scholarly journals Interdisciplinary Approach to Improving the Organization of Surgical Care for Patients with Thyroid Pathology

2021 ◽  
Vol 6 (5) ◽  
pp. 276-284
Author(s):  
I. A. Klimenko ◽  
◽  
O. K. Tolstanov
Keyword(s):  
Data Exchange ◽  
Circulatory System ◽  
Malignant Neoplasm ◽  
Surgical Care ◽  
Interdisciplinary Approach ◽  
Benign Neoplasm ◽  
Endocrine Surgery ◽  
Multidisciplinary Teams ◽  
Surgical Interventions ◽  
Thyroid Pathology

The interdisciplinary approach is recognized as the gold standard for organizing medical care for patients with oncological pathology. It is declared at the normative level in Ukraine, but the forms and methods of work, channels and methods of communication of specialists are not detailed. This requires further research, in particular, when providing surgical care to patients with thyroid pathology. The purpose of the study was to investigate the state of activity organization of multidisciplinary teams in the provision of surgical care to patients with thyroid pathology and to propose approaches for its improvement. Materials and methods: accounting forms No. 003 for 2019 (1208 units), constituent and administrative documents for the institution, department regulations, job descriptions, clinical pathway of patients (15 units in total). The base of research was communal non-profit enterprise "Kiev City Clinical Endocrinological Center". The methods, which were used, are systematic approach, medical and statistical, medical and geographical methods, content analysis, graphic. Results and discussion. Patients of the Department of Endocrine Surgery were from almost all regions of Ukraine. 3.5% of patients were referred by a general practitioner, 55.7% - by an endocrinologist, 40.1% - independently applied. Malignant neoplasm of the thyroid gland was detected in 33.9% of patients, non-toxic multinodular goiter – in 25.2%, benign neoplasm – in 16.3%. In 448 (37.1%) patients, 687 concomitant diseases and complications were identified. Their structure consisted of diseases of the heart and circulatory system – 40.0%, eye diseases – 3.1%, diseases of the nervous system – 2.0%. In order to meet the needs of patients, instrumental and laboratory studies, consultative examinations, consultations and surgical interventions were carried out. The low level of communication between inpatient doctors and outpatient doctors has been shown. This was the reason for the excessive length of stay in bed – 12.6 ± 2.7 days. There is a separate participation of specialist doctors in accompanying patients in the hospital. It was proposed to formalize the official status and develop a typical provision for a multidisciplinary team of specialists; joint discussion, debate, data exchange within the team and with outpatient doctors; afford access to corporate information for the team and coordinate the work of authorized employees. Conclusion. Improving the efficiency of multidisciplinary teams is possible by strengthening collaboration within the team and communication with outpatient doctors

scholarly journals Surgical Interventions in Patients Hospitalised with COVID-19. A Review of Seven Months of Experience Working in a COVID-19 Dedicated Centre

2021 ◽  
Vol 10 (3) ◽  
pp. 395
Author(s):  
Justyna Rymarowicz ◽  
Michał Pędziwiatr ◽  
Piotr Major ◽  
Bryan Donohue ◽  
Karol Ciszek ◽  
...  
Keyword(s):  
Emergency Surgery ◽  
Surgical Procedure ◽  
Surgical Care ◽  
Major Surgery ◽  
Surgical Specialty ◽  
Surgical Interventions ◽  
Face To Face ◽  
Overall Mortality

The Coronavirus Disease 2019 (COVID-19) pandemic has made changes to the traditional way of performing surgical consultations. The aim of the present study was to assess the need for surgical care performed by various surgical specialties among patients infected with COVID-19 hospitalized in a COVID-19 dedicated hospital. All surgical consultations performed for patients infected with COVID-19 in a COVID dedicated hospital in a seven month period were evaluated. Data on demographics, surgical specialty, consult reason, procedure performed, and whether it was a standard face to face or teleconsultation were gathered. Out of 2359 COVID-19 patients admitted to the hospital in the seven month period, 229 (9.7%) required surgical care. Out of those 108 consultations that did not lead to surgery, 71% were managed by telemedicine. A total of 36 patients were operated on while suffering from COVID-19. Out of them, only three patients admitted primarily for COVID-19 pneumonia underwent emergency surgery. The overall mortality among those operated on was 16.7%. Conclusions: Patients hospitalised with COVID-19 may require surgical care from various surgical specialties, especially during peaks of the pandemic. However, they rarely require a surgical procedure and only occasionally require major surgery. A significant portion of potentially surgical problems could be managed by teleconsultations.

