A critical Review of Dhoopan Karma in Ayurveda and Dhoopana of an Ayurvedic Herbomineral formulation Yavasarshapadi churna in context of Sterilization.

Dhoopana Karma is classical remedy mentioned in various Ayurvedic scriptures to maintain disease free and hygienic environment in the world. As per Ayurvedic scriptures Dhoopana is indicated for Rakshoghna Karma which means killing of disease producing microorganisms. Hence, it plays key role in prevention and cure of various infectious diseases.A similar process called fumigation is one of best and fastest method to maintain asepsis, antisepsis in wards and operation theatres of hospitals.Additionally, this study comprises critical literary review of herbomineral formulation named Yavasarshapadi Choorna which is indicated in form of incense for Dhoopana karma. It is indicated in Ayurvedic scripture Charaka Samhita in chapter Jatisutriya Sharir Adhyaya of Sharir Sthana. It was reviewed in context of sterilization activity to maintain asepsis and antisepsis. Specifically, it is indicated for fumigation of cloths and belongings of post-natal period of Women and that of the New born, Drug preparation room, New born care room, Surgical Procedure room modern surgery, traditional operation theatre sterilization was done by formalin gas fumigation over many decades which is found to have carcinogenic effect over human lives. Ayurvedic modality named Dhoopana was undertaken in current study as it is a safe and healthy alternative for sterilization.It overcomes harmful effects caused by modern sterilization method i.e. Formalin gas fumigation which is need of an hour. The Analytical study of antimicrobial and antifungal effect of various Ayurvedic Dhoopana Dravyas is the need of the hour along with preclinical and clinical study to verify Sterilization activity of various Ayurvedic Dhoopana Dravyas.

WALANT Hand and Upper Extremity Procedures Performed With Minor Field Sterility Are Associated With Low Infection Rates

Background: The use of minor field sterility in hand/upper extremity cases has been shown to improve workflow efficiency while maintaining patient safety. As this finding has been limited to specific procedures, we investigated the safety of performing a wide array of hand/upper extremity procedures outside the main operating room using minimal field sterility with Wide-Awake Local Anaesthesia No Tourniquet (WALANT) anaesthesia by evaluating superficial and deep infection rates across a diverse series of cases. Methods: This study was a case series conducted between October 2017 and June 2020. Of all, 217 patients underwent hand/upper extremity procedures performed in a minor procedure room via WALANT technique with field sterility. Primary outcome measures include superficial and deep surgical site infections within 14 days post-surgery. Results: Of all, 217 patients were included in this study; 265 consecutive hand/upper extremity operations were performed by a single surgeon, with notable case diversity. The majority of patients (n = 215, 99.1%) did not report or present with signs of infection before or after their operation. We report 0% 14-day and 0.37% 30-day surgical site infection rates for such hand/upper extremity procedures performed in a minor procedure room with field sterility. Conclusion: Hand/upper extremity procedures performed via WALANT technique with field sterility in a minor procedure room are associated with low surgical site infection rates. These rates are comparable to surgical site infection rates for similar surgeries performed in main operating rooms with standard sterilization procedures. Thus, the implementation of this technique may allow for improved workflow efficiency and reduced waste, all while maintaining patient safety.

Comparison of trans-catheter closure of paravalvular leak versus surgical approach-outcomes and cost analysis

Background The outcomes and costs of trans-catheter closure (TC) of paravalvular leak (PVL) compared with surgical closure (SC) are rarely described. Purpose The aim of the study was to assess the outcomes and hospital costs of patients who underwent TC or SC of PVL in our center. Methods Patients who underwent TC and SC of PVL between Jan. 2016 and Dec. 2019 were enrolled. Baseline characteristics, procedural, in-hospital and mid-term outcomes and hospital costs were compared. Results A total of 141 patients were studied (TC, n=65 and SC, n=76). The patients were elder in TC group (56.8±12.8 years vs. 50.1±12.8 years, p=0.002). Technical success was higher in SC group (83.1% vs. 98.7%, p<0.001). Procedure room time (93±38 min vs. 395±132 min, p<0.001), intensive care unit time (0 h vs. 25 h, p<0.001), length of stay from hospitalization to discharge (7 days vs. 21 days, p<0.001) and costs (¥45090±19343 vs. ¥164165±94300, p<0.001) were significantly less in TC group. After risk adjustment, there was no significant differences between in 30 days survival between TC group and SC group. However, the residual PVLs were less in SC group (43.1% vs. 12.0%, p=0.012). At a median follow-up of 21 months, there was a trend towards reduce all-cause death following TC versus SC (OR=0.054, 95% CI: 0.070 to 0.445, p=0.007). Conclusions SC for PVL is associated with higher technical rates and less residual shunt. But, the shorter length of stay and lower resources use with TC group significantly reduce hospital costs. In addition, TC achieve a better mid-term results in survival. Funding Acknowledgement Type of funding source: None

Bargain Hunting for Buffered Lidocaine: A Collaborative Discovery of Cost-saving Strategies That Can Improve Patient Care

Buffered lidocaine is a local anesthetic option during percutaneous needle-directed procedures in the breast. At our institution, sodium bicarbonate (the buffer) is dispensed in volumes that frequently lead to medical waste and shortages. In this study, we describe how moving the buffering of lidocaine from the procedure room to our clinical hospital pharmacy results in a reduction in costs and improves satisfaction across the breast radiology department. While cost savings are difficult to tease out in practices that opt for bundled payments, we were able to access pricing and supply data and coordinate with our pharmacy to change our practice. Making these changes saves our practice $26 000 a year and allows us to continue to offer buffered lidocaine even during sodium bicarbonate shortages. This manuscript describes how these changes came about and their economic impact.