Science.gov

Sample records for organization surgical safety

  1. 77 FR 25179 - Patient Safety Organizations: Voluntary Relinquishment From Surgical Safety Institute

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-27

    ... patient safety and the quality of health care delivery. HHS issued the Patient Safety and Quality... of health care delivery. The Patient Safety Rule, 42 CFR part 3, authorizes AHRQ, on behalf of the... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:...

  2. Impact of the World Health Organization's Surgical Safety Checklist on safety culture in the operating theatre: a controlled intervention study

    PubMed Central

    Haugen, A. S.; Søfteland, E.; Eide, G. E.; Sevdalis, N.; Vincent, C. A.; Nortvedt, M. W.; Harthug, S.

    2013-01-01

    Background Positive changes in safety culture have been hypothesized to be one of the mechanisms behind the reduction in mortality and morbidity after the introduction of the World Health Organization's Surgical Safety Checklist (SSC). We aimed to study the checklist effects on safety culture perceptions in operating theatre personnel using a prospective controlled intervention design at a single Norwegian university hospital. Methods We conducted a study with pre- and post-intervention surveys using the intervention and control groups. The primary outcome was the effects of the Norwegian version of the SSC on safety culture perceptions. Safety culture was measured using the validated Norwegian version of the Hospital Survey on Patient Safety Culture. Descriptive characteristics of operating theatre personnel and checklist compliance data were also recorded. A mixed linear regression model was used to assess changes in safety culture. Results The response rate was 61% (349/575) at baseline and 51% (292/569) post-intervention. Checklist compliance ranged from 77% to 85%. We found significant positive changes in the checklist intervention group for the culture factors ‘frequency of events reported’ and ‘adequate staffing’ with regression coefficients at −0.25 [95% confidence interval (CI), −0.47 to −0.07] and 0.21 (95% CI, 0.07–0.35), respectively. Overall, the intervention group reported significantly more positive culture scores—including at baseline. Conclusions Implementation of the SSC had rather limited impact on the safety culture within this hospital. PMID:23404986

  3. Use of a Surgical Safety Checklist to Improve Team Communication.

    PubMed

    Cabral, Richard A; Eggenberger, Terry; Keller, Kathryn; Gallison, Barry S; Newman, David

    2016-09-01

    To improve surgical team communication, a team at Broward Health Imperial Point Hospital, Ft Lauderdale, Florida, implemented a program for process improvement using a locally adapted World Health Organization Surgical Safety Checklist. This program included a standardized, comprehensive time out and a briefing/debriefing process. Postimplementation responses to the Safety Attitudes Questionnaire revealed a significant increase in the surgical team's perception of communication compared with that reported on the pretest (6% improvement resulting in t79 = -1.72, P < .05, d = 0.39). Perceptions of communication increased significantly for nurses (12% increase, P = .002), although the increase for surgeons and surgical technologists was lower (4% for surgeons, P = .15 and 2.3% for surgical technologists, P = .06). As a result of this program, we have observed improved surgical teamwork behaviors and an enhanced culture of safety in the OR. PMID:27568533

  4. World Health Organization (WHO) surgical safety checklist implementation and its impact on perioperative morbidity and mortality in an academic medical center in Chile

    PubMed Central

    Lacassie, Hector J.; Ferdinand, Constanza; Guzmán, Sergio; Camus, Lorena; Echevarria, Ghislaine C.

    2016-01-01

    Abstract Health care organizations are unsafe. Numerous centers have incorporated the WHO Surgical Safety Checklist in their processes with good results; however, only limited information is available about its effectiveness in Latin America. We aimed to evaluate the impact of the checklist implementation on the in-hospital morbidity and mortality rate in a tertiary health care center. After Institutional review board approval, and using data from our hospital administrative records, we conducted a retrospective analysis of all surgical encounters (n = 70,639) over the period from January 2005 to December 2012. Propensity scoring (PS) methods (matching and inverse weighting) were used to compare the pre and postintervention period, after controlling for selection bias. After PS matching (n = 29,250 matched pairs), the in-hospital mortality rate was 0.82% [95% confidence interval (CI), 0.73–0.92] before and 0.65% (95% CI, 0.57–0.74) after checklist implementation [odds ratio (OR) 0.73; 95% CI, 0.61–0.89]. The median length of stay was 3 days [interquartile range (IQR), 1–5] and 2 days (IQR, 1–4) for the pre and postchecklist period, respectively (P < 0.01). This is the first Latin American study reporting a decrease in mortality after the implementation of the WHO Surgical Checklist in adult surgical patients. This is a strong and simple tool to make health care safer, especially in developing countries. PMID:27281092

  5. World Health Organization (WHO) surgical safety checklist implementation and its impact on perioperative morbidity and mortality in an academic medical center in Chile.

    PubMed

    Lacassie, Hector J; Ferdinand, Constanza; Guzmán, Sergio; Camus, Lorena; Echevarria, Ghislaine C

    2016-06-01

    Health care organizations are unsafe. Numerous centers have incorporated the WHO Surgical Safety Checklist in their processes with good results; however, only limited information is available about its effectiveness in Latin America. We aimed to evaluate the impact of the checklist implementation on the in-hospital morbidity and mortality rate in a tertiary health care center. After Institutional review board approval, and using data from our hospital administrative records, we conducted a retrospective analysis of all surgical encounters (n = 70,639) over the period from January 2005 to December 2012. Propensity scoring (PS) methods (matching and inverse weighting) were used to compare the pre and postintervention period, after controlling for selection bias. After PS matching (n = 29,250 matched pairs), the in-hospital mortality rate was 0.82% [95% confidence interval (CI), 0.73-0.92] before and 0.65% (95% CI, 0.57-0.74) after checklist implementation [odds ratio (OR) 0.73; 95% CI, 0.61-0.89]. The median length of stay was 3 days [interquartile range (IQR), 1-5] and 2 days (IQR, 1-4) for the pre and postchecklist period, respectively (P < 0.01).This is the first Latin American study reporting a decrease in mortality after the implementation of the WHO Surgical Checklist in adult surgical patients. This is a strong and simple tool to make health care safer, especially in developing countries. PMID:27281092

  6. Perspectives in quality: designing the WHO Surgical Safety Checklist.

    PubMed

    Weiser, Thomas G; Haynes, Alex B; Lashoher, Angela; Dziekan, Gerald; Boorman, Daniel J; Berry, William R; Gawande, Atul A

    2010-10-01

    The World Health Organization's Patient Safety Programme created an initiative to improve the safety of surgery around the world. In order to accomplish this goal the programme team developed a checklist with items that could and, if at all possible, should be practised in all settings where surgery takes place. There is little guidance in the literature regarding methods for creating a medical checklist. The airline industry, however, has more than 70 years of experience in developing and using checklists. The authors of the WHO Surgical Safety Checklist drew lessons from the aviation experience to create a safety tool that supports essential clinical practice. In order to inform the methodology for development of future checklists in health care, we review how we applied lessons learned from the aviation experience in checklist development to the development of the Surgical Safety Checklist and also discuss the differences that exist between aviation and medicine that impact the use of checklists in health care. PMID:20702569

  7. Safety organizations and experts

    NASA Technical Reports Server (NTRS)

    Mandel, G.; Rubinstein, R. I.; Pinto, J. J.; Meschkow, S. Z.

    1977-01-01

    Handbook lists organizations and experts in specific, well defined areas of safety technology. Special emphasis is given to relevant safety information sources on aircraft fire hazards and aircraft interior flammability.

  8. Surgical safety checklists briefings: Perceived efficacy and team member involvement.

    PubMed

    McDowell, D S; McComb, S

    2016-06-01

    Researchers have shown inconsistencies in compliance, outcomes and attitudes of surgical team members related to surgical safety checklist briefings. The purpose of this study was to examine surgical circulator and scrub practitioners' perceptions of safety checklist briefings and team member involvement, and to identify potential improvements in the process based on those perceptions. An anonymous survey was conducted with members of the Association of periOperative Registered Nurses (AORN) and the Association of Surgical Technologists (AST). Questions focused on perceptions of checklist briefing efficacy and team member involvement in safety practices. From the 346 usable responses, a third respondent group of self-identified perioperative leaders emerged. Significant results were obtained related to leaders' perceptions, post-procedure briefings and various perceptions of team member involvement. Study results indicate that variances in safety practices continue as perceived by surgical team members thus presenting opportunities for further examination and improvement of processes in reducing surgical errors. PMID:27498438

  9. [Organization of surgical measure in military hospitals].

    PubMed

    Efimenko, N A

    2007-09-01

    The reform of military health service intends a clear organization of medical attendance, and, first of all, surgical one, particularly in military hospitals with different patient capacity. Seeing it leaders of surgery units in medical service got the task to elaborate the standards of realization of surgical attendance for military hospitals with different patient capacity during peaceful time, correctly execute all orders on preparation of military surgeons, enroot new high-quality and expensive types of maintenance into practice. Optimization and standardization of processes of surgical maintenance in Defense Establishment of Russian Federation, of tasks in the sphere of staff politics and of teaching process, modernization of technical equipment of medical service and enrooting new high-quality methods in practice allows augment the effectiveness of surgical attendance in military hospitals with different patient capacity. PMID:18154046

  10. Surgical Safety in Pediatrics: practical application of the Pediatric Surgical Safety Checklist1

    PubMed Central

    Pires, Maria Paula de Oliveira; Pedreira, Mavilde L. G.; Peterlini, Maria Angélica Sorgini

    2015-01-01

    Objectives: to assess the practical application of the Pediatric Surgical Safety Checklist on the preoperative period and to verify family satisfaction regarding the use of the material. Method: exploratory study that aimed to analyze the use of the checklist by children who underwent surgical interventions. The sample was constituted by 60 children (from preschoolers to teens) and 60 family members. The variables related to demographic characterization, filling out the checklist, and family satisfaction, being evaluated through inferential and descriptive statistical analysis. Results: most children (71.7%) were male, with a median age of 7.5 years. We identified the achievement of 65.3% of the checklist items, 30.0% were not filled due to non-performance of the team and 4.7% for children and family reasons. In the association analysis, we found that the removal of accessories item (p = 0.008) was the most checked by older children. Regarding satisfaction, the family members evaluated the material as great (63.3%) and good (36.7%) and believed that there was a reduction of the child's anxiety (83.3%). Conclusion: the use of the checklist in clinical practice can change health services regarding safety culture and promote customer satisfaction. PMID:26626002

  11. Patients' Perspectives of Surgical Safety: Do They Feel Safe?

    PubMed Central

    Dixon, Jennifer L.; Tillman, Matthew M.; Wehbe-Janek, Hania; Song, Juhee; Papaconstantinou, Harry T.

    2015-01-01

    Background Increased focus on reducing patient harm has led to surgical safety initiatives, including time-out, surgical safety checklists, and debriefings. The perception of the lay public of the surgical safety process is largely unknown. Methods A 20-question survey focused on perceptions of surgical safety practice was distributed to a random sample of patients following elective operations requiring hospitalization. Responses were measured by a 7-point Likert scale. Qualitative feedback was obtained through nonphysician-moderated sessions. Participation was voluntary and anonymous. Results Surveys were distributed to 345 patients of whom 102 (29.5%) responded. Overall, patients felt safe as evidenced by scores for the questions “I felt safe the day of my surgery” (6.53 ± 0.72) and “Mistakes rarely happen during surgery” (5.39 ± 1.51). Patients undergoing their first surgery and patients with higher income levels were associated with a significant decrease in specific safety perceptions. Qualitative feedback sessions identified the physician-patient relationship as the most important factor positively influencing patient safety perceptions. Conclusion Current surgical safety practice is perceived positively by our patients; however, patients still identify physician-patient interactions, relationships, and trust as the most positive factors influencing their perception of the safety environment. PMID:26130976

  12. The WHO surgical safety checklist: survey of patients’ views

    PubMed Central

    Russ, Stephanie Jane; Rout, Shantanu; Caris, Jochem; Moorthy, Krishna; Mayer, Erik; Darzi, Ara; Sevdalis, Nick; Vincent, Charles

    2014-01-01

    Background Evidence suggests that full implementation of the WHO surgical safety checklist across NHS operating theatres is still proving a challenge for many surgical teams. The aim of the current study was to assess patients’ views of the checklist, which have yet to be considered and could inform its appropriate use, and influence clinical buy-in. Method Postoperative patients were sampled from surgical wards at two large London teaching hospitals. Patients were shown two professionally produced videos, one demonstrating use of the WHO surgical safety checklist, and one demonstrating the equivalent periods of their operation before its introduction. Patients’ views of the checklist, its use in practice, and their involvement in safety improvement more generally were captured using a bespoke 19-item questionnaire. Results 141 patients participated. Patients were positive towards the checklist, strongly agreeing that it would impact positively on their safety and on surgical team performance. Those worried about coming to harm in hospital were particularly supportive. Views were divided regarding hearing discussions around blood loss/airway before their procedure, supporting appropriate modifications to the tool. Patients did not feel they had a strong role to play in safety improvement more broadly. Conclusions It is feasible and instructive to capture patients’ views of the delivery of safety improvements like the checklist. We have demonstrated strong support for the checklist in a sample of surgical patients, presenting a challenge to those resistant to its use. PMID:25038036

  13. [Errors in surgery. Strategies to improve surgical safety].

    PubMed

    Arenas-Márquez, Humberto; Anaya-Prado, Roberto

    2008-01-01

    Surgery is an extreme experience for both patient and surgeon. The patient has to be rescued from something so serious that it may justify the surgeon to violate his/her integrity in order to resolve the problem. Nevertheless, both physician and patient recognize that the procedure has some risks. Medical errors are the 8th cause of death in the U.S., and malpractice can be documented in >50% of the legal prosecutions in Mexico. Of special interest is the specialty of general surgery where legal responsibility can be confirmed in >80% of the cases. Interest in mortality attributed to medical errors has existed since the 19th century; clearly identifying the lack of knowledge, abilities, and poor surgical and diagnostic judgment as the cause of errors. Currently, poor organization, lack of team work, and physician/ patient-related factors are recognized as the cause of medical errors. Human error is unavoidable and health care systems and surgeons should adopt the culture of error analysis openly, inquisitively and permanently. Errors should be regarded as an opportunity to learn that health care should to be patient centered and not surgeon centered. In this review, we analyze the causes of complications and errors that can develop during routine surgery. Additionally, we propose measures that will allow improvements in the safety of surgical patients. PMID:18778549

  14. [How frequently is the WHO Surgical Safety Checklist used?].

    PubMed

    Nørgaard, Aleksander; Johnsen, Roar; Marhaug, Gudmund

    2016-05-01

    BACKGROUND Through its patient safety programme «In safe hands,» the Norwegian Directorate of Health's objective is to ensure that the WHO Surgical Safety Checklist is used for all relevant surgical procedures. The purpose of this study was to investigate the recorded use of the WHO Surgical Safety Checklist, as well as to illuminate the factors that covary with its use, in order to be able to identify improvement measures.MATERIAL AND METHOD All surgical operations were reviewed at five surgical units at St Olavs Hospital Health Trust in three two-week periods in 2013. Recorded use of the checklist at each unit was compared to time of surgery, day surgery, acute or elective surgery and operating theatre time before, during and after surgery.RESULTS A total of 2297 operations were included. In 47 % of the operations, use of the entire checklist was recorded, in 31 % use of only parts was recorded and in 22 % no parts of it were recorded as having been used. The unit to which the patient belonged had the most bearing on the extent to which the checklists were used. A short time spent in the operating theatre, as well as operations that were classified in advance as acute, were associated with less recorded use.INTERPRETATION St. Olavs Hospital Health Trust has not achieved the objective of full implementation of the WHO checklist. There is considerable variation in recorded use at the units studied, and less recorded use of the checklist in the case of short and acute operations. PMID:27221181

  15. Use of the surgical safety checklist to improve communication and reduce complications.

    PubMed

    Pugel, Anne E; Simianu, Vlad V; Flum, David R; Patchen Dellinger, E

    2015-01-01

    Existing evidence suggests that communication failures are common in the operating room, and that they lead to increased complications, including infections. Use of a surgical safety checklist may prevent communication failures and reduce complications. Initial data from the World Health Organization Surgical Safety Checklist (WHO SSC) demonstrated significant reductions in both morbidity and mortality with checklist implementation. A growing body of literature points out that while the physical act of "checking the box" may not necessarily prevent all adverse events, the checklist is a scaffold on which attitudes toward teamwork and communication can be encouraged and improved. Recent evidence reinforces the fact the compliance with the checklist is critical for the effects on patient safety to be realized. PMID:25731674

  16. [Does Surgical Safety Checklist for cesarean section improve maternal and neonatal outcome?].

    PubMed

    Sumikura, Hiroyuki

    2014-03-01

    Surgical Safety Checklist published by WHO (World Health Organization) has been widely accepted and contributed to reduce postoperative mortality and morbidity. However, the implementation of the original checklist for cesarean section has been questioned as most of the patients for cesarean section being awake at the occasion of time out, and some patients requiring emergency cesarean section. From these points of view, modified versions of the checklist for cesarean section have been proposed. Recently, NPSA (National Patient Safety Agency) and RCOG (Royal College of Obstetricians and Gynaecologists) from U. K. published a checklist specifically for obstetric surgery, and its usefulness has been evaluated. The most important modification of the checklist seems to be adoption of classification of urgency of cesarean section by NICE (National Institute of Clinical Excellence) into the time out Surgical Safety Checklist from U. K. is introduced with its recent evaluation, and its possible adoption in Japanese hospitals will be discussed. PMID:24724434

  17. 14 CFR 417.103 - Safety organization.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Safety organization. 417.103 Section 417... OF TRANSPORTATION LICENSING LAUNCH SAFETY Launch Safety Responsibilities § 417.103 Safety organization. (a) A launch operator must maintain and document a safety organization. A launch operator...

  18. 14 CFR 417.103 - Safety organization.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Safety organization. 417.103 Section 417... OF TRANSPORTATION LICENSING LAUNCH SAFETY Launch Safety Responsibilities § 417.103 Safety organization. (a) A launch operator must maintain and document a safety organization. A launch operator...

  19. 14 CFR 417.103 - Safety organization.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Safety organization. 417.103 Section 417... OF TRANSPORTATION LICENSING LAUNCH SAFETY Launch Safety Responsibilities § 417.103 Safety organization. (a) A launch operator must maintain and document a safety organization. A launch operator...

  20. 14 CFR 417.103 - Safety organization.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Safety organization. 417.103 Section 417... OF TRANSPORTATION LICENSING LAUNCH SAFETY Launch Safety Responsibilities § 417.103 Safety organization. (a) A launch operator must maintain and document a safety organization. A launch operator...

  1. [Surgical safety cheklist at the management of the hybrid operating room].

    PubMed

    Cherkashin, M A; Berezina, N A; Kuplevatsky, V I; Serov, A V; Mefodovsky, A A

    2016-01-01

    An essential aspect of the work of the operating room is the provision of safety of both the patient and staff. The organization of the activity of the surgical service requires serious elaboration of each of its stage, as well as standardization in using various validated instruments. When speaking of a hybrid operating room with the use of intraoperative magnetic resonance tomography, such an approach becomes not merely a recommendation but rather forced and justified necessity. Simultaneous use of various technologies of imaging and treatment with the engagement of physicians of various specialties requires especially thorough control. A generally accepted international standard of the work of the operating block is the use of checklists, and since 2008 the initiative of the World Health Organization "Safe Surgery Saves Lives" has globally been working to promote implementation of the WHO Surgical Safety Checklists (SSCL) to the real clinical practice. The intraoperative MR-diagnostic stage dictates rigid requirements for proper inventory of ferromagnetic and nonmagnetic surgical tools, verified logistics, and routing of the patient in the conditions of high and extremely high (1.5-3.0 T) magnetic field. A separate and not less important problem is anaesthesiological support during MRT. In order to optimise the patient's movements and adequate monitoring of his/her safety inside the operating department, the authors have modified the standard WHO Surgical Safety Checklist. Implementation of the modified checklist for the MRT-equipped hybrid operating room should improve the control over the processes, as well as increase safety of both the patient and personnel. PMID:27336334

  2. Undergraduate Organic Chemistry Laboratory Safety

    NASA Astrophysics Data System (ADS)

    Luckenbaugh, Raymond W.

    1996-11-01

    Each organic chemistry student should become familiar with the educational and governmental laboratory safety requirements. One method for teaching laboratory safety is to assign each student to locate safety resources for a specific class laboratory experiment. The student should obtain toxicity and hazardous information for all chemicals used or produced during the assigned experiment. For example, what is the LD50 or LC50 for each chemical? Are there any specific hazards for these chemicals, carcinogen, mutagen, teratogen, neurotixin, chronic toxin, corrosive, flammable, or explosive agent? The school's "Chemical Hygiene Plan", "Prudent Practices for Handling Hazardous Chemicals in the Laboratory" (National Academy Press), and "Laboratory Standards, Part 1910 - Occupational Safety and Health Standards" (Fed. Register 1/31/90, 55, 3227-3335) should be reviewed for laboratory safety requirements for the assigned experiment. For example, what are the procedures for safe handling of vacuum systems, if a vacuum distillation is used in the assigned experiment? The literature survey must be submitted to the laboratory instructor one week prior to the laboratory session for review and approval. The student should then give a short presentation to the class on the chemicals' toxicity and hazards and describe the safety precautions that must be followed. This procedure gives the student first-hand knowledge on how to find and evaluate information to meet laboartory safety requirements.

  3. Developing and Implementing a Culture of Safety in the Dentoalveolar Surgical Practice.

    PubMed

    Hupp, James R

    2015-08-01

    The health care industry and delivery systems are placing greater emphasis on making their organizations safe. They do this by cultivating a culture of safety to help anticipate and prevent injuries and documenting and investigating injuries to develop prevention protocols. Many of the strategies used in the hospital industry can be applied to the dentoalveolar surgery practice of oral-maxillofacial surgeons and other dentists. This article discusses the development of a culture of safety in the dentoalveolar practice and gives ideas of how threats of injuries to patients, guests, and the surgical care team can be reduced or eliminated. PMID:26001630

  4. 14 CFR 415.33 - Safety organization.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Safety organization. 415.33 Section 415.33... TRANSPORTATION LICENSING LAUNCH LICENSE Safety Review and Approval for Launch From a Federal Launch Range § 415.33 Safety organization. (a) An applicant shall maintain a safety organization and document it...

  5. 14 CFR 415.33 - Safety organization.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Safety organization. 415.33 Section 415.33... TRANSPORTATION LICENSING LAUNCH LICENSE Safety Review and Approval for Launch From a Federal Launch Range § 415.33 Safety organization. (a) An applicant shall maintain a safety organization and document it...

  6. 14 CFR 415.33 - Safety organization.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Safety organization. 415.33 Section 415.33... TRANSPORTATION LICENSING LAUNCH LICENSE Safety Review and Approval for Launch From a Federal Launch Range § 415.33 Safety organization. (a) An applicant shall maintain a safety organization and document it...

  7. 14 CFR 415.33 - Safety organization.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Safety organization. 415.33 Section 415.33... TRANSPORTATION LICENSING LAUNCH LICENSE Safety Review and Approval for Launch From a Federal Launch Range § 415.33 Safety organization. (a) An applicant shall maintain a safety organization and document it...

  8. 76 FR 9350 - Patient Safety Organizations: Voluntary Delisting From Rocky Mountain Patient Safety Organization

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-17

    ... Delisting From Rocky Mountain Patient Safety Organization AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS. ACTION: Notice of Delisting. SUMMARY: Rocky Mountain Patient Safety Organization: AHRQ has accepted a notification of voluntary relinquishment from Rocky Mountain Patient Safety Organization,...

  9. 14 CFR 415.33 - Safety organization.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Safety organization. 415.33 Section 415.33....33 Safety organization. (a) An applicant shall maintain a safety organization and document it by... communication, both within the applicant's organization and between the applicant and any federal launch...

  10. Surgical team member assessment of the safety of surgery practice in 38 South Carolina hospitals.

    PubMed

    Singer, Sara J; Jiang, Wei; Huang, Lyen C; Gibbons, Lorri; Kiang, Mathew V; Edmondson, Lizabeth; Gawande, Atul A; Berry, William R

    2015-06-01

    We assessed surgical team member perceptions of multiple dimensions of safe surgical practice in 38 South Carolina hospitals participating in a statewide initiative to implement surgical safety checklists. Primary data were collected using a novel 35-item survey. We calculated the percentage of 1,852 respondents with strongly positive, positive, and neutral/negative responses about the safety of surgical practice, compared results by hospital and professional discipline, and examined how readiness, teamwork, and adherence related to staff perception of care quality. Overall, 78% of responses were positive about surgical safety at respondent's hospitals, but in each survey dimension, from 16% to 40% of responses were neutral/negative, suggesting significant opportunity to improve surgical safety. Respondents not reporting they would feel safe being treated in their operating rooms varied from 0% to 57% among hospitals. Surgeons responded more positively than nonsurgeons. Readiness, teamwork, and practice adherence related directly to staff perceptions of patient safety (p < .001). PMID:25828528

  11. 14 CFR 417.103 - Safety organization.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Safety organization. 417.103 Section 417... organization. (a) A launch operator must maintain and document a safety organization. A launch operator must... within the launch operator's organization and between the launch operator and any federal launch range...