scholarly journals Leveraging 3D geometric knowledge in the product lifecycle based on industrial standards

2017 ◽  
Vol 5 (1) ◽  
pp. 54-67 ◽  
Author(s):  
Alain Pfouga ◽  
Josip Stjepandić
Keyword(s):  
Supply Chain ◽  
Product Development ◽  
Data Exchange ◽  
Multidisciplinary Teams ◽  
Product Lifecycle ◽  
Product Data ◽  
Primary Focus ◽  
Virtual Product Development ◽  
Digital Enterprise ◽  
Virtual Product

Abstract With their practical introduction by the 1970s, virtual product data have emerged to a primary technical source of intelligence in manufacturing. Modern organization have since then deployed and continuously improved strategies, methods and tools to feed the individual needs of their business domains, multidisciplinary teams, and supply chain, mastering the growing complexity of virtual product development. As far as product data are concerned, data exchange, 3D visualization, and communication are crucial processes for reusing manufacturing intelligence across lifecycle stages. Research and industry have developed several CAD interoperability, and visualization formats to uphold these product development strategies. Most of them, however, have not yet provided sufficient integration capabilities required for current digital transformation needs, mainly due to their lack of versatility in the multi-domains of the product lifecycle and primary focus on individual product descriptions. This paper analyses the methods and tools used in virtual product development to leverage 3D CAD data in the entire life cycle based on industrial standards. It presents a set of versatile concepts for mastering exchange, aware and unaware visualization and collaboration from single technical packages fit purposely for various domains and disciplines. It introduces a 3D master document utilizing PDF techniques, which fulfills requirements for electronic discovery and enables multi-domain collaboration and long-term data retention for the digital enterprise. Highlights With their practical introduction by the 1970s, virtual product data have emerged to a primary technical source of intelligence in manufacturing. Modern organization have since then deployed and continuously improved strategies, methods and tools to feed the individual needs of their business domains, multidisciplinary teams, and supply chain, mastering the growing complexity of virtual product development. As far as product data are concerned, data exchange, 3D visualization, and communication are crucial processes for reusing manufacturing intelligence across lifecycle stages. Research and industry have developed several CAD interoperability, and visualization formats to uphold these product development strategies. Most of them, however, have not yet provided sufficient integration capabilities required for current digital transformation needs, mainly due to their lack of versatility in the multi-domains of the product lifecycle and primary focus on individual product descriptions. This paper analyses the methods and tools used in virtual product development to leverage 3D CAD data in the entire life cycle. It presents a set of versatile concepts for mastering exchange, aware and unaware visualization and collaboration from single technical packages fit purposely for various domains and disciplines. It introduces a 3D master document utilizing PDF techniques, which fulfills requirements for electronic discovery and enables multi-domain collaboration and long-term data retention for the digital enterprise. 3D interoperability makes an important contribution to engineering collaboration. Several formats made to that end successively deal with challenges of their time. Some of these such as STEP are highly verbose formats, which gradually encapsulate all information necessary to define a product, its manufacture, and lifecycle support. Others are focusing best on lightweight visualization use cases and endure better with increasing size and complexity of data. Traditional formats like STEP and JT, though, are not capable of supporting the publishing activity in even broader fashion. New tendencies therefore are aiming at strengthening these individual formats through combination with complementary standards or by using document-based approaches. Unlike STEP or JT, 3D PDF can serve multiple purposes and leverages 3D data downstream throughout the product lifecycle to create, distribute and manage ubiquitous, highly consumable, role-specific rich renditions. Based on its container structure, 3D PDF is a fundamentally different approach from traditional experience established in product development – it is an exceptionally proficient contextual aggregation of multi-domain and multi-disciplinary product data. The manufacturing community should embrace it as an addition and great improvement to current engineering collaboration standards. All engineering components required for its descriptions are meanwhile published international standards. The productive use of 3D PDF for sure requires a change in the current mode of operation, be it simply because the traditional CAD model promptly demands new technical descriptions. More perspectives, which have not been primary focus of this approach need to be addressed in order to implement the 3D digital master concept of this paper in the industry. For the complete process to work properly, the actual workflows of today's business organizations must succeed a readiness check involving enhanced technical documentation capabilities of the authoring (CAx) applications based on 3D, PLM, and manufacturing workflows as well as new ways for engineering data communication with supply chain partners in the digital enterprise.

