The Effectiveness of Minor Procedure as the Management of Onychocryptosis in Community Podiatry Setting: A Retrospective Study

Background: Onychocryptosis is a common and debilitating condition that often require surgical management. Despite this minor procedure being the most common and effective method in managing this condition, as well as being one of the essential services provided by Health Care Professional Council (HCPC) registered podiatrists, there is limited evidence around the effectiveness of this procedure in the community setting. The aim of this study was to evaluate the effectiveness of a non-invasive minor procedure for the management of onychocryptosis. Methods: A retrospective study was undertaken within the community podiatry department. All patients who underwent minor procedure for the management of onychocryptosis between June 2018 and December 2019 were included in this study. The data were collected from the electronic patient records using a comprehensive data collection tool. Recurrence rate and infection rate were calculated to determine the effectiveness of the minor procedure. Results: 354 minor procedures were performed on 272 patients presenting with onychocryptosis. The recurrence rate of nail regrowth following intervention was 5.6% (N=20). Patients <40 years old were more likely to experience a recurrence of nail regrowth following an intervention (N=16). The postoperative infection rate was 8.8% (N=31). Patients who had a partial nail avulsion procedure were more likely to experience postoperative infection compared to total nail avulsion.Conclusions: Although the management of onychocryptosis with this minor procedure is effective within the community podiatry department, incorporation of evaluation of patient satisfaction following this procedure is suggested within the recommendations. The limitations of this study have been highlighted and a mixed method research project is recommended to explore this area of specialty to improve patient outcome.

625 Intracranial Gossypiboma Nine Years After Intracranial Pressure Bolt Insertion - A Case Report

Background Resorbable hemostatic agents are commonly used to control bleeding intra- and post- operatively. Once left behind, these agents can occasionally trigger pathological, granulomatous reactions, resulting in space-occupying lesions known as gossypibomas. Here we report a case of an intracranial gossypiboma. These are notoriously difficult to diagnose as they are exceedingly rare and frequently radiologically indistinguishable from other lesions (tumors, abscess etc). Case Presentation A 35-year-old woman presented with a generalized tonic-clonic seizure and subsequent left-sided hemiparesis. MRI demonstrated an enhancing lobulated lesion subjacent to a right frontal burr hole, surrounded by vasogenic edema with mass effect and midline shift. Nine years ago, she had a triple bolt inserted to monitor intracranial pressure after sustaining traumatic brain injury in a road traffic accident. Surgicel was used to control bleeding during insertion. She made a full recovery. Co-location of the lesion with the position of triple bolt nine years ago raised a suspicion for gossypiboma. However, the minor nature of the surgery, and the length of time since surgery to presentation were placing this case well outside range of cases reported in the literature. The lesion was resected en bloc, with no recurrence 18 months later. Histological examination revealed presence of foreign material, confirming the suspicion of Surgicel-elicited gossypiboma. Conclusions We show here that gossypibomas can occur following a relatively minor procedure and remain clinically and radiologically silent for much longer than what was previously reported. Thus, they should be included in differential diagnoses despite being remarkably rare.

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.

Procedural Sedation in Minor Procedure Rooms for Pediatric Myringotomy and Tympanostomy: A Quality Improvement Initiative

Objective Lengthy wait times for elective surgery is a widespread health care system conundrum that may increase patient distress and jeopardize health outcomes. The primary aim of this quality improvement project was to reduce the surgical wait time in patients undergoing tympanostomy tube insertion. Methods As of January 2018, our tertiary care institution implemented a novel protocol whereby healthy children may undergo tympanostomy tube insertion in a minor procedure room under ketamine sedation administered by pediatric emergency physicians to address lack of both physical and anesthesia staffing resources. A retrospective study of all children undergoing elective tympanostomy tube insertion was conducted between September 1, 2017, and May 8, 2019, to assess wait time to surgery, as well as anesthesia-related and surgical complications. Results Procedural sedation in minor procedure rooms effectively decreased surgical wait times by 53 days (from 134 to 81 days, P < .001) at 16 months postimplementation. This new protocol was found to be safe and effective for healthy children, with no major surgical or anesthesia-related complications noted in 113 patients having undergone the procedure in the novel setting. Discussion Although conscious sedation by emergency physicians has been well studied across a variety of surgical procedures, its novel use in pediatric tympanostomy tube insertion requires careful patient selection to enhance accessibility while maintaining anesthetic safety. Implications for Practice This quality improvement project describes a novel combination of processes, using a minor procedure room space and ketamine-based procedural sedation to address surgical wait times in pediatric patients undergoing tympanostomy tube insertion.

COMPARATIVE STUDY OF CONTINUOUS METHOD AND INTERRUPTED METHOD OF EPISIOTOMY IN TERMS OF HEALING OF THE SURGICAL WOUND.

Episiotomy is a most commonly performed minor procedure. There are various type of episiotomy suturing, in this study two most common types of episiotomy suturing techniques were compare in terms of healing rate. This study concluded that the continuous method of episiotomy suturing is although faster, cosmetically better and associated with less post-operative pain but it heals signicantly better than interrupted method of suturing

Biochemical profile of urine in guinea pigs (Cavia porcellus)

Guinea pigs are common patients in veterinary clinics. Knowledge of the urine composition is necessary for the evaluation of their health. We, therefore, analysed the urine of fifty guinea pigs, thirty-two males, and eighteen females, aged between four months and seven years. None of these guinea pigs showed clinical signs of urinary tract diseases. The urine samples were obtained as part of a preventive check-up, during a regular dental check-up or another minor procedure. The urine was acquired by spontaneous micturition after inducing a short-term, light isoflurane anaesthesia. A macroscopic evaluation of the urine samples and a urine dipstick test were used for the preliminary examination. The average pH was determined to be 8.5 ± 0.5, and in three animals, moderate glycosuria was detected using the urine dipsticks. No urobilinogen, ketone bodies, haemoglobin, or blood traces were present in any of the samples. Severe proteinuria was detected in all the samples. The samples were subsequently evaluated in a laboratory for the following values: specific gravity 1 024.40 ± 1.83 kg/m³, osmolality 601.14 ± 52.28 mOsm/kg, total protein 290.16 ± 34.73 mg/l, albumin 12.04 ± 1.92 mg/l, glucose 0.77 ± 0.20 mmol/l, urea 217.60 ± 24.23 mmol/l, creatinine 3.98 ± 0.48 mmol/l, bilirubin 9.63 ± 1.73 μmol/l, calcium 6.14 ± 0.40 mmol/l, phosphorus 4.95 ± 1.30 mmol/l, magnesium 9.86 ± 0.57 mmol/l, sodium 49.15 ± 6.67 mmol/l, potassium 152.21 ± 10.62 mmol/l, chloride 51.14 ± 5.81 mmol/l, activity of gamma-glutamyltransferase 0.72 ± 0.14 μkat/l, alkaline phosphatase 0.56 ± 0.11 μkat/l and lactate dehydrogenase 0.68 ± 0.14 μkat/l. The descriptive values of the urine biochemical parameters of guinea pigs were determined for the first time in this study.