  12. Obstetrical and Gynecological Devices; Reclassification of Surgical Mesh for Transvaginal Pelvic Organ Prolapse Repair; Final order.

    PubMed

    2016-01-01

    The Food and Drug Administration (FDA or the Agency) is issuing a final order to reclassify surgical mesh for transvaginal pelvic organ prolapse (POP) repair from class II to class III. FDA is reclassifying these devices based on the determination that general controls and special controls together are not sufficient to provide reasonable assurance of safety and effectiveness for this device, and these devices present a potential unreasonable risk of illness or injury. The Agency is reclassifying surgical mesh for transvaginal POP repair on its own initiative based on new information. PMID:26742182

  13. 14 CFR 431.33 - Safety organization.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Safety organization. 431.33 Section 431.33... TRANSPORTATION LICENSING LAUNCH AND REENTRY OF A REUSABLE LAUNCH VEHICLE (RLV) Safety Review and Approval for Launch and Reentry of a Reusable Launch Vehicle § 431.33 Safety organization. (a) An applicant...

  14. Surgical techniques for advanced stage pelvic organ prolapse.

    PubMed

    Brown, Douglas N; Strauchon, Christopher; Gonzalez, Hector; Gruber, Daniel

    2016-02-01

    Pelvic organ prolapse is an extremely common condition, with approximately 12% of women requiring surgical correction over their lifetime. This manuscript reviews the most recent literature regarding the comparative efficacy of various surgical repair techniques in the treatment of advanced stage pelvic organ prolapse. Uterosacral ligament suspension has similar anatomic and subjective outcomes when compared to sacrospinous ligament fixation at 12 months and is considered to be equally effective. The use of transvaginal mesh has been shown to be superior to native tissue vaginal repairs with respect to anatomic outcomes but at the cost of a higher complication rate. Minimally invasive sacrocolpopexy appears to be equivalent to abdominal sacrocolpopexy (ASC). Robot-assisted sacrocolpopexy (RSC) and laparoscopic sacrocolpopexy (LSC) appear as effective as abdominal sacrocolpopexy, however, prospective studies of comparing long-term outcomes of ASC, LSC, and RSC in relation to health care costs is paramount in the near future. Surgical correction of advanced pelvic organ prolapse can be accomplished via a variety of proven techniques. Selection of the correct surgical approach is a complex decision process and involves a multitude of factors. When deciding on the most suitable surgical intervention, the chosen route must be individualized for each patient taking into account the specific risks and benefits of each procedure. PMID:26448444

  15. Guidelines for providing privileges and credentials to physicians for transvaginal placement of surgical mesh for pelvic organ prolapse.

    PubMed

    2012-01-01

    The adoption of new technology or procedures into a clinician's surgical armamentarium is driven by multiple factors. Patient safety and anticipated long-term improvement in outcomes should be the primary objective that guides a surgeon's decision to deliver care involving new procedures. Surgically complex procedures require a balance of knowledge, surgical skill, and experience, with appropriate ongoing surgical volume and monitoring of outcomes and adverse events. Transvaginal placement of surgical mesh for pelvic organ prolapse has the potential to improve quality of life and anatomic outcomes (especially in the anterior compartment), but also has potential serious adverse events as outlined by the FDA's July 2011 Safety Communication. This document provides Guidelines for privileging and credentialing of physicians planning to implement or continue using this new technology in clinical practice. PMID:22777366

  16. Surgical checklist application and its impact on patient safety in pediatric surgery

    PubMed Central

    Oak, SN; Dave, NM; Garasia, MB; Parelkar, SV

    2015-01-01

    Background: Surgical care is an essential component of health care of children worldwide. Incidences of congenital anomalies, trauma, cancers and acquired diseases continue to rise and along with that the impact of surgical intervention on public health system also increases. It then becomes essential that the surgical teams make the procedures safe and error proof. The World Health Organization (WHO) has instituted the surgical checklist as a global initiative to improve surgical safety. Aims: To assess the acceptance, application and adherence to the WHO Safe Surgery Checklist in Pediatric Surgery Practice at a university teaching hospital. Materials and Methods: In a prospective study, spanning 2 years, the checklist was implemented for all patients who underwent operative procedures under general anesthesia. The checklist identified three phases of an operation, each corresponding to a specific period in the normal flow of work: Before the induction of anesthesia (“sign in”), before the skin incision (“time out”) and before the patient leaves the operating room (“sign out”). In each phase, an anesthesiologist,-“checklist coordinator”, confirmed that the anesthesia, surgery and nursing teams have completed the listed tasks before proceeding with the operation and exit. The checklist was used for 3000 consecutive patients. Results: No major perioperative errors were noted. In 54 (1.8%) patients, children had the same names and identical surgical procedure posted on the same operation list. The patient identification tag was missing in four (0.1%) patients. Mention of the side of procedures was missing in 108 (3.6%) cases. In 0.1% (3) of patients there was mix up of the mention of side of operation in the case papers and consent forms. In 78 (2.6%) patients, the consent form was not signed by parents/guardians or the side of the procedure was not quoted. Antibiotic orders were missing in five (0.2%) patients. In 12 (0.4%) cases, immobilization of

  17. 76 FR 58812 - Patient Safety Organizations: Delisting for Cause of Patient Safety Organization One, Inc.

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-22

    ... information regarding the quality and safety of health care delivery. The Patient Safety and Quality... organizations whose mission and primary activity is to conduct activities to improve patient safety and the quality of health care delivery. HHS issued the Patient Safety Rule to implement the Patient Safety......

  18. 14 CFR 431.33 - Safety organization.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... TRANSPORTATION LICENSING LAUNCH AND REENTRY OF A REUSABLE LAUNCH VEHICLE (RLV) Safety Review and Approval for Launch and Reentry of a Reusable Launch Vehicle § 431.33 Safety organization. (a) An applicant shall... organization, between the applicant and the launch site, and between the applicant and the reentry site,...

  19. 14 CFR 431.33 - Safety organization.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... TRANSPORTATION LICENSING LAUNCH AND REENTRY OF A REUSABLE LAUNCH VEHICLE (RLV) Safety Review and Approval for Launch and Reentry of a Reusable Launch Vehicle § 431.33 Safety organization. (a) An applicant shall... organization, between the applicant and the launch site, and between the applicant and the reentry site,...

  20. 14 CFR 431.33 - Safety organization.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... TRANSPORTATION LICENSING LAUNCH AND REENTRY OF A REUSABLE LAUNCH VEHICLE (RLV) Safety Review and Approval for Launch and Reentry of a Reusable Launch Vehicle § 431.33 Safety organization. (a) An applicant shall... organization, between the applicant and the launch site, and between the applicant and the reentry site,...

  1. Elastically deformable 3D organs for haptic surgical simulation.

    PubMed

    Webster, Roger; Haluck, Randy; Ravenscroft, Rob; Mohler, Betty; Crouthamel, Eric; Frack, Tyson; Terlecki, Steve; Sheaffer, Jeremy

    2002-01-01

    This paper describes a technique for incorporating real-time elastically deformable 3D organs in haptic surgical simulators. Our system is a physically based particle model utilizing a mass-springs-damper connectivity with an implicit predictor to speed up calculations during each time step. The solution involves repeated application of Newton's 2ndd Law of motion: F = ma using an implicit solver for numerically solving the differential equations. PMID:15458154

  2. Surgical innovation-enhanced quality and the processes that assure patient/provider safety: A surgical conundrum.

    PubMed

    Bruny, Jennifer; Ziegler, Moritz

    2015-12-01

    Innovation is a crucial part of surgical history that has led to enhancements in the quality of surgical care. This comprises both changes which are incremental and those which are frankly disruptive in nature. There are situations where innovation is absolutely required in order to achieve quality improvement or process improvement. Alternatively, there are innovations that do not necessarily arise from some need, but simply are a new idea that might be better. All change must assure a significant commitment to patient safety and beneficence. Innovation would ideally enhance patient care quality and disease outcomes, as well stimulate and facilitate further innovation. The tensions between innovative advancement and patient safety, risk and reward, and demonstrated effectiveness versus speculative added value have created a contemporary "surgical conundrum" that must be resolved by a delicate balance assuring optimal patient/provider outcomes. This article will explore this delicate balance and the rules that govern it. Recommendations are made to facilitate surgical innovation through clinical research. In addition, we propose options that investigators and institutions may use to address competing priorities. PMID:26653169

  3. 78 FR 59036 - Patient Safety Organizations: Voluntary Relinquishment From Cogent Patient Safety Organization, Inc.

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-25

    ... regarding the quality and safety of health care delivery. The Patient Safety and Quality Improvement Final... organizations whose mission and primary activity is to conduct activities to improve patient safety and the quality of health care delivery. HHS issued the Patient Safety Rule to implement the Patient......

  4. 76 FR 79192 - Patient Safety Organizations: Voluntary Relinquishment From HSMS Patient Safety Organization

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-21

    ... confidential information regarding the quality and safety of health care delivery. The Patient Safety and... conduct activities to improve patient safety and the quality of health care delivery. HHS issued the... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:...

  5. 14 CFR 431.33 - Safety organization.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Safety organization. 431.33 Section 431.33 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION LICENSING LAUNCH AND REENTRY OF A REUSABLE LAUNCH VEHICLE (RLV) Safety Review and Approval for Launch and Reentry of a...

  6. Surgical safety checklists and understanding of Never Events, in UK and Irish dental hospitals.

    PubMed

    Pemberton, M N

    2016-06-10

    Aim To identify the procedures in dental hospitals where a surgical safety checklist is used and in addition, in England, to identify the understanding of hospitals regarding patient safety incidents requiring reporting as Never Events to NHS England.Method A self-completed questionnaire survey asking about the use of checklists was distributed to 16 dental hospitals associated with undergraduate dental schools in the UK and Ireland in the summer of 2015. For hospitals in England (10), additional questions regarding their understanding of incidents to be reported as Never Events were asked.Results Thirteen hospitals replied (8 in England). All use a surgical safety checklist in an operating theatre setting. Ten use a surgical safety checklist in an outpatient setting for the extraction of teeth. There is variable use of checklists for other procedures. The majority of English hospitals thought that the reporting of a 'Never Event' was required following wrong tooth extraction in whatever setting it occurred, including general dental practice.Conclusion Surgical safety checklists are increasingly used in dental hospitals, especially for oral surgery procedures. Beyond 'wrong tooth extraction', English dental hospitals have different understandings of what other oral and dental procedures require reporting as Never Events to NHS England. PMID:27283566

  7. 75 FR 75471 - Patient Safety Organizations: Voluntary Delisting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-03

    ... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary... Safety Organization (PSO). The Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act... organizations whose mission and primary activity is to conduct activities to improve patient safety and...

  8. Parental involvement in the preoperative surgical safety checklist is welcomed by both parents and staff.

    PubMed

    Corbally, Martin T; Tierney, Eamon

    2014-01-01

    We involved the parents of paediatric patients in the first part of the three-stage WHO Surgical Safety Checklist (SSC) process. Forty-two parents took part in the study. They came to the theatre suite with their child and into the induction room. Immediately before induction of anaesthesia they were present at, and took part in, the first stage of the three-stage SSC process, confirming with staff the identity of their child, the procedure to be performed, the operating site, and the consent being adequately obtained and recorded. We asked parents and theatre staff later whether they thought that parental involvement in the SSC was beneficial to patient safety. Both parents and staff welcomed parental involvement in the WHO Surgical Safety Checklist and felt that it improved patient safety. PMID:24834075

  9. Recommendations for surgical safety checklist use in Canadian children’s hospitals

    PubMed Central

    Skarsgard, Erik D.

    2016-01-01

    Background There is ample evidence that avoidable harm occurs in patients, including children, who undergo surgical procedures. Among a number of harm mitigation strategies, the use of surgical safety checklists (SSC) is now a required organizational practice for accreditation in all North American hospitals. Although much has been written about the effects of SSC on outcomes of adult surgical patients, there is a paucity of literature on the use and role of the SSC as an enabler of safe surgery for children. Methods The Pediatric Surgical Chiefs of Canada (PSCC) advocates on behalf of all Canadian children undergoing surgical procedures. We undertook a survey of the use of SSC in Canadian children’s hospitals to understand the variability of implementation of the SSC and understand its role as both a measure and driver of patient safety and to make specific recommendations (based on survey results and evidence) for standardized use of the SSC in Canadian children’s hospitals. Results Survey responses were received from all 15 children’s hospitals and demonstrated significant variability in how the checklist is executed, how compliance is measured and reported, and whether or not use of the checklist resulted in specific instances of error prevention over a 12-month observation period. There was near unanimous agreement that use of the SSC contributed positively to the safety culture of the operating room. Conclusion Based on the survey results, the PSCC have made 5 recommendations regarding the use of the SSC in Canadian children’s hospitals. PMID:27240284

  10. Thinking in three's: changing surgical patient safety practices in the complex modern operating room.

    PubMed

    Gibbs, Verna C

    2012-12-14

    The three surgical patient safety events, wrong site surgery, retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to study. The likelihood of occurrence and the magnitude of risk for each of these surgical safety events are undefined. Many providers may never have a personal experience with one of these events and training and education on these topics are sparse. These circumstances lead to faulty thinking that a provider won't ever have an event or if one does occur the provider will intuitively know what to do. Surgeons are not preoccupied with failure and tend to usually consider good outcomes, which leads them to ignore or diminish the importance of implementing and following simple safety practices. These circumstances contribute to the persistent low level occurrence of these three events and to the difficulty in generating sufficient interest to resource solutions. Individual facilities rarely have the time or talent to understand these events and develop lasting solutions. More often than not, even the most well meaning internal review results in a new line to a policy and some rigorous enforcement mandate. This approach routinely fails and is another reason why these problems are so persistent. Vigilance actions alone have been unsuccessful so hospitals now have to take a systematic approach to implementing safer processes and providing the resources for surgeons and other stakeholders to optimize the OR environment. This article discusses standardized processes of care for mitigation of injury or outright prevention of wrong site surgery, RSI and surgical fires in an action-oriented framework illustrating the strategic elements important in each event and focusing on the responsibilities for each of the three major OR agents-anesthesiologists, surgeons and nurses. A Surgical Patient Safety Checklist is discussed that incorporates the necessary elements to

  11. Thinking in three's: Changing surgical patient safety practices in the complex modern operating room

    PubMed Central

    Gibbs, Verna C

    2012-01-01

    The three surgical patient safety events, wrong site surgery, retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to study. The likelihood of occurrence and the magnitude of risk for each of these surgical safety events are undefined. Many providers may never have a personal experience with one of these events and training and education on these topics are sparse. These circumstances lead to faulty thinking that a provider won’t ever have an event or if one does occur the provider will intuitively know what to do. Surgeons are not preoccupied with failure and tend to usually consider good outcomes, which leads them to ignore or diminish the importance of implementing and following simple safety practices. These circumstances contribute to the persistent low level occurrence of these three events and to the difficulty in generating sufficient interest to resource solutions. Individual facilities rarely have the time or talent to understand these events and develop lasting solutions. More often than not, even the most well meaning internal review results in a new line to a policy and some rigorous enforcement mandate. This approach routinely fails and is another reason why these problems are so persistent. Vigilance actions alone have been unsuccessful so hospitals now have to take a systematic approach to implementing safer processes and providing the resources for surgeons and other stakeholders to optimize the OR environment. This article discusses standardized processes of care for mitigation of injury or outright prevention of wrong site surgery, RSI and surgical fires in an action-oriented framework illustrating the strategic elements important in each event and focusing on the responsibilities for each of the three major OR agents-anesthesiologists, surgeons and nurses. A Surgical Patient Safety Checklist is discussed that incorporates the necessary elements to

  12. What Does a Hospital Survey on Patient Safety Reveal About Patient Safety Culture of Surgical Units Compared With That of Other Units?

    PubMed

    Shu, Qin; Cai, Miao; Tao, Hong-Bing; Cheng, Zhao-Hui; Chen, Jing; Hu, Yin-Huan; Li, Gang

    2015-07-01

    The objective of this study was to examine the strengths and weaknesses of surgical units as compared with other units, and to provide an opportunity to improve patient safety culture in surgical settings by suggesting targeted actions using Hospital Survey on Patient Safety Culture (HSOPSC) investigation.A Hospital Survey on Patient Safety questionnaire was conducted to physicians and nurses in a tertiary hospital in Shandong China. 12 patient safety culture dimensions and 2 outcome variables were measured.A total of 23.5% of respondents came from surgical units, and 76.5% worked in other units. The "overall perceptions of safety" (48.1% vs 40.4%, P < 0.001) and "frequency of events reported" (63.7% vs 60.7%, P = 0.001) of surgical units were higher than those of other units. However, the communication openness (38.7% vs 42.5%, P < 0.001) of surgical units was lower than in other units. Medical workers in surgical units reported more events than those in other units, and more respondents in the surgical units assess "patient safety grade" to be good/excellent. Three dimensions were considered as strengths, whereas 5 other dimensions were considered to be weaknesses in surgical units. Six dimensions have potential to aid in improving events reporting and patient safety grade. Appropriate working times will also contribute to ensuring patient safety. Medical staff with longer years of experience reported more events.Surgical units outperform the nonsurgical ones in overall perception of safety and the number of events reported but underperform in the openness of communication. Four strategies, namely deepening the understanding about patient safety of supervisors, narrowing the communication gap within and across clinical units, recruiting more workers, and employing the event reporting system and building a nonpunitive culture, are recommended to improve patient safety in surgical units in the context of 1 hospital. PMID:26166083

  13. 75 FR 57048 - Patient Safety Organizations: Voluntary Delisting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-17

    ... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary... Patient Safety of Chicagoland (CQPS) of its status as a Patient Safety Organization (PSO). The Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act), Public Law 109-41, 42 U.S.C....

  14. Attitudes and beliefs about the surgical safety checklist: Just another tick box?

    PubMed Central

    Dharampal, Navjit; Cameron, Christopher; Dixon, Elijah; Ghali, William; Quan, May Lynn

    2016-01-01

    Background Following a landmark study showing decreased morbidity and mortality after implementation of the surgical safety checklist (SSC), it has been widely adopted into perioperative policy. We explored the impact of attitudes and beliefs surrounding the SSC on its uptake in Calgary. Methods We used qualitative methodology to examine factors influencing SSC use. We performed semistructured interviews based on Rogers’ theory of diffusion of innovation. Purposive and snowball sampling were used to identify surgeons, anesthesiologists and operating room nurses from hospitals in Calgary. Data collection and analysis were based on grounded theory. Two individuals jointly analyzed data and achieved consensus on emerging themes. Results Generated themes included 1) the SSC has brought organization to previous informal perioperative checks, 2) the SSC is most helpful when it is simple, and 3) the 3 current components of the checklist are redundant. The briefing was considered the most important aspect and the debriefing the least important. Initially the SSC was difficult to implement owing to a shift in time management and perioperative culture; however, it has now assimilated into perioperative routine. Finally, though most participants agreed that the SSC might avoid some delays and complications, only a few believe there have been observable improvements to morbidity and mortality. Conclusion Although the SSC has been integrated into perioperative practice in Calgary, participants believe that previous informal checkpoints were able to circumvent most perioperative issues. Although the SSC may help with flow and equipment, participants believe it fails to show a subjective, clinically important improvement. PMID:27454839

  15. 75 FR 57281 - Patient Safety Organizations: Voluntary delisting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-20

    ... safety of health care ] delivery. The Patient Safety and Quality Improvement Final Rule (Patient Safety... patient safety and the quality of health care delivery. HHS issued the Patient Safety Rule to implement... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:......

  16. 75 FR 63498 - Patient Safety Organizations: Voluntary Delisting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-15

    ... safety of health care delivery. The Patient Safety and Quality Improvement Final Rule (Patient Safety... patient safety and the quality of health care delivery. HHS issued the Patient Safety Rule to implement... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:......

  17. Surgical Mesh

    MedlinePlus

    ... Device Safety Safety Communications Surgical Mesh: FDA Safety Communication Share Tweet Linkedin Pin it More sharing options ... Prolapse and Stress Urinary Incontinence More in Safety Communications Information About Heparin Preventing Tubing and Luer Misconnections ...

  18. 75 FR 57477 - Patient Safety Organizations: Voluntary Delisting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-21

    ... the quality and safety of health care delivery. The Patient Safety and Quality Improvement Final Rule... activities to improve patient safety and the quality of health care delivery. HHS issued the Patient Safety... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:...

  19. 75 FR 75472 - Patient Safety Organizations: Voluntary Delisting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-03

    ... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary... Group, Inc. of its status as a Patient Safety Organization (PSO). The Patient Safety and Quality... or component organizations whose mission and primary activity is to conduct activities to...

  20. 75 FR 75473 - Patient Safety Organizations: Voluntary Delisting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-03

    ... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary... Medical, Inc., of its status as a Patient Safety Organization (PSO). The Patient Safety and Quality... or component organizations whose mission and primary activity is to conduct activities to...

  1. Effectiveness in professional organizations: the impact of surgeons and surgical staff organizations on the quality of care in hospitals.

    PubMed Central

    Flood, A B; Scott, W R; Ewy, W; Forrest, W H

    1982-01-01

    In this research, we examine the relative importance of different structural units in a professional organization, the hospital, as they affect organizational effectiveness. The difficulties of measuring effectiveness in a complex professional organization are discussed, and an adjusted measure of surgical outcome is developed. Data are drawn from a prospective study of over 8,000 surgical patients treated by more than 500 surgeons in 15 hospitals throughout the nation. Two different types of analyses are presented, both indicating that hospital features have more impact on surgical outcomes than do surgeon characteristics. The second analysis assesses the relative importance of specific attributes of the hospital, surgical staff organization, and surgeon characteristics on surgical outcomes. PMID:7152960

  2. 76 FR 60495 - Patient Safety Organizations: Voluntary Relinquishment From the Patient Safety Group

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-29

    ... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From the Patient Safety Group AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS... relinquishment from The Patient Safety Group of its status as a Patient Safety Organization (PSO). The...

  3. 78 FR 17212 - Patient Safety Organizations: Voluntary Relinquishment From Universal Safety Solution PSO

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-20

    ... and primary activity is to conduct activities to improve patient safety and the quality of health care... safety of health care delivery. The Patient Safety and Quality Improvement Final Rule (Patient Safety... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:...

  4. 78 FR 40146 - Patient Safety Organizations: Voluntary Relinquishment From Northern Metropolitan Patient Safety...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-03

    ... information regarding the quality and safety of health care delivery. The Patient Safety and Quality... patient safety and the quality of health care delivery. HHS issued the Patient Safety Rule to implement... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:...

  5. [Work strain by anaesthetic gas and surgical smoke due to tissue coagulation as well as safety measures in surgical operating rooms - what the surgeon needs to know].

    PubMed

    Boeckelmann, I; Sammito, S; Meyer, F

    2013-02-01

    Exposure of the respiratory tract during surgical interventions is an important topic of occupational medicine, which has only rarely been investigated. Based on a literature search, relevant information on the possible health risk is summarised. Within the operating room, an exposure of the respiratory tract to gas (volatile anaesthetics) and aerosols (smoking gas by coagulation) can occur. This exposure needs to be considered as a potential health risk if safety measures are not sufficient. Health risks comprise possible disturbances of gravidity and fertility, neurotoxicity and cancer generation. Such health risks can be prevented with primary preventive measures and can be early recognised/diagnosed by preventive investigations of occupational medicine (secondary prevention). Safety measures are developed according to the STOP principle (substitution, technical, organisatory and personal measures). Assessment of the potential danger begins with an appropriate description of the working procedure and detection of the toxic features of the drugs and medical products, which helps to determine individual exposure and to estimate risk potential. Required occupational safety measures can be derived from this and, subsequently, the work organisation can be optimised. In addition, employees in the operating room are to be instructed about the indicated preventive mode of behaviour. Due to better implementation of the above-mentioned basic principles, introduction of novel narcotics and technological developments, potential exposure of the respiratory tract within the operating room has been reduced over the last 10 years. Thus, risks for gravidity and possible disturbances of fertility by exposure to volatile narcotics are currently assessed to be low. However, available data on health risks of the chronic exposure to smoking gases are still deficient although toxic and cancerogenic organic pyrolysis products are generated. The protection effect of modern air

  6. Organic Tanks Safety Program: Waste aging studies

    SciTech Connect

    Camaioni, D.M.; Samuels, W.D.; Lenihan, B.D.; Clauss, S.A.; Wahl, K.L.; Campbell, J.A.