scholarly journals MODERN SURGICAL INTERVENTIONS IN PATIENTS WITH THYROID DISEASES

2019 ◽  
Vol 21 (1) ◽  
pp. 69-72
Author(s):  
D D Dolidze ◽  
A V Shabunin ◽  
R B Mumladze ◽  
A V Vardanyan ◽  
I N Lebedinskiy ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Stress Test ◽  
Thyroid Diseases ◽  
Endocrine Surgery ◽  
Surgical Interventions ◽  
Postoperative Hypoparathyroidism ◽  
Operative Complications ◽  
Cosmetic Effect ◽  
Methodological Approaches ◽  
Group Ii

The study is based on the analysis of the results of surgical treatment of 298 patients with various diseases of the thyroid gland, who were examined and treated in the department of endocrine surgery of the City Clinical Hospital named after S. P. Botkin from 2012 to 2016. 147 (49.3%) patients of the I group were operated on using extrafascial technique with intersection of the prelaryngeal muscles and visualization of the recurrent laryngeal nerve. 151 (51.7%) patients of group II underwent extrafascial surgical interventions from reduced migratory approaches using modern, including original, methodological approaches. For the prevention of paresis of the larynx in the allocation of recurrent laryngeal nerves, microsurgical instruments and magnifying devices were used. For the prevention of postoperative hypoparathyroidism, in addition to carefully accounting for anatomical and topographic-anatomical features, a «stress-test» and a method of double visual-instrumental recording of the parathyroid gland-induced fluorescence were used. In the first group of patients with surgical treatment, the following complications were recorded: in 2 (1.4%) patients developed permanent, in 8 (5.4%) transient postoperative hypoparathyroidism, and in 3 (2.0%) - temporary unilateral laryngeal paresis. The overall incidence of operative complications was 8.8% (13 patients). In the postoperative period, the following complications were recorded in group II: 2 (1.3%) patients developed transient hypocalcemia, and 1 (0.7%) patient had unilateral laryngeal paresis. The overall incidence of operative complications was 1.99% (3 patients). Analysis of the cosmetic result of the intervention, assessed on the POSAS scale, showed that cosmetic effect was better in group II (p 0.05). Thus, modern surgical interventions in patients with thyroid diseases, including new methodological approaches, have improved the results of surgical treatment with a decrease of the number of complications and achieving a better cosmetic effect of the surgical intervention.

scholarly journals A Case Report of a Solitary Fibrous Tumor of the Maxillary Sinus

Reports ◽  
2021 ◽  
Vol 4 (4) ◽  
pp. 33
Author(s):  
Mattia Di Bartolomeo ◽  
Sara Negrello ◽  
Arrigo Pellacani ◽  
Anna Maria Cesinaro ◽  
Stefano Vallone ◽  
...  
Keyword(s):  
Case Report ◽  
Head And Neck ◽  
Maxillary Sinus ◽  
Solitary Fibrous Tumor ◽  
Malignant Neoplasm ◽  
Neck Region ◽  
Benign Neoplasm ◽  
Surgical Excision ◽  
Purulent Discharge ◽  
Fibrous Tumor

