the patients having lengths of stay ≤1 day. Similarly, increases in the logits of nurse anesthetists’ work habits had negative-signed non-significant associations with the logits of the probabilities of the patients having lengths of stay ≤1 day.</div></div><div><h3>Conclusions</h3><div>The results show with substantial certainty that higher-performing anesthesia practitioners do not have briefer lengths of stay. Anesthesiologists and nurse anesthetists should not be compared among one another based on whether their patients have a greater than predicted risk of procedure-adjusted hospital admission after ambulatory surgery.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100441"},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1016/j.pcorm.2024.100439
Marwa Mahmoud AbdelRady , Ghada Mohammad AboElfadl , Mohamed Nassar Ibrahim , Hany Ahmed Ibraheem El-Morabaa , Ahmad Mohamed Aboelfadl , Ahmed Aboulfotouh
Background
Heart disease, which carries a high risk, is the main factor contributing to maternal death and morbidity during pregnancy. In this trial, we examined how well intravenous (IV) granisetron prevented bradycardia and hypotension in rheumatic patients undergoing elective cesarean delivery.
Patients and methods
There were 102 patients total in the study, 51 in each of the two groups. Patients in Group G received 1 mg of IV granisetron diluted to 5 ml before the start of spinal anaesthesia, while those in Group S received 5 ml of 0.9 % normal saline. It has been recorded how much atropine and vasopressor were used overall. The Apgar scores at one and five minutes were also examined.
Results
In Group S, the prevalence of hypotension was 60.7 %, compared to 33.3 % in Group G (p < 0.05). As a result, patients in Group S needed considerably more ephedrine (p < 0.05). Patients in Group G had their hemodynamic parameters well maintained for the duration of the research. The Apgar score measured the neonatal outcome at 0-, 1-, and 5 min following birth, and it was equivalent between the two study groups.
Conclusion
Before spinal anaesthesia, intravenous granisetron 1 mg can lower hypotension in cardiac parturients without negatively affecting the mother or the baby.
背景心脏病具有高风险,是导致妊娠期产妇死亡和发病的主要因素。在这项试验中,我们研究了静脉注射(IV)格拉司琼对接受择期剖宫产的风湿病患者心动过缓和低血压的预防效果。G 组患者在脊髓麻醉开始前静脉注射 1 毫克稀释至 5 毫升的格拉司琼,而 S 组患者则注射 5 毫升 0.9 % 的生理盐水。阿托品和血管加压剂的总体使用量已记录在案。结果 S 组的低血压发生率为 60.7%,而 G 组为 33.3%(p < 0.05)。因此,S 组患者需要更多的麻黄碱(p < 0.05)。在研究期间,G 组患者的血液动力学参数保持良好。Apgar评分衡量了新生儿在出生后0分钟、1分钟和5分钟的预后,两个研究组的评分相当。结论在脊髓麻醉前,静脉注射格拉司琼1毫克可降低心脏病产妇的低血压,而不会对母亲或婴儿产生负面影响。
{"title":"Role of Granisetron in preventing hypotension after spinal anaesthesia with Levobupivacaine in rheumatic patients undergoing elective cesarean section: A randomized controlled trial","authors":"Marwa Mahmoud AbdelRady , Ghada Mohammad AboElfadl , Mohamed Nassar Ibrahim , Hany Ahmed Ibraheem El-Morabaa , Ahmad Mohamed Aboelfadl , Ahmed Aboulfotouh","doi":"10.1016/j.pcorm.2024.100439","DOIUrl":"10.1016/j.pcorm.2024.100439","url":null,"abstract":"<div><h3>Background</h3><div>Heart disease, which carries a high risk, is the main factor contributing to maternal death and morbidity during pregnancy. In this trial, we examined how well intravenous (IV) granisetron prevented bradycardia and hypotension in rheumatic patients undergoing elective cesarean delivery.</div></div><div><h3>Patients and methods</h3><div>There were 102 patients total in the study, 51 in each of the two groups. Patients in Group G received 1 mg of IV granisetron diluted to 5 ml before the start of spinal anaesthesia, while those in Group S received 5 ml of 0.9 % normal saline. It has been recorded how much atropine and vasopressor were used overall. The Apgar scores at one and five minutes were also examined.</div></div><div><h3>Results</h3><div>In Group S, the prevalence of hypotension was 60.7 %, compared to 33.3 % in Group G (<em>p</em> < 0.05). As a result, patients in Group S needed considerably more ephedrine (<em>p</em> < 0.05). Patients in Group G had their hemodynamic parameters well maintained for the duration of the research. The Apgar score measured the neonatal outcome at 0-, 1-, and 5 min following birth, and it was equivalent between the two study groups.</div></div><div><h3>Conclusion</h3><div>Before spinal anaesthesia, intravenous granisetron 1 mg can lower hypotension in cardiac parturients without negatively affecting the mother or the baby.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100439"},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142662554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-17DOI: 10.1016/j.pcorm.2024.100440
Weiwei Zhou , Fangfang Liang , Jiajia Qin , Hui Wei , Arshad Mehmood , Yourong Cao , Qijia Huang , Zhong Lin , Yi Mo
Background
This paper analyzes the urgency, importance, and current situation of continuing medical education in hospitals.