    1994-11-01

    The underground storage tanks at the Hanford Complex contain wastes generated from many years of plutonium production and recovery processes, and mixed wastes from radiological degradation processes. The chemical changes of the organic materials used in the extraction processes have a direct on several specific safety issues, including potential energy releases from these tanks. This report details the first year`s findings of a study charged with determining how thermal and radiological processes may change the composition of organic compounds disposed to the tank. Their approach relies on literature precedent, experiments with simulated waste, and studies of model reactions. During the past year, efforts have focused on the global reaction kinetics of a simulated waste exposed to {gamma} radiation, the reactions of organic radicals with nitrite ion, and the decomposition reactions of nitro compounds. In experiments with an organic tank non-radioactive simulant, the authors found that gas production is predominantly radiolytically induced. Concurrent with gas generation they observe the disappearance of EDTA, TBP, DBP and hexone. In the absence of radiolysis, the TBP readily saponifies in the basic medium, but decomposition of the other compounds required radiolysis. Key organic intermediates in the model are C-N bonded compounds such as oximes. As discussed in the report, oximes and nitro compounds decompose in strong base to yield aldehydes, ketones and carboxylic acids (from nitriles). Certain aldehydes can react in the absence of radiolysis to form H{sub 2}. Thus, if the pathways are correct, then organic compounds reacting via these pathways are oxidizing to lower energy content. 75 refs.

  7. Simulation Training Improves Surgical Proficiency and Safety During Diagnostic Shoulder Arthroscopy Performed by Residents.

    PubMed

    Waterman, Brian R; Martin, Kevin D; Cameron, Kenneth L; Owens, Brett D; Belmont, Philip J

    2016-05-01

    Although virtual reality simulators have established construct validity, no studies have proven transfer of skills from a simulator to improved in vivo surgical skill. The current authors hypothesized that simulation training would improve residents' basic arthroscopic performance and safety. Twenty-two orthopedic surgery trainees were randomized into simulation or standard practice groups. At baseline testing, all of the participants performed simulator-based testing and a supervised, in vivo diagnostic shoulder arthroscopy with video recording. The simulation group subsequently received 1 hour of total instruction during a 3-month period, and the standard practice group received no simulator training. After intervention, both groups were reevaluated with simulator testing and a second recorded diagnostic shoulder arthroscopy. Two blinded, independent experts evaluated arthroscopic performance using the anatomic checklist, Arthroscopic Surgery Skill Evaluation Tool (ASSET) score, and total elapsed time. All outcome measures were compared within and between groups. After intervention, mean time required by the simulation group to complete the simulator task (30.64 seconds) was 8±1.2 seconds faster than the time required by the control group (38.64 seconds; P=.001). Probe distance (51.65 mm) was improved by 41.2±6.08 mm compared with the control (92.83 mm; P=.001). When comparing ASSET safety scores, the simulation group was competent (3.29) and significantly better than the control group (3.00; P=.005) during final arthroscopic testing. This study establishes transfer validity for an arthroscopic shoulder simulator model. Simulator training for residents in training can decrease surgical times, improve basic surgical skills, and confer greater patient safety during shoulder arthroscopy. [Orthopedics. 2016; 39(3):e479-e485.]. PMID:27135460

  8. A Targeted E-Learning Program for Surgical Trainees to Enhance Patient Safety in Preventing Surgical Infection

    ERIC Educational Resources Information Center

    McHugh, Seamus Mark; Corrigan, Mark; Dimitrov, Borislav; Cowman, Seamus; Tierney, Sean; Humphreys, Hilary; Hill, Arnold

    2010-01-01

    Introduction: Surgical site infection accounts for 20% of all health care-associated infections (HCAIs); however, a program incorporating the education of surgeons has yet to be established across the specialty. Methods: An audit of surgical practice in infection prevention was carried out in Beaumont Hospital from July to November 2009. An…

  9. 76 FR 9351 - Patient Safety Organizations: Voluntary Delisting From West Virginia Center for Patient Safety

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-17

    ... information regarding the quality and safety of health care delivery. The Patient Safety and Quality... is to conduct activities to improve patient safety and the quality of health care delivery. HHS... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:...

  10. 76 FR 71345 - Patient Safety Organizations: Voluntary Relinquishment From Emergency Medicine Patient Safety...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-17

    ... confidential information regarding the quality and safety of health care delivery. The Patient Safety and... conduct activities to improve patient safety and the quality of health care delivery. HHS issued the... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:...

  11. 76 FR 7853 - Patient Safety Organizations: Voluntary Delisting From Oregon Patient Safety Commission

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-11

    ... organizations whose mission and primary activity is to conduct activities to improve patient safety and the quality of health care delivery. HHS issued the Patient Safety Rule to implement the Patient Safety Act..., and analyze confidential information regarding the quality and safety of health care delivery....

  12. 76 FR 71345 - Patient Safety Organizations: Voluntary Relinquishment From Child Health Patient Safety...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-17

    ... confidential information regarding the quality and safety of health care delivery. The Patient Safety and... conduct activities to improve patient safety and the quality of health care delivery. HHS issued the... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:...

  13. 75 FR 75472 - Patient Safety Organizations: Voluntary Delisting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-03

    ... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary... Group (A Component of Helmet Fire, Inc. of its status as a Patient Safety Organization (PSO). The... the listing of PSOs, which are entities or component organizations whose mission and primary...

  14. Diffusion of Surgical Innovations, Patient Safety, and Minimally Invasive Radical Prostatectomy

    PubMed Central

    Parsons, J. Kellogg; Messer, Karen; Palazzi, Kerrin; Stroup, Sean; Chang, David

    2015-01-01

    IMPORTANCE Surgical innovations disseminate in the absence of coordinated systems to ensure their safe integration into clinical practice, potentially exposing patients to increased risk for medical error. OBJECTIVE To investigate associations of patient safety with the diffusion of minimally invasive radical prostatectomy (MIRP) resulting from the development of the da Vinci robot. DESIGN, SETTING, AND PARTICIPANTS A cohort study of 401 325 patients in the Nationwide Inpatient Sample who underwent radical prostatectomy during MIRP diffusion between January 1, 2003, and December 31, 2009. MAIN OUTCOMES AND MEASURES We used Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs), which measure processes of care and surgical provider performance. We estimated the prevalence of MIRP among all prostatectomies and compared PSI incidence between MIRP and open radical prostatectomy in each year during the study. We also collected estimates of MIRP incidence attributed to the manufacturer of the da Vinci robot. RESULTS Patients who underwent MIRP were more likely to be white (P = .004), have fewer comorbidities (P = .02), and have undergone surgery in higher-income areas (P = .005). The incidence of MIRP was substantially lower than da Vinci manufacturer estimates. Rapid diffusion onset occurred in 2006, when MIRP accounted for 10.4% (95% CI, 10.2-10.7) of all radical prostatectomies in the United States. In 2005, MIRP was associated with an increased adjusted risk for any PSI (adjusted odds ratio, 2.0; 95% CI, 1.1-3.7; P = .02) vs open radical prostatectomy. Stratification by hospital status demonstrated similar patterns: rapid diffusion onset among teaching hospitals occurred in 2006 (11.7%; 95% CI, 11.3-12.0), with an increased risk for PSI for MIRP in 2005 (adjusted odds ratio, 2.7; 95% CI, 1.4-5.3; P = .004), and onset among nonteaching hospitals occurred in 2008 (27.1%; 95% CI, 26.6-27.7), with an increased but nonsignificant risk for PSI in 2007

  15. Women as leaders in organized surgery and surgical education. Has the time come?

    PubMed

    Jonasson, O

    1993-06-01

    Women have entered medicine in large numbers during the past three decades, and are increasing their representation in some surgical fields at a rapid pace. Few women are found in senior roles in organized surgery or at the senior ranks of academic surgical faculty. Factors influencing this imbalance include family demands, sexism, and stereotypes that hinder the advancement of women into leadership roles. Strategies for correcting this imbalance include affirmative recruitment of women into surgery, particularly into academic surgical faculties; support systems, such as child care and adjustment of promotion and tenure timetables; mentoring; and programs of career development that emphasize skills in management as well as research and teaching. PMID:8503762

  16. [Clinical governance and continuous quality improvement in surgical organizations].

    PubMed

    Finocchiaro, G; Paparo, D; Gitto, G; Caruso, R; Parisi, A

    2009-01-01

    Recently the awareness had progressively strengthened that the main interest of health care organizations is effectiveness and appropriateness of clinical performance. They have a statutory duty to seek quality improvement through clinical governance. All health care operators are involved in clinical governance implementation, in respect of their organizational positions toward continuous quality improvement. In this way health care organizations, professionals and patients will benefit of outcomes of the change. PMID:19272236

  17. A preliminary study of patients' perceptions on the implementation of the WHO surgical safety checklist in women who had Cesarean sections.

    PubMed

    Kawano, Takashi; Tani, Megumi; Taniwaki, Miki; Ogata, Kimiyo; Yokoyama, Masataka

    2015-06-01

    The surgical safety checklist (SSCL), developed by the World Health Organization, is widely implemented by surgical staff for the improvement of their communication, teamwork, and safety culture in the operating room. However, there is no research available addressing the question of how surgical patients perceive the implementation of the SSCL. In order to address this issue, a questionnaire-based preliminary study was conducted for patients who had undergone elective Cesarean section under awake regional anesthesia. Although most participants had not been informed about the implementation of the SSCL before surgery, all of the patients were aware that the SSCL had been performed in the operating room. Over 80% of patients answered that the implementation of the SSCL could help to reduce their feelings of anxiety, tension, and fear, as well as enhance their feeling of security. Furthermore, most patients answered that they were able to understand the components as well as the purpose of the SSCL, and considered that the SSCL should be implemented. These results suggest that awake patients undergoing Cesarean section perceive the implementation of the SSCL to be a highly positive aspect of their surgical care. PMID:25374137

  18. Safety in Numbers: Progressive Implementation of a Robotics Program in an Academic Surgical Oncology Practice.

    PubMed

    King, Jonathan C; Zeh, Herbert J; Zureikat, Amer H; Celebrezze, James; Holtzman, Matthew P; Stang, Michael L; Tsung, Allan; Bartlett, David L; Hogg, Melissa E

    2016-08-01

    Background Robotic-assisted surgery has potential benefits over laparoscopy yet little has been published on the integration of this platform into complex surgical oncology. We describe the outcomes associated with integration of robotics into a large surgical oncology program, focusing on metrics of safety and efficiency. Methods A retrospective review of a prospectively maintained database of robotic procedures from July 2009 to October 2014 identifying trends in volume, operative time, complications, conversion to open, and 90-day mortality. Results Fourteen surgeons performed 1236 cases during the study period: thyroid (246), pancreas/duodenum (458), liver (157), stomach (56), colorectal (129), adrenal (38), cholecystectomy (102), and other (48). There were 38 conversions to open (3.1%), 230 complications (18.6%), and 13 mortalities (1.1%). From 2009 to 2014, operative volume increased (7 cases/month vs 24 cases/month; P < .001) and procedure time decreased (471 ± 166 vs 211 ± 140 minutes; P < .001) with statistically significant decreases for all years except 2014 when volume and time plateaued. Conversion to open decreased (12.1% vs 1.7%; P = .009) and complications decreased (48.5% vs 12.3%; P < .001) despite increasing complexity of cases performed. There were 13 deaths within 90 days (5/13 30-day mortality) and 2 (15.4%) were from palliative surgeries. Conclusions Implementation of a diverse robotic surgical oncology program utilizing multiple surgeons is safe and feasible. As operative volume increased, operative time, complications, and conversions to open decreased and plateaued at approximately 3 years. No unanticipated adverse events attributable to the introduction of this platform were observed. PMID:27130645

  19. 77 FR 11120 - Patient Safety Organizations: Voluntary Relinquishment From UAB Health System Patient Safety...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-24

    ... analyze confidential information regarding the quality and safety of health care delivery. The Patient... mission and primary activity is to conduct activities to improve patient safety and the quality of health... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:...

  20. System Safety in an IT Service Organization

    NASA Astrophysics Data System (ADS)

    Parsons, Mike; Scutt, Simon

    Within Logica UK, over 30 IT service projects are considered safetyrelated. These include operational IT services for airports, railway infrastructure asset management, nationwide radiation monitoring and hospital medical records services. A recent internal audit examined the processes and documents used to manage system safety on these services and made a series of recommendations for improvement. This paper looks at the changes and the challenges to introducing them, especially where the service is provided by multiple units supporting both safety and non-safety related services from multiple locations around the world. The recommendations include improvements to service agreements, improved process definitions, routine safety assessment of changes, enhanced call logging, improved staff competency and training, and increased safety awareness. Progress is reported as of today, together with a road map for implementation of the improvements to the service safety management system. A proposal for service assurance levels (SALs) is discussed as a way forward to cover the wide variety of services and associated safety risks.

  1. Improving patient safety in cardiothoracic surgery: an audit of surgical handover in a tertiary center

    PubMed Central

    Bauer, Natasha Johan

    2016-01-01

    Background Novel research has revealed that the relative risk of death increased by 10% and 15% for admissions on a Saturday and Sunday, respectively. With an imminent threat of 7-day services in the National Health Service, including weekend operating lists, handover plays a pivotal role in ensuring patient safety is paramount. This audit evaluated the quality, efficiency, and safety of surgical handover of pre- and postoperative cardiothoracic patients in a tertiary center against guidance on Safe Handover published by the Royal College of Surgeons of England and the British Medical Association. Methods A 16-item questionnaire prospectively audited the nature, time and duration of handover, patient details, operative history and current clinical status, interruptions during handover, and difficulties cross-covering specialties over a month. Results Just over half (52%) of the time, no handover took place. The majority of handovers (64%) occurred over the phone; two-thirds of these were uninterrupted. All handovers were less than 10 minutes in duration. About half of the time, the senior house officer had previously met the registrar involved in the handover, but the overwhelming majority felt it would facilitate the handover process if they had prior contact. Patient details handed over 100% of the time included name, ward, and current clinical diagnosis. A third of the time, the patient’s age, responsible consultant, and recent operations or procedures were not handed over, potentially compromising future management due to delays and lack of relevant information. Perhaps the most revealing result was that the overall safety of handover was perceived to be five out of ten, with ten being very safe with no aspects felt to impact negatively on optimal patient care. Conclusion These findings were presented to the department, and a handover proforma was implemented. Recommendations included the need for a new face-to-face handover. A reaudit will evaluate the

  2. GSFC Safety and Mission Assurance Organization

    NASA Technical Reports Server (NTRS)

    Kelly, Michael P.

    2010-01-01

    This viewgraph presentation reviews NASA Goddard Space Flight Center's approach to safety and mission assurance. The contents include: 1) NASA GSFC Background; 2) Safety and Mission Assurance Directorate; 3) The Role of SMA-D and the Technical Authority; 4) GSFC Mission assurance Requirements; 5) GSFC Systems Review Office (SRO); 6) GSFC Supply Chain Management Program; and 7) GSFC ISO9001/AS9100 Status Brief.

  3. Using patient safety organizations to further clinical integration.

    PubMed

    Gosfield, Alice G

    2014-01-01

    This article addresses why in the current context of driving toward improved value, physician groups ought to consider developing a patient safety evaluation system and reporting to a patient safety organization. The fundamental challenge to physicians to succeed in the future is to clinically integrate within their own practices, standardizing to the evidence base, and measuring their performance. In addition, it is increasingly clear that the physician office practice is a source of patient safety issues. The Patient Safety and Quality Improvement Act provides two powerful protections for data that will support and bolster clinical integration and patient safety. The protections and how to deploy them are presented. PMID:24873122

  4. Mathematical simulation of an urgent surgical pathology of abdominal cavity organs

    NASA Astrophysics Data System (ADS)

    Shorokh, G. P.; Savel'Ev, V. A.; Lobachenko, M. B.; Lobachenko, N. I.

    1996-05-01

    We developed a technology of creating computer models of acute surgical diseases of abdominal cavity organs on the basis of the pattern recognition theory and multifactor analysis of traditional symptomatology. We employed an algorithm consisting of the method of evaluating vectors and method of patterns that rests on special rules of extended production for solving medicinal problems.

  5. Clinical Characteristics and Surgical Safety in Patients with Acute Appendicitis Aged over 80

    PubMed Central

    Moon, Kwon Sang; Jung, Yong Hwan; Lee, Eun Hun

    2012-01-01

    Purpose The aim of this study was to evaluate the clinical characteristics and treatment outcomes, including surgical safety, in patients over 80 years of age who underwent an appendectomy. Methods This study involved 160 elderly patients who underwent an appendectomy for acute appendicitis: 28 patients over 80 years old and 132 patients between 65 and 79 years old. Results The rate of positive rebound tenderness was significantly higher in the over 80 group (P = 0.002). Comparisons of comorbidity, diagnostic tool and delay in surgical treatment between the two groups were not statistically different. American Society of Anesthesiologists score was significantly higher in the over 80 group than in the 65 to 79 group (2.4 ± 0.5 vs. 1.6 ± 0.5; P < 0.00005). Comparisons of operative times and use of drainage between the two groups were not statistically different. In the pathologic findings, periappendiceal abscess was more frequent in the over 80 group (P = 0.011). No significant differences existed between the two groups when comparing the results of gas out and the time to liquid diet, but the postoperative hospital stay was significantly longer in the over 80 group (P = 0.001). Among the postoperative complications, pulmonary complication was significantly higher in the over 80 group (P = 0.005). However, operative mortality was zero in each group. Conclusion In case of suspicious appendicitis in elderly patients, efforts should be made to use aggressive diagnostic intervention, do appropriate surgery and prevent pulmonary complications especially in patients over 80 years of age. PMID:22606649

  6. Automating Safety for a More Efficient Organization

    ERIC Educational Resources Information Center

    Folkman, John; Strasburger, Tom

    2009-01-01

    Despite the challenges of understaffing, unfunded legislative mandates, and tight budgets, district support services departments are still expected to meet school systems' myriad noncurriculum-related needs. But the very nature of these services, even when they are focused on school safety and security, is so diverse and labor-intensive that…

  7. Surgical briefings, checklists, and the creation of an environment of safety in the neurosurgical intraoperative magnetic resonance imaging suite.

    PubMed

    Rahmathulla, Gazanfar; Recinos, Pablo F; Traul, David E; Avitsian, Rafi; Yunak, Marisa; Harper, Nicole T; Barnett, Gene H; Recinos, Violette Renard

    2012-11-01

    Technological advances have made it possible to seamlessly integrate modern neuroimaging into the neurosurgical operative environment. This integration has introduced many new applications improving surgical treatments. One major addition to the neurosurgical armamentarium is intraoperative navigation and MRI, enabling real-time use during surgery. In the 1970s, the American College of Radiology issued safety guidelines for diagnostic MRI facilities. Until now, however, no such guidelines existed for the MRI-integrated operating room, which is a high-risk zone requiring standardized protocols to ensure the safety of both the patient and the operating room staff. The forces associated with the strong 1.5- and 3.0-T magnets used for MRI are potent and hazardous, creating distinct concerns regarding safety, infection control, and image interpretation. Authors of this paper provide an overview of the intraoperative MRI operating room, safety considerations, and a series of checklists and protocols for maintaining safety in this zero tolerance environment. PMID:23116092

  8. Safety culture in the nuclear versus non-nuclear organization

    SciTech Connect

    Haber, S.B.; Shurberg, D.A.

    1996-10-01

    The importance of safety culture in the safe and reliable operation of nuclear organizations is not a new concept. The greatest barriers to this area of research are twofold: (1) the definition and criteria of safety culture for a nuclear organization and (2) the measurement of those attributes in an objective and systematic fashion. This paper will discuss a proposed resolution of those barriers as demonstrated by the collection of data across nuclear and non-nuclear facilities over a two year period.

  9. Safety zone for surgical access in the middle third of the clavicle: study on cadavers☆

    PubMed Central

    Ribeiro, Fabiano Rebouças; de Marchi Bosi Porto, Fernanda; Silva, Marcio Vieira Sanches; Tenor Junior, Antonio Carlos; da Costa, Miguel Pereira; Filardi, Cantidio

    2015-01-01

    Objective The aim of this study was to establish a neurovascular safety zone for surgical access in the middle third of the clavicle, by means of dissection on cadavers. Methods Twenty shoulders were dissected in 10 cadavers, with deep dissection of the middle third of the clavicle. The following structures were identified: subclavian vein, upper trunk of the brachial plexus (anterior and posterior divisions) and suprascapular nerve. These structures were marked out in order to measure their distances from the most proximal point of the middle third of the clavicle. Results The mean distances from the middle third of the clavicle to the suprascapular nerve, subclavian vein, upper trunk, anterior division of the upper trunk and posterior division of the upper trunk were respectively, for the right side: 15.92 cm, 10.77 cm, 23.68 cm, 14.60 cm and 15.42 cm; and for the left side: 12.69 cm; 9.82 cm; 22.19 cm; 12.16 cm and 13.46 cm. Conclusion There was a statistical difference in the distances to the suprascapular nerve and anterior division of the upper trunk, in comparing between the right and left sides. The closest neurovascular structures to the middle third of the clavicle were the suprascapular nerve and subclavian vein. PMID:26229929

  10. Development of a surgical site infection (SSI) surveillance system, calculation of SSI rates and specification of important factors affecting SSI in a digestive organ surgical department.

    PubMed

    Kimura, Koji; Sawa, Akihiro; Akagi, Shinji; Kihira, Kenji

    2007-06-01

    We have developed an original system to conduct surgical site infection (SSI) surveillance. This system accumulates SSI surveillance information based on the National Nosocomial Infections Surveillance (NNIS) System and the Japanese Nosocomial Infections Surveillance (JNIS) System. The features of this system are as follows: easy input of data, high generality, data accuracy, SSI rate by operative procedure and risk index category (RIC) can be promptly calculated and compared with the current NNIS SSI rate, and the SSI rates and accumulated data can be exported electronically. Using this system, we monitored 798 patients in 24 operative procedure categories in the Digestive Organs Surgery Department of Mazda Hospital, Mazda Motor Corporation, from January 2004 through December 2005. The total number and rate of SSI were 47 and 5.89%, respectively. The SSI rates of 777 patients were calculated based on 15 operative procedure categories and Risk Index Categories (RIC). The highest SSI rate was observed in the rectum surgery of RIC 1 (30%), followed by the colon surgery of RIC3 (28.57%). About 30% of the isolated infecting bacteria were Enterococcus faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli. Using quantification theory type 2, the American Society of Anesthesiology score (4.531), volume of hemorrhage under operation (3.075), wound classification (1.76), operation time (1.352), and history of diabetes (0.989) increased to higher ranks as factors for SSI. Therefore, we evaluated this system as a useful tool in safety control for operative procedures. PMID:17760267

  11. Safety assessment and detection methods of genetically modified organisms.

    PubMed

    Xu, Rong; Zheng, Zhe; Jiao, Guanglian

    2014-01-01

    Genetically modified organisms (GMOs), are gaining importance in agriculture as well as the production of food and feed. Along with the development of GMOs, health and food safety concerns have been raised. These concerns for these new GMOs make it necessary to set up strict system on food safety assessment of GMOs. The food safety assessment of GMOs, current development status of safety and precise transgenic technologies and GMOs detection have been discussed in this review. The recent patents about GMOs and their detection methods are also reviewed. This review can provide elementary introduction on how to assess and detect GMOs. PMID:25342147

  12. When Operating on Dead People Saves Lives: Benefits of Surgical Organ Donor Intensivists.

    PubMed

    Long, Kristin; Talley, Cynthia; Yarrison, Rebecca B; Bernard, Andrew

    2015-01-01

    Solid organ transplantation has emerged as a life-saving treatment for many patients suffering from end-stage organ failure. Organs have been successfully recovered after a variety of aggressive interventions. We propose that decompressive laparotomy, when clinically indicated, should be considered in the aggressive resuscitation of potential organ donors. A thorough literature review examining aggressive interventions on potential organ donors was conducted after experience with a unique case at this institution. Articles were reviewed for the types of interventions performed as well as the time frame in relation to organ donation. In our case, several ethical issues were raised when considering decompressive laparotomy in a patient pronounced dead by neurologic criteria. We propose that having a surgical intensivist involved in the management of potential donors will further increase the salvage rate, as more invasive resuscitation options are possible. PMID:26078909

  13. Infective Endocarditis: Diagnosis, Treatment, and Mortality, as Related to Surgical Timing and Infectious Organism

    PubMed Central

    Attum, Abdulla A.; Masri, Zahi; Yared, Sam F.; Johnson, G. Stephan; Girardet, Roland; Lansing, Allan M.