A solitary fibrous tumor (SFT) is a benign neoplasm, firstly described as a mesenchymal tumor of the pleura. Its incidence range in the head and neck region is about 5–27%, but only rarely does it affect paranasal sinuses. The differential diagnosis is challenging, owing to its erosive growth pattern and immuno-histochemical features. SFTs have an aggressive behavior and an important recurrence potential. Therefore, a radical surgical excision is the gold standard therapeutic procedure. A rare SFT originating from the right maxillary sinus is reported here. The 37-year-old patient presented to the outpatient clinic with a painful expansive lesion in the whole right maxillary region. The overlying skin was inflamed and the patient had no epistaxis episodes. The 1.5 dentary element tested negative for vitality; however, a puncture of the lesion led to a hematic spill and no purulent discharge. An endoscopic-guided biopsy was suggestive either of SFT or hemangioperictoma, excluding a malignant neoplasm. A multi-equipe surgical team was activated. The lesion was embolized in order to achieve a good hemostatic control and, after 48 h, the neoplasm was radically excised with a combined open and endoscopic approach. The patient was disease-free at 12-month radiological and clinical follow-up. Given the rarity of this lesion and the delicacy required in addressing head and neck neoplasms, we believe that the present case report might be of help in further understanding how to approach cranio-facial SFTs.

scholarly journals Essential Emergency Surgical Care in Remote Hilly Districts of Karnali - A Cross-Sectional Survey

2020 ◽  
Vol 3 (2) ◽  
pp. 116-121
Author(s):  
Praveen Kumar Giri ◽  
Prem Prasad Panta ◽  
Niresh Thapa
Keyword(s):  
Human Resources ◽  
Electrical Power ◽  
Unmet Need ◽  
Surgical Care ◽  
Situational Analysis ◽  
Care Providers ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Running Water ◽  
Surgical Interventions

Background: Remote hilly areas of Karnali Province has one in all the very best burdens of surgically treatable conditions within the world and therefore, the highest unmet need. The first objective of our study was to gauge the capacity of first-referral health facilities in remote districts of Karnali Province to perform basic surgical procedures. The aim is to assess the status of Essential Emergency Surgical Care in remote hilly districts of Karnali region of Nepal. Method: The screening Tool was Situational Analysis to Assess Emergency and Essential Surgical Care, to spot the health facility’s capacity to perform basic surgical (including obstetrics and trauma) and anesthetic procedures by investigating four categories of data: human resources, infrastructure, equipment and interventions available. The tool interrogated the supply of eight sorts of care providers, 35 surgical interventions and 67 items of apparatus. Results: on the average, 72.83% of all admissions required either minor or major surgical interventions. Oxygen supplies, electrical power backup, running water, blood bank, hospital guidelines were inconsistent. Only 1 Hospital have trained Surgeons, Anesthesiologist and Obstetrician/Gynecologist. Only 1 hospital can perform around 97.1% of procedures. Conclusion: The capacity for essential surgery is severely limited in Karnali region of Nepal. Limitations was seen in basic equipment, human resources, infrastructure, and supplies.  

scholarly journals The Global Burden of Surgical Disease: An Analysis on Inaccessible Surgical Care in Low and Middle Income Countries

2018 ◽  
Vol 7 (1) ◽  
pp. 8-15 ◽  
Author(s):  
Chau Huynh ◽  
Minh NQ Huynh
Keyword(s):  
Global Health ◽  
Financial Burden ◽  
Surgical Care ◽  
Anaesthetic Management ◽  
Global Burden ◽  
Political Climate ◽  
Middle Income ◽  
Surgical Interventions ◽  
Middle Income Countries ◽  
Low And Middle Income

Worldwide, 4.8 billion people do not have access to safe, adequate surgical care and anaesthetic management. Surgical care has been deemed “the neglected child of global health,” a startling reminder of the disparities in health services. The provision of surgical interventions can avert 11% of the global burden of disease and 1.5 million deaths each year. Many obstacles exist for low- and middle-income countries (LMIC) to progress towards accessible surgical care. The first challenge is delivering cost-effective surgical care despite financial constraints and political turmoil. Foreign aid was established to alleviate the financial burden and its contributions have been pivotal. However, based on the political climate in certain countries, funds are siphoned to government sectors other than health care. Moreover, the lack of infrastructure, equipment, and personnel in LMIC compound the issue. The other challenge is determining if surgery is as feasible and effective as non-surgical health interventions. Surgical care is crucial and this paper aims to assess the challenges that limit its stature in global health discussions. The paper will address the influence of financing, infrastructure, workforce, service delivery, and information management on surgical care, and the current resolutions, such as humanitarian aid missions.