Methods
To solve the existing problems in continuing medical education, a series of countermeasures and management schemes to improve the quality of continuing medical education were put forward.
Results
These solutions include setting up specialized agencies in the field of continuing medical education, strengthening the construction of teaching staff, perfecting the teaching contents and methods, normative training management measures, and improving the participation willingness of the medical staff.
Conclusion
These countermeasures and management schemes will help the hospital improve the quality of continuing medical education, promote academic exchanges and cooperation with medical staff, improve the quality of medical services, and promote the healthy development of the medical industry.
{"title":"Countermeasures and management schemes for improving the quality of continuing medical education in hospitals","authors":"Weiwei Zhou , Fangfang Liang , Jiajia Qin , Hui Wei , Arshad Mehmood , Yourong Cao , Qijia Huang , Zhong Lin , Yi Mo","doi":"10.1016/j.pcorm.2024.100440","DOIUrl":"10.1016/j.pcorm.2024.100440","url":null,"abstract":"<div><h3>Background</h3><div>This paper analyzes the urgency, importance, and current situation of continuing medical education in hospitals.</div></div><div><h3>Methods</h3><div>To solve the existing problems in continuing medical education, a series of countermeasures and management schemes to improve the quality of continuing medical education were put forward.</div></div><div><h3>Results</h3><div>These solutions include setting up specialized agencies in the field of continuing medical education, strengthening the construction of teaching staff, perfecting the teaching contents and methods, normative training management measures, and improving the participation willingness of the medical staff.</div></div><div><h3>Conclusion</h3><div>These countermeasures and management schemes will help the hospital improve the quality of continuing medical education, promote academic exchanges and cooperation with medical staff, improve the quality of medical services, and promote the healthy development of the medical industry.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100440"},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-15DOI: 10.1016/j.pcorm.2024.100436
Lilibeth Acero , Mandy Spitzer
Over 40 million major surgeries are performed each year in the US, and perioperative care areas are a high-risk environment for the development of pressure injuries (PI). A unique set of challenges for the prevention of PI is faced during the perioperative period due to prolonged immobility and positioning on a relatively hard surface. The Acero Perioperative Skin Bundle (APSB) was developed to facilitate risk assessment and application of appropriate interventions at a 500+ bed safety-net, teaching hospital. Prior to the implementation of the bundle, there was a perioperative-acquired incidence of 1.9 %, accounting for 38 % of all hospital-acquired PI. In the 24-months following implementation of the bundle the hospital has maintained a perioperative-acquired PI incidence of 0 % (p = .0001). This quality improvement report demonstrates how the implementation of standardized risk assessment and application of evidence-based interventions was cost effective and significantly reduced PI acquired in perioperative care.