    1987-01-01

    To evaluate the timing of surgical treatment in infective endocarditis and to determine the relationship between the risk of mortality and the species of infectious organism, we reviewed a consecutive series of 65 cases involving patients with infective endocarditis who had been treated over a 17-year period. The patients included 41 males and 24 females, who ranged in age from 6 to 85 years (mean, 39.3 years). Forty-five had native valve endocarditis, 14 had prosthetic valve endocarditis, and six had endocarditis associated with congenital heart defects. Fifty-two patients underwent valve replacement, which was associated with an overall operative mortality of 19%. Those who underwent valve replacement during the early active stage (first 3 weeks) of infection had a higher mortality rate than those who had surgery either during the late active stage (second 3 weeks) of infection or after 6 weeks of antibiotic therapy. S. aureus and Pseudomonas organisms were responsible for the most deaths. On the basis of this study, we recommend that, when cardiovascular function permits, patients who are hemodynamically stable and free of emboli should receive 4 to 6 weeks of antibiotic therapy before undergoing surgical treatment. In contrast, patients with high-risk organisms are more likely to survive if subjected to early surgical intervention. (Texas Heart Institute Journal 1987; 14:401-410) Images PMID:15227297

  14. Implementation of a Surgical Safety Checklist: Interventions to Optimize the Process and Hints to Increase Compliance

    PubMed Central

    Sendlhofer, Gerald; Mosbacher, Nina; Karina, Leitgeb; Kober, Brigitte; Jantscher, Lydia; Berghold, Andrea; Pregartner, Gudrun; Brunner, Gernot; Kamolz, Lars Peter

    2015-01-01

    Background A surgical safety checklist (SSC) was implemented and routinely evaluated within our hospital. The purpose of this study was to analyze compliance, knowledge of and satisfaction with the SSC to determine further improvements. Methods The implementation of the SSC was observed in a pilot unit. After roll-out into each operating theater, compliance with the SSC was routinely measured. To assess subjective and objective knowledge, as well as satisfaction with the SSC implementation, an online survey (N = 891) was performed. Results During two test runs in a piloting unit, 305 operations were observed, 175 in test run 1 and 130 in test run 2. The SSC was used in 77.1% of all operations in test run 1 and in 99.2% in test run 2. Within used SSCs, completion rates were 36.3% in test run 1 and 1.6% in test run 2. After roll-out, three unannounced audits took place and showed that the SSC was used in 95.3%, 91.9% and 89.9%. Within used SSCs, completion rates decreased from 81.7% to 60.6% and 53.2%. In 2014, 164 (18.4%) operating team members responded to the online survey, 160 of which were included in the analysis. 146 (91.3%) consultants and nursing staff reported to use the SSC regularly in daily routine. Conclusion These data show that the implementation of new tools such as the adapted WHO SSC needs constant supervision and instruction until it becomes self-evident and accepted. Further efforts, consisting mainly of hands-on leadership and training are necessary. PMID:25658317

  15. [Report of a tour of the surgical centers in the United States organized by the Japanese Association for Operative Medicine].

    PubMed

    Mizutani, Koh; Nagase, Kiyoshi; Shinomiya, Satoshi; Orita, Mutsuko

    2011-11-01

    We, 4 authors, visited 4 surgical centers in the United States last year on a tour sponsored by the Japanese Association for Operative Medicine. The surgical center of each hospital we visited aimed to contribute to the hospital not only in terms of financial strength but also in the creation of a unique hospital brand value by increasing the number of surgeries compared with previous years as much as possible. The role of surgical centers in the United States was comparable with what we consider an ideal center in Japan. We also found that management of the surgical centers by directors who are specialized anesthesiologists is well organized to promote efficiency with respect to organization, utilities and human resources, and realized that these anesthesiologists must know how to manage the team members and the organization of the surgical centers to improve the quality of operative medicine. PMID:22175177

  16. Product Safety, It's No Accident. A Consumer Product Safety Monthly Planning Guide for Community Organizations.

    ERIC Educational Resources Information Center

    Consumer Product Safety Commission, Washington, DC.

    A consumer product safety monthly planning guide for community organizations is provided. The material is organized into suggested monthly topics with seasonal emphasis. Each section highlights selected information about how to identify potential hazards associated with categories of products. Each section also includes recommendaitons of ways to…

  17. Characterization strategy report for the organic safety issues

    SciTech Connect

    Goheen, S.C.; Campbell, J.A.; Fryxell, G.E.

    1997-08-01

    This report describes a logical approach to resolving potential safety issues resulting from the presence of organic components in hanford tank wastes. The approach uses a structured logic diagram (SLD) to provide a pathway for quantifying organic safety issue risk. The scope of the report is limited to selected organics (i.e., solvents and complexants) that were added to the tanks and their degradation products. The greatest concern is the potential exothermic reactions that can occur between these components and oxidants, such as sodium nitrate, that are present in the waste tanks. The organic safety issue is described in a conceptual model that depicts key modes of failure-event reaction processes in tank systems and phase domains (domains are regions of the tank that have similar contents) that are depicted with the SLD. Applying this approach to quantify risk requires knowing the composition and distribution of the organic and inorganic components to determine (1) how much energy the waste would release in the various domains, (2) the toxicity of the region associated with a disruptive event, and (3) the probability of an initiating reaction. Five different characterization options are described, each providing a different level of quality in calculating the risks involved with organic safety issues. Recommendations include processing existing data through the SLD to estimate risk, developing models needed to link more complex characterization information for the purpose of estimating risk, and examining correlations between the characterization approaches for optimizing information quality while minimizing cost in estimating risk.

  18. The use of report cards and outcome measurements to improve the safety of surgical care: the American College of Surgeons National Surgical Quality Improvement Program

    PubMed Central

    Maggard-Gibbons, Melinda

    2014-01-01

    Postoperative adverse events occur all too commonly and contribute greatly to our large and increasing healthcare costs. Surgeons, as well as hospitals, need to know their own outcomes in order to recognise areas that need improvement before they can work towards reducing complications. In the USA, the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) collects clinical data that provide benchmarks for providers and hospitals. This review summarises the history of ACS NSQIP and its components, and describes the evidence that feeding outcomes back to providers, along with real-time comparisons with other hospital rates, leads to quality improvement, better patient outcomes, cost savings and overall improved patient safety. The potential harms and limitations of the program are discussed. PMID:24748371

  19. Safety and Efficacy of Laparoscopic Access in a Surgical Training Program.

    PubMed

    Johnson, Timothy G; Hooks, William B; Adams, Ashley; Hope, William W

    2016-02-01

    Our study evaluated outcomes of laparoscopic access in a surgical residency program and identified variables associated with adverse outcomes. Following IRB approval, we reviewed prospectively collected data from consecutive laparoscopic surgeries from a single surgeon August 2008 to November 2011. Descriptive statistics were generated, and successful and unsuccessful access techniques were compared using the t test, Fisher exact test, and χ test of independence, with P<0.05 considered significant. Five hundred consecutive laparoscopic surgeries were evaluated; the average patient age was 47 years and 55% of patients were female. The most common procedures included laparoscopic cholecystectomy (29%), laparoscopic ventral hernia (15%), laparoscopic appendectomy (12%), laparoscopic colon/small bowel (11%), and laparoscopic inguinal hernia (10%). Successful laparoscopic access was obtained in 98% of patients. The most common access techniques were umbilical stalk technique (57%) and Veress followed by optical trocar technique (29%). The complication rate was 7% and included multiple access attempts in 3.4%, attending physician having to take over access in 1.6%, bleeding/solid organ injury in 0.8%, insufflating peritoneum in 0.6%, and bowel injury in 0.2%. There was a significant relationship between entry technique and failure rate. Open cutdown away from umbilicus had a higher failure rate than other techniques (P=0.0002). There was also a significant relationship between type of surgery and failure rate of technique, with laparoscopic ventral hernia and laparoscopic small bowel cases having the highest failure rate (P=0.005). We observed no difference in success rate based on age, sex, race, previous surgery, and resident training level (P>0.05). Laparoscopic access using appropriate techniques can be safely performed in a residency training program. Laparoscopic ventral hernia and small bowel procedures for obstruction can be difficult cases to obtain access, and

  20. Procedure-specific Surgical Site Infection Incidence Varies Widely within Certain National Healthcare Safety Network Surgery Groups

    PubMed Central

    Saeed, Mohammed J; Dubberke, Erik R; Fraser, Victoria J; Olsen, Margaret A

    2015-01-01

    Background The National Healthcare Safety Network (NHSN) classifies surgical procedures into 40 categories. The objective of this study was to determine surgical site infection (SSI) incidence for clinically defined subgroups within 5 heterogeneous NHSN surgery categories. Methods This is a retrospective cohort study using the longitudinal State Inpatient Database. We identified 5 groups of surgical procedures (amputation; biliary, liver and pancreas [BILI]; breast; colon and hernia) using ICD-9-CM procedure codes in community hospitals in California, Florida and New York from January 2009 through September 2011 in persons aged ≥18 years. Each of these 5 categories was classified to more specific surgical procedures within the group. 90-day SSI rates were calculated using ICD-9-CM diagnosis codes. Results There were 62,901 amputation, 33,358 BILI, 72,058 breast, 125,689 colon and 85,745 hernia surgeries in 349,298 people. 90-day SSI rates varied significantly within each of the 5 subgroups. Within the BILI category, bile duct, pancreas and laparoscopic liver procedures had SSI rates of 7.2%, 17.2%, and 2.2%, respectively (p<0.0001 for each) compared to open liver procedures (11.1% SSI). Conclusion 90-day SSI rates varied widely within certain NHSN categories. Risk adjustment for specific surgery type is needed in order to make valid comparisons between hospitals. PMID:25818024

  1. Safety and Tumor-specificity of Cetuximab-IRDye800 for Surgical Navigation in Head and Neck Cancer

    PubMed Central

    Rosenthal, Eben L; Warram, Jason M; de Boer, Esther; Chung, Thomas K; Korb, Melissa L; Brandwein-Gensler, Margie; Strong, Theresa V; Schmalbach, Cecelia E; Morlandt, Anthony B; Agarwal, Garima; Hartman, Yolanda E; Carroll, William R; Richman, Joshua S; Clemons, Lisa K; Nabell, Lisle M; Zinn, Kurt R

    2016-01-01

    Purpose Positive margins dominate clinical outcomes after surgical resections in most solid cancer types including head and neck squamous cell carcinoma. Unfortunately, surgeons remove cancer in the same manner they have for a century with complete dependence on subjective tissue changes to identify cancer in the operating room. To effect change, we hypothesize that epidermal growth factor receptor (EGFR) can be targeted for safe and specific real-time localization of cancer. Experimental design A dose escalation study of cetuximab conjugated to IRDye800 was performed in patients (n=12) undergoing surgical resection of squamous cell carcinoma arising in the head and neck. Safety and pharmacokinetic data were obtained out to 30 days post-infusion. Multi-instrument fluorescence imaging was performed in the operating room and in surgical pathology. Results There were no grade 2 or higher adverse events attributable to cetuximab-IRDye800. Fluorescence imaging with an intraoperative, wide-field device successfully differentiated tumor from normal tissue during resection with an average tumor-to-background ratio of 5.2 in the highest dose range. Optical imaging identified opportunity for more precise identification of tumor during the surgical procedure and during the pathological analysis of tissues ex-vivo. Fluorescence levels positively correlated with EGFR levels. Conclusion We demonstrate for the first time that commercially available antibodies can be fluorescently labeled and safely administered to humans to identify cancer with sub-millimeter resolution, which has the potential to improve outcomes in clinical oncology. PMID:25904751

  2. Resolution of Hanford tanks organic complexant safety issue

    SciTech Connect

    Kirch, N.W.

    1998-05-14

    The Hanford Site tanks have been assessed for organic complexant reaction hazards. The results have shown that most tanks contain insufficient concentrations of TOC to support a propagating reaction. It has also been shown that those tanks where the TOC concentration approaches levels of concern, degradation of the organic complexants to less energetic compounds has occurred. The results of the investigations have been documented. The residual organic complexants in the Hanford Site waste tanks do not present a safety concern for long-term storage.

  3. 76 FR 60494 - Patient Safety Organizations: Voluntary Relinquishment From HPI-PSO

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-29

    ... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary... Organization (PSO). The Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act), Public Law 109... Patient Safety Act authorizes the listing of PSOs, which are entities or component organizations...

  4. Project plan for resolution of the organic waste tank safety issues at the Hanford Site

    SciTech Connect

    Meacham, J.E.

    1996-10-03

    A multi-year project plan for the Organic Safety Project has been developed with the objective of resolving the organic safety issues associated with the High Level Waste (HLW) in Hanford`s single-shell tanks (SSTS) and double-shell tanks (DSTs). The objective of the Organic Safety Project is to ensure safe interim storage until retrieval for pretreatment and disposal operations begins, and to resolve the organic safety issues by September 2001. Since the initial identification of organics as a tank waste safety issue, progress has been made in understanding the specific aspects of organic waste combustibility, and in developing and implementing activities to resolve the organic safety issues.

  5. Nuclear Criticality Safety Organization training implementation. Revision 4

    SciTech Connect

    Carroll, K.J.; Taylor, R.G.; Worley, C.A.

    1997-05-19

    The Nuclear Criticality Safety Organization (NCSO) is committed to developing and maintaining a staff of qualified personnel to meet the current and anticipated needs in Nuclear Criticality Safety (NCS) at the Oak Ridge Y-12 Plant. This document provides a listing of the roles and responsibilities of NCSO personnel with respect to training and details of the Training Management System (TMS) programs, Mentoring Checklists and Checksheets, as well as other documentation utilized to implement the program. This Training Implementation document is applicable to all technical and managerial NCSO personnel, including temporary personnel, sub-contractors and/or LMES employees on loan to the NCSO, who are in a qualification program.

  6. 76 FR 7854 - Patient Safety Organizations: Voluntary Delisting From Quality Excellence, Inc./PSO

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-11

    ... safety of health care delivery. The Patient Safety and Quality Improvement Final Rule (Patient Safety... patient safety and the quality of health care delivery. HHS issued the Patient Safety Rule to implement... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:......

  7. 76 FR 7855 - Patient Safety Organizations: Voluntary Delisting From Community Medical Foundation for Patient...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-11

    ... safety of health care delivery. The Patient Safety and Quality Improvement Final Rule (Patient Safety... patient safety and the quality of health care delivery. HHS issued the Patient Safety Rule to implement... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:......

  8. [Genetically modified organisms: a new threat to food safety].

    PubMed

    Spendeler, Liliane

    2005-01-01

    This article analyzes all of the food safety-related aspects related to the use of genetically modified organisms into agriculture and food. A discussion is provided as to the uncertainties related to the insertion of foreign genes into organisms, providing examples of unforeseen, undesirable effects and of instabilities of the organisms thus artificially fabricated. Data is then provided from both official agencies as well as existing literature questioning the accuracy and reliability of the risk analyses as to these organisms being harmless to health and discusses the almost total lack of scientific studies analyzing the health safety/dangerousness of transgenic foods. Given all these unknowns, other factors must be taken into account, particularly genetic contamination of the non-genetically modified crops, which is now starting to become widespread in some parts of the world. Not being able of reversing the situation in the even of problems is irresponsible. Other major aspects are the impacts on the environment (such as insects building up resistances, the loss of biodiversity, the increase in chemical products employed) with indirect repercussions on health and/or future food production. Lastly, thoughts for discussion are added concerning food safety in terms of food availability and food sovereignty, given that the transgenic seed and related agrochemicals market is currently cornered by five large-scale transnational companies. The conclusion entails an analysis of biotechnological agriculture's contribution to sustainability. PMID:15913060

  9. Qualitative study exploring surgical team members' perception of patient safety in conflict-ridden Eastern Democratic Republic of Congo

    PubMed Central

    Labat, Francoise; Sharma, Anjali

    2016-01-01

    Objective To identify potential barriers to patient safety (PS) interventions from the perspective of surgical team members working in an operating theatre in Eastern Democratic Republic of Congo (DRC). Design In-depth interviews were conducted and analysed using qualitative content analysis. Setting Governmental referral teaching hospital in Eastern DRC. Participants We purposively selected 2–4 national and expatriate surgical team members from each specialisation. Of the 31 eligible surgical health workers (HWs), 17 volunteered to be interviewed. Results Economics issues affected PS throughout the entire health system, from human resources and hospital management, to access to healthcare for patients. Surgical team members seemed embedded in a paternalistic organisational structure and blame culture accompanied by perceived inefficient support services and low salaries. The armed conflict did not only worsen these system failures, it also carried direct threats to patients and HWs, and resulted in complex indirect consequences compromising PS. The increased corruption within health organisations, and population impoverishment and substance abuse among health staff adversely altered safe care. Simultaneously, HWs’ reported resilience and resourcefulness to address barrier to PS. Participants had varying views on external aid depending on its relevance. Conclusions The complex links between war and PS emphasise the importance of a comprehensive approach including occupational health to strengthen HWs' resilience, external clinical audits to limit corruption, and educational programmes in PS to support patient-centred care and address blame culture. Finally, improvement of equity in the health financing system seems essential to ensure access to healthcare and safe perioperative outcomes for all. PMID:27113232

  10. Surgical innovation and safety: femoroacetabular impingement and the IDEAL collaborative framework.

    PubMed

    Lee, Cara Beth

    2016-07-01

    Operative treatment of femoroacetabular impingement (FAI) is a relatively new, yet rapidly expanding surgical innovation. Although the practice of surgery is inherently innovative, there is no clear distinction between minor technical variation and true modification that warrants testing. This raises important questions about how new procedures should be evaluated before being broadly disseminated. The IDEAL Collaborative is a consortium that promotes safe and responsible translation of research into clinical practice. The collaborative has delineated the typical stages of evolution of new interventional technologies, and the type of study designs appropriate for each stage. This report examines the surgical treatment of FAI as a case study of the IDEAL framework and discusses both missed and future opportunities for critical assessment. PMID:27583143

  11. Surgical innovation and safety: femoroacetabular impingement and the IDEAL collaborative framework

    PubMed Central

    Lee, Cara Beth

    2016-01-01

    Operative treatment of femoroacetabular impingement (FAI) is a relatively new, yet rapidly expanding surgical innovation. Although the practice of surgery is inherently innovative, there is no clear distinction between minor technical variation and true modification that warrants testing. This raises important questions about how new procedures should be evaluated before being broadly disseminated. The IDEAL Collaborative is a consortium that promotes safe and responsible translation of research into clinical practice. The collaborative has delineated the typical stages of evolution of new interventional technologies, and the type of study designs appropriate for each stage. This report examines the surgical treatment of FAI as a case study of the IDEAL framework and discusses both missed and future opportunities for critical assessment. PMID:27583143

  12. A Phase II Randomized Controlled Trial Comparing Safety, Procedure Time, and Cost of the PrePex™ Device to Forceps Guided Surgical Circumcision in Zimbabwe

    PubMed Central

    Tshimanga, Mufuta; Mangwiro, Tonderayi; Mugurungi, Owen; Xaba, Sinokuthemba; Murwira, Munyaradzi; Kasprzyk, Danuta; Montaño, Daniel E.; Nyamukapa, Daisy; Tambashe, Basile; Chatikobo, Pesanai; Gundidza, Patricia; Gwinji, Gerald

    2016-01-01

    Background The World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS promote MC (male circumcision) as a key HIV prevention strategy where HIV prevalence and incidence are high and MC prevalence is low. In Zimbabwe, to achieve the 1.26 million circumcisions needed to be performed by 2015 to achieve optimal MC coverage, a new approach was needed. The primary objective of the current trial was to assess the performance (safety, procedure time, and cost) of the PrePex device compared to forceps-guided surgical circumcision. Methods and Findings This Phase II, randomized, open-label trial in Zimbabwe involved healthy, non-circumcised adult male volunteers who were randomly assigned to the PrePex device (n = 160) or surgical arm (n = 80). Three doctors and 4 nurses, all certified on both circumcision methods, performed the procedures. The PrePex device procedure involves a plastic ring with a rubber O-ring that necrotizes the foreskin to facilitate easy and minimally invasive removal. Total procedure time was the primary endpoint. Adverse event (AE) data were also gathered for 90 days post-procedure. All 80 participants in the surgical arm and 158 participants in the PrePex arm achieved complete circumcision. The total procedure time for the PrePex device was approximately one-third of the total surgical procedure (4.8 minutes, Standard Deviation [SD]: 1.2 versus 14.6 minutes; SD: 4.2; p<0.00001). There were 2 AEs for 2 participants (rate of 1.3%, 95% Confidence Interval: 0.0025–4.53%), which were resolved with simple intervention. The AEs were device related, including 1 case of pain leading to device removal and 1 case of removal of the device. Conclusions The trial supports previous studies’ conclusions that the PrePex procedure is safe, quick, easy to apply, and effective in terms of procedure time as an alternative to traditional surgical circumcision. The PrePex device has great potential for use in overburdened health systems and in

  13. 78 FR 70560 - Patient Safety Organizations: Voluntary Relinquishment From GE-PSO

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-26

    ... health care delivery. The Patient Safety and Quality Improvement Final Rule (Patient Safety Rule), 42 CFR... activities to improve patient safety and the quality of health care delivery. HHS issued the Patient Safety... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:......

  14. 78 FR 17212 - Patient Safety Organizations: Voluntary Relinquishment From QAISys, Inc.

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-20

    ... of health care delivery. The Patient Safety and Quality Improvement Final Rule (Patient Safety Rule... activities to improve patient safety and the quality of health care delivery. HHS issued the Patient Safety... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:......

  15. 77 FR 65892 - Patient Safety Organizations: Voluntary Relinquishment From PDR Secure, LLC

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-31

    ... of health care delivery. The Patient Safety and Quality Improvement Final Rule (Patient Safety Rule... activities to improve patient safety and the quality of health care delivery. HHS issued the Patient Safety... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:......

  16. 78 FR 6819 - Patient Safety Organizations: Voluntary Relinquishment From the BREF PSO

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-31

    ... of health care delivery. The Patient Safety and Quality Improvement Final Rule (Patient Safety Rule... activities to improve patient safety and the quality of health care delivery. HHS issued the Patient Safety... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:......

  17. 78 FR 70561 - Patient Safety Organizations: Delisting for Cause for Leadership Triad

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-26

    ... patient safety and the quality of health care delivery. HHS issued the Patient Safety and Quality... confidential information regarding the quality and safety of health care delivery. The Patient Safety Rule, 42... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Delisting...

  18. 77 FR 42738 - Patient Safety Organizations: Voluntary Relinquishment From the Coalition for Quality and Patient...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-20

    ... confidential information regarding the quality and safety of health care delivery. The Patient Safety and... activities to improve patient safety and the quality of health care delivery. HHS issued the Patient Safety... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:......

  19. Organizing safety: conditions for successful information assurance programs.

    PubMed

    Collmann, Jeff; Coleman, Johnathan; Sostrom, Kristen; Wright, Willie

    2004-01-01

    Organizations must continuously seek safety. When considering computerized health information systems, "safety" includes protecting the integrity, confidentiality, and availability of information assets such as patient information, key components of the technical information system, and critical personnel. "High Reliability Theory" (HRT) argues that organizations with strong leadership support, continuous training, redundant safety mechanisms, and "cultures of high reliability" can deploy and safely manage complex, risky technologies such as nuclear weapons systems or computerized health information systems. In preparation for the Health Insurance Portability and Accountability Act (HIPAA) of 1996, the Office of the Assistant Secretary of Defense (Health Affairs), the Offices of the Surgeons General of the United States Army, Navy and Air Force, and the Telemedicine and Advanced Technology Research Center (TATRC), US Army Medical Research and Materiel Command sponsored organizational, doctrinal, and technical projects that individually and collectively promote conditions for a "culture of information assurance." These efforts include sponsoring the "P3 Working Group" (P3WG), an interdisciplinary, tri-service taskforce that reviewed all relevant Department of Defense (DoD), Miliary Health System (MHS), Army, Navy and Air Force policies for compliance with the HIPAA medical privacy and data security regulations; supporting development, training, and deployment of OCTAVE(sm), a self-directed information security risk assessment process; and sponsoring development of the Risk Information Management Resource (RIMR), a Web-enabled enterprise portal about health information assurance. PMID:15650526

  20. 76 FR 60495 - Patient Safety Organizations: Voluntary Relinquishment From Illinois PSO

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-29

    ... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary... from the Illinois PSO of its status as a Patient Safety Organization (PSO). The Patient Safety and... PSOs, which are entities or component organizations whose mission and primary activity is to...

