scholarly journals EP.FRI.792 Laparoscopic port positioning in paediatric appendicectomy - a closed loop audit

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Irena Stefanova ◽  
James O'Brien ◽  
Timothy Pencavel
Keyword(s):  
Iliac Fossa ◽  
Education Programme ◽  
Laparoscopic Appendicectomy ◽  
Bladder Injury ◽  
Local Policy ◽  
Port Placement ◽  
Left Iliac Fossa ◽  
Left Hand ◽  
Before And After ◽  
Who Checklist

Abstract Aims Laparoscopic appendicectomy is the most common laparoscopic procedure performed in children, typically with a suprapubic (SP) left-hand port position. This has been associated with bladder injury. Pre-operative bladder emptying can reduce the risk of this complication. The aim of this study was to evaluate compliance with local policy mandating left iliac fossa port placement (LIFPP) rather than SP. We assessed the rate of LIFPP before and after an educational intervention, and also audited if voiding status was included as part of the paediatric WHO checklist.  Methods Retrospective data was collected before and after implementation of education, for 50 consecutive patients aged <16 years undergoing laparoscopic appendicectomy. The education programme targeted operating department practitioners, paediatric nurses and surgeons, and included seminars and regular dissemination of the local protocol. Data analysis was performed using GraphPad Prism.  Results Patients were evenly distributed by gender with 94% above the age of 10. Mean age was 13.8 years. There was a statistically significant improvement in compliance with LIFPP, from 72% to 100% (p < 0.0001) after introduction of improved education, as well as significantly improved documentation of pre-operative voiding status from 12% to 40% (p = 0.0026). The rate of catheterisation intra-operatively was reduced from 20% to 8% (p = 0.1478). Conclusions Improved education has led to a significantly increased compliance with local port placement policy. Documentation of pre-operative voiding status has been included in the paediatric WHO checklist ‘SIGN IN’ section locally.

IMPROVEMENT LAYOUT AND ELEMENTS WORK IN ERGONOMIC ASPECTS

2012 ◽  
Vol 2 (2) ◽  
pp. 84-99
Author(s):  
Beci Sariani ◽  
Meizul Zuki ◽  
Yusril Dany
Keyword(s):  
Working Conditions ◽  
Cycle Time ◽  
Completion Time ◽  
Content Creation ◽  
Left Hand ◽  
Total Distance ◽  
Standard Time ◽  
Before And After ◽  
Right And Left Hand

The purpose of this study is to describe layout and elements of the movement labor, determine cake making job completion time before and after repair, complaints of pain workers and recomendation improved layout and elements work in ergonomic aspects. Layout and elements of the cake making job is less visible than ergonomic working conditions with temperatures as high as 290C and 300C, total distance moving much material for the production namely 2407 cm, manufacture molen 180 cm, 2926 cm baking and packaging 626 cm. Percentage of use right and left hand at creation pia cake is 50.11% and 54.4%. Making molen is 100% and 76.69%. Pia cake making is 12.76% and 12.21%. Packaging is 100% and 84.8%. Cycle time, normal time and standard time of content creation, namely 17004.15, 18.534.52 and 25.577.64 seconds (2 basins). Making molen is 560.23, 616.25 and 751.82 seconds (1 basin). Pia cake making is 1.165,45, 1314.63 and 1.603,85 seconds (2 trays), and packaging is 15,40, 16,79 and 23.17 seconds (2 pack). The application of ergonomics : 8 types of grievances felt a bit sick and 1 type of grievances felt sick. Station molen manufacture, workers felt no pain. Baking station pia (sub-stations) only complaint molen rolling on his back felt a little sore. Sub-station charging only 3 workers who feel a little pain complaints and pain. In the sub-station : 6 types pengovenan grievances felt a little sick. The packing station after repairs only felt a little pain in the waist

Abdominal apoplexy during pregnancy

2020 ◽  
Vol 13 (10) ◽  
pp. e235946
Author(s):  
Jasmeet Kumari ◽  
Rosemary Harkin
Keyword(s):  
Iliac Fossa ◽  
Unknown Origin ◽  
Breech Presentation ◽  
Sudden Onset ◽  
Left Iliac Fossa ◽  
Safe Delivery ◽  
Uterine Contractions ◽  
Early Labour ◽  
Increased Risk ◽  
High Index Of Suspicion