scholarly journals PUNCTIONAL DRAINAGES UNDER ULTRASOUND CONTROL IN ABDOMINAL SURGERY

2018 ◽  
Vol 14 (1-2) ◽  
pp. 49-53
Author(s):  
R.A. Sydorenko
Keyword(s):  
Abdominal Cavity ◽  
Surgical Care ◽  
Operative Management ◽  
Pathological Process ◽  
Term Treatment ◽  
Main Task ◽  
Complex Treatment ◽  
Surgical Interventions ◽  
Endogenous Factors ◽  
Abdominal Organs

Relevance. Punctic-drainage interventions under the control of ultrasound have become an effective help in complex treatment. But some technological aspects in the procedure and post-operative management of patients remain the subject of discussion. Objective: to improve the results of the use of punctional drainages under ultrasound control in abdominal and retroperitoneal pathology. Materials and methods. Echo-controlled puncture-drainage interventions are used in 89 patients: with pancreatogenic fluid concentrations in the stuffing box, parapancreatic cellular spaces (34); with intra-abdominal complications following operations on the abdominal organs (18), inflammatory processes in the gall bladder (15), tumor obstruction of the bile ducts (12), and with liver abscesses (10). Depending on the nature of the contents of the "target", its localization for puncture drainage was used by trokars of various modifications and diameters, as well as stylet-catheters of the type "PIGTAIL". Manipulation was carried out using ultrasonic devices with convection (frequency 3.5 MHz) and linear (frequency 7-12 MHz) sensors. In 68 patients, the display for intervention was infected fluid formation. In 12 – jaundice syndrome and 9 patients – sterile clusters of enzymatically active content. The main task of puncture-drainage procedures was the evacuation of the content of pathological or anatomical fluid formations to reduce intoxication and (or) their decompression. In assessing the effectiveness of minimally invasive techniques, account was taken of the effectiveness of the operation, that is, the target effect for which the intervention was performed, and the number of complications. Results. Puncture-drainage interventions have become independent and end-of-term treatment in 68 out of 85 cases (with the exception of 4 patients who, due to complications during the procedure, used other methods). The reasons for the reduced effectiveness of echo-controlled puncture-drainage interventions in 9 patients were: the predominance of the tissue component (large sequester) in the cavity, the presence of multiple isolated gates, the use of drainage structures with insufficient drainage properties. Fatal consequences in 5 patients are caused both by the above reasons, and by endogenous factors (a significant prevalence of the pathological process, decompensated background pathology, reduction of internal reserves of the organism). Conclusions. Puncture-draining interventions under ultrasound control are an alternative to open surgical interventions, especially in patients with severe concomitant pathology, severe general condition. In this case, they can be as element (stage) of complex treatment and an independent, final method of surgical care. The choice of echo-controlled interventional technologies as a method of operational correction should be carried out with understanding their capabilities. The effectiveness of such mini-invasive methods allows us to recommend their acceptance in surgical hospitals for diseases of the abdominal cavity organs and retroperitoneal space.

scholarly journals P-BN34 A single centre study of outcomes for Hiatal Surgery during the Covid-19 pandemic

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Ahmad Faraz ◽  
Gary Dobson ◽  
Ronan Gray ◽  
Scott McCain ◽  
Gary Spence
Keyword(s):  
Length Of Stay ◽  
Healthcare Providers ◽  
Surgical Care ◽  
Primary Outcome Measure ◽  
Surgical Interventions ◽  
Patients With Cancer ◽  
Operative Care ◽  
Time Period ◽  
Single Centre Study ◽  
Free Environment