  1. Surgical debriefing: a reliable roadmap to completing the patient safety cycle.

    PubMed

    Zuckerman, Scott L; France, Daniel J; Green, Cain; Leming-Lee, Susie; Anders, Shilo; Mocco, J

    2012-11-01

    Morbidity and mortality due to preventable medical errors are a disastrous reality in medicine. Debriefing, a process that allows individuals to discuss team performance in a constructive, supportive environment, has been linked to improved performance in various medical and surgical fields, including improvements in specific procedures, teamwork and communication, and error identification. However, the neurosurgical literature on this topic is limited. The authors review the debriefing literature in the field of medicine, with a specific emphasis on the operating room, and they report their own institutional experience with a debriefing module, from invention to pilot implementation, at Vanderbilt University Medical Center. The authors share the challenges and lessons learned from their quality improvement project. The field of neurosurgery would undoubtedly benefit from embracing debriefing, as its potential has been established in other medical specialties and can serve as a valuable role in immediately learning from mistakes. The authors hope that their colleagues can learn from this experience and improve their own. PMID:23116099

  2. Forum for debate: Safety of allogeneic blood transfusion alternatives in the surgical/critically ill patient.

    PubMed

    Muñoz Gómez, M; Bisbe Vives, E; Basora Macaya, M; García Erce, J A; Gómez Luque, A; Leal-Noval, S R; Colomina, M J; Comin Colet, J; Contreras Barbeta, E; Cuenca Espiérrez, J; Garcia de Lorenzo Y Mateos, A; Gomollón García, F; Izuel Ramí, M; Moral García, M V; Montoro Ronsano, J B; Páramo Fernández, J A; Pereira Saavedra, A; Quintana Diaz, M; Remacha Sevilla, Á; Salinas Argente, R; Sánchez Pérez, C; Tirado Anglés, G; Torrabadella de Reinoso, P

    2015-12-01

    In recent years, several safety alerts have questioned or restricted the use of some pharmacological alternatives to allogeneic blood transfusion in established indications. In contrast, there seems to be a promotion of other alternatives, based on blood products and/or antifibrinolytic drugs, which lack a solid scientific basis. The Multidisciplinary Autotransfusion Study Group and the Anemia Working Group España convened a multidisciplinary panel of 23 experts belonging to different healthcare areas in a forum for debate to: 1) analyze the different safety alerts referred to certain transfusion alternatives; 2) study the background leading to such alternatives, the evidence supporting them, and their consequences for everyday clinical practice, and 3) issue a weighted statement on the safety of each questioned transfusion alternative, according to its clinical use. The members of the forum maintained telematics contact for the exchange of information and the distribution of tasks, and a joint meeting was held where the conclusions on each of the items examined were presented and discussed. A first version of the document was drafted, and subjected to 4 rounds of review and updating until consensus was reached (unanimously in most cases). We present the final version of the document, approved by all panel members, and hope it will be useful for our colleagues. PMID:26183121

  3. Effective Date of Requirement for Premarket Approval for Surgical Mesh for Transvaginal Pelvic Organ Prolapse Repair. Final order.

    PubMed

    2016-01-01

    The Food and Drug Administration (FDA or the Agency) is issuing a final order to require the filing of a premarket approval application (PMA) or notice of completion of a product development protocol (PDP) for surgical mesh for transvaginal pelvic organ prolapse (POP) repair. PMID:26742183

  4. Organic Tanks Safety Program: Advanced organic analysis FY 1996 progress report

    SciTech Connect

    1996-09-01

    Major focus during the first part of FY96 was to evaluate using organic functional group concentrations to screen for energetics. Fourier transform infrared and Raman spectroscopy would be useful screening tools for determining C-H and COO- organic content in tank wastes analyzed in a hot cell. These techniques would be used for identifying tanks of potential safety concern that may require further analysis. Samples from Tanks 241-C-106 and -C-204 were analyzed; the major organic in C-106 was B2EHPA and in C-204 was TBP. Analyses of simulated wastes were also performed for the Waste Aging Studies Task; organics formed as a result of degradation were identified, and the original starting components were monitored quantitatively. Sample analysis is not routine and required considerable methods adaptation and optimization. Several techniques have been evaluated for directly analyzing chelator and chelator fragments in tank wastes: matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and liquid chromatography with ultraviolet detection using Cu complexation. Although not directly funded by the Tanks Safety Program, the success of these techniques have implications for both the Flammable Gas and Organic Tanks Safety Programs.

  5. Safety of instrumentation and fusion at the time of surgical debridement for spinal infection.

    PubMed

    Talia, Adrian J; Wong, Michael L; Lau, Hui C; Kaye, Andrew H

    2015-07-01

    The present study aims to assess the results of single-stage instrumentation and fusion at the time of surgical debridement of spinal infections; vertebral osteomyelitis or epidural abscess. Nine patients with spinal infection were treated with instrumentation and fusion after radical debridement in a single-stage operation. Predisposing factors and comorbidities, pain, American Spinal Injury Association motor scores, primary pathologies, microbiology and perioperative markers were recorded. Seven patients with pyogenic and two with tuberculous spinal infection were encountered; the most common pathogen was Staphylococcus aureus. Five patients were predisposed to infection because of diabetes mellitus. Duration of antibiotic therapy lasted up to 12 months. Six patients had thoracic infection, two lumbar and one cervical. No post-operative complications were encountered. There was a significant reduction in pain scores compared to pre-operatively. All patients with neurological deficits improved post-operatively. Despite introduction of hardware, no patients had a recurrence of their infection in the 12 month follow up period. Single-stage debridement and instrumentation appeared to be a safe and effective method of managing spinal infections. The combination of debridement and fusion has the dual benefit of removing a focus of infection and stabilising the spine. The current series confirms that placing titanium cages into an infected space is safe in a majority of patients. Stabilisation and correction of spinal deformity reduces pain, aids neurologic recovery and improves quality of life. The small patient population and retrospective nature limit the present study. PMID:25911501

  6. Establishment and use of surgical rat models for assessment of organ specific in vivo clearance.

    PubMed

    Vestergaard, Bill

    2016-06-01

    Knowledge of clearance plays a key role in the development of new drug entities, especially in the development of improved analogues for treatment of chronic conditions. Improved pharmacokinetic properties can be used to increase dosing interval and thereby improve patient compliance. This will lead to improved treatment outcome or decreased risk of treatment failure when treating chronic conditions. Therefore, animal models for assessment of organ-specific clearance are of great value in preclinical drug development. These models can be used to obtain insights into the relative importance of a clearance organ and thereby guide drug design of new analogues in early drug discovery. The current PhD project was undertaken to explore surgical in vivo models, which could be used in the assessment of the relative importance of major clearance organs. It was the aim of the PhD project to establish and validate both a nephrectomy model and a hepatectomy model as tools to investigate relative importance of renal and hepatic clearance. Furthermore, the project aim was to investigate renal clearance of rFVIIa and rhGH using a nephrectomy model in rats. The thesis is composed of a short theoretical background, a literature review, two papers based on experimental work as well as experimental work not included in the papers. Chapter one is an introduction with the specific aims and hypotheses. The chapters from two to five contain theoretical background of the clearance concept, anatomical and physiological description of clearance organs and a brief overview of potential clearance models including in vivo models. Chapters six through nine highlight the experimental work with the results obtained during the PhD project. Lastly, the chapters from ten to twelve contain a general discussion, conclusion and perspectives of the current thesis. Paper I "Nephrectomized and hepatectomized animal models as tools in preclinical pharmacokinetics" provides a literature review of animal

  7. 76 FR 79192 - Patient Safety Organizations: Voluntary Relinquishment From the Georgia Hospital Association...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-21

    ... organizations whose mission and primary activity is to ] conduct activities to improve patient safety and the quality of health care delivery. HHS issued the Patient Safety Rule to implement the Patient Safety Act..., and analyze confidential information regarding the quality and safety of health care delivery....

  8. 78 FR 70560 - Patient Safety Organizations: Voluntary Relinquishment From Morgridge Institute for Research PSO

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-26

    ... and primary activity is to conduct activities to improve patient safety and the quality of health care... quality and safety of health care delivery. The Patient Safety and Quality Improvement Final Rule (Patient... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:...

  9. 76 FR 7853 - Patient Safety Organizations: Voluntary Delisting From Apollo Publishing, Inc.

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-11

    ... confidential information regarding the quality and safety of health care delivery. The Patient Safety and... is to conduct activities to improve patient safety and the quality of health care delivery. HHS... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:...

  10. 78 FR 6819 - Patient Safety Organizations: Voluntary Relinquishment From The Connecticut Hospital Association...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-31

    ... confidential information regarding the quality and safety of health care delivery. The Patient Safety and... conduct activities to improve patient safety and the quality of health care delivery. HHS issued the... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:...

  11. 76 FR 7853 - Patient Safety Organizations: Voluntary Delisting From HealthDataPSO

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-11

    ... collect, aggregate, and analyze confidential information regarding the quality and safety of health care... quality of health care delivery. HHS issued the Patient Safety Rule to implement the Patient Safety Act... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:...

  12. An investigation of safety climate in OHSAS 18001-certified and non-certified organizations.

    PubMed

    Ghahramani, Abolfazl

    2016-09-01

    Many organizations worldwide have implemented Occupational Health and Safety Assessment Series (OHSAS) 18001 in their premises because of the assumed positive effects of this standard on safety. Few studies have analyzed the effect of the safety climate in OHSAS 18001-certified organizations. This case-control study used a new safety climate questionnaire to evaluate three OHSAS 18001-certified and three non-certified manufacturing companies in Iran. Hierarchical regression indicated that the safety climate was influenced by OHSAS implementation and by safety training. Employees who received safety training had better perceptions of the safety climate and its dimensions than other respondents within the certified companies. This study found that the implementation of OHSAS 18001 does not guarantee improvement of the safety climate. This study also emphasizes the need for high-quality safety training for employees of the certified companies to improve the safety climate. PMID:27108658

  13. Bilateral deep brain stimulation of the fornix for Alzheimer's disease: surgical safety in the ADvance trial.

    PubMed

    Ponce, Francisco A; Asaad, Wael F; Foote, Kelly D; Anderson, William S; Rees Cosgrove, G; Baltuch, Gordon H; Beasley, Kara; Reymers, Donald E; Oh, Esther S; Targum, Steven D; Smith, Gwenn S; Lyketsos, Constantine G; Lozano, Andres M

    2016-07-01

    OBJECT This report describes the stereotactic technique, hospitalization, and 90-day perioperative safety of bilateral deep brain stimulation (DBS) of the fornix in patients who underwent DBS for the treatment of mild, probable Alzheimer's disease (AD). METHODS The ADvance Trial is a multicenter, 12-month, double-blind, randomized, controlled feasibility study being conducted to evaluate the safety, efficacy, and tolerability of DBS of the fornix in patients with mild, probable AD. Intraoperative and perioperative data were collected prospectively. All patients underwent postoperative MRI. Stereotactic analyses were performed in a blinded fashion by a single surgeon. Adverse events (AEs) were reported to an independent clinical events committee and adjudicated to determine the relationship between the AE and the study procedure. RESULTS Between June 6, 2012, and April 28, 2014, a total of 42 patients with mild, probable AD were treated with bilateral fornix DBS (mean age 68.2 ± 7.8 years; range 48.0-79.7 years; 23 men and 19 women). The mean planned target coordinates were x = 5.2 ± 1.0 mm (range 3.0-7.9 mm), y = 9.6 ± 0.9 mm (range 8.0-11.6 mm), z = -7.5 ± 1.2 mm (range -5.4 to -10.0 mm), and the mean postoperative stereotactic radial error on MRI was 1.5 ± 1.0 mm (range 0.2-4.0 mm). The mean length of hospitalization was 1.4 ± 0.8 days. Twenty-six (61.9%) patients experienced 64 AEs related to the study procedure, of which 7 were serious AEs experienced by 5 patients (11.9%). Four (9.5%) patients required return to surgery: 2 patients for explantation due to infection, 1 patient for lead repositioning, and 1 patient for chronic subdural hematoma. No patients experienced neurological deficits as a result of the study, and no deaths were reported. CONCLUSIONS Accurate targeting of DBS to the fornix without direct injury to it is feasible across surgeons and treatment centers. At 90 days after surgery, bilateral fornix DBS was well tolerated by patients with

  14. Attitudes towards the surgical safety checklist and factors associated with its use: A global survey of frontline medical professionals☆

    PubMed Central

    Vohra, Ravinder S.; Cowley, Jonathan B.; Bhasin, Neeraj; Barakat, Hashem M.; Gough, Michael J.

    2015-01-01

    Background The Surgical Safety Checklist (SSC) has been shown to reduce perioperative errors and complications and its implementation is recommended by the World Health Organisation (WHO). However, it is unknown how widely this intervention is used. We investigated attitudes and factors associated with use of WHO SSC in frontline medical professionals across the globe using a survey distributed through social networks. Methods A survey of usage and opinions regarding the SSC was posted on the Facebook and Twitter pages of a not-for-profit surgical news website for one month (March 2013). Respondents were grouped into four groups based on their country's Gross National Income: high, upper middle, lower middle and low income. Univariate and multivariate analyses were performed to investigate how different factors were associated with the use of the SSC. Results 6269 medical professionals from 69 countries responded to the survey: most respondents were from lower middle (47.4%) countries, followed by: high (35.0%), upper middle (14.6%), and low (3.0%) income countries. In total, 57.5% reported that they used the WHO SSC perioperatively. Fewer respondents used the WHO SSC in upper middle, lower middle and low income countries (LMICs) compared to high income countries (43.5% vs. 83.5%, p < 0.001). Female (61.3% vs. 56.4% males, p = 0.001), consultant surgeons (59.6% vs. 53.2% interns, p < 0.001) and working in university hospitals (61.4% vs. 53.7% non-university hospitals, p < 0.001) were more likely to use the SSC. Believing the SSC was useful, did not work or caused delays was independently associated with the respondents reported use of the SSC (OR 1.22 95% CI 1.07–1.39; OR 0.47 95% CI 0.36–0.60; OR 0.64 95% CI 0.53–0.77, respectively). Conclusion This study suggests the use of the WHO SSC is variable across countries, especially in LMICs where it has the most potential to improve patient safety. Critical appraisal of the documented benefits of the WHO

  15. Efficiency and safety of surgical intervention to patients with Non-Cystic Fibrosis bronchiectasis: a meta-analysis

    PubMed Central

    Fan, Li-Chao; Liang, Shuo; Lu, Hai-Wen; Fei, Ke; Xu, Jin-Fu

    2015-01-01

    No quantitative systematic review was found to report the efficiency and safety of surgical resection in the management of non-cystic fibrosis (non-CF) bronchiectasis. We therefore conducted a meta-analysis to assess the effects of operative intervention to patients with non-CF bronchiectasis. PubMed, the Cochrane library and Web of Science databases were searched up to July 8th, 2015. The pooled mortality from 34 studies recruiting 4788 patients was 1.5% (95% CI, 0.9–2.5%). The pooled morbidity from 33 studies consisting of 4583 patients was 16.7% (95% CI, 14.8–18.6%). The pooled proportion of patients from 35 studies, consisting of 4614 patients who were free of symptoms was 66.5% (95% CI, 61.3–71.7%) after surgery. The summary proportion of patients from 35 articles including 4279 participants who were improved was 27.5% (95% CI, 22.5–32.5%), and 9.1% (95% CI, 7.3–11.5%) showed no clinical improvement. In conclusion, our analysis indicated that lung resection in the management of non-CF bronchiectasis is associated with significant improvements in symptoms, low risk of mortality and acceptable morbidity. PMID:26627202

  16. Thermal effects of white light illumination during microsurgery: clinical pilot study on the application safety of surgical microscopes

    NASA Astrophysics Data System (ADS)

    Hibst, Raimund; Saal, David; Russ, Detlef; Kunzi-Rapp, Karin; Kienle, Alwin; Stock, Karl

    2010-07-01

    Modern operating microscopes offer high power illumination to ensure optimal visualization, but can also cause thermal damage. The aim of our study is to quantify the thermal effects in vivo and discuss conditions for safe use. In a pilot study on volunteers, we measured the temperature at the skin surface during microscope illumination, including the influence of anaesthesia and the effects of staining, draping, or moistening of the skin. Irradiation within the limit given by safety regulations (200 mW/cm2) results in skin surface temperature of 43 °C. Higher intensities (forearm 335 mW/cm2, back 250 mW/cm2) are tolerated, resulting in reversible hyperaemia. At a very high illumination intensity (750 mW/cm2), pain occurs within 30 s at temperatures of 46 °C+/-1 °C (hand and forearm), and 43 °C+/-2 °C (back), respectively. Anaesthesia has no distinct effect on the temperature, whereas staining and drapes result in much higher temperatures (>100 °C). Moistening at practicable flow rates can reduce temperature efficiently when combined with a light absorbing and water absorbent drape. In conclusion, surgeons must be aware that surgical microscope illumination without protective means can cause skin temperatures to rise much above pain threshold, which in our study serves as a (conservative) benchmark for potential damage.

  17. The process and results of departmental specific safety surveys for health care organizations. Successful program.

    PubMed

    Meittunen, E; Snyder, B; Meyer, M

    2001-04-01

    1. Meeting compliance and accreditation standards can be challenging for any organization, especially in the health care setting. Safety surveys can play a strategic role in proactively preparing for such events. 2. Implementing department specific safety surveys offers a tailored approach to monitoring and addressing the occupational safety issues that occur within each department. 3. Safety surveys are a method for assessing and monitoring the environment and employee training needs, and for driving safety decisions. 4. Safety in the workplace must be a shared and continuous responsibility among employees. A formal safety survey process instilling a culture of responsibility and "buy in" by all employees is necessary. PMID:11760523

  18. 78 FR 12065 - Patient Safety Organizations: Delisting for Cause for Independent Data Safety Monitoring, Inc.

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-21

    ... whose mission and primary activity is to conduct activities to improve patient safety and the quality of health care delivery. HHS issued the Patient Safety and Quality Improvement Final Rule (Patient Safety..., aggregate, and analyze confidential information regarding the quality and safety of health care...

  19. Intraocular Lens-Shell Technique: Adjustment of the Surgical Procedure Leads to Greater Safety When Treating Dense Nuclear Cataracts

    PubMed Central

    Chen, Weirong; Qu, Bo; Zhang, Xinyu; Lin, Zhuoling; Chen, Jingjing; Liu, Yizhi

    2014-01-01

    Objective To compare the efficacy and safety of the intraocular lens (IOL)-shell procedure versus conventional phacoemulsification for the surgical treatment of dense cataracts. Methods Eighty eyes with dense nuclear cataracts were enrolled in a prospective, randomized controlled study. Patients were assigned to two groups. In Group I, the IOL was traditionally implanted after all nuclear fragments were completely removed, and in Group II, the IOL was innovatively implanted in the bag before the last residual nuclear fragment was removed. This novel adjusted surgical procedure, named the “IOL-shell technique”, features use of the IOL as a protective barrier rather than simply as a refractive alternative, and it is conceptually different from the traditional step-by-step procedure. Clinical examinations, including uncorrected visual acuity, central corneal thickness (CCT), temporal clear corneal incision thickness and corneal endothelial cell density, were carried out. Results The inter-group difference in temporal corneal thickness was found to be of no statistical significance at any of the visits. Compared to eyes in Group I, those in Group II were shown to have significantly less corneal endothelial cell loss on both the 7th and 30th day following surgery. At 7 days after surgery, the mean corneal endothelial cell loss in Group II was 10.29%, compared to 14.37% in Group I (P<0.05). The mean endothelial cell loss measured on postoperative day 30 was 16.88% in Group II compared to 23.32% in Group I (P<0.05). On the 1st day after surgery, the mean CCT of eyes in Group II was significantly smaller compared to Group I (Group I vs. Group II: 19.42% vs. 13.50%, P<0.05). Conclusions Compared to conventional phacoemulsification, the IOL-shell technique was shown to be a relatively safer procedure without compromised efficiency for dense cataracts, and it caused less corneal endothelial cell loss and milder postoperative corneal edema (Clinical Trials Identifier: NCT

  20. Advanced organic analysis and analytical methods development: FY 1995 progress report. Waste Tank Organic Safety Program

    SciTech Connect

    Wahl, K.L.; Campbell, J.A.; Clauss, S.A.

    1995-09-01

    This report describes the work performed during FY 1995 by Pacific Northwest Laboratory in developing and optimizing analysis techniques for identifying organics present in Hanford waste tanks. The main focus was to provide a means for rapidly obtaining the most useful information concerning the organics present in tank waste, with minimal sample handling and with minimal waste generation. One major focus has been to optimize analytical methods for organic speciation. Select methods, such as atmospheric pressure chemical ionization mass spectrometry and matrix-assisted laser desorption/ionization mass spectrometry, were developed to increase the speciation capabilities, while minimizing sample handling. A capillary electrophoresis method was developed to improve separation capabilities while minimizing additional waste generation. In addition, considerable emphasis has been placed on developing a rapid screening tool, based on Raman and infrared spectroscopy, for determining organic functional group content when complete organic speciation is not required. This capability would allow for a cost-effective means to screen the waste tanks to identify tanks that require more specialized and complete organic speciation to determine tank safety.

  1. Feasibility and safety of on table extubation after corrective surgical repair of tetralogy of Fallot in a developing country: A case series

    PubMed Central

    Akhtar, Mohammad Irfan; Hamid, Mohammad; Anwar-Ul-Haq; Minai, Fauzia; Rehman, Naveed

    2015-01-01

    Fast-track extubation is an established safe practice in pediatric congenital heart disease (CHD) surgical patients. On table extubation (OTE) in acyanotic CHD surgical patients is well established with validated safety profile. This practice is not yet reported in tetralogy of Fallot (TOF) cardiac surgical repair patients in developing countries. Evidence suggests that TOF total correction patients should be extubated early, as positive pressure ventilation has a negative impact on right ventricular function and the overall increase in post-TOF repair complications such as low cardiac output state and arrhythmias. The objective of the case series was to determine the safety and feasibility of OTE in elective TOF total correction cardiac surgical patients with an integrated team approach. To the best of our knowledge, this is the first reported case series. A total of 8 elective male and female TOF patients were included. Standard anesthetic, surgical and perfusion techniques were used in these procedures. All patients were extubated in the operating room safely without any complications with the exception of one patient who continued to bleed for 3 h of postextubation at 2–3 ml/kg/h which was managed with transfusion of fresh frozen plasma at 15 mL/kg, packed red blood cells 10 mL/kg and bolus of transamine at 20 mg/kg. Apart from better surgical and bypass techniques, the most important factor leading to successful OTE was an excellent analgesia. On the basis of the case series, it is suggested to extubate selected TOF cardiac surgery repair patients on table safely with integrated multidisciplinary approach. PMID:25849700

  2. Feasibility and safety of on table extubation after corrective surgical repair of tetralogy of Fallot in a developing country: a case series.

    PubMed

    Akhtar, Mohammad Irfan; Hamid, Mohammad; Minai, Fauzia; Rehman, Naveed

    2015-01-01

    Fast-track extubation is an established safe practice in pediatric congenital heart disease (CHD) surgical patients. On table extubation (OTE) in acyanotic CHD surgical patients is well established with validated safety profile. This practice is not yet reported in tetralogy of Fallot (TOF) cardiac surgical repair patients in developing countries. Evidence suggests that TOF total correction patients should be extubated early, as positive pressure ventilation has a negative impact on right ventricular function and the overall increase in post-TOF repair complications such as low cardiac output state and arrhythmias. The objective of the case series was to determine the safety and feasibility of OTE in elective TOF total correction cardiac surgical patients with an integrated team approach. To the best of our knowledge, this is the first reported case series. A total of 8 elective male and female TOF patients were included. Standard anesthetic, surgical and perfusion techniques were used in these procedures. All patients were extubated in the operating room safely without any complications with the exception of one patient who continued to bleed for 3 h of postextubation at 2-3 ml/kg/h which was managed with transfusion of fresh frozen plasma at 15 mL/kg, packed red blood cells 10 mL/kg and bolus of transamine at 20 mg/kg. Apart from better surgical and bypass techniques, the most important factor leading to successful OTE was an excellent analgesia. On the basis of the case series, it is suggested to extubate selected TOF cardiac surgery repair patients on table safely with integrated multidisciplinary approach. PMID:25849700

  3. [EXPERIENCE OF RELAPAROTOMY APPLICATION IN SURGICAL TREATMENT OF THE ABDOMINAL CAVITY ORGANS DISEASES].

    PubMed

    Malyk, S V; Podlesnyi, V I; Lavrenko, D O; Ksyonz, I V

    2015-10-01

    During 2011 - 2014 yrs in Surgical Clinic of The First City Clinic (Poltava) a relaparotomy was performed in 127 patients. There was established, that relaparotomy constitutes the only one procedure for such life threatening states, as intraabdominal bleeding, ileus in a decompensation stage, eventration, progressing peritonitis, abdominal compartment syndrome stages III - IV. The rate of relaparotomy application after performance of urgent operative interventions is bigger than after planned operations (ratio 4:1). Individual estimation of a state and choice of optimal surgical tactics during primary and secondary operative interventions are needed to improve the results of treatment. PMID:26946667

  4. Community Organizations' Involvement in School Safety Planning: Does It Make a Difference in School Violence?

    ERIC Educational Resources Information Center

    Patton, Joy D.

    2011-01-01

    This study examines the relationship between school violence and involvement of community organizations in school safety planning. The study is a secondary analysis of data from the School Survey on Crime and Safety 2003-2004 (U.S. Department of Education, Institute of Education Sciences, 2006). This survey collects data on crime and safety from…

  5. 77 FR 25179 - Patient Safety Organizations: Expired Listing for Medkinetics, LLC

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-27

    ... mission and primary activity is to conduct activities to improve patient safety and the quality of health..., aggregate, and analyze confidential information regarding the quality and safety of health care delivery... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Expired...