We report a case of idiopathic spontaneous intraperitoneal haemorrhage (ISIH) in a 31-year-old patient at 37 weeks gestation in her second pregnancy. The patient presented to the labour ward with abdominal pain and uterine contractions. The initial complain was of sudden onset, severe sharp pain in left iliac fossa. She started having uterine contractions within 30 min of her presentation. Examination confirmed early labour with a footling breech presentation. Urgent caesarean section was performed that confirmed peritoneal bleeding of unknown origin with safe delivery of the baby. Mother and baby were safely discharged on day 5. ‘Abdominal apoplexy’ (ISIH), is a rare obstetric emergency with increased risk of fetal and maternal morbidity and mortality. With various clinical presentations as a possibility, diagnosis is challenging. High index of suspicion with prompt management of suspected cases can be pivotal life saving measure for the fetus and mother.

Imperforate hymen mimicking acute appendicitis in an adolescent woman: a rare presentation

2021 ◽  
Vol 14 (3) ◽  
pp. e238547
Author(s):  
Victoria Rose Russell ◽  
Mohamed Ibrahim ◽  
Georgina Phillips ◽  
Tom Setchell ◽  
Sanjay Purkayastha
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Iliac Fossa ◽  
Female Genital Tract ◽  
Delayed Diagnosis ◽  
Rare Presentation ◽  
Left Iliac Fossa ◽  
Imperforate Hymen ◽  
Retrograde Menstruation ◽  
Low Incidence

Imperforate hymen is a rare congenital malformation of the female genital tract. The condition poses several diagnostic challenges owing to its low incidence and often atypical presentation. Classical symptoms include amenorrhoea and cyclical abdominal pain. Delayed diagnosis leads to potentially irreversible and lifechanging sequelae including infertility, endometriosis and renal failure. A premenarchal 13-year-old girl with a background of chronic constipation presented with symptoms mimicking acute appendicitis. The underlying cause was imperforate hymen and retrograde menstruation. The diagnosis was made during diagnostic laparoscopy. As with this patient, pre-existing symptoms are often troublesome long before the true diagnosis is made. This case report highlights the importance of recognising imperforate hymen as a potential cause of acute abdominal pain in premenarchal adolescent girls. The clinical picture may present as right or left iliac fossa pain. Early identification reduces the risk of adverse complications and avoids unnecessary and potentially harmful interventions.

scholarly journals The Effects of Unit Exercises on the Hand Grip Strength of Arm Wrestlers

2017 ◽  
Vol 5 (6) ◽  
pp. 196
Author(s):  
Sezer S Yonca ◽  
Çelikel B Engin ◽  
Yücel A Serdar ◽  
Karadağ Mustafa ◽  
Savucu Yüksel
Keyword(s):  
Grip Strength ◽  
Exercise Program ◽  
Hand Grip Strength ◽  
Weight Lifting ◽  
Test Analysis ◽  
Significance Level ◽  
Left Hand ◽  
Hand Grip ◽  
Before And After ◽  
The Right

The aim of this research is to evaluate the change in the hand grip strength of the male arm wrestlers before and after a unit of exercise. The participants of the research consist of sportsmen (n=16) of Fırat University arm wrestling team in 18-25 age group.Within the scope of the research, all of the tests and measurements (age, length, body weight, sports age, hand grip strength) were carried out on the experimental group before they started training and the same tests were repeated just after the exercises. A unit of exercise program consisted of warm up, cool down, and 5 sets of weight lifting with 12 repetitions and intensity of 70% that were in that day’s plan and program applied by the trainer.While descriptive statistics were adopted in the statistical analysis, to identify the significance level between the hand grip strength before and after the exercise paired sample t-test analysis was used. The significance level was shown as α = 0.05 in the analyses. While the right hand grip strength of the sportsmen (n=16) was statistically significant at 51.1062 ± 1.69709 before and 49.0437 ± 1.71770 (p=0.000) after the exercise, the left hand grip strength was statistically significant at 46.9000 ± 1.16179 before and 45.8063 ± 1.30078 (p=0.000) after the exercise.In conclusion, it was observed that there is a statistically significant negative decline in the hand grip strength of the arm wrestling sportsmen after a unit of exercise and it can be said that it is because of the exhaustion expected after the exercise.

