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Efficiency
Published in Lawrence S. Chan, William C. Tang, Engineering-Medicine, 2019
A recent study from pediatric specialty examined whether a reduction of utilizing computed tomography (CT scan, more sensitive and more expensive) in pediatric patients as a result of switching to ultrasonography (US, less sensitive and less expensive) would adversely affect the clinical outcomes (measured for negative appendectomy, appendiceal perforation, and 3-day emergency room revisit (Bachur et al. 2015). Although CT scan is generally recognized as a more sensitive diagnostic methodology, this study showed no difference between patients whom the diagnoses were made by CT scan and US in the measures of appendiceal perforation or 3-day emergency room revisit (Bachur et al. 2015). There is a slight decline in negative appendectomy (defined as appendectomy performed in patients without true appendicitis) in patients diagnosed by US (Bachur et al. 2015). Thus, this kind of evidence-based medicine training would be able help future physicians to achieve identical healthcare outputs with lower cost (less input effort) (Carroll 2015). If this kind of evidence-based information gathering and sharing are assisted by Big Data analytic, one can achieve an even better outcome of efficiency (see Chapter 13). Furthermore, the elimination of potential side effects of ionized radiation with CT scan on children if the diagnoses were made by US would also be considered a cost-reduction to the entire health system, although this aspect of cost saving would be difficult to measure (Carroll 2015).
Biological Properties of Suture Materials
Published in Chih-Chang Chu, J. Anthony von Fraunhofer, Howard P. Greisler, Wound Closure Biomaterials and Devices, 2018
M. K. Hirko, P. H. Lin, H. P. Greisler, C. C. Chu
In addition to the suture form, polydioxanone was also used as a “clip” in performing appendectomy during pelvic reconstructive surgery. Bellina and Lee75 applied polydioxanone clips on 32 patients undergoing surgical management of endometriosis. Twelve patients had surgical reconstructions for pelvic adhesive disease and endometriosis with pelvic adhesive disease. After the procedure, among the 32 patients with endometriosis, 12 appendices were confirmed by histology to contain endometriosis; 1 contained a benign carcinoid tumor. Of the 12 patients with pelvic adhesive disease, 2 had associate endometriosis. Twenty-four appendices were histologically normal.
Operating at the Sharp End: The Complexity of Human Error
Published in Marilyn Sue Bogner, Human Error in Medicine, 2018
Richard I. Cook, David D. Woods
On a weekend in a large tertiary care hospital, the anesthesiology team (consisting of four physicians of whom three are residents in training) was called on to perform anesthetics for an in vitro fertilization, a perforated viscus, reconstruction of an artery of the leg, and an appendectomy, in one building, and one exploratory laparotomy in another building. Each of these cases was an emergency, that is, a case that cannot be delayed for the regular daily operating room schedule. The exact sequence in which the cases were done depended on multiple factors. The situation was complicated by a demanding nurse who insisted that the exploratory laparotomy be done ahead of other cases. The nurse was only responsible for that single case; the operating room nurses and technicians for that case could not leave the hospital until the case had been completed. The surgeons complained that they were being delayed and their cases were increasing in urgency because of the passage of time. There were also some delays in preoperative preparation of some of the patients for surgery. In the primary operating room suites, the staff of nurses and technicians were only able to run two operating rooms simultaneously. The anesthesiologist in charge was under pressure to attempt to overlap portions of procedures by starting one case as another was finishing so as to use the available resources maximally. The hospital also served as a major trauma center, which means that the team needed to be able to start a large emergency case with minimal (less than 10 minutes) notice. In committing all of the residents to doing the waiting cases, the anesthesiologist in charge produced a situation in which there were no anesthetists available to start a major trauma case. There were no trauma cases, and all the surgeries were accomplished. Remarkably, the situation was so common in the institution that it was regarded by many as typical rather than exceptional.