  6. 76 FR 7854 - Patient Safety Organizations: Voluntary Delisting From Lumetra PSO

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-11

    ... mission and primary activity is to conduct activities to improve patient safety and the quality of health... analyze confidential information regarding the quality and safety of health care delivery. The Patient... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:...

  7. Using the Job Demands-Resources model to investigate risk perception, safety climate and job satisfaction in safety critical organizations.

    PubMed

    Nielsen, Morten Birkeland; Mearns, Kathryn; Matthiesen, Stig Berge; Eid, Jarle

    2011-10-01

    Using the Job Demands-Resources model (JD-R) as a theoretical framework, this study investigated the relationship between risk perception as a job demand and psychological safety climate as a job resource with regard to job satisfaction in safety critical organizations. In line with the JD-R model, it was hypothesized that high levels of risk perception is related to low job satisfaction and that a positive perception of safety climate is related to high job satisfaction. In addition, it was hypothesized that safety climate moderates the relationship between risk perception and job satisfaction. Using a sample of Norwegian offshore workers (N = 986), all three hypotheses were supported. In summary, workers who perceived high levels of risk reported lower levels of job satisfaction, whereas this effect diminished when workers perceived their safety climate as positive. Follow-up analyses revealed that this interaction was dependent on the type of risks in question. The results of this study supports the JD-R model, and provides further evidence for relationships between safety-related concepts and work-related outcomes indicating that organizations should not only develop and implement sound safety procedures to reduce the effects of risks and hazards on workers, but can also enhance other areas of organizational life through a focus on safety. PMID:21534979

  8. Simultaneous “hybrid” percutaneous coronary intervention and minimally invasive surgical bypass grafting: Feasibility, safety, and clinical outcomes

    PubMed Central

    Reicher, Barry; Poston, Robert S.; Mehra, Mandeep R.; Joshi, Ashish; Odonkor, Patrick; Kon, Zachary; Reyes, Peter A.; Zimrin, David A.

    2009-01-01

    Surgical and percutaneous coronary artery intervention revascularization are traditionally considered isolated options. A simultaneous hybrid approach may allow an opportunity to match the best strategy for a particular anatomic lesion. Concerns regarding safety and feasibility of such an approach exist. We examined the safety, feasibility, and early outcomes of a simultaneous hybrid revascularization strategy (minimally invasive direct coronary bypass grafting of the left anterior descending [LAD] artery and drug-eluting stent [DES] to non-LAD lesions) in 13 patients with multivessel coronary artery disease that underwent left internal mammary artery to LAD minimally invasive direct coronary bypass performed through a lateral thoracotomy, followed by stenting of non-LAD lesions, in a fluoroscopy-equipped operating room. Assessment of coagulation parameters was also undertaken. Inhospital and postdischarge outcomes of these patients were compared to a group of 26 propensity score matched parallel controls that underwent standard off-pump coronary artery bypass. Baseline characteristics were similar in both groups. All hybrid patients were successfully treated with DES and no inhospital mortality occurred in either group. Hybrid patients had a shorter length of stay (3.6 ± 1.5 vs 6.3 ± 2.3 days, P < .0001) and intubation times (0.5 ± 1.3 vs 11.7 ± 9.6 hours, P < .02). Despite aggressive anticoagulation and confirmed platelet inhibition, hybrid patients had less blood loss (581 ± 402 vs 1242 ± 941 mL, P < .05) and decreased transfusions (0.33 ± 0.49 vs 1.47 ± 1.53 U, P < .01). Six-month angiographic vessel patency and major adverse cardiac events were similar in the hybrid and off-pump coronary artery bypass groups. A simultaneous hybrid approach consisting of minimally invasive coronary artery bypass grafting with left internal mammary artery to LAD combined with revascularization of the remaining coronary targets using percutaneous coronary artery

  9. The Gap between Individual Perception and Compliance: A Qualitative Follow-Up Study of the Surgical Safety Checklist Application

    PubMed Central

    Sendlhofer, Gerald; Lumenta, David Benjamin; Leitgeb, Karina; Kober, Brigitte; Jantscher, Lydia; Schanbacher, Monika; Berghold, Andrea; Pregartner, Gudrun; Brunner, Gernot; Tax, Christa; Kamolz, Lars Peter

    2016-01-01

    Background “The Surgical Safety Checklist (SSC) is important, but we don’t use it adequately” is a well-suited statement that reflects the SSC's application in hospitals. Our aim was to follow up on our initial study on compliance (2014) by analysing differences between individual perception and compliance with the SSC. Methods We conducted a follow-up online survey to assess healthcare professionals’ individual perception of, as well as satisfaction and compliance with the SSC three years following its thorough implementation. Results 171 (19.5%) of 875 operating team members completed the online survey. 99.4% confirmed using the SSC. Self-estimated subjective knowledge about the intention of the checklist was high, whereas objective knowledge was moderate, but improved as compared to 2014. According to an independent audit the SSC was used in 93.1% of all operations and among the SSCs used the completion rate was 57.2%. The use of the SSC was rated as rather easy [median (IQR): 7 (6–7)], familiar [7 (6–7)], generally important [7 (7–7)], and good for patients [7 (6–7)] as well as for employees [7 (7–7)]. Only comfort of use was rated lower [6 (5–7)]. Conclusion There is a gap between individual perception and actual application of the SSC. Despite healthcare professionals confirming the importance of the SSC, compliance was moderate. The introduction of SSCs in the health care sector remains a constant challenge and requires continuous re-evaluation as well as a sensible integration into existing workflows in hospitals. PMID:26925579

  10. Resistance to synthetic blood penetration of National Institute for Occupational Safety and Health-approved N95 filtering facepiece respirators and surgical N95 respirators

    PubMed Central

    Rengasamy, Samy; Sbarra, Deborah; Nwoko, Julian; Shaffer, Ronald

    2015-01-01

    Background Surgical N95 filtering facepiece respirators (FFRs), certified by the National Institute for Occupational Safety and Health (NIOSH) as a respirator and cleared by the Food and Drug Administration (FDA) as a surgical mask, are often used to protect from the inhalation of infectious aerosols and from splashes/sprays of body fluids in health care facilities. A shortage of respirators can be expected during a pandemic. The availability of surgical N95 FFRs can potentially be increased by incorporating FDA clearance requirements in the NIOSH respirator approval process. Methods Fluid resistance of NIOSH-approved N95 FFRs, and FDA-cleared surgical N95 FFRs and surgical masks was tested using the ASTM F1862 method at 450 and 635 cm/sec velocities and compared with the results from a third-party independent laboratory. Blood penetration through different layers of filter media of masks were also analyzed visually. Results Four N95 FFR models showed no test failures at both velocities. The penetration results obtained in the NIOSH laboratory were comparable to those from the third-party independent laboratory. The number of respirator samples failing the test increased with increasing test velocity. Conclusions The results indicate that several NIOSH-approved N95 FFR models would likely pass FD clearance requirements for resistance to synthetic blood penetration. PMID:26231551

  11. 77 FR 38294 - Patient Safety Organizations: Delisting for Cause for Medical Informatics

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-27

    ... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Delisting for Cause for Medical Informatics AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS. ACTION: Notice of Delisting. SUMMARY: AHRQ has delisted Medical Informatics as a Patient Safety Organization...

  12. [Achievements and challenges in implementing the surgical checklist in a pediatric hospital].

    PubMed

    Dackiewicz, Nora; Viteritti, Laura; Marciano, Beatriz; Bailez, Marcela; Merino, Patricia; Bortolato, Diana; Jaichenko, André; Seminara, Rodolfo; Amarilla, Analía

    2012-12-01

    Patient safety in the operating room is a topic of universal concern. Several studies support the existence of a high percentage of complications and a high mortality rate in surgical procedures (0.5 to 5%). The World Health Organization (WHO) has proposed the implementation of surgical check list in order to improve patient safety in the operating room. In Hospital Garrahan, 9600 surgeries and surgical anesthesia for more than 8000 studies and other invasive procedures are performed per year. WHO checklist adaptation and implementation was considered an institutional priority. We describe difficulties and solutions in implementing the surgical checklist. Surgical team involvement in project planning and development was essential. PMID:23224308

  13. 76 FR 74788 - Patient Safety Organizations: Voluntary Relinquishment From HealthWatch, Inc.

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-01

    ...AHRQ has accepted a notification of voluntary relinquishment from HealthWatch, Inc. of its status as a Patient Safety Organization (PSO). The Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act), Public Law 109-41, 42 U.S.C. 299b-21--b-26, provides for the formation of PSOs, which collect, aggregate, and analyze confidential information regarding the quality and safety of......

  14. [A surgical safety checklist implementation: experience of a start-up phase of a collaborative project in hospitals of Catalonia, Spain].

    PubMed

    Secanell, Mariona; Orrego, Carola; Vila, Miquel; Vallverdú, Helena; Mora, Núria; Oller, Anna; Bañeres, Joaquim

    2014-07-01

    Surgical patient safety is a priority in the national and international quality healthcare improvement strategies. The objective of the study was to implement a collaborative intervention with multiple components and to evaluate the impact of the patient surgical safety checklist (SSC) application. This is a prospective, longitudinal multicenter study with a 7-month follow-up period in 2009 based on a collaborative intervention for the implementation of a 24 item-SSC distributed in 3 different stages (sign in, time out, sign out) for its application to the surgical patient. A total number of 27 hospitals participated in the strategy. The global implementation rate was 48% (95%CI, 47.6%-48.4%) during the evaluation period. The overall compliance with all the items of the SSC included in each stage (sign in, time out, sign out) was 75,1% (95%CI, 73.5%-76.7%) for the sign in, 77.1% (95%CI, 75.5%-78.6%) for the time out and 88.3% (95%CI, 87.2%-89.5%) for the sign out respectively. The individual compliance with each item of the SSC has remained above 85%, except for the surgical site marking with an adherence of 67.4% (95%CI, 65.7%-69.1%)] and 71.2% (95%CI, 69.6%-72.9%)] in the sign in and time out respectively. The SSC was successfully implemented to 48% of the surgeries performed to the participating hospitals. The global compliance with the SSC was elevated and the intervention trend was stable during the evaluation period. Strategies were identified to allow of a higher number of surgeries with application of the SSC and more professional involvement in measures compliance such as surgical site marking. PMID:25128355

  15. Non-surgical interventions for pelvic organ prolapse in rural Nepal: a prospective monitoring and evaluation study

    PubMed Central

    Fitchett, Joseph R; Bhatta, Surya; Sherpa, Tenzing Y; Malla, Bishwo S; A Fitchett, Elizabeth J; Samen, Arlene

    2015-01-01

    Objectives Pelvic organ prolapse (POP) is a major cause of morbidity in Nepal, particularly affecting women in the rural communities. Women with POP in Nepal may suffer from symptoms for decades. At present, the Government of Nepal advocates surgical intervention but access to surgical care is inadequate. This report evaluated the feasibility of a non-surgical public health programme in rural Nepal, and describes risk factors associated with POP in this setting. Design Prospective monitoring and evaluation study of a new public health programme. Setting Baglung district, rural Nepal. Participants Women with gynaecological symptoms of POP. Main outcome measures Risk factors for disease progression were assessed using Fisher’s exact test, Pearson’s χ2-test and logistic regression analysis. Results Of the 74 women included in this analysis, 70.8% were diagnosed with stage 2 POP or greater. The majority of women did not have any further children following the onset of POP symptoms (63.5%). Duration of symptoms ranged from 2 months to 60 years, with 73.4% of women suffering for over 5 years and 28.4% suffering for over 20 years. Univariate analyses identified age at screening, age at onset of symptoms, the duration of symptoms and an associated rectocele as factors associated with increasing POP severity (p < 0.05). Kegel exercises were taught to 25 (33.8%) women with POP and ring pessaries were offered to 47 (63.5%) women with POP. Conclusions Non-surgical interventions may provide an opportunity to address the significant burden of POP in rural Nepal. PMID:26664731

  16. 77 FR 32975 - Patient Safety Organizations: Expired Listing for The American Cancer Biorepository, Inc. d/b/a...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-04

    ... activities to improve patient safety and the quality of health care delivery. HHS issued the Patient Safety... regarding the quality and safety of health care delivery. The Patient Safety Rule, 42 CFR part 3, authorizes... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Expired......

  17. Spectrophotometer properties of vein blood plasma in UF-region patients with sharp surgical pathology of abdominal region organs

    NASA Astrophysics Data System (ADS)

    Guminestskij, S. G.; Polianski, I. J.; Motrich, A. V.; Grunchuk, F. W.

    2006-05-01

    It is set that there are two maximums in UF- region absorption of vein blood plasma of a man: at λ = 235 nm and at λ = 280 nm. It is shown that there are the substantial changes of values of the optical density D comparative with controls (for donors) exactly in a maximum at development of sharp surgical diseases of organs of abdominal region λ = 280 nm, in that time as maximum at λ = 235 nm in this plan is not informing. Resulted results of researches of dynamics of changes of optical properties of vein blood plasma in UF- region of patients with pathology of abdominal region organs in after operating period (sharp appendicitis, sharp pancreatitis, intestinal impassability and others like that), which can have the diagnostic value.

  18. Waste Tank Organic Safety Project: Analysis of liquid samples from Hanford waste tank 241-C-103

    SciTech Connect

    Pool, K.H.; Bean, R.M.

    1994-03-01

    A suite of physical and chemical analyses has been performed in support of activities directed toward the resolution of an Unreviewed Safety Question concerning the potential for a floating organic layer in Hanford waste tank 241-C-103 to sustain a pool fire. The analysis program was the result of a Data Quality Objectives exercise conducted jointly with staff from Westinghouse Hanford Company and Pacific Northwest Laboratory (PNL). The organic layer has been analyzed for flash point, organic composition including volatile organics, inorganic anions and cations, radionuclides, and other physical and chemical parameters needed for a safety assessment leading to the resolution of the Unreviewed Safety Question. The aqueous layer underlying the floating organic material was also analyzed for inorganic, organic, and radionuclide composition, as well as other physical and chemical properties. This work was conducted to PNL Quality Assurance impact level III standards (Good Laboratory Practices).

  19. 76 FR 37817 - Cooperative Agreement With the World Health Organization Department of Food Safety and Zoonoses...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-28

    ... levels, across the full length of the food-production chain, in order to reduce significantly the... HUMAN SERVICES Food and Drug Administration Cooperative Agreement With the World Health Organization Department of Food Safety and Zoonoses in Support of Strategies That Address Food Safety Problems That...

  20. Abortion - surgical

    MedlinePlus

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... problem. Your pregnancy is harmful to your health (therapeutic abortion). The pregnancy resulted after a traumatic event ...

  1. Environment Health & Safety Research Program. Organization and 1979-1980 Publications

    SciTech Connect

    1981-01-01

    This document was prepared to assist readers in understanding the organization of Pacific Northwest Laboratory, and the organization and functions of the Environment, Health and Safety Research Program Office. Telephone numbers of the principal management staff are provided. Also included is a list of 1979 and 1980 publications reporting on work performed in the Environment, Health and Safety Research Program, as well as a list of papers submitted for publication.

  2. Corporate Functional Management Evaluation of the LLNL Radiation Safety Organization

    SciTech Connect

    Sygitowicz, L S

    2008-03-20

    A Corporate Assess, Improve, and Modernize review was conducted at Lawrence Livermore National Laboratory (LLNL) to evaluate the LLNL Radiation Safety Program and recommend actions to address the conditions identified in the Internal Assessment conducted July 23-25, 2007. This review confirms the findings of the Internal Assessment of the Institutional Radiation Safety Program (RSP) including the noted deficiencies and vulnerabilities to be valid. The actions recommended are a result of interviews with about 35 individuals representing senior management through the technician level. The deficiencies identified in the LLNL Internal Assessment of the Institutional Radiation Safety Program were discussed with Radiation Safety personnel team leads, customers of Radiation Safety Program, DOE Livermore site office, and senior ES&H management. There are significant issues with the RSP. LLNL RSP is not an integrated, cohesive, consistently implemented program with a single authority that has the clear roll and responsibility and authority to assure radiological operations at LLNL are conducted in a safe and compliant manner. There is no institutional commitment to address the deficiencies that are identified in the internal assessment. Some of these deficiencies have been previously identified and corrective actions have not been taken or are ineffective in addressing the issues. Serious funding and staffing issues have prevented addressing previously identified issues in the Radiation Calibration Laboratory, Internal Dosimetry, Bioassay Laboratory, and the Whole Body Counter. There is a lack of technical basis documentation for the Radiation Calibration Laboratory and an inadequate QA plan that does not specify standards of work. The Radiation Safety Program lack rigor and consistency across all supported programs. The implementation of DOE Standard 1098-99 Radiological Control can be used as a tool to establish this consistency across LLNL. The establishment of a site

  3. Promoting child passenger safety in children served by a health maintenance organization.

    PubMed

    Chang, A; Hearey, C D; Gallagher, K D; English, P; Chang, P C

    1989-06-01

    A patient education program, based on the health belief model, promoting child passenger safety was developed and implemented at a health maintenance organization. The program included individual counseling by pediatricians, use of audiovisual materials and pamphlets, and (for newborn infants) a home visit by a child safety specialist. Based on parking lot observations, child safety device use increased to greater than 60% in both intervention and comparison-group children 1-4 years of age. During the child health supervision visit, pediatricians can play a leadership role in promoting child passenger safety. PMID:10293483

  4. Abortion - surgical

    MedlinePlus

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  5. Organic tanks safety program FY95 waste aging studies

    SciTech Connect

    Camaioni, D.M.; Samuels, W.D.; Clauss, S.A.; Lenihan, B.D.; Wahl, K.L.; Campbell, J.A.; Shaw, W.J.

    1995-09-01

    This report gives the second year`s findings of a study of how thermal and radiological processes may change the composition of organic compounds in the underground tanks at Hanford. Efforts were focused on the global reaction kinetics in a simulated waste exposed to {gamma} rays and the reactions of organic radicals with nitrite ion. The gas production is predominantly radiolytic. Decarboxylation of carboxylates is probably an aging pathway. TBP was totaly consumed in almost every run. Radiation clearly accelerated consumption of the other compounds. EDTA is more reactive than citrate. Oximes and possibly organic nitro compounds are key intermediates in the radiolytic redox reactions of organic compounds with nitrate/nitrite. Observations are consistent with organic compounds being progressively degraded to compounds with greater numbers of C-O bonds and fewer C-H and C-C bonds, resulting in an overall lower energy content. If the radwaste tanks are adequately ventilated and continually dosed by radioactivity, their total energy content should have declined. Level of risk depends on how rapidly carboxylate salts of moderate energy content (including EDTA fragments) degrade to low energy oxalate and formate.

  6. Surgical extraction of human dorsal root ganglia from organ donors and preparation of primary sensory neuron cultures.

    PubMed

    Valtcheva, Manouela V; Copits, Bryan A; Davidson, Steve; Sheahan, Tayler D; Pullen, Melanie Y; McCall, Jordan G; Dikranian, Krikor; Gereau, Robert W

    2016-10-01

    Primary cultures of rodent sensory neurons are widely used to investigate the cellular and molecular mechanisms involved in pain, itch, nerve injury and regeneration. However, translation of these preclinical findings may be greatly improved by direct validation in human tissues. We have developed an approach to extract and culture human sensory neurons in collaboration with a local organ procurement organization (OPO). Here we describe the surgical procedure for extraction of human dorsal root ganglia (hDRG) and the necessary modifications to existing culture techniques to prepare viable adult human sensory neurons for functional studies. Dissociated sensory neurons can be maintained in culture for >10 d, and they are amenable to electrophysiological recording, calcium imaging and viral gene transfer. The entire process of extraction and culturing can be completed in <7 h, and it can be performed by trained graduate students. This approach can be applied at any institution with access to organ donors consenting to tissue donation for research, and is an invaluable resource for improving translational research. PMID:27606776

  7. Work organization research at the National Institute for Occupational Safety and Health.

    PubMed

    Rosenstock, L

    1997-01-01

    For 25 years, the National Institute for Occupational Safety and Health (NIOSH) has conducted and sponsored laboratory, field, and epidemiological studies that have helped define the role of work organization factors in occupational safety and health. Research has focused on the health effects of specific job conditions, occupational stressors in specific occupations, occupational difference in the incidence of stressors and stress-related disorders, and intervention strategies. NIOSH and the American Psychological Association have formalized the concept of occupational health psychology and developed a postdoctoral training program. The National Occupational Research Agenda recognizes organization of work as one of 21 national occupational safety and health research priority areas. Future research should focus on industries, occupations, and populations at special risk; the impact of work organization on overall health; the identification of healthy organization characteristics; and the development of intervention strategies. PMID:9552275

  8. Alternative and Organic Beef Production: Food-Safety Issues

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The sales of organic beef is increasing yearly due to the perception of it being more nutritious, better for the environment, contains minimal levels of pesticides, is produced without growth hormones, is not genetically engineered, and is produced using improved animal welfare practices. Artisan, ...

  9. 76 FR 71346 - Patient Safety Organizations: Voluntary Relinquishment From Peminic Inc. dba The Peminic-Greeley PSO

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-17

    ... confidential information regarding the quality and safety of health care delivery. The Patient Safety and... conduct activities to improve patient safety and the quality of health care delivery. HHS issued the... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations:...

  10. Indications, Contraindications, and Complications of Mesh in Surgical Treatment of Pelvic Organ Prolapse

    PubMed Central

    Ellington, David R.; Richter, Holly E.

    2013-01-01

    Women are seeking care for pelvic organ prolapse (POP) in increasing numbers and a significant proportion of them will undergo a second repair for recurrence. This has initiated interest by both surgeons and industry to utilize and design prosthetic mesh materials to help augment longevity of prolapse repairs. Unfortunately, the introduction of transvaginal synthetic mesh kits for use in women was done without the benefit of Level 1 data to determine its utility compared to native tissue repair. This report summarizes the potential benefit/risks of transvaginal synthetic mesh use for POP and recommendations regarding its continued use. PMID:23563869

  11. Organic tanks safety program FY96 waste aging studies

    SciTech Connect

    Camaioni, D.M.; Samuels, W.D.; Linehan, J.C.; Clauss, S.A.; Sharma, A.K.; Wahl, K.L.; Campbell, J.A.

    1996-10-01

    Uranium and plutonium production at the Hanford Site produced large quantities of radioactive by-products and contaminated process chemicals, which are stored in underground tanks awaiting treatment and disposal. Having been made strongly alkaline and then subjected to successive water evaporation campaigns to increase storage capacity, the wastes now exist in the physical forms of salt cakes, metal oxide sludges, and partially saturated aqueous brine solutions. The tanks that contain organic process chemicals mixed with nitrate/nitrite salt wastes may be at risk for fuel- nitrate combustion accidents. The purpose of the Waste Aging Task is to elucidate how chemical and radiological processes will have aged or degraded the organic compounds stored in the tanks. Ultimately, the task seeks to develop quantitative measures of how aging changes the energetic properties of the wastes. This information will directly support efforts to evaluate the hazard as well as to develop potential control and mitigation strategies.

  12. Real-time deformations of organ based on structural mechanics for surgical simulators

    NASA Astrophysics Data System (ADS)

    Nakaguchi, Toshiya; Tagaya, Masashi; Tamura, Nobuhiko; Tsumura, Norimichi; Miyake, Yoichi

    2006-03-01

    This research proposes the deformation model of organs for the development of the medical training system using Virtual Reality (VR) technology. First, the proposed model calculates the strains of coordinate axis. Secondly, the deformation is obtained by mapping the coordinate of the object to the strained coordinate. We assume the beams in the coordinate space to calculate the strain of the coordinate axis. The forces acting on the object are converted to the forces applied to the beams. The bend and the twist of the beams are calculated based on the theory of structural mechanics. The bend is derived by the finite element method. We propose two deformation methods which differ in the position of the beams in the coordinate space. One method locates the beams along the three orthogonal axes (x, y, z). Another method locates the beam in the area where the deformation is large. In addition, the strain of the coordinate axis is attenuated in proportion to the distance from the point of action to consider the attenuation of the stress which is a viscoelastic feature of the organs. The proposed model needs less computational cost compared to the conventional deformation method since our model does not need to divide the object into the elasticity element. The proposed model was implemented in the laparoscopic surgery training system, and a real-time deformation can be realized.

  13. Lethal and sublethal effects of cadmium on marine organisms: a critical discussion about ''safety levels''

    SciTech Connect

    Sperling, K.R.

    1983-12-01

    The applicability of terms such as ''safety level'' and ''safety factor'' for the purpose of risk assessment in the frame of the marine dumping conventions is discussed. In view of a series of experiments on sublethal effects of cadmium on marine organisms it is stated that the dose-response relationships cover a range of 10(4), and that there is no indication that the lowest level found so far is actually just above a no-effect threshold.