Iatrogenic bladder injury from port insertion during laparoscopic appendicectomy

2021 ◽  
Vol 14 (1) ◽  
pp. e239361
Author(s):  
Chloe Liwen Lim ◽  
Shu Hui Neo ◽  
Lui Shiong Lee ◽  
Palaniappan Sundaram
Keyword(s):  
Diagnostic Laparoscopy ◽  
Laparoscopic Appendicectomy ◽  
Bladder Injury ◽  
Urethral Catheterisation ◽  
Contrast Enhanced ◽  
Computed Tomography Urography ◽  
Drain Fluid ◽  
High Index Of Suspicion ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

A 26-year-old man underwent laparoscopic appendicectomy for acute appendicitis that was carried out uneventfully after initial urethral catheterisation to empty the bladder. Postoperatively, he developed oliguria associated with high drain output and elevated drain fluid creatinine. A contrast-enhanced computed tomography urography scan showed a small amount of contrast in the intraperitoneal space. A diagnostic laparoscopy performed for a suspected bladder injury revealed that the drain (inserted via the suprapubic port) had traversed the bladder. The drain was removed, and the bladder defects were repaired. The catheter was removed 2 weeks later uneventfully. It is important to recognise and avoid the urinary bladder during suprapubic port insertion during laparoscopic appendicectomy. This complication can be minimised via initial bladder decompression and introduction of the suprapubic port lateral to the umbilical ligaments. A high index of suspicion is required to diagnose a small bladder injury.

Common Organisms Responsible for Healthcare-associated Infection (HCAI)

2019 ◽  
Author(s):  
George Jacob ◽  
Martina N. Cummins
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Local Policy ◽  
Healthcare Associated Infection ◽  
Beta Lactam ◽  
Beta Lactam Antibiotics ◽  
Patient Admissions ◽  
Before And After ◽  
Control And Prevention ◽  
Infectious Waste

MRSA are S. aureus which become methicillin resistant by the acquisition of the mec A gene which is on a mobile chromosomal determinant called staphylococcal cassette chromosome mec (SCC mec). The mec A gene encodes for a penicillin- binding protein (PBP2a) which has a low affinity for isoxazolyl-penicillins (MICs to oxacillin/ meticillin ≥ 4μg/ ml) and is resistant to all classes of beta-lactam antibiotics. Current Department of Health (DOH) guidance (2014) recommends that mandatory MRSA screening be streamlined to include only: ● All patient admissions to high- risk units; ● Healthcare workers; and ● All patients previously identified as colonized or infected with MRSA. The guidance also advises Trusts to follow local risk assessment policies to identify other potential high- risk units or units with a history of high endemicity of MRSA; and The guidance also recommends regular auditing of compliance with MRSA screening policy. The 2006 guideline for the control and prevention of MRSA in healthcare facilities recommends the following four measures. ● Isolation MRSA- positive patients should be nursed in a single room or if none is available, cohorting into a bay after risk assessment. Patient movement, and the number of staff and visitors looking after the patient, should be minimized. ● Hand hygiene and use of personal protective equipment (PPE) All staff and visitors should decontaminate their hands with soap and water/or an alcohol rub before and after contact with the patient or their immediate surroundings. Single-use disposable gloves and aprons/non- permeable gowns should be used by staff and visitors if there is a risk of contamination with body fluids. ● Disposal of waste and laundry All waste from colonized/ infected patients should be placed in the infectious waste stream. All linen and bedding from patients colonized/infected with MRSA should be considered as contaminated and processed as infected linen. ● Cleaning and decontamination The patient’s room should be cleaned/disinfected daily with an appropriate detergent/disinfectant as per local policy. On discharge of the patient, the room needs to be terminally cleaned before it is reused. All patient equipment should either be single-patient use or be cleaned, disinfected, and sterilized.

scholarly journals A case of successful surgical management of primary retroperitoneal mucinous cystadenoma

2020 ◽  
Vol 2020 (3) ◽  
Author(s):  
Zeeshan Afzal ◽  
Weronika Stupalkowska ◽  
Maria B Mahler-Araujo ◽  
David Bowden ◽  
Richard J Davies
Keyword(s):  
Iliac Fossa ◽  
Mucinous Cystadenoma ◽  
Surgical Excision ◽  
Mass Effect ◽  
Rare Tumour ◽  
Left Iliac Fossa ◽  
Female Population ◽  
Midline Laparotomy ◽  
Complete Surgical Excision ◽  
Primary Retroperitoneal

