Management of postoperative bleeding in surgically debrided wounds: topical haemostat versus electrocautery

2020 ◽  
Vol 29 (8) ◽  
pp. 444-451
Author(s):  
Kerry T Thibodeaux ◽  
Marcus S Speyrer ◽  
Ryan P Thibodeaux ◽  
Alan A Rogers ◽  
Mark G Rippon
Keyword(s):  
Postoperative Bleeding ◽  
Bleeding Control ◽  
Effective Management ◽  
Prospective Evaluation ◽  
Surgical Wound ◽  
Time Saving ◽  
Significant Saving ◽  
Wound Debridement ◽  
The Mean ◽  
Time Savings

Objective: To compare the effectiveness of a temporary topical external haemostat (OMNI-STAT Granules, Omni-stat Medical Inc., US) versus the use of electrocautery for bleeding control in patients who have undergone surgical wound debridement. Time saved in the operating room (OR) was evaluated. Method: A prospective evaluation of use of a topical haemostat in an OR setting was compared with retrospective data collected using electrocautery to understand the time-saving benefits of using a topical haemostat versus electrocautery. Results: A total of 52 patients were treated with the topical haemostat, and 89 patients with electrocautery. The topical haemostat was shown to be as effective in achieving haemostasis post-surgical debridement as electrocautery, with the added benefits of significant time savings in the OR (reducing the mean total OR time by 19.1%). Additionally, preprocedure and surgical procedure times in patients treated with the topical haemostat were significantly reduced. The results showed that wounds treated with the topical haemostat demonstrated a more advanced stage of healing, which may be a result of the lack of tissue damage demonstrated with the topical haemostat compared with electrocautery. Conclusion: This study found that the temporary topical haemostat was equally as effective as cauterisation in achieving haemostasis. In addition, significant saving in OR time was demonstrated relative to electrocautery. The improved OR times may translate into increased cost-effectiveness, relative to electrocautery, by increasing the number of surgical cases per day and/or using resources more effectively to treat more patients. It may also enable bleeding control in the outpatient clinic or at the bedside, freeing up costly OR time and enabling more effective management of healthcare resources.

Vesseg: An Open-Source Tool for Deep Learning-Based Atherosclerotic Plaque Quantification in Histopathology Image

2021 ◽  
Author(s):  
J.M. Murray ◽  
P. Pfeffer ◽  
R. Seifert ◽  
A. Hermann ◽  
J. Handke ◽  
...  
Keyword(s):  
Deep Learning ◽  
Open Source ◽  
Atherosclerotic Plaque ◽  
State Of The Art ◽  
The Mean ◽  
Time Savings ◽  
Plaque Quantification ◽  
Atherosclerosis Research ◽  
Hematoxylin Eosin ◽  
Microscopy Images

Objective: Manual plaque segmentation in microscopy images is a time-consuming process in atherosclerosis research and potentially subject to unacceptable user-to-user variability and observer bias. We address this by releasing Vesseg a tool that includes state-of-the-art deep learning models for atherosclerotic plaque segmentation. Approach and Results: Vesseg is a containerized, extensible, open-source, and user-oriented tool. It includes 2 models, trained and tested on 1089 hematoxylin-eosin stained mouse model atherosclerotic brachiocephalic artery sections. The models were compared to 3 human raters. Vesseg can be accessed at https://vesseg .online or downloaded. The models show mean Soerensen-Dice scores of 0.91±0.15 for plaque and 0.97±0.08 for lumen pixels. The mean accuracy is 0.98±0.05. Vesseg is already in active use, generating time savings of >10 minutes per slide. Conclusions: Vesseg brings state-of-the-art deep learning methods to atherosclerosis research, providing drastic time savings, while allowing for continuous improvement of models and the underlying pipeline.