Comparison of surgical gloves: perforation, satisfaction and manual dexterity
Published in International Journal of Occupational Safety and Ergonomics, 2022
Tulay Basak, Gul Sahin, Ayla Demirtas
An observational, prospective study was performed during April–May 2018. Scrub nurses used specified gloves during nine selected surgeries: (a) total hip prosthesis or total knee prosthesis; (b) lumbar laminectomy; (c) vitrectomy; (d) transurethral resection of the prostate or ureterorenoscopy; (e) ileus surgery; (f) caesarean section; (g) graft-flap surgeries; (h) video-assisted thoracoscopic surgery (VATS); (i) appendectomy surgery. We determined the cases by taking the frequencies of procedures into consideration in our hospital. A homogeneous number for the surgeries is aimed at mostly operative clinics in our hospital. scrub nurses wore antiallergenic surgical (powder and latex free). Also use powder and latex free gloves during three operations, double latex and powdered gloves during three operations and single latex and powdered gloves during three operations. Within the scope of the study, each type of glove was used in each of nine operations. All gloves were worn 105 times by 35 nurses. Thus, the effectiveness of all types of gloves was examined 315 times in total (Figure 1). If the gloves were visibly perforated during surgery, they were immediately replaced with new gloves of the same type and size. The number of punctured gloves was recorded. Among the scrub nurses, 60% were women and 40% were men.
Design and fluid flow simulation of modified laparoscopic forceps
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Md. Abdul Raheem Junaidi, Ram Chandra Murthy Kalluri, Y. V. Daseswara Rao, Alla Gopala Krishna Gokhale, Aakrit Patel
Laparoscopy has been widely put to practice from the 1990s and is gaining popularity in the field of surgery. Of late, it is very common to perform laparoscopic surgeries as the patient experiences less postoperative pain, minimum stay duration, and lesser infection complications. Despite having these benefits from laparoscopy, surgeons continue to face other issues like longer surgery time and non-ergonomic laparoscopic instruments (van Veelen and Meijer 1999; Cigaina and Jenkins 2000; Sari et al. 2010; Tung et al. 2015). Other factors that affect surgical procedures are low- or high-surgery table height, poor positioning of the monitor, design of instrument handle, posture of surgeons etc. These factors influence surgeons as they experience physical strain during laparoscopic surgeries. Some inventors came up with an ergonomic handle design of Maryland forceps, which improved the positioning of forceps at an appropriate location and orientation (Moran et al. 2008; Castro and Welt 2011; Jones et al. 2015; Fan et al. 2015). Laparoscopic surgical techniques find applications in laparoscopic cholecystectomy (removal of gall bladder), laparoscopic myomectomy (removal of fibroids from uterus), laparoscopic hysterectomy (removal of the uterus), laparoscopic appendectomy (removal of the appendix), laparoscopic splenectomy (removal of the spleen), diagnostic laparoscopy (viewing internal organs), nephrectomy (removal of kidney), kidney transplantation etc.
Head Transplantation: The Immune System, Phantom Sensations, and the Integrated Mind
Published in The New Bioethics, 2018
Amputees, or those in whom tissue fails to develop, may experience ‘phantom sensations’, feeling sensation in the absent body part (Ramachandran and Hirstein 1998). While this phenomenon is more clearly defined for limb amputees, where it has been reported to occur in upwards of 80% of patients (Russell and Tsao 2018), it should be noted that the ability to sense absent tissue, and even experience pain in it, is by no means confined to limbs. It has, for example, been observed in patients who have experienced spinal injury, appendectomy, mastectomy, hysterectomy, those who have had the globe of an eye removed, and those who have undertaken both male-to-female and female-to-male gender reassignment surgery (Ramachandran and Hirstein 1998; Moore et al. 2000; Ramachandran and McGeoch 2007; Ramesh et al. 2009; Andreotti et al. 2014) As such, the syndrome can be described using the generic term ‘phantom tissue syndrome’ (PTS). Those individuals who have had gender reassignment surgery phantom sensations can experience phantom erections (Namba et al. 2008) and alterations in tissue perception that may contribute to a level of identity confusion (Case et al. 2017). There is evidence to suggest that the underlying reason for this is related to remapping of the brain following interruption or damage to the original nerve connections (Ramachandran and Rogers-Ramachandran 2000; Flor et al. 2013; Russell and Tsao 2018), indicating, once again, a level of integration between body and brain.