scholarly journals 262 Analysis of the Factors Contributing to Unplanned Admissions of Surgical Day Cases

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Al-Zubaidy ◽  
C Greaney ◽  
H Malik ◽  
F Awan

Abstract Introduction Day surgery has many benefits including a reduction in waiting lists, cancellations, hospital acquired infections and need for inpatient beds. It is also highly cost effective. The aim of this study is to identify which factors lead to the unanticipated admission of day cases, in order to adjust future patient selection, and retain efficiency Method A list of day cases that took place in 2017 was obtained from the HIPE department in St. Luke’s General Hospital. Day case patients who required admission were retrospectively analysed with the use of patient charts. Patient factors such as age, gender and co morbidities were recorded. The root cause of admission was identified, and the data collated. Results 457-day cases took place during 2017. 35/457 patients were admitted postoperatively (admission rate of 7.8%). The majority of patients were admitted post cholecystectomy (22) and incisional hernia repair (8). Surgical factors were responsible for almost all admissions. Conclusions Surgical factors/complications are not always predictable, but a thorough review of a patient’s background history and imaging can lead to the identification of patients, who should be directed away from day surgery, minimising the need for unexpected admissions, and maximising the efficiency of the unit.

1995 ◽  
Vol 23 (2) ◽  
pp. 158-161 ◽  
Author(s):  
L. Cade ◽  
P. Kakulas

Laparoscopic sterilization is commonly performed as a day surgery procedure despite difficulties in providing adequate postoperative analgesia for all patients. We have examined the analgesic utility of intramuscular ketorolac in this setting by comparing it with intramuscular pethidine, both given after induction in a randomized, double-blind study in sixty such patients. Although the analgesic effects of the two drugs were comparable in the immediate postoperative period, ketorolac provided significantly better analgesia four hours after surgery (pain score of 2.7 v. 4.2, P=0.006). The recovery times taken to awake, to ambulate and for discharge were all significantly shorter after ketorolac (4.6 v. 8.8 min, P=0.01; 178 v. 260 min, P=0.0005; 242 v. 320 min, P=0.02), and the unplanned admission rate was also significantly less after ketorolac (7% v. 33%, P=0.01). Ketorolac appears to be a useful supplement for analgesia after laparoscopic sterilization, providing improved analgesia as well as decreased recovery time and fewer unplanned admissions.


2002 ◽  
Vol 116 (10) ◽  
pp. 791-793 ◽  
Author(s):  
R. G. Rowlands ◽  
R. Harris ◽  
J. Hern ◽  
J. R. Knight

Abstract Traditionally major ear surgery in children has been regarded as an in-patient procedure. Evidence from the USA for adults, however, concludes that it is both safe and effective to perform many major ear procedures as day cases. We have been carrying out major ear operations on children as day cases routinely for six years in a dedicated children’s day unit and examined our data to find out whether it was both safe and feasible to perform major ear surgery in children on a day-case basis. As our main outcome measure we used the rate of unplanned admissions.We found that the unplanned admission rate for surgery, excluding mastoid surgery, was 6.7 per cent and that procedures such as myringoplasty, ossiculoplasty, bilateral pinnaplasty, meatoplasty and tympanotomy with excision of cholesteatoma, were eminently suitable for day surgery.


2020 ◽  
Vol 6 (3) ◽  
pp. 180-191
Author(s):  
Kavitha Chandrasekaran

Background:: In the long run, synthetic tints were found to be harmful to the chemicals. As a result natural tints have come to be used for their many intrinsic values. The main reason being, then availability of local plants as the main source of natural colorants. Their easy availability in the country being zero cost – effective and planted for other purposes are the main reasons for utilizing them as natural tints. Almost all the parts of the plants, namely stem, leaves, fruits, seeds, barks etc. are used for extracting natural colour. In addition, they are antimicrobial antifungal, insect – repellant deodorant, disinfectant having medicinal values. Methods:: Sweet Indrajao leaves were cleaned by washing with water and dried under direct sunlight and ground as fine powder. A fine strainer was used to remove the wastages. After all these processes, 1-kilogram leaves weighed 318 grams. Then, it is put in 75% ethanol 25% water and heated in a breaker which in kept over a water bath for 2 hours. After this, the contents were filtered and kept in a separate beaker. Bleached fleece draperies stained with stain extract were made to become wet and put into different stain baths which contain the required amount of stain extract and water. Acetic acid was added to it after 20 minutes. The fleece drapery was stained for about one hour at 60oC. The draperies thus stained were removed, squeezed, and put to treatment with metal salts without washing. Different metal salts were used for the treatment using 3% of any one of the chemical mordants like alum, stannous chloride, potassium dichromate, ferrous sulphate, nickel sulphate, copper sulphate and natural mordants such as myrobolan, turmeric, cow dung, Banana sap juice at 60oC for 30 minutes with MLR of 1:30. The stained draperies were washed repeatedly in all the three methods in water and dried in air. At last, the stained draperies were put to soap with soap solution at 60oC for 10 minutes. The draperies were repeatedly washed in water and dried under the sun. Results:: Sweet Indrajao leaves discharged colour easily in alcoholic water. The fleece draperies were stained with chemical and natural mordants. It was observed that the stain uptake was found to be good in post-mordanting method. Ultrasonication has clearly improved the stainability of the draperies at pH 3 and 3.5 values. The pH decreases the stain ability under both Conventional and Ultrasonic conditions. The colour strength increases with an increase in staining temperature in both cases of US and CH methods. Conclusion:: Sweet Indrajao.L has been found to have good ultrasonic potential as a stain plant. The stain uptake as well as the fastness properties of the fleece drapery were found to enhance when metal mordant was used in conjugation with ultra-sonication for the extract of Sweet Indrajao. It was also found that the enhancement of staining ability was better without mordant draperies. The dye extract showed good antibacterial activity against the three bacterial pathogens. Among the three bacterial pathogens, dye extract showed more effective against Escherichia coli pathogens and dye extract showed more effective against Aspergillus pathogens. Hence, the ultrasonic method of drapery staining may be appropriate and beneficial for society at large in future.


