Evaluation of the Effect of PDCA in Hospital Health Management

PDCA plays a very important role in the hygienic management of hospital operating rooms. Before the PDCA management from February 2018 to February 2019, routine hygiene management in the operating room was adopted; after the PDCA management from February 2018 to February 2019, PDCA cycle management was adopted. 500 surgical patients were randomly selected from both groups. We compare the quality control checklist scores of hand hygiene management, environmental hygiene management, medical waste management, and disinfection and isolation management in the routine group and the PDCA group. We also compared the detection rate of pathogenic bacteria in surgical incisions of the routine group and the PDCA group and the infection rate of various surgical incisions, air samples, surface samples, disinfectants, and sterilization rates of sterile items. The PDCA group’s hand hygiene management score, environmental hygiene management score, medical waste management score, and disinfection and isolation management score were higher than those in the conventional group ( P < 0.05 ). The detection rate of pathogenic bacteria in the PDCA group, the infection rate of type I, type II, and type III incisions, and the total infection rate of surgical incisions were lower than those in the conventional group, and the difference was statistically significant ( P < 0.05 ). The qualified rate of air samples and surface samples in the PDCA group was higher than that in the conventional group ( P < 0.05 ), and the difference in the qualified rate of disinfectants and sterile items between the two groups was not statistically significant ( P > 0.05 ). The hygiene management of the operating room adopts PDCA sustainable improvement management measures to effectively increase the qualification rate of disinfection and sterilization, reduce the detection rate of pathogenic bacteria and infection rate of surgical incisions, and strengthen the management quality of hand hygiene, environmental hygiene, medical waste, and disinfection and isolation.

Usefulness of a needleless suture technique for midline laparotomy wound dehiscence: a case report

Surgical wound dehiscence after a laparotomy is a serious complication, and it presents the mechanical wound healing failure of surgical incisions. Since the development of needleless suture techniques, there have been attempts to use a needleless suture for wounds from several surgery types. Recently, many studies have shown that a needleless suture technique leads to good wound healing results. It is rapid, cost effective, can minimize ventilator dependency, and is well tolerated by patients. Here, we report a case of a patient who received a needleless suture technique for midline laparotomy wound dehiscence.

Robotic Hybrid Coronary Revascularization - a need for strategy specific data.

Robotic totally endoscopic techniques to perform the LITA to LAD graft, coupled with PCI, provides the least invasive option to achieve hybrid coronary revascularization (HCR). Shorter hospital stay and reduced need for blood transfusions have been consistently being reported by several studies along with similar long-term outcomes. Considerable variations exist in the definition of HCR which can be single or two-staged with surgical revascularization being carried out after PCI or vice versa. Variations also exist with respect to usage of cardiopulmonary bypass, surgical incisions, and use of minimally invasive robotic techniques. The different strategies of HCR do not lead to similar outcomes and the findings of one strategy cannot be extrapolated to the entire group. Studies reporting different strategies of HCR, should ideally provide more granular data when reporting outcomes.

Local Swelling and Redness Associated with Supraclavicular Nerve Injury

Supraclavicular nerves are at risk in operative procedures when surgical incisions are placed over the clavicle. This report describes a 50-year-old man who developed local swelling and redness of the supraclavicular region after undergoing Weaver-Dunn reconstruction of the coracoclavicular ligament. ENMG was consistent with supraclavicular nerve injury. Since the symptoms may mimic infection, the awareness of this complication will aid the clinician to avoid unnecessary use of antimicrobials.

Medical and surgical outcome of retropharyngeal abscess and its prognosis

Although retropharyngeal abscess is not a common condition, it can impact the quality of life of the affected patients, and can even be life-threatening. Asphyxia, upper respiratory tract obstruction, and respiratory distress might then develop secondary to this abscess which continues to grow even larger increasing the seriousness of the complications. Surgical incisions and long-course medical and antibiotic therapies have been described in the literature for the management of retropharyngeal abscess. In this study, the literature review discusses the surgical and medical treatment of retropharyngeal abscesses and the predicted prognosis of the disease after treatment based on evidence obtained from studies in the literature. Early presentation and management are important in achieving better outcomes and enhancing the prognosis. Therefore, patients should be aware enough of the symptoms that might suggest the presence of a retropharyngeal abscess. Using intravenous antibiotics can achieve favorable outcomes. However, some adverse events might be associated and the treatment might not be completed as a result of reduced patient compliance. Surgical management is also efficacious and can be done by different approaches as discussed earlier. Nevertheless, it can also be associated with some complications. Therefore, providing optimal care for these patients should be considered in all scenarios to enhance the prognosis.