A Novel Nonsurgical Technique for Correcting Congenital Auricular Anomalies

2021 ◽  
Author(s):  
Shay I. Duvdevani ◽  
Hadas Knoller ◽  
Noa Rozendorn ◽  
Eran E. Alon ◽  
Ory Madgar
Keyword(s):  
Treatment Initiation ◽  
Neonatal Period ◽  
Cost Effective ◽  
Normal Appearance ◽  
Time Saving ◽  
Effective Time ◽  
Custom Made ◽  
The Mean ◽  
Ear Anomalies ◽  
Surgical Corrections

AbstractCongenital ear anomalies are associated with psychological morbidity. Ear deformities can usually be corrected by nonsurgical techniques such as splinting or molding in the neonatal period, initiated before 6 weeks. Without early corrections, many will require otoplasty during childhood. We introduce a novel silicone-based custom mold technique for congenital ear anomalies. The highly malleable silicone was pushed into every part of the auricle, enabling the auricle to remain in the desired shape, with new molds made weekly. Of 31 newborns (18 males, 13 females), 54 ears were treated. Average age at treatment initiation was 26.8 days. The mean treatment duration was 43.2 days, with a median of 28 days. Normal appearance and parent's satisfaction were achieved in 30 patients with 49 deformed ears and also in four newborns older than 6 weeks. Three concha type microtia in two patients achieved great improvements and parents' satisfaction. No complications were reported. Marked aesthetic improvements and normal appearance were achieved for all deformed auricles treated, and improvements in the concha type microtia will partially alleviate future surgical corrections. The results are not inferior to other techniques. The advantages are as follows: cost-effective, time-saving, simple to master, no need for hair shaving, and easy use for parents. Patients older than 6 weeks of age achieved normal auricle appearance, enabling the correction in older newborns. Custom made silicone auricle molding offers a simple nonsurgical technique for correcting congenital ear anomalies, alleviating the need for future surgical corrections.

Do methods of hospital pre-alerts influence the on-scene times for acute pre-hospital stroke patients? A retrospective observational study

2021 ◽  
Vol 6 (2) ◽  
pp. 19-25
Author(s):  
Jacob Gunn
Keyword(s):  
Standard Deviation ◽  
Observational Study ◽  
Acute Stroke ◽  
Ambulance Service ◽  
Time Saving ◽  
North East ◽  
Admission Policies ◽  
The Mean ◽  
Time Critical ◽  
Mean Time

Introduction: Stroke is one of the leading causes of death and disability worldwide. The ambulance service is often the first medical service to reach an acute stroke patient, and due to the time-critical nature of stroke, a time-critical assessment and rapid transport to a hyper acute stroke unit are essential. As stroke services have been centralised, different hospitals have implemented different pre-alert admission policies that may affect the on-scene time of the attending ambulance crew. The aim of this study is to investigate if the different pre-alert admission policies affect time on scene.Method: The current study is a retrospective quantitative observational study using data routinely collected by North East Ambulance Service NHS Foundation Trust. The time on scene was divided into two variables; group one was a telephone pre-alert in which a telephone discussion with the receiving hospital is required before they accept admission of the patient. Group two was a radio-style pre-alert in which the attending clinician makes an autonomous decision on the receiving hospital and alerts them via a short radio message of the incoming patient. These times were then compared to identify if there was any difference between them.Results: Data on 927 patients over a three-month period, from October to December 2019, who had received the full stroke bundle of care, were within the thrombolysis window and recorded as a stroke by the attending clinician, were split into the variable groups and reported on. The mean time on scene for a telephone call pre-alert was 33 minutes and 19 seconds, with a standard deviation of 13 minutes and 8 seconds. The mean on-scene time for a radio pre-alert was 28 minutes and 24 seconds, with a standard deviation of 11 minutes and 51 seconds.Conclusion: A pre-alert given via radio instead of via telephone is shown to have a mean time saving of 4 minutes and 55 seconds, representing an important decrease in time which could be beneficial to patients.

scholarly journals Zooplankton community dynamics and environmental factors in Lake Ozeros (Greece)

2013 ◽  
Vol 14 (3) ◽  
pp. 32 ◽  
Author(s):  
E. CHALKIA ◽  
G. KEHAYIAS
Keyword(s):  
Community Dynamics ◽  
Zooplankton Community ◽  
Trophic State Index ◽  
Zooplankton Abundance ◽  
The Novel ◽  
Effective Management ◽  
Eutrophic Lakes ◽  
State Index ◽  
The Mean ◽  
One Year