2003 ◽  
Vol 16 (2) ◽  
pp. 71-84 ◽  
Author(s):  
B. Croxson ◽  
P. Allen ◽  
J. A. Roberts ◽  
K. Archibald ◽  
S. Crawshaw ◽  
...  

The problems associated with hospital-acquired infection have been causing increasing concern in England in recent years. This paper reports the results of a nationwide survey of hospital infection control professionals' views concerning the organizational structures used to manage and obtain funding for control of infection. A complex picture with significant variation between hospitals emerges. Although government policy dictates that specific funding for hospital infection control is formally made available, it is not always the case that infection control professionals have adequate resources to undertake their roles. In some cases this reflects the failure of hospitals' infection control budgetary mechanisms; in others it reflects the effects of decentralizing budgets to directorate or ward level. Some use was made of informal mechanisms either to supplement or to substitute for the formal ones. But almost all infection control professionals still believed they were constrained in their ability to protect the hospital population from the risk of infectious disease. It is clear that recent government announcements that increased effort will be made to support local structures and thereby improve the control of hospital acquired infection are to be welcomed.


2003 ◽  
Vol 24 (3) ◽  
pp. 214-223 ◽  
Author(s):  
Nicholas Graves ◽  
Tanya M. Nicholls ◽  
Arthur J. Morris

AbstractObjective:To model the economic costs of hospital-acquired infections (HAIs) in New Zealand, by type of HAI.Design:Monte Carlo simulation model.Setting:Auckland District Health Board Hospitals (DHBH), the largest publicly funded hospital group in New Zealand supplying secondary and tertiary services. Costs are also estimated for predicted HAIs in admissions to all hospitals in New Zealand.Patients:All adults admitted to general medical and general surgical services.Method:Data on the number of cases of HAI were combined with data on the estimated prolongation of hospital stay due to HAI to produce an estimate of the number of bed days attributable to HAI. A cost per bed day value was applied to provide an estimate of the economic cost. Costs were estimated for predicted infections of the urinary tract, surgical wounds, the lower and upper respiratory tracts, the bloodstream, and other sites, and for cases of multiple sites of infection. Sensitivity analyses were undertaken for input variables.Results:The estimated costs of predicted HAIs in medical and surgical admissions to Auckland DHBH were $10.12 (US $4.56) million and $8.64 (US $3.90) million, respectively. They were $51.35 (US $23.16) million and $85.26 (US $38.47) million, respectively, for medical and surgical admissions to all hospitals in New Zealand.Conclusions:The method used produces results that are less precise than those of a specifically designed study using primary data collection, but has been applied at a lower cost. The estimated cost of HAIs is substantial, but only a proportion of infections can be avoided. Further work is required to identify the most cost-effective strategies for the prevention of HAI.


2021 ◽  
Author(s):  
Hamed Azarbad ◽  
Julien Tremblay ◽  
Luke D. Bainard ◽  
Etienne Yergeau

AbstractNext-generation sequencing is recognized as one of the most popular and cost-effective way of characterizing microbiome in multiple samples. However, most of the currently available amplicon sequencing approaches are inherently limited, as they are often presented based on the relative abundance of microbial taxa, which may not fully represent actual microbiome profiles. Here, we combined amplicon sequencing (16S rRNA gene for bacteria and ITS region for fungi) with real-time quantitative PCR (qPCR) to characterize the rhizosphere microbiome of wheat. We show that the increase in relative abundance of major microbial phyla does not necessarily result in an increase in abundance. One striking observation when comparing relative and quantitative abundances was a substantial increase in the abundance of almost all phyla associated with the rhizosphere of plants grown in soil with no history of water stress as compared with the rhizosphere of plants growing in soil with a history of water stress, which was in contradiction with the trends observed in the relative abundance data. Our results suggest that the estimated absolute abundance approach gives a different perspective than the relative abundance approach, providing complementary information that helps to better understand the rhizosphere microbiome.