{"title":"The Acero perioperative skin bundle: An intuitive perioperative pressure injury prevention bundle","authors":"Lilibeth Acero , Mandy Spitzer","doi":"10.1016/j.pcorm.2024.100436","DOIUrl":"10.1016/j.pcorm.2024.100436","url":null,"abstract":"<div><div>Over 40 million major surgeries are performed each year in the US, and perioperative care areas are a high-risk environment for the development of pressure injuries (PI). A unique set of challenges for the prevention of PI is faced during the perioperative period due to prolonged immobility and positioning on a relatively hard surface. The Acero Perioperative Skin Bundle (APSB) was developed to facilitate risk assessment and application of appropriate interventions at a 500+ bed safety-net, teaching hospital. Prior to the implementation of the bundle, there was a perioperative-acquired incidence of 1.9 %, accounting for 38 % of all hospital-acquired PI. In the 24-months following implementation of the bundle the hospital has maintained a perioperative-acquired PI incidence of 0 % (p = .0001). This quality improvement report demonstrates how the implementation of standardized risk assessment and application of evidence-based interventions was cost effective and significantly reduced PI acquired in perioperative care.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100436"},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.pcorm.2024.100437
Marco Sguanci , Stefano Mancin , Sara Morales Palomares , Giovanni Cangelosi , Mauro Parozzi , Michela Piredda , Maria Grazia De Marinis
Background
The global health crisis caused by the COVID-19 pandemic has prompted discussions regarding the best approach to safely manage COVID-19 positive patients in the operating room.
Objective
This study aimed to highlight the importance of "standardised clinical practice" and the role of the "Clinical Nurse Specialist" in treating COVID-19 positive patients in the operating room. Methods: A scoping review based on Arksey and O'Malley's methodology was conducted. Searches were conducted in Cochrane Library, PubMed, Embase, CINAHL, Scopus, and Web of Science for studies on perioperative management and the Clinical Nurse Specialist's role in COVID-19 surgeries. Manual searches included reference lists and Google Scholar. Two reviewers independently screened, selected, and included articles, assessing the risk of bias and methodological quality.
Results
From 278 identified records, 24 studies were included. Two key aspects emerged: clinical safety procedures and the Clinical Nurse Specialist's role in the perioperative setting. Standardised practice in the operating room is crucial, and the Clinical Nurse Specialist has significant potential in managing COVID-19 patients.
Conclusions
Healthcare organizations should prioritize standardized practices for surgical assistance of COVID-19 patients. While global implementation of the Clinical Nurse Specialist is limited, their inclusion in perioperative settings could enhance care efficiency.
背景 COVID-19 大流行引发的全球健康危机促使人们讨论在手术室安全管理 COVID-19 阳性患者的最佳方法。研究方法根据Arksey和O'Malley的方法进行了范围界定综述。在 Cochrane Library、PubMed、Embase、CINAHL、Scopus 和 Web of Science 中检索有关围手术期管理和临床专科护士在 COVID-19 手术中的作用的研究。人工检索包括参考文献列表和谷歌学术。两名审稿人对文章进行了独立筛选、甄别和收录,并对偏倚风险和方法学质量进行了评估。出现了两个关键方面:临床安全程序和临床专科护士在围手术期环境中的作用。结论医疗机构应优先考虑 COVID-19 患者手术援助的标准化实践。虽然临床专科护士在全球范围内的应用有限,但将其纳入围手术期环境可提高护理效率。
{"title":"The role of Clinical Nurse Specialist and the safety management in operating theatre during the COVID-19 pandemic: An integrative scoping review","authors":"Marco Sguanci , Stefano Mancin , Sara Morales Palomares , Giovanni Cangelosi , Mauro Parozzi , Michela Piredda , Maria Grazia De Marinis","doi":"10.1016/j.pcorm.2024.100437","DOIUrl":"10.1016/j.pcorm.2024.100437","url":null,"abstract":"<div><h3>Background</h3><div>The global health crisis caused by the COVID-19 pandemic has prompted discussions regarding the best approach to safely manage COVID-19 positive patients in the operating room.</div></div><div><h3>Objective</h3><div>This study aimed to highlight the importance of \"standardised clinical practice\" and the role of the \"Clinical Nurse Specialist\" in treating COVID-19 positive patients in the operating room. Methods: A scoping review based on Arksey and O'Malley's methodology was conducted. Searches were conducted in Cochrane Library, PubMed, Embase, CINAHL, Scopus, and Web of Science for studies on perioperative management and the Clinical Nurse Specialist's role in COVID-19 surgeries. Manual searches included reference lists and Google Scholar. Two reviewers independently screened, selected, and included articles, assessing the risk of bias and methodological quality.</div></div><div><h3>Results</h3><div>From 278 identified records, 24 studies were included. Two key aspects emerged: clinical safety procedures and the Clinical Nurse Specialist's role in the perioperative setting. Standardised practice in the operating room is crucial, and the Clinical Nurse Specialist has significant potential in managing COVID-19 patients.</div></div><div><h3>Conclusions</h3><div>Healthcare organizations should prioritize standardized practices for surgical assistance of COVID-19 patients. While global implementation of the Clinical Nurse Specialist is limited, their inclusion in perioperative settings could enhance care efficiency.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100437"},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142416044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-02DOI: 10.1016/j.pcorm.2024.100438