A one year investigation of the zooplankton community composition and dynamics in Lake Οzeros (western Greece) revealed 25 invertebrate species (16 rotifers, three copepods, five cladocerans and one mollusc larva). The mean zooplankton abundance fluctuated between 59.4 to 818 ind l-1, having maximum values in spring. The species composition and seasonal variation do not differentiate Lake Ozeros from the nearby lakes. The presence of the dominant calanoid copepod Eudiaptomus drieschi and some of the rotifer species recorded are characteristics of either oligo- or eutrophic lakes. According to the trophic state index (TSI) Lake Ozeros is a meso-eutrophic ecosystem, in which the eutrophic character was possibly the result of the high charge with phosphorus (being raised by 28.9 % in comparison to previous decades), which came into the lake via the surrounding agricultural cultivations and mainly the pig-raising activities. In contrast, the concentrations of ΝΟ3, ΝΟ2 and NH4 have considerably decreased possibly due to the termination of the tobacco cultivations around the lake during the last years. The novel information on the abiotic and especially the biotic elements of Lake Ozeros provided by the present study can contribute to the effective management of this aquatic ecosystem in the future.

Abstract 29: A Neighborhood Local Volunteer Response Network Improves Response Time for Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Karl B Kern ◽  
Carter Newton ◽  
Charles " Wunder ◽  
Thomas P Colberg ◽  
Marvin J Slepian
Keyword(s):  
Cardiac Arrest ◽  
Response Times ◽  
Retirement Community ◽  
Time Of Arrival ◽  
Time Saving ◽  
Response Network ◽  
Community Boundaries ◽  
The Mean ◽  
Mean Time ◽  
Hospital Cardiac Arrest

Background: Minutes are crucial in the treatment of out-of-hospital cardiac arrest (CA). Immediate chest compressions and early defibrillation are keys to good outcomes. Local neighborhood volunteer (vol) response programs may decrease delays to early CPR and AED use. We hypothesized that a coordinated effort of alerting trained neighborhood vols simultaneously with 911 activation of professional EMS providers would provide earlier CPR and defibrillation in such communities. Methods: We developed a program of simultaneously alerting CPR and AED trained neighborhood vols and the local EMS system for cardiac arrest events in a retirement community in Southern Arizona, encompassing approximately 17,300 homes and 21,500 residents. EMS services are provided by 5 stations within the community boundaries. Within a single housing development neighborhood, 9 vols and the closest EMS station were involved in 3 days of mock CA notifications (total of 12 different alerts at various times during daytime hours were sent). This provided a total of 120 response opportunities, 12 for EMS and 108 for vols. The distance to the mock event and the time from alert to arrival were recorded and compared. Results: In the selected 55+ neighborhood, the two groups differed significantly in both distance to the mock cardiac arrest event and in response times. The volunteers average 0.33±0.19 miles from the mock CA incidences while the closest EMS station was 3.3 miles from the tested neighborhood (p<0.0001). Response times (time from call to arrival) were also different. The earliest Vol arrived at 1min 30sec±48sec*, 2 Vols & AED at 1min 38 sec±53sec*, all arriving Vols at 3min 23 sec*, and EMS at 7min 20 sec±1min 13sec (*p<0.0001 vs EMS). Conclusion: When the neighborhood volunteers in this testing period were geographically closer to the mock CA event, they arrived significantly sooner to the scene than did the EMS service. The mean time of arrival for at least 2 vols with an AED was 5 min 42 sec faster than the professional rescuers. The implications for such a time saving could be as much as a 240% increase (25% to 85%) in survival for those with shockable rhythms.

Have Students Used Techniques to Stop the Bleed?