Abstract Primary retroperitoneal mucinous cystadenoma (PRMC) is a rare tumour. It was first reported in 1965, and since then, less than 100 cases have been reported. It is cystic in nature and most commonly affects the female population. It becomes symptomatic in later stages due to its mass effect, making the diagnosis challenging in its early asymptomatic stage. We report a case of a 32-year-old female who presented with abdominal pain and a mass in left iliac fossa. Diagnostic imaging revealed a large cystic lesion in retroperitoneum. A midline laparotomy was performed, and a complete surgical excision was accomplished without any spillage. Surgical histology confirmed the diagnosis of PRMC. The patient was discharged on postoperative day 2. There was no evidence of tumour recurrence on repeat imaging at 90-day follow-up. Surgical approach, with complete resection and without any spillage, remains the most effective and appropriate treatment for this tumour.

Herniography: A Prospective, Randomized Study Between Midline and Left Iliac Fossa Puncture Techniques

2001 ◽  
Vol 56 (5) ◽  
pp. 389-392 ◽  
Author(s):  
Sanjay Nadkarni ◽  
Peter W.G. Brown ◽  
Edwin J.R. van Beek ◽  
Michael C. Collins
Keyword(s):  
Iliac Fossa ◽  
Randomized Study ◽  
Prospective Randomized Study ◽  
Left Iliac Fossa

scholarly journals 53 Does the Community Geriatrician’s Role in Advanced Care Planning Help Community Dwellers Achieve Their Preferred Place of Care?

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i14-i17
Author(s):  
K Honney ◽  
H Judd ◽  
A Mitchell ◽  
H Nash ◽  
J Ford ◽  
...  
Keyword(s):  
End Of Life ◽  
Statistical Significance ◽  
Care Home ◽  
Education Programme ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Chi Square ◽  
Before And After ◽  
Chi Square Test ◽  
Community Dwellers

Abstract Introduction Advanced Care Planning (ACP) is well established for patients with terminal cancer diagnoses but is poorly utilised when caring for elderly patients with other terminal illnesses. We aimed to assess the effectiveness of ACP in our older, community dwellers following a period of increased awareness. Methods A closed loop audit was undertaken, assessing deaths from a dementia care home within rural Norfolk, before and after implementation of an education and focus programme (cycle 1=Jan 2017-Jan 2018, cycle 2: Feb 2018-Jan-2019). Deceased patients were identified from care home records and data from electronic hospital and general practice records were analysed. Results were compared according to existing guidance outlined in the Palliative Gold Standards Framework (GSF) and Department of Health End of Life Care Strategy 2009. Compliance between cycles was compared using the chi-square test with p=.05 indicative of statistical significance. Results 59 patients were included (median age=84, male=31). Results of the audit for each criterion are shown in table 1. More patients achieved their preferred place of care (PPOC) following the implementation of the education programme, with access to end of life medications significantly improving. Conclusions Increasing awareness and understanding of ACP in the community has been shown to improve compliance with GSF standards, particularly access to end of life medications. Further efforts are still required to improve care and a third cycle is scheduled for January 2020, following further training.

The Effects of Left Hand Fatigue on Right Hand Performance

1980 ◽  
Vol 24 (1) ◽  
pp. 643-646
Author(s):  
Marian E. Benton ◽  
Robert P. Bateman
Keyword(s):  
Bicycle Ergometer ◽  
Tracking Performance ◽  
Experimental Conditions ◽  
Left Hand ◽  
Tracking Tasks ◽  
Significant Decrement ◽  
Crossover Fatigue ◽  
Before And After ◽  
Hand Performance ◽  
The Right

Twenty-five subjects performed tracking tasks with the right arm before and after cranking a bicycle ergometer with the left arm. Three experimental conditions consisted of cranking the ergo-meter for 60, 90, and 120 seconds. The results indicate there was a significant decrement in tracking performance the first ten seconds after each of the cranking periods. By thirty seconds after cranking, tracking performance returned to pre-cranking level for each of the conditions. The decrement was not attributable to heart rate or breathing rate increases which remained for periods of up to five minutes. The crossover fatigue effect warrants further study.

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