Abner M.P. Barbosa , Mark J. Saari , Peter F. Nichol
Background
Errors in sterile processing of surgical instruments result in wasted chargeable operating room minutes. Data delineating this problem have been generated primarily through human observation and reporting. Given the inherent error rate in human tasks, we hypothesized that the observed rate of surgical instrument errors per case per day would increase over a six-week longitudinal study as observers became more familiar with their environment and more comfortable identifying errors.
Methods
A previously published dataset on surgical instrument errors was analyzed for the average errors per case per day over six weeks. Errors per case per day were compared to the percentage of inpatient cases for each respective date since the error rate in inpatient cases is twice that of outpatient cases.
Results
While the average errors per case per day increases from 0.28 to 0.62, indicating a potential increase over time, no statistically significant trend was found (p = 0.157). A positive but modest correlation was observed between inpatient percentage and error rates (Pearson correlation = 0.344), nearing statistical significance (p = 0.068). The inpatient case percentage remained stable over time, with no significant trend detected (p = 0.284).
Conclusions
Human observation is a critical tool for defining waste arising from sterile processing errors. While the gradual increase in errors per case per day increases, the variability cannot be attributed to the initial adaptation the observer's environment. Future studies should assess inter-rated reliability and explore alternative automated observation methods to have a more accurate measurement of the number of errors observed.
{"title":"The fault in our nature: Error rates in a human observation study on surgical instrument errors in the OR","authors":"Abner M.P. Barbosa , Mark J. Saari , Peter F. Nichol","doi":"10.1016/j.pcorm.2024.100438","DOIUrl":"10.1016/j.pcorm.2024.100438","url":null,"abstract":"<div><h3>Background</h3><div>Errors in sterile processing of surgical instruments result in wasted chargeable operating room minutes. Data delineating this problem have been generated primarily through human observation and reporting. Given the inherent error rate in human tasks, we hypothesized that the observed rate of surgical instrument errors per case per day would increase over a six-week longitudinal study as observers became more familiar with their environment and more comfortable identifying errors.</div></div><div><h3>Methods</h3><div>A previously published dataset on surgical instrument errors was analyzed for the average errors per case per day over six weeks. Errors per case per day were compared to the percentage of inpatient cases for each respective date since the error rate in inpatient cases is twice that of outpatient cases.</div></div><div><h3>Results</h3><div>While the average errors per case per day increases from 0.28 to 0.62, indicating a potential increase over time, no statistically significant trend was found (<em>p</em> = 0.157). A positive but modest correlation was observed between inpatient percentage and error rates (Pearson correlation = 0.344), nearing statistical significance (<em>p</em> = 0.068). The inpatient case percentage remained stable over time, with no significant trend detected (<em>p</em> = 0.284).</div></div><div><h3>Conclusions</h3><div>Human observation is a critical tool for defining waste arising from sterile processing errors. While the gradual increase in errors per case per day increases, the variability cannot be attributed to the initial adaptation the observer's environment. Future studies should assess inter-rated reliability and explore alternative automated observation methods to have a more accurate measurement of the number of errors observed.</div></div>","PeriodicalId":53468,"journal":{"name":"Perioperative Care and Operating Room Management","volume":"37 ","pages":"Article 100438"},"PeriodicalIF":0.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142416043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}