2021 ◽  
pp. 000313482110545
Author(s):  
Katherine Kelley ◽  
James Martinson ◽  
Sharon Henry ◽  
Thomas Scalea ◽  
Habeeba Park
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Gunshot Wound ◽  
Motor Vehicle ◽  
Utilization Rate ◽  
Bleeding Control ◽  
Medical Field ◽  
Hemorrhage Control ◽  
Control Techniques ◽  
Vehicle Collision ◽  
The Mean

Introduction The Stop the Bleed course was initiated in response to the Hartford Consensus and over 1 million people have been taught basic bleeding control techniques. Our study sought to determine the extent to which this training has been utilized. Methods Surveys were sent by email to students that had taken the Stop the Bleed course through our institution in 2017 or 2018. Data were collected utilizing the REDCap system and statistical calculations were performed. Results 2505 surveys were sent with 445 (18%) responses. The mean age of respondents was 48 years of age, 343 (77%) were female, and 230 (52%) were in the medical field. There were 17 respondents (3.8%) that stated they had utilized the techniques taught in the course; 16 out of 17 put pressure on a wound, 7 packed a wound, and 6 used a tourniquet. Patients had been injured by a variety of mechanisms including gunshot wound, stabbing, accidental laceration, and motor vehicle collision. Patients had good outcomes with 3 out of 17 surviving to emergency medical services arrival without known final outcome and the remaining 14 were known to do well. Conclusion The Stop the Bleed course is important to enable bystanders to provide hemorrhage control. Our study shows that the techniques have been utilized with 17 treated patients having a good outcome and while a utilization rate of 3.8% may appear low, it is similar to the utilization rate of cardiopulmonary resuscitation instruction of 2%.

Performance Analyses of Information-Based Managed Lane Choice Decisions in a Connected Vehicle Environment

2020 ◽  
Vol 2674 (11) ◽  
pp. 120-133 ◽  
Author(s):  
Xiaoyu Guo ◽  
Yongxin Peng ◽  
Sruthi Ashraf ◽  
Mark W. Burris
Keyword(s):  
Travel Time ◽  
Travel Behavior ◽  
Information Exchange ◽  
Traffic Management ◽  
Connected Vehicle ◽  
Market Penetration ◽  
Performance Measurements ◽  
Time Saving ◽  
Travel Time Savings ◽  
Time Savings

Connected vehicle (CV) technology can connect, communicate, and share information between vehicles, infrastructure, and other traffic management systems. Recent research has examined and promoted CV and connected automated vehicle (CAV) technology on managed lane systems to increase capacity and reduce congestion, as managed lane systems could be equipped with advanced infrastructure relatively quickly. However, the effect on travel considering, information-based managed lane choice decisions in a CV environment is not clear. Therefore, this research analyzed the potential effects on a managed lane system with connected vehicles considering several travel behavior elements, including drivers’ willingness to reroute and their choice of managed lanes based on individual travel time savings. This study analyzed the potential effects on a managed lane system by assigning different market penetration rates (0%, 10%, 50%, 100%) of CVs and informing CV drivers about travel time savings for a 10-mi stretch at 5-min intervals. How the traffic performance measurements (i.e., throughput, travel time saving, average speed and average travel time) vary under different market penetration rates of CVs is then investigated. Two major conclusions are reached: (i) although information exchange was assumed to be instantaneous between vehicles and the system, there existed a response time (or time delay) in the macroscopic traffic reflection; (ii) managed lane use may decrease, when travel time information becomes available, since drivers perceive they are saving more travel time than they actually do save.

scholarly journals Acoustic Target Strength of the Endangered Chinese Sturgeon (Acipenser sinensis) by Ex Situ Measurements and Theoretical Calculations

2018 ◽  
Vol 8 (12) ◽  
pp. 2554 ◽  
Author(s):  
Hui Zhang ◽  
Junyi Li ◽  
Chongrui Wang ◽  
Chengyou Wang ◽  
Jinming Wu ◽  
...  
Keyword(s):  
Theoretical Calculations ◽  
Breeding Population ◽  
Ex Situ ◽  
Target Strength ◽  
Effective Management ◽  
Chinese Sturgeon ◽  
Acipenser Sinensis ◽  
Acoustic Target ◽  
The Mean ◽  
Db Difference