Modification of Sabaneev's method of ankle joint resection

If we compare the number of methods of surgical incisions for accessing the joints, then, it seems, in no other area, so many of these methods have been proposed as in the area of the ankle joint.

Cingulate Gyrus Access with Focused Ultrasound Ablation

Cancer is associated with pain in a high number of patients. The higher the stage of cancer the more likely there is an associated pain condition. With terminally ill cancer pain patients, ablative neurosurgical procedures can significantly improve pain and transition patients out of inpatient settings and into post hospital care settings. These procedures require surgical incisions which poses a risk in this delicate population. The current study aims to determine if the ExAblate system has the capability of reaching the anterior cingulate gyrus, a common site for targeting cancer associated pain in terminally ill patients.

Comparison Between Nylon and Polyglactin Sutures in Pediatric Cataract Surgery: A Randomized Controlled Clinical Trial

Purpose: To compare the performance of nylon sutures to that of polyglactin sutures in pediatric patients undergoing cataract surgery.Setting: University of Campinas (UNICAMP), Campinas, São Paulo, BrazilDesign: A prospective, randomized, partially masked, single-site clinical trial. (https://clinicaltrials.gov/ct2/show/NCT03812640).Methods: A total of 80 eyes from 80 patients who underwent pediatric cataract surgery were randomized into two groups in block sizes of four. Group A consisted of 41 patients whose surgical incisions were sutured with polyglactin 10-0 material. Group B consisted of 39 patients whose surgical incisions were sutured with nylon 10-0 material. The primary outcome was frequency of suture-related complications in each group. Secondary outcomes were the frequency with which suture removal was necessary.Results: The incidence of suture-related complications within 6 months of follow up was 0 out of 41 eyes (0.00%) in the polyglactin group and 17 out of 39 eyes (43.59%) in the nylon control group (p &lt; 0.001). In all of the eyes with suture-related complications, the sutures were promptly removed. The most frequent complications were vascularization near the suture (17.95%) and loose sutures (17.95%). No ocular or systemic study-related adverse events were observed.Conclusions: Polyglactin sutures were found to be safe and effective for pediatric patients undergoing cataract surgery. Their lower rate of complications and reduced likelihood of removal (and the subsequent need for general anesthesia) make their use preferrable to that of nylon sutures. This study represents the first controlled randomized clinical trial to compare nylon sutures to polyglactin sutures in pediatric patients undergoing cataract surgery.Clinical Trial Registration: URL: https://clinicaltrials.gov/ct2/show/, Identifier: NCT03812640.

Single Incision Approach for Decompression of Greater, Lesser and Third Occipital Nerves in Migraine Surgery

Background The traditional approach for occipital migraine surgery encompasses 3 separate surgical incisions in the posterior neck to decompress the great occipital nerves (GON), lesser occipital nerves (LON) and third occipital nerves (TON). We sought to evaluate a single midline incision approach for decompression of all 6 occipital nerves. Methods Using 10 cadaveric hemi-sides (5 fresh cadaver head and necks). Anatomic landmarks and the location of the bilateral GON, LON and TON were marked according to previous anatomic studies. A single midline 9-cm incision was made and lateral skin flaps were raised to decompress or avulse all 6 nerves. Results The GON and TON were identified 3.5 and 6.2 cm, respectively inferior to a line bisecting the external auditory canal (EAC) and 1.5 cm lateral to the midline. The LON was identified 6-cm inferior and 6.5-cm medial to a line bisecting the EAC in the plane just above the investing layer of the deep cervical fascia until the posterior boarder of the sternocleidomastoid was encountered. The LON had the greatest amount of variation, but was identified lateral to the posterior border of the SCM. Conclusions A single midline incision approach allows for successful identification and decompression of all 6 occipital nerves in migraine surgery.