  14. Development of AR Surgical Navigation Systems for Multiple Surgical Regions.

    PubMed

    Suzuki, Naoki; Hattori, Asaki; Iimura, Jiro; Otori, Nobuyoshi; Onda, Shinji; Okamoto, Tomoyoshi; Yanaga, Katsuhiko

    2014-01-01

    The purpose of our research is to develop surgical navigation systems to enhance surgical safety. Our systems make use of augmented reality technology to superimpose, on the surgery screen on a real time basis, patients' organ models reconstructed in 3D from their X-ray CT data taken before surgery. By doing so, the systems display anatomical risk materials, tumors and blood vessels which surgeons cannot see with their naked eyes. This will in turn lead to surgeons intuitively grasping the inner structures of the operational fields. We so far have been developing navigation systems that can conduct surgeries in various fields. The basic structure of the navigation systems are the same. The navigation systems uses different peripheral equipment and different methods to display navigation images which best meet the demands of each type of surgery. In this thesis, we report on our navigation systems for 2 types of surgery - endoscopic sinus surgery and hepatobilialy-pancreatic surgery. PMID:24732545

  15. The Vaccine Safety Datalink: immunization research in health maintenance organizations in the USA.

    PubMed Central

    Chen, R. T.; DeStefano, F.; Davis, R. L.; Jackson, L. A.; Thompson, R. S.; Mullooly, J. P.; Black, S. B.; Shinefield, H. R.; Vadheim, C. M.; Ward, J. I.; Marcy, S. M.

    2000-01-01

    The Vaccine Safety Datalink is a collaborative project involving the National Immunization Program of the Centers for Disease Control and Prevention and several large health maintenance organizations in the USA. The project began in 1990 with the primary purpose of rigorously evaluating concerns about the safety of vaccines. Computerized data on vaccination, medical outcome (e.g. outpatient visits, emergency room visits, hospitalizations, and deaths) and covariates (e.g. birth certificates, census data) are prospectively collected and linked under joint protocol at multiple health maintenance organizations for analysis. Approximately 6 million persons (2% of the population of the USA) are now members of health maintenance organizations participating in the Vaccine Safety Datalink, which has proved to be a valuable resource providing important information on a number of vaccine safety issues. The databases and infrastructure created for the Vaccine Safety Datalink have also provided opportunities to address vaccination coverage, cost-effectiveness and other matters connected with immunization as well as matters outside this field. PMID:10743283

  16. Who is Using Telehealth in Primary Care? Safety Net Clinics and Health Maintenance Organizations (HMOs).

    PubMed

    Coffman, Megan; Moore, Miranda; Jetty, Anuradha; Klink, Kathleen; Bazemore, Andrew

    2016-01-01

    Despite rapid advancements in telehealth services, only 15% of family physicians in a 2014 survey reported using telehealth; use varied widely according to the physician's practice setting or designation. Users were significantly more likely than nonusers to work in federally designated "safety net" clinics and health maintenance organizations (HMOs) but not more likely than nonusers to report working in a patient-centered medical home (PCMH) or accountable care organization. PMID:27390373

  17. Safety evaluation for packaging for onsite transfer of B Plant organic waste

    SciTech Connect

    Mercado, M.S.

    1996-10-07

    This safety evaluation for packaging authorizes the use of a 17,500-L (4,623-gal) tank manufactured by Brenner Tank, Incorporated, to transport up to 16,221 L (4,285 gal) of radioactive organic liquid waste. The waste will be transported from the organic loading pad to a storage pad. Both pads are within the B Plant complex, but approximately 4 mi apart.

  18. The role for leaders of health care organizations in patient safety.

    PubMed

    Clarke, John R; Lerner, Jeffrey C; Marella, William

    2007-01-01

    We review what leaders of health care systems, including chief executive officers and board members, need to know to have "patient safety literacy" and do to make their systems safe. High reliability organizations produce reliable results that are not dependent on providers being perfect. Their characteristics include the commitment of leadership to safety as a system responsibility, with a culture of safety that decreases variability with standardized care and does not condone "at-risk behavior." A business case can be made for investing resources into systems that produce good outcomes reliably. Leaders must see patient safety problems as problems with their system, not with their employees. Leaders need to give providers information to make and monitor system progress. All medical errors, including near misses, and processes associated with all adverse events may provide information for system improvement. Improving systems should produce better long-term results than educating workers to be more careful. PMID:17804390

  19. Continuing Education Meets the Learning Organization: The Challenge of a Systems Approach to Patient Safety.

    ERIC Educational Resources Information Center

    Eisenberg, John M.

    2000-01-01

    Increased attention to medical errors and patient safety highlights the importance of quality improvement in continuing medical education. Ways to enhance quality include informatics, clinical practice guidelines, learning from opinion leaders and patients, learning organizations, and just-in-time and point-of-care delivery of continuing…

  20. OVERVIEW OF SAFETY OF MICROBIAL INSECTICIDES TO ESTUARINE AND MARINE ORGANISMS

    EPA Science Inventory

    The chapter presents an overview of safety tests of microbial insecticides to estuarine and marine organisms that have been performed to date. Approaches and experimental design, species of MPCAs tested, systems used, and endpoints and results evaluated for determination of risks...

  1. The SAFER guides: empowering organizations to improve the safety and effectiveness of electronic health records.

    PubMed

    Sittig, Dean F; Ash, Joan S; Singh, Hardeep

    2014-05-01

    Electronic health records (EHRs) have potential to improve quality and safety of healthcare. However, EHR users have experienced safety concerns from EHR design and usability features that are not optimally adapted for the complex work flow of real-world practice. Few strategies exist to address unintended consequences from implementation of EHRs and other health information technologies. We propose that organizations equipped with EHRs should consider the strategy of "proactive risk assessment" of their EHR-enabled healthcare system to identify and address EHR-related safety concerns. In this paper, we describe the conceptual underpinning of an EHR-related self-assessment strategy to provide institutions a foundation upon which they could build their safety efforts. With support from the Office of the National Coordinator for Health Information Technology (ONC), we used a rigorous, iterative process to develop a set of 9 self-assessment tools to optimize the safety and safe use of EHRs. These tools, referred to as the Safety Assurance Factors for EHR Resilience (SAFER) guides, could be used to self-assess safety and effectiveness of EHR implementations, identify specific areas of vulnerability, and create solutions and culture change to mitigate risks. A variety of audiences could conduct these assessments, including frontline clinicians or care teams in different practices, or clinical, quality, or administrative leaders within larger institutions. The guides use a multifaceted systems-based approach to assess risk and empower organizations to work with internal or external stakeholders (eg, EHR developers) on optimizing EHR functionality and using EHRs to drive improvements in the quality and safety of healthcare. PMID:25181570

  2. The Safety and Acceptance of the PrePex Device for Non-Surgical Adult Male Circumcision in Rakai, Uganda. A Non-Randomized Observational Study

    PubMed Central

    Kigozi, Godfrey; Musoke, Richard; Watya, Stephen; Kighoma, Nehemia; Nkale, James; Nakafeero, Mary; Namuguzi, Dan; Serwada, David; Nalugoda, Fred; Sewankambo, Nelson; Wawer, Maria Joan; Gray, Ronald Henry

    2014-01-01

    Objectives To assess the safety and acceptance of the PrePex device for medical male circumcision (MMC) in rural Uganda. Methods In an observational study, HIV-uninfected, uncircumcised men aged 18 and older who requested elective MMC were informed about the PrePex and dorsal slit methods and offered a free choice of their preferred procedure. 100 men received PrePex to assess preliminary safety (aim 1). An additional 329 men, 250 chose PrePex and 79 chose Dorsal slit, were enrolled following approval by the Safety Monitoring Committee (aim 2). Men were followed up at 7 days to assess adverse events (AEs) and to remove the PrePex device. Wound healing was assessed at 4 weeks, with subsequent weekly follow up until completed healing. Results The PrePex device was contraindicated in 5.7% of men due to a tight prepuce or phimosis/adhesions. Among 429 enrolled men 350 (82.0%) got the PrePex device and 79 (18.0%) the dorsal slit procedure. 250 of 329 men (76.0%) who were invited to choose between the 2 procedures chose Prepex. There were 9 AEs (2.6%) with the PrePex, of which 5 (1.4%) were severe complications, 4 due to patient self-removal of the device leading to edema and urinary obstruction requiring emergency surgical circumcision, and one due to wound dehiscence following device removal. 71.8% of men reported an unpleasant odor prior to PrePex removal. Cumulative rates of completed wound healing with the PrePex were 56.7% at week 4, 84.8% week 5, 97.6% week 6 and 98.6% week 7, compared to 98.7% at week 4 with dorsal slit (p<0.0001). Conclusion The PrePex device was well accepted, but healing was slower than with dorsal slit surgery. Severe complications, primarily following PrePex self-removal, required rapid access to emergency surgical facilities. The need to return for removal and delayed healing may increase Program cost and client burden. PMID:25144194

  3. Resolving the safety issue for radioactive waste tanks with high organic content

    SciTech Connect

    Babad, H.; Crippen, M.D.; Turner, D.A. ); Gerber, M.A. )

    1993-02-01

    An overview of the Waste Tank Safety Organic Program is provided. The overview discusses the history of the wastes containing high concentrations of organics, existing safety criteria associated with those tanks, and details of thermodynamic studies by Westinghouse Hanford Company bounding potential reactivity. The program to be discussed contains the elements of the collection and analysis of tank historical information; reevaluation of organic tank-listing criteria; the performance of detailed studies on simulated waste; completion of waste characterization for each affected tank; and, as part of issue closure, the preparation of short-term and long-term safety and risk assessments based on results from characterization and the waste simulant studies. This document reports on a number of simplified thermodynamic calculations that were performed to ascertain combustion limits for simple surrogates of organic materials in a nitrate-nitrite containing alkaline waste. For expected waste species, the results of these calculations indicate that the range of reactivity encompasses energies that vary only by a factor of three over the range of normal paraffin hydrocarbon (NPH) (a fuel rich solvent) to sodium oxalate (a degradation product resulting from in situ organic complexant destruction in Hanford Site wastes).

  4. The changing organization of work and the safety and health of working people: a commentary.

    PubMed

    Landsbergis, Paul A

    2003-01-01

    Recent trends in the organization of work may affect worker health through a variety of pathways--by increasing the risk of stress-related illnesses, such as cardiovascular disease, musculoskeletal disorders, and psychological disorders, by increasing exposure to hazardous substances and violence on the job, or by affecting occupational health services and training programs. Much remains to be learned about the nature of changes in work organization, and how they affect worker health and safety. While available evidence is limited, such evidence suggests that recent trends in work organization may be increasing the risk of occupational illnesses. In a groundbreaking publication, the National Institute for Occupational Safety and Health has provided a concise summary of available knowledge and a detailed agenda for research and development. PMID:12553180

  5. Safety subcultures in health-care organizations and managing medical error.

    PubMed

    Sirriyeh, Reema; Lawton, Rebecca; Armitage, Gerry; Gardner, Peter; Ferguson, Sally

    2012-02-01

    Leadership has been proposed as a key latent factor influencing the safety culture of an organization, the likelihood of errors occurring and the way in which these are managed. Therefore, when an error occurs, managers have an integral role to ensure that the most desirable outcomes are achieved for patients, health-care staff and their organization. Semistructured interviews were conducted in a large UK teaching hospital to explore the perspectives of staff who are tasked in some way with managing patient safety. Data from 26 transcripts were analysed using an adapted version of Spencer's (2003) qualitative framework, which revealed five primary themes. This paper reports findings from two overarching primary themes, described as being management and safety subcultures. These themes describe experiences of managing medical errors and the subgroup variations between professions, ranks and specialties in attitudes and behaviours towards error, and its management in a large National Health Service Trust. We discuss implications for health-care managers and health professionals in developing a stronger and more unified safety culture in their organizations, along with considerations for academic researchers when undertaking health services research. PMID:22323667

  6. Safety analysis of exothermic reaction hazards associated with the organic liquid layer in tank 241-C-103

    SciTech Connect

    Postma, A.K.; Bechtold, D.B.; Borsheim, G.L.; Grisby, J.M.; Guthrie, R.L.; Kummerer, M.; Turner, D.A.; Plys, M.G.

    1994-03-01

    Safety hazards associated with the interim storage of a potentially flammable organic liquid in waste Tank C-103 are identified and evaluated. The technical basis for closing the unreviewed safety question (USQ) associated with the floating liquid organic layer in this tank is presented.

  7. Early experience of a safety net provider reorganizing into an accountable care organization.

    PubMed

    Hacker, Karen; Santos, Palmira; Thompson, Douglas; Stout, Somava S; Bearse, Adriana; Mechanic, Robert E

    2014-08-01

    Although safety net providers will benefit from health insurance expansions under the Affordable Care Act, they also face significant challenges in the postreform environment. Some have embraced the concept of the accountable care organization to help improve quality and efficiency while addressing financial shortfalls. The experience of Cambridge Health Alliance (CHA) in Massachusetts, where health care reform began six years ago, provides insight into the opportunities and challenges of this approach in the safety net. CHA's strategies include care redesign, financial realignment, workforce transformation, and development of external partnerships. Early results show some improvement in access, patient experience, quality, and utilization; however, the potential efficiencies will not eliminate CHA's current operating deficit. The patient population, payer mix, service mix, cost structure, and political requirements reduce the likelihood of financial sustainability without significant changes in these factors, increased public funding, or both. Thus the future of safety net institutions, regardless of payment and care redesign success, remains at risk. PMID:24842968

  8. Organized labor and the origins of the Occupational Safety and Health Act.

    PubMed

    Asher, Robert

    2014-11-01

    New Solutions is republishing this 1991 article by Robert Asher, which reviews the history of organized labor's efforts in the United States to secure health and safety protections for workers. The 1877 passage of the Massachusetts factory inspection law and the implementation of primitive industrial safety inspection systems in many states paralleled labor action for improved measures to protect workers' health and safety. In the early 1900s labor was focusing on workers' compensation laws. The New Deal expanded the federal government's role in worker protection, supported at least by the Congress of Industrial Organizations (CIO), but challenged by industry and many members of the U.S. Congress. The American Federation of Labor (AFL) and the CIO backed opposing legal and inspection strategies in the late 1940s and through the 1950s. Still, by the late 1960s, several unions were able to help craft the Occupational Safety and Health Act of 1970 and secure new federal protections for U.S. workers. PMID:25261023

  9. Nonsteroidal Anti-Inflammatory Drugs: A survey of practices and concerns of pediatric medical and surgical specialists and a summary of available safety data

    PubMed Central

    2010-01-01

    Objectives To examine the prescribing habits of NSAIDs among pediatric medical and surgical practitioners, and to examine concerns and barriers to their use. Methods A sample of 1289 pediatricians, pediatric rheumatologists, sports medicine physicians, pediatric surgeons and pediatric orthopedic surgeons in the United States and Canada were sent an email link to a 22-question web-based survey. Results 338 surveys (28%) were completed, 84 were undeliverable. Of all respondents, 164 (50%) had never prescribed a selective cyclooxygenase-2 (COX-2) NSAID. The most common reasons for ever prescribing an NSAID were musculoskeletal pain, soft-tissue injury, fever, arthritis, fracture, and headache. Compared to traditional NSAIDs, selective COX-2 NSAIDs were believed to be as safe (42%) or safer (24%); have equal (52%) to greater efficacy (20%) for pain; have equal (59%) to greater efficacy (15%) for inflammation; and have equal (39%) to improved (44%) tolerability. Pediatric rheumatologists reported significantly more frequent abdominal pain (81% vs. 23%), epistaxis (13% vs. 2%), easy bruising (64% vs. 8%), headaches (21% vs. 1%) and fatigue (12% vs. 1%) for traditional NSAIDs than for selective COX-2 NSAIDs. Prescribing habits of NSAIDs have changed since the voluntary withdrawal of rofecoxib and valdecoxib; 3% of pediatric rheumatologists reported giving fewer traditional NSAID prescriptions, and while 57% reported giving fewer selective COX-2 NSAIDs, 26% reported that they no longer prescribed these medications. Conclusions Traditional and selective COX-2 NSAIDs were perceived as safe by pediatric specialists. The data were compared to the published pediatric safety literature. PMID:20181090

  10. Waste Tank Organic Safety Program: Analytical methods development. Progress report, FY 1994

    SciTech Connect

    Campbell, J.A.; Clauss, S.A.; Grant, K.E.

    1994-09-01

    The objectives of this task are to develop and document extraction and analysis methods for organics in waste tanks, and to extend these methods to the analysis of actual core samples to support the Waste Tank organic Safety Program. This report documents progress at Pacific Northwest Laboratory (a) during FY 1994 on methods development, the analysis of waste from Tank 241-C-103 (Tank C-103) and T-111, and the transfer of documented, developed analytical methods to personnel in the Analytical Chemistry Laboratory (ACL) and 222-S laboratory. This report is intended as an annual report, not a completed work.

  11. Hanford Site organic waste tanks: History, waste properties, and scientific issues. Hanford Tank Safety Project

    SciTech Connect

    Strachan, D.M.; Schulz, W.W.; Reynolds, D.A.

    1993-01-01

    Eight Hanford single-shell waste tanks are included on a safety watch list because they are thought to contain significant concentrations of various organic chemical. Potential dangers associated with the waste in these tanks include exothermic reaction, combustion, and release of hazardous vapors. In all eight tanks the measured waste temperatures are in the range 16 to 46{degree}C, far below the 250 to 380{degree}C temperatures necessary for onset of rapid exothermic reactions and initiation of deflagration. Investigation of the possibility of vapor release from Tank C-103 has been elevated to a top safety priority. There is a need to obtain an adequate number of truly representative vapor samples and for highly sensitive and capable methods and instruments to analyze these samples. Remaining scientific issues include: an understanding of the behavior and reaction of organic compounds in existing underground tank environments knowledge of the types and amounts of organic compounds in the tanks knowledge of selected physical and chemical properties of organic compounds source, composition, quality, and properties of the presently unidentified volatile organic compound(s) apparently evolving from Tank C-103.

  12. Factors in the Growth and Decline of System Safety within Organizations

    SciTech Connect

    GANTER, JOHN H.; STORAGE, WILLIAM K.

    1999-08-16

    System safety as a technical field faces numerous opportunities, and some challenges, in the high technology, low cost future. As a relatively small field best known in high consequence domains (defense, aviation, space) it may have to tailor its messages and approaches to influence organizations (both private and public) pressured by incessant competition and ''Internet time.'' We present a model of organizations as cultures that carefully ration attention and reward personnel who successfully pursue goals. These evolving goals result from a fusing of both external influences (market share: regulation) and internal influences (dominant group identities such as marketers or engineers). In the context of organizational goals, these same influences cause people to search narrowly and quickly for technologies and ideas that can fit through ''influence gates'' in the organization and that will likely grow there. System safety must thus compete with all manner of cost-cutting and quality management approaches, in an environment currently obsessed with short-term value and return on investment. From this model we develop some ideas for the communication and promotion of system safety that could increase the net impact and effectiveness of the field.

  13. Application of the risk-based strategy to the Hanford tank waste organic-nitrate safety issue

    SciTech Connect

    Hunter, V.L.; Colson, S.D.; Ferryman, T.; Gephart, R.E.; Heasler, P.; Scheele, R.D.

    1997-12-01

    This report describes the results from application of the Risk-Based Decision Management Approach for Justifying Characterization of Hanford Tank Waste to the organic-nitrate safety issue in Hanford single-shell tanks (SSTs). Existing chemical and physical models were used, taking advantage of the most current (mid-1997) sampling and analysis data. The purpose of this study is to make specific recommendations for planning characterization to help ensure the safety of each SST as it relates to the organic-nitrate safety issue. An additional objective is to demonstrate the viability of the Risk-Based Strategy for addressing Hanford tank waste safety issues.

  14. Safety.

    ERIC Educational Resources Information Center

    Education in Science, 1996

    1996-01-01

    Discusses safety issues in science, including: allergic reactions to peanuts used in experiments; explosions in lead/acid batteries; and inspection of pressure vessels, such as pressure cookers or model steam engines. (MKR)

  15. Transforming communication and safety culture in intrapartum care: a multi-organization blueprint.

    PubMed

    Lyndon, Audrey; Johnson, M Christina; Bingham, Debra; Napolitano, Peter G; Joseph, Gerald; Maxfield, David G; O'Keeffe, Daniel F

    2015-01-01

    Effective, patient-centered communication facilitates interception and correction of potentially harmful conditions and errors. All team members, including women, their families, physicians, midwives, nurses, and support staff, have a role in identifying the potential for harm during labor and birth. However, the results of collaborative research studies conducted by organizations that represent professionals who care for women during labor and birth indicate that health care providers may frequently witness, but may not always report, problems with safety or clinical performance. Some of these health care providers felt resigned to the continuation of such problems and fearful of retribution if they tried to address them. Speaking up to address safety and quality concerns is a dynamic social process. Every team member must feel empowered to speak up about concerns without fear of put-downs, retribution, or receiving poor-quality care. Patient safety requires mutual accountability: individuals, teams, health care facilities, and professional associations have a shared responsibility for creating and sustaining environments of mutual respect and engaging in highly reliable perinatal care. Defects in human factors, communication, and leadership have been the leading contributors to sentinel events in perinatal care for more than a decade. Organizational commitment and executive leadership are essential to creating an environment that proactively supports safety and quality. The problem is well-known; the time for action is now. PMID:25857371

  16. Transforming communication and safety culture in intrapartum care: a multi-organization blueprint.

    PubMed

    Lyndon, Audrey; Johnson, M Christina; Bingham, Debra; Napolitano, Peter G; Joseph, Gerald; Maxfield, David G; OʼKeeffe, Daniel F

    2015-05-01

    Effective, patient-centered communication facilitates interception and correction of potentially harmful conditions and errors. All team members, including women, their families, physicians, midwives, nurses, and support staff, have a role in identifying the potential for harm during labor and birth. However, the results of collaborative research studies conducted by organizations that represent professionals who care for women during labor and birth indicate that health care providers may frequently witness, but may not always report, problems with safety or clinical performance. Some of these health care providers felt resigned to the continuation of such problems and fearful of retribution if they tried to address them. Speaking up to address safety and quality concerns is a dynamic social process. Every team member must feel empowered to speak up about concerns without fear of put-downs, retribution, or receiving poor-quality care. Patient safety requires mutual accountability: individuals, teams, health care facilities, and professional associations have a shared responsibility for creating and sustaining environments of mutual respect and engaging in highly reliable perinatal care. Defects in human factors, communication, and leadership have been the leading contributors to sentinel events in perinatal care for more than a decade. Organizational commitment and executive leadership are essential to creating an environment that proactively supports safety and quality. The problem is well-known; the time for action is now. PMID:25932832

  17. Transforming communication and safety culture in intrapartum care: a multi-organization blueprint.

    PubMed

    Lyndon, Audrey; Johnson, M Christina; Bingham, Debra; Napolitano, Peter G; Joseph, Gerald; Maxfield, David G; O'Keeffe, Daniel F

    2015-01-01

    Effective, patient-centered communication facilitates interception and correction of potentially harmful conditions and errors. All team members, including women, their families, physicians, midwives, nurses, and support staff, have roles in identifying the potential for harm during labor and birth. However, the results of collaborative research studies conducted by organizations that represent professionals who care for women during labor and birth indicate that health care providers may frequently witness, but may not always report, problems with safety or clinical performance. Some of these health care providers felt resigned to the continuation of such problems and fearful of retribution if they tried to address them. Speaking up to address safety and quality concerns is a dynamic social process. Every team member must feel empowered to speak up about concerns without fear of put-downs, retribution, or receiving poor-quality care. Patient safety requires mutual accountability: individuals, teams, health care facilities, and professional associations have a shared responsibility for creating and sustaining environments of mutual respect and engaging in highly reliable perinatal care. Defects in human factors, communication, and leadership have been the leading contributors to sentinel events in perinatal care for more than a decade. Organizational commitment and executive leadership are essential to creating an environment that proactively supports safety and quality. The problem is well-known; the time for action is now. PMID:25851413

  18. Food safety in free-range and organic livestock systems: risk management and responsibility.

    PubMed

    Kijlstra, A; Meerburg, B G; Bos, A P

    2009-12-01

    Animal production systems that offer outdoor access to the animals have become increasingly popular in the Western world due to the growing general discontent of consumers with conventional bioindustrial farming practices. These open production systems offer improved animal welfare but may create new problems for animal health, resulting in increased food safety risks from bacterial, viral, or parasitic infections or environmental contaminants. Examples of these new problems include increased Toxoplasma gondii infections in pigs and high dioxin levels in eggs from free-range hens. In this review, the relation between positive and negative points of free-range and organic livestock production systems is discussed with reference to production in The Netherlands. We investigated how proponents of more animal welfare friendly systems deal with potential negative issues in public and whether any risk communication is used. Generally, we found that the existence of a dilemma is disputed or avoided in communication with the consumer. This avoidance could be detrimental for public trust in alternative animal production systems, should problems occur. To prevent future problems, it will be necessary to communicate about the relevant types and sources of the food safety risks to the consumers. The responsibility for protecting food safety should be properly divided among the various parties involved: producers, processors, governments, nongovernmental organizations, and consumers. PMID:20003752

  19. Exploring the state of health and safety management system performance measurement in mining organizations

    PubMed Central

    Haas, Emily Joy; Yorio, Patrick

    2016-01-01

    Complex arguments continue to be articulated regarding the theoretical foundation of health and safety management system (HSMS) performance measurement. The culmination of these efforts has begun to enhance a collective understanding. Despite this enhanced theoretical understanding, however, there are still continuing debates and little consensus. The goal of the current research effort was to empirically explore common methods to HSMS performance measurement in mining organizations. The purpose was to determine if value and insight could be added into the ongoing approaches of the best ways to engage in health and safety performance measurement. Nine site-level health and safety management professionals were provided with 133 practices corresponding to 20 HSMS elements, each fitting into the plan, do, check, act phases common to most HSMS. Participants were asked to supply detailed information as to how they (1) assess the performance of each practice in their organization, or (2) would assess each practice if it were an identified strategic imperative. Qualitative content analysis indicated that the approximately 1200 responses provided could be described and categorized into interventions, organizational performance, and worker performance. A discussion of how these categories relate to existing indicator frameworks is provided. The analysis also revealed divergence in two important measurement issues; (1) quantitative vs qualitative measurement and reporting; and (2) the primary use of objective or subjective metrics. In lieu of these findings we ultimately recommend a balanced measurement and reporting approach within the three metric categories and conclude with suggestions for future research. PMID:26823642

  20. The safety assessment of food ingredients derived from plant cell, tissue and organ cultures: a review.

    PubMed

    Murthy, Hosakatte Niranjana; Georgiev, Milen I; Park, So-Young; Dandin, Vijayalaxmi S; Paek, Kee-Yoeup

    2015-06-01

    Plant cell, tissue and organ cultures (PCTOC) have become an increasingly attractive alternative for the production of various high molecular weight molecules which are used as flavourings, fragrances, colouring agents and food additives. Although PCTOC products are cultivated in vitro in a contamination free environment, the raw material produced from PCTOC may contain many components apart from the target compound. In some cases, PCTOC raw materials may also carry toxins, which may be naturally occurring or accumulated during the culture process. Assessment of the safety of PCTOC products is, therefore, a priority of the biotech industries involved in their production. The safety assessment involves the evaluation of starting material, production process and the end product. Before commercialisation, PCTOC products should be evaluated for their chemical and biological properties, as well as for their toxicity. In this review, measures and general criteria for biosafety evaluation of PCTOC products are addressed and thoroughly discussed. PMID:25624252

  1. Surgical Instrument Restraint in Weightlessness

    NASA Technical Reports Server (NTRS)

    Campbell, Mark R.; Dawson, David L.; Melton, Shannon; Hooker, Dona; Cantu, Hilda

    2000-01-01

    Performing a surgical procedure during spaceflight will become more likely with longer duration missions in the near future. Minimal surgical capability has been present on previous missions as the definitive medical care time was short and the likelihood of surgical events too low to justify surgical hardware availability. Early demonstrations of surgical procedures in the weightlessness of parabolic flight indicated the need for careful logistical planning and restraint of surgical hardware. The consideration of human ergonomics also has more impact in weightlessness than in the conventionall-g environment. Three methods of surgical instrument restraint - a Minor Surgical Kit (MSK), a Surgical Restraint Scrub Suit (SRSS), and a Surgical Tray (ST) were evaluated in parabolic flight surgical procedures. The Minor Surgical Kit was easily stored, easily deployed, and demonstrated the best ability to facilitate a surgical procedure in weightlessness. Important factors in this surgical restraint system include excellent organization of supplies, ability to maintain sterility, accessibility while providing secure restraint, ability to dispose of sharp items and biological trash, and ergonomical efficiency.

  2. Organic food: buying more safety or just peace of mind? A critical review of the literature.

    PubMed

    Magkos, Faidon; Arvaniti, Fotini; Zampelas, Antonis

    2006-01-01

    Consumer concern over the quality and safety of conventional food has intensified in recent years, and primarily drives the increasing demand for organically grown food, which is perceived as healthier and safer. Relevant scientific evidence, however, is scarce, while anecdotal reports abound. Although there is an urgent need for information related to health benefits and/or hazards of food products of both origins, generalized conclusions remain tentative in the absence of adequate comparative data. Organic fruits and vegetables can be expected to contain fewer agrochemical residues than conventionally grown alternatives; yet, the significance of this difference is questionable, inasmuch as actual levels of contamination in both types of food are generally well below acceptable limits. Also, some leafy, root, and tuber organic vegetables appear to have lower nitrate content compared with conventional ones, but whether or not dietary nitrate indeed constitutes a threat to human health is a matter of debate. On the other hand, no differences can be identified for environmental contaminants (e.g. cadmium and other heavy metals), which are likely to be present in food from both origins. With respect to other food hazards, such as endogenous plant toxins, biological pesticides and pathogenic microorganisms, available evidence is extremely limited preventing generalized statements. Also, results for mycotoxin contamination in cereal crops are variable and inconclusive; hence, no clear picture emerges. It is difficult, therefore, to weigh the risks, but what should be made clear is that 'organic' does not automatically equal 'safe.' Additional studies in this area of research are warranted. At our present state of knowledge, other factors rather than safety aspects seem to speak in favor of organic food. PMID:16403682

  3. Preliminary safety criteria for organic watch list tanks at the Hanford site

    SciTech Connect

    Webb, A.B.; Stewart, J.L.; Turner, O.A.; Plys, M.G.; Malinovic, B.; Grigsby, J.M.; Camaioni, D.M.; Heasler, P.G.; Samuels, W.O.; Toth, J.J.

    1995-11-01

    Condensed-phase, rapid reactions of organic salts with nitrates/nitrites in Hanford High Level Radioactive Waste single-shell tanks could lead to structural failure of the tanks resulting in significant releases of radionuclides and toxic materials. This report establishes appropriate preliminary safety criteria to ensure that tank wastes will be maintained safe. These criteria show that if actual dry wastes contain less than 1.2 MJ/kg of reactants reaction energy or less 4.5 wt % of total organic carbon, then the waste will be safe and will not propagate if ignited. Waste moisture helps to retard reactions; when waste moisture exceeds 20 wt %, rapid reactions are prevented, regardless of organic carbon concentrations. Aging and degradation of waste materials has been considered to predict the types and amounts to organic compounds present in the waste. Using measurements of 3 waste phases (liquid, salt cake, and sludge) obtained from tank waste samples analyzed in the laboratory, analysis of variance (ANOVA) models were used to estimate waste states for unmeasured tanks. The preliminary safety criteria are based upon calorimetry and propagation testing of likely organic compounds which represent actual tank wastes. These included sodium salts of citrate, formate, acetate and hydroxyethylethylenediaminetricetate (HEDTA). Hot cell tests of actual tank wastes are planned for the future to confirm propagation tests performed in the laboratory. The effects of draining liquids from the tanks which would remove liquids and moisture were considered because reactive waste which is too dry may propagate. Evaporation effects which could remove moisture from the tanks were also calculated. The various ways that the waste could be heated or ignited by equipment failures or tank operations activities were considered and appropriate monitoring and controls were recommended.

  4. Surgical Airway

    PubMed Central

    Patel, Sapna A; Meyer, Tanya K

    2014-01-01

    Close to 3% of all intubation attempts are considered difficult airways, for which a plan for a surgical airway should be considered. Our article provides an overview of the different types of surgical airways. This article provides a comprehensive review of the main types of surgical airways, relevant anatomy, necessary equipment, indications and contraindications, preparation and positioning, technique, complications, and tips for management. It is important to remember that the placement of a surgical airway is a lifesaving procedure and should be considered in any setting when one “cannot intubate, cannot ventilate”. PMID:24741501

  5. Surgical Simulation

    PubMed Central

    Sutherland, Leanne M.; Middleton, Philippa F.; Anthony, Adrian; Hamdorf, Jeffrey; Cregan, Patrick; Scott, David; Maddern, Guy J.

    2006-01-01

    Objective: To evaluate the effectiveness of surgical simulation compared with other methods of surgical training. Summary Background Data: Surgical simulation (with or without computers) is attractive because it avoids the use of patients for skills practice and provides relevant technical training for trainees before they operate on humans. Methods: Studies were identified through searches of MEDLINE, EMBASE, the Cochrane Library, and other databases until April 2005. Included studies must have been randomized controlled trials (RCTs) assessing any training technique using at least some elements of surgical simulation, which reported measures of surgical task performance. Results: Thirty RCTs with 760 participants were able to be included, although the quality of the RCTs was often poor. Computer simulation generally showed better results than no training at all (and than physical trainer/model training in one RCT), but was not convincingly superior to standard training (such as surgical drills) or video simulation (particularly when assessed by operative performance). Video simulation did not show consistently better results than groups with no training at all, and there were not enough data to determine if video simulation was better than standard training or the use of models. Model simulation may have been better than standard training, and cadaver training may have been better than model training. Conclusions: While there may be compelling reasons to reduce reliance on patients, cadavers, and animals for surgical training, none of the methods of simulated training has yet been shown to be better than other forms of surgical training. PMID:16495690

  6. The Patient's Voice in Pharmacovigilance: Pragmatic Approaches to Building a Patient-Centric Drug Safety Organization.

    PubMed

    Smith, Meredith Y; Benattia, Isma

    2016-09-01

    Patient-centeredness has become an acknowledged hallmark of not only high-quality health care but also high-quality drug development. Biopharmaceutical companies are actively seeking to be more patient-centric in drug research and development by involving patients in identifying target disease conditions, participating in the design of, and recruitment for, clinical trials, and disseminating study results. Drug safety departments within the biopharmaceutical industry are at a similar inflection point. Rising rates of per capita prescription drug use underscore the importance of having robust pharmacovigilance systems in place to detect and assess adverse drug reactions (ADRs). At the same time, the practice of pharmacovigilance is being transformed by a host of recent regulatory guidances and related initiatives which emphasize the importance of the patient's perspective in drug safety. Collectively, these initiatives impact the full range of activities that fall within the remit of pharmacovigilance, including ADR reporting, signal detection and evaluation, risk management, medication error assessment, benefit-risk assessment and risk communication. Examples include the fact that manufacturing authorization holders are now expected to monitor all digital sources under their control for potential reports of ADRs, and the emergence of new methods for collecting, analysing and reporting patient-generated ADR reports for signal detection and evaluation purposes. A drug safety department's ability to transition successfully into a more patient-centric organization will depend on three defining attributes: (1) a patient-centered culture; (2) deployment of a framework to guide patient engagement activities; and (3) demonstrated proficiency in patient-centered competencies, including patient engagement, risk communication and patient preference assessment. Whether, and to what extent, drug safety departments embrace the new patient-centric imperative, and the methods and

  7. Surgical revolutions.

    PubMed

    Toledo-Pereyra, Luis H

    2008-01-01

    Many surgical revolutions distinguish the history and evolution of surgery. They come in different sizes and exert a variable effect on the development and practice of the discipline. As science and technology rapidly evolve, so too does the creation of new paradigms, ideas and innovations or discoveries for the improvement of the surgical sciences. Surgical revolutions are not new, and have existed for centuries even though they have been more frequently recognized since the middle of the 19th century, 20th century and down to the present. Surgical revolutionaries are indispensable in the conception and completion of any surgical revolution. However, scientific and technological advances have supported the culmination of each revolution. PMID:18615311

  8. Biodegradable scaffold with built-in vasculature for organ-on-a-chip engineering and direct surgical anastomosis

    NASA Astrophysics Data System (ADS)

    Zhang, Boyang; Montgomery, Miles; Chamberlain, M. Dean; Ogawa, Shinichiro; Korolj, Anastasia; Pahnke, Aric; Wells, Laura A.; Massé, Stéphane; Kim, Jihye; Reis, Lewis; Momen, Abdul; Nunes, Sara S.; Wheeler, Aaron R.; Nanthakumar, Kumaraswamy; Keller, Gordon; Sefton, Michael V.; Radisic, Milica

    2016-06-01

    We report the fabrication of a scaffold (hereafter referred to as AngioChip) that supports the assembly of parenchymal cells on a mechanically tunable matrix surrounding a perfusable, branched, three-dimensional microchannel network coated with endothelial cells. The design of AngioChip decouples the material choices for the engineered vessel network and for cell seeding in the parenchyma, enabling extensive remodelling while maintaining an open-vessel lumen. The incorporation of nanopores and micro-holes in the vessel walls enhances permeability, and permits intercellular crosstalk and extravasation of monocytes and endothelial cells on biomolecular stimulation. We also show that vascularized hepatic tissues and cardiac tissues engineered by using AngioChips process clinically relevant drugs delivered through the vasculature, and that millimetre-thick cardiac tissues can be engineered in a scalable manner. Moreover, we demonstrate that AngioChip cardiac tissues implanted with direct surgical anastomosis to the femoral vessels of rat hindlimbs establish immediate blood perfusion.

  9. Guidance for implementing an environmental, safety, and health-assurance program. Volume 15. A model plan for line organization environmental, safety, and health-assurance programs

    SciTech Connect

    Ellingson, A.C.; Trauth, C.A. Jr.

    1982-01-01

    This is 1 of 15 documents designed to illustrate how an Environmental, Safety and Health (ES and H) Assurance Program may be implemented. The generic definition of ES and H Assurance Programs is given in a companion document entitled An Environmental, Safety and Health Assurance Program Standard. This particular document presents a model operational-level ES and H Assurance Program that may be used as a guide by an operational-level organization in developing its own plan. The model presented here reflects the guidance given in the total series of 15 documents.

  10. Safety Evaluation of Osun River Water Containing Heavy Metals and Volatile Organic Compounds (VOCs) in Rats.

    PubMed

    Azeez, L; Salau, A K; Adewuyi, S O; Osineye, S O; Tijani, K O; Balogun, R O

    2015-01-01

    This study evaluated the pH, heavy metals and volatile organic compounds (VOCs) in Osun river water. It also evaluated its safety in rats. Heavy metals were determined by atomic absorption spectrophotometry (AAS) while VOCs were determined by gas chromatography coupled with flame ionization detector (GC-FID). Male and female rats were exposed to Osun river water for three weeks and then sacrificed. The abundance of heavy metals in Osun river followed the trend Pb > Cd > Zn > Fe > Cr > Cu while VOCs followed the trend benzene < ethylbenzene < toluene < xylene. The concentrations of Pb, Cd and benzene were higher than the permissible limits of Standards Organization of Nigeria (SON) and World Health Organization (WHO) respectively. Rats exposed to Osun river water for three weeks had increased WBC, thiobarbituric acid reactive substances (TBARS), serum proteins and serum aminotransferases. There were also significant decreases in HCT, PLT, liver aminotransferases and liver glutathione compared to the control. These results show that the pollutants in Osun river water are capable of inducing hematological imbalance and liver cell injury. The toxicity induced in blood was sex-dependent affecting female rats more than male rats. PMID:27506174

  11. Surgical Technologists

    MedlinePlus

    ... in place during the procedure, or set up robotic surgical equipment. Technologists also may handle specimens taken ... sterilization techniques, how to set up technical or robotic equipment, and preventing and controlling infections. In addition ...

  12. Hydrogen Safety Project chemical analysis support task: Window C'' volatile organic analysis

    SciTech Connect

    Gillespie, B.M.; Stromatt, R.W.; Ross, G.A.; Hoope, E.A.

    1992-01-01

    This data package contains the results obtained by Pacific Northwest Laboratory (PNL) staff in the characterization of samples for the 101-SY Hydrogen Safety Project. The samples were submitted for analysis by Westinghouse Hanford Company (WHC) under the Technical Project Plan (TPP) 17667 and the Quality Assurance Plan MCS-027. They came from a core taken during Window C'' after the May 1991 gas release event. The analytical procedures required for analysis were defined in the Test Instructions (TI) prepared by the PNL 101-SY Analytical Chemistry Laboratory (ACL) Project Management Office in accordance with the TPP and the QA Plan. The requested analysis for these samples was volatile organic analysis. The quality control (QC) requirements for each sample are defined in the Test Instructions for each sample. The QC requirements outlined in the procedures and requested in the WHC statement of work were followed.

  13. Hydrogen Safety Project chemical analysis support task: Window ``C`` volatile organic analysis

    SciTech Connect

    Gillespie, B.M.; Stromatt, R.W.; Ross, G.A.; Hoope, E.A.

    1992-01-01

    This data package contains the results obtained by Pacific Northwest Laboratory (PNL) staff in the characterization of samples for the 101-SY Hydrogen Safety Project. The samples were submitted for analysis by Westinghouse Hanford Company (WHC) under the Technical Project Plan (TPP) 17667 and the Quality Assurance Plan MCS-027. They came from a core taken during Window ``C`` after the May 1991 gas release event. The analytical procedures required for analysis were defined in the Test Instructions (TI) prepared by the PNL 101-SY Analytical Chemistry Laboratory (ACL) Project Management Office in accordance with the TPP and the QA Plan. The requested analysis for these samples was volatile organic analysis. The quality control (QC) requirements for each sample are defined in the Test Instructions for each sample. The QC requirements outlined in the procedures and requested in the WHC statement of work were followed.

  14. Waste Tank Safety Program. Annual status report for FY 1993, Task 3: Organic chemistry

    SciTech Connect

    Lucke, R.B.; Clauss, T.T.W.; Hoheimer, R.; Goheen, S.C.

    1994-02-01

    This task supports the tank-vapor project, mainly by providing organic analytical support and by analyzing Tank 241-C-103 (Tank C-103) vapor-space samples, collected via SUMMA{trademark} canisters, by gas chromatography (GC) and GC/mass spectrometry (MS). In the absence of receiving tank-vapor samples, we have focused our efforts toward validating the normal paraffin hydrocarbon (NPH) sampling and analysis methods and preparing the SUMMA{trademark} laboratory. All required milestones were met, including a report on the update of phase I sampling and analysis on August 15, 1993. This update described the work involved in preparing to analyze phase I samples (Appendix A). This report describes the analytical support provided by Pacific Northwest Laboratory (PNL){sup (a)} to the Hanford Tank Safety Vapor Program.

  15. 77 FR 42737 - Patient Safety Organizations: Delisting for Cause for The Steward Group PSO

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-20

    ... whose mission and primary activity is to conduct activities to improve patient safety and the quality of health care delivery. HHS issued the Patient Safety and Quality Improvement Final Rule (Patient Safety..., aggregate, and analyze confidential information regarding the quality and safety of health care...

  16. Biomechanical properties of synthetic surgical meshes for pelvic prolapse repair.

    PubMed

    Todros, S; Pavan, P G; Natali, A N

    2015-03-01

    Synthetic meshes are widely used for surgical repair of different kind of prolapses. In the light of the experience of abdominal wall repair, similar prostheses are currently used in the pelvic region, to restore physiological anatomy after organ prolapse into the vaginal wall, that represent a recurrent dysfunction. For this purpose, synthetic meshes are surgically positioned in contact with the anterior and/or posterior vaginal wall, to inferiorly support prolapsed organs. Nonetheless, while mesh implantation restores physiological anatomy, it is often associated with different complications in the vaginal region. These potentially dangerous effects induce the surgical community to reconsider the safety and efficacy of mesh transvaginal placement. For this purpose, the evaluation of state-of-the-art research may provide the basis for a comprehensive analysis of mesh compatibility and functionality. The aim of this work is to review synthetic surgical meshes for pelvic organs prolapse repair, taking into account the mechanics of mesh material and structure, and to relate them with pelvic and vaginal tissue biomechanics. Synthetic meshes are currently available in different chemical composition, fiber and textile conformations. Material and structural properties are key factors in determining mesh biochemical and mechanical compatibility in vivo. The most significant results on vaginal tissue and surgical meshes mechanical characterization are here reported and discussed. Moreover, computational models of the pelvic region, which could support the surgeon in the evaluation of mesh performances in physiological conditions, are recalled. PMID:26615384

  17. Biodegradable scaffold with built-in vasculature for organ-on-a-chip engineering and direct surgical anastomosis

    PubMed Central

    Zhang, Boyang; Montgomery, Miles; Chamberlain, M. Dean; Ogawa, Shinichiro; Korolj, Anastasia; Pahnke, Aric; Wells, Laura A.; Massé, Stéphane; Kim, Jihye; Reis, Lewis; Momen, Abdulah; Nunes, Sara S.; Wheeler, Aaron; Nanthakumar, Kumaraswamy; Keller, Gordon; Sefton, Michael V.; Radisic, Milica

    2016-01-01

    We report the fabrication of a scaffold (hereafter referred to as AngioChip) that supports the assembly of parenchymal cells on a mechanically tunable matrix surrounding a perfusable, branched, three-dimensional microchannel network coated with endothelial cells. The design of AngioChip decouples the material choices for the engineered vessel network and for cell seeding in the parenchyma, enabling extensive remodelling while maintaining an open-vessel lumen. The incorporation of nanopores and micro-holes in the vessel walls enhances permeability, and permits intercellular crosstalk and extravasation of monocytes and endothelial cells on biomolecular stimulation. We also show that vascularized hepatic tissues and cardiac tissues engineered by using AngioChips process clinically relevant drugs delivered through the vasculature, and that millimeter-thick cardiac tissues can be engineered in a scalable manner. Moreover, we demonstrate that AngioChip cardiac tissues implanted via direct surgical anastomosis to the femoral vessels of rat hindlimbs establish immediate blood perfusion. PMID:26950595

  18. Biodegradable scaffold with built-in vasculature for organ-on-a-chip engineering and direct surgical anastomosis.

    PubMed

    Zhang, Boyang; Montgomery, Miles; Chamberlain, M Dean; Ogawa, Shinichiro; Korolj, Anastasia; Pahnke, Aric; Wells, Laura A; Massé, Stéphane; Kim, Jihye; Reis, Lewis; Momen, Abdul; Nunes, Sara S; Wheeler, Aaron R; Nanthakumar, Kumaraswamy; Keller, Gordon; Sefton, Michael V; Radisic, Milica

    2016-06-01

    We report the fabrication of a scaffold (hereafter referred to as AngioChip) that supports the assembly of parenchymal cells on a mechanically tunable matrix surrounding a perfusable, branched, three-dimensional microchannel network coated with endothelial cells. The design of AngioChip decouples the material choices for the engineered vessel network and for cell seeding in the parenchyma, enabling extensive remodelling while maintaining an open-vessel lumen. The incorporation of nanopores and micro-holes in the vessel walls enhances permeability, and permits intercellular crosstalk and extravasation of monocytes and endothelial cells on biomolecular stimulation. We also show that vascularized hepatic tissues and cardiac tissues engineered by using AngioChips process clinically relevant drugs delivered through the vasculature, and that millimetre-thick cardiac tissues can be engineered in a scalable manner. Moreover, we demonstrate that AngioChip cardiac tissues implanted with direct surgical anastomosis to the femoral vessels of rat hindlimbs establish immediate blood perfusion. PMID:26950595

  19. Hazardous organic compounds in biogas plant end products--soil burden and risk to food safety.

    PubMed

    Suominen, K; Verta, M; Marttinen, S

    2014-09-01

    The end products (digestate, solid fraction of the digestate, liquid fraction of the digestate) of ten biogas production lines in Finland were analyzed for ten hazardous organic compounds or compound groups: polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs), polychlorinated biphenyls (PCB(7)), polyaromatic hydrocarbons (PAH(16)), bis-(2-ethylhexyl) phthalate (DEHP), perfluorinated alkyl compounds (PFCs), linear alkylbenzene sulfonates (LASs), nonylphenols and nonylphenol ethoxylates (NP+NPEOs), polybrominated diphenyl ethers (PBDEs), hexabromocyclododecane (HBCD) and tetrabromobisphenol A (TBBPA). Biogas plant feedstocks were divided into six groups: municipal sewage sludge, municipal biowaste, fat, food industry by-products, animal manure and others (consisting of milling by-products (husk) and raw former foodstuffs of animal origin from the retail trade). There was no clear connection between the origin of the feedstocks of a plant and the concentrations of hazardous organic compounds in the digestate. For PCDD/Fs and for DEHP, the median soil burden of the compound after a single addition of digestate was similar to the annual atmospheric deposition of the compound or compound group in Finland or other Nordic countries. For PFCs, the median soil burden was somewhat lower than the atmospheric deposition in Finland or Sweden. For NP+NPEOs, the soil burden was somewhat higher than the atmospheric deposition in Denmark. The median soil burden of PBDEs was 400 to 1000 times higher than the PBDE air deposition in Finland or in Sweden. With PBDEs, PFCs and HBCD, the impact of the use of end products should be a focus of further research. Highly persistent compounds, such as PBDE- and PFC-compounds may accumulate in agricultural soil after repeated use of organic fertilizers containing these compounds. For other compounds included in this study, agricultural use of biogas plant end products is unlikely to cause risk to food safety in Finland. PMID:24593894

  20. Surgical exposures of the hand.

    PubMed

    Watt, Andrew J; Chung, Kevin C

    2014-11-01

    Surgical approaches to the