The Chinese sturgeon, Acipenser sinensis, is a large anadromous and highly endangered protected species. The assessment of its breeding population in the Yangtze River is critically important for effective management and population preservation. Currently, hydroacoustic methods have been widely used to study the adult sturgeons in the river, whereas the acoustic target strength (TS) characteristics of the species have not been studied. In this study, the TS of Chinese sturgeon was carefully evaluated both by ex situ measurements and theoretical calculations. Six Chinese sturgeons (Body Length (BL): 74.0−92.6 cm) were measured by a 199 kHz split echosounder in a 10-m deep net cage. The computed tomography of a Chinese sturgeon (BL: 110.0 cm) was conducted and the Kirchhoff ray mode (KRM) method was used to estimate the theoretical TS. As a result, the mean ex situ TS range of the six specimens was from −26.9 to −31.4 dB, which was very close to the KRM estimation (~1 dB difference). Then, the KRM method was used to predict the TS of Chinese sturgeon as a function of BL in six frequencies commonly used in freshwater environments and to estimate the TS of a representative adult Chinese sturgeon (250 cm) as a function of frequency and tilt angle. This study can provide a good basis for future hydroacoustic studies on the critically endangered Chinese sturgeon.

scholarly journals Challenge of diagnosing pyoderma gangrenosum after caesarean section

2019 ◽  
Vol 12 (7) ◽  
pp. e230315 ◽  
Author(s):  
Philipp Foessleitner ◽  
Ulrike Just ◽  
Herbert Kiss ◽  
Alex Farr
Keyword(s):  
Caesarean Section ◽  
Wound Infection ◽  
Pyoderma Gangrenosum ◽  
Rare Complication ◽  
Surgical Wound Infection ◽  
Interdisciplinary Treatment ◽  
High Dose ◽  
Surgical Wound ◽  
Wound Debridement ◽  
Rare Diagnosis

Pyoderma gangrenosum is a neutrophilic skin disease that leads to extensive, painful, necrotic ulcerations, particularly at surgical sites. As obstetric cases with pyoderma gangrenosum are rare and, therefore, often misdiagnosed initially, it is important to raise awareness about this rare complication. Here, we describe a patient who presented with pyoderma gangrenosum at the surgical site 4 days after undergoing a caesarean section. The erythema was initially misdiagnosed as wound infection, and the patient, who was experiencing pain, underwent antibiotic treatment and surgical wound debridement. When the wound was unresponsive to these treatments, a dermatologist was consulted who suspected pyoderma gangrenosum and began a high-dose corticosteroids therapy, which led to a fulminant improvement of the local wound. In conclusion, the rare diagnosis of pyoderma gangrenosum should be considered in the differential diagnosis of a suspected surgical wound infection. Early interdisciplinary treatment is essential to avoid further complications.

scholarly journals Management of bleeding associated with radiofrequency ablation of benign thyroid nodules

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052093752
Author(s):  
Kunpeng Hu ◽  
Yufan Lian ◽  
Jinfen Wang ◽  
Wenchao Li ◽  
Zhicheng Yao ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Thyroid Nodules ◽  
Effective Management ◽  
Voice Change ◽  
Life Threatening ◽  
The Mean ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid ◽  
Clinical Strategy

Objective This study was performed to explore the effective management of bleeding associated with radiofrequency ablation (RFA) of benign thyroid nodules. Methods Thirty-five patients with benign thyroid nodules who were treated with ultrasound-guided RFA from July 2015 to December 2016 at the Third Affiliated Hospital of Sun Yat-sen University were retrospectively reviewed. The technique efficacy, bleeding, and other complications were assessed during the follow-up period. Results The mean technique efficacy was 55.6%±22.8% at 1 month and 24.1%±17.1% at 6 months after the procedure. One case of an intranodular haematoma and two cases of voice change (>1 month) were observed. All patients recovered with corresponding treatment. Conclusion Although the incidence of haemorrhage is low, serious haematomas are life-threatening. Therefore, having a comprehensive understanding of the potential complications, an accurate clinical strategy, and adequate technical skills may prevent or help to properly manage these complications.

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