Abstract Background Covid-19 has had a significant adverse impact on our ability to maintain provision of surgical interventions for a range of conditions, due to the diversion of resources to care for Covid related emergency admissions. Furthermore, there is clear evidence demonstrating how covid-19 infection in the peri-operative period is associated with dramatically increased rates of morbidity for patients. It has therefore become incumbent on healthcare providers to create peri-operative care pathways which can facilitate delivery of surgical care in a Covid safe environment.   Methods In response to the Covid-19 pandemic our institution implemented a ‘Covid-lite’ pathway in order to allow the admission for patients for surgical procedures on the basis of urgent need. This included patients requiring surgery benign upper GI conditions. Patients underwent pre-operative PCR Covid testing,and asked to isloate from time of swab until admission for surgery. Post-opertive operative care was provided on the elective surgical ward which is is all single rooms, and was maintianed as a Covid free environment. We conducted a review of outcomes for all patients undergoing hiatal procedures between January 2020 – April 2021. Surgeries included were Para-Oesophageal Hernia Repair (POH), Anti-reflux Surgery (ARS) & surgery for achalasia (LCM). The primary outcome measure was the rate of Covid-19 infection in the peri-operative period. Measurements were also taken of length of stay, and any signifcant morbidity. Results Hiatal surgery was performed on 42 patients in this time period (28 female, 14 male). The median age was 73 years. Three patients underwent elective ARS and 39 had repair of POH. All ARS procedures were performed laparoscopically. For those having POH repair, 31 cases were elective admissions. 30/31 cases had laparoscopic procedures, with 50% of emergency cases also treated laparoscopically. All elective maptients were managed via the The median length of stay for elective cases was 2 days vs. 14.5 for emergencies (p = 0.001). Zero patients returned positive Covid-19 tests pre-operatively or during their inpatient stay. Two patients were re-admitted within 30 days, although neither were related to covid-19. Conclusions These results indicate that it is possible to safely maintain the provision of hiatal surgery in the Covid-19 era for both elective and emergency cases. The use of a dedicated pathway demonstrates our ability to minimise risk of peri-operative Covid-19 infection and any associated morbidity or mortality. Although there has been a significant attempt prioritise surgery for patients with cancer during the Covid-19 pandemic, these resuts provide a strong case that it possible to provide safe and timely interventions for other necessary surgical interventions with appropriate risk reducing measures.

scholarly journals Emergency surgical care for patients with COVID-19 and tuberculosis coinfection at multispecialty hospital

2021 ◽  
Author(s):  
MN Reshetnikov ◽  
DV Plotkin ◽  
ON Zuban ◽  
EM Bogorodskaya
Keyword(s):  
Psoas Abscess ◽  
Postoperative Mortality ◽  
Surgical Care ◽  
Surgical Patients ◽  
The Novel ◽  
Lung Involvement ◽  
Double Burden ◽  
Surgical Interventions ◽  
Global Challenge ◽  
Novel Coronavirus

The double burden of the novel coronavirus infection and tuberculosis (TB) is a global challenge. The aspects of emergency surgical care for patients with COVID-19 and TB coinfection remain understudied. The aim of this study was to assess treatment outcomes in acute surgical patients with COVID-19 and preexisting TB coinfection. In 2020, our Center delivered surgical care to 465 patients with COVID-19 and preexisting TB; a total of 64 emergency surgeries were performed on 36 (5.6%) patients, of whom 16 had HIV. Thirteen patients (36.1%) were diagnosed with pulmonary TB; 23 patients (63.9%) had disseminated TB. Chest CT scans showed >25% lung involvement in 61.9% of the patients with COVID-19 pneumonia, 25–50% lung involvement in 30.6% of the patients, and 50–75% lung involvement in 5.6% of the patients. By performing abdominal CT, we were able to detect abdominal TB complications, including perforated tuberculous ulcers of the intestine, intestinal obstruction and tuberculous peritonitis, as well as tuberculous spondylitis complicated by psoas abscess. Of all surgical interventions, 28.2% were abdominal, 23.2% were thoracic, 15.6% were surgeries for soft tissue infection, and 32.8% were other types of surgery. Postoperative mortality was 22.2%. We conclude that COVID-19 did not contribute significantly to postoperative mortality among acute surgical patients with TB.

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