2020 ◽  
Vol 5 (4) ◽  
pp. 1237-1252
Author(s):  
Paul Pirrie ◽  
David Campos-Gaona ◽  
Olimpo Anaya-Lara

Abstract. Multi-rotor wind turbines (MRWTs) have been suggested in the literature as a solution to achieving wind turbine systems with capacities greater than 10 MW. MRWTs utilize a large number of small rotors connected to one support structure instead of one large rotor with the aim of circumventing the square cube law. Potential benefits of MRWTs include cost and material savings, standardization of parts, increased control possibilities, and improved logistics for assembly and maintenance. Almost all previous work has focused on mechanical and aerodynamic feasibility, with almost no attention being paid to the electrical systems. In this research eight different topologies of the electrical collection network for MRWTs are analysed to assess which are the most economically and practically viable options. AC and DC collection networks are presented in radial, star, cluster and DC series topologies. Mass, capital cost and losses are estimated based on scaling relationships from the academic literature and up-to-date commercial data. The focus of this study is the assessment of the type of electrical collector topology, so component type and voltage level are kept consistent between topology designs in order to facilitate a fair comparison. Topologies are compared in terms of four main criteria: capital cost, cost effectiveness, total mass and reliability. A comparison table is presented to summarize the findings of the research in a convenient way. It is found that the most cost-effective solutions are the AC radial and AC star topologies, with the least cost-effective being the DC series–parallel and DC cluster topologies. This is due to the high cost of DC–DC converters and DC switchgear along with the lower efficiency of DC converters. Radial designs perform best in terms of efficiency and annual energy capture. DC systems achieve a slightly lower nacelle mass compared to their equivalent AC systems. DC topologies are generally found to be more expensive when compared to their AC counterparts due to the high cost of DC–DC converters and DC switchgear. Star topologies are considered to have the best reliability due to having no shared equipment. The most suitable collection topology for MRWTs is shown to be of the star type, in which each turbine is connected to the step-up transformer via its own cable.


2017 ◽  
Vol 4 (8) ◽  
pp. 2455
Author(s):  
Shivakumar C. R. ◽  
Mohammad Fazelul Rahman Shoeb ◽  
Anil Reddy Pinate

Background: Surgical site infection is a one of the most common postoperative complication and causes significant postoperative morbidity and mortality. WHO described Hospital acquired infections as one of the major infectious diseases having huge economic impact. Perioperative antibiotics constitute the bulk of antimicrobial consumption in any hospital. We need to adapt the policies that decrease the incidence of postoperative wound infection.Methods: Patients undergoing elective surgeries for clean contaminated cases for various causes from 15th May 2014 to 15th June 2017 under Surgical 1st Unit of District hospital Gulbarga (Affiliated to Gulbarga Institute of Medical Sciences, Gulbarga) are included in our study. During this period, a total of 216 patients participated, of which 145 were males and 71 were females. Patients received two doses of perioperative antibiotics, first dose before surgery and second dose after surgery, 12 hours apart during this period.Results: In this study, surgical site infection rate is 2.3% in clean-contaminated surgeries.Conclusions: The findings indicate that a short course of perioperative antibiotics where in first dose is given 30 minutes to one hour before surgery and second dose is given 12 hours after surgery are sufficient and efficacious as infection rate is acceptable (1%-3%).Infection rate in our study was 2.3%. It is cost-effective as well for prevention of surgical site infections in clean-contaminated surgeries in Indian surgical setup.


Author(s):  
Sergey Nogin ◽  
Jânio Monteiro ◽  
Sergio Gómez Melgar ◽  
José Peyroteo ◽  
António Mortal ◽  
...  

Tourists today are more likely to be concerned with the environment and greener lifestyle choices. In this context, a green flagship of some hotels can be an important selection criteria at the time of selecting one. In the near future, buildings should become nearly zero energy, consuming as low as possible and producing almost all the energy they need, using renewable energy sources. To achieve this goal, hotel buildings need to pass through a transformation process that will make them more efficient. In this process, a decision support platform would be important to help hoteliers monitor their energy consumption, identify which points are consuming more than expected, decide which investments are more cost effective and manage their equipment in an optimum way. This chapter describes the challenges involved in developing such a platform, covering several research and development fields, including Internet of Things networks, ICT, Smart Grids, Renewable Energy, Energy efficiency, as well as algorithms for machine learning and optimization.


Molecules ◽  
2019 ◽  
Vol 24 (18) ◽  
pp. 3267 ◽  
Author(s):  
Sahoo ◽  
Crisponi

Iron(III) is well-known to play a vital role in a variety of metabolic processes in almost all living systems, including the human body. However, the excess or deficiency of Fe3+ from the normal permissible limit can cause serious health problems. Therefore, novel analytical methods are developed for the simple, direct, and cost-effective monitoring of Fe3+ concentration in various environmental and biological samples. Because of the high selectivity and sensitivity, fast response time, and simplicity, the fluorescent-based molecular probes have been developed extensively in the past few decades to detect Fe3+. This review was narrated to summarize the Fe3+-selective fluorescent probes that show fluorescence enhancement (turn-on) and ratiometric response. The Fe3+ sensing ability, mechanisms along with the analytical novelties of recently reported 77 fluorescent probes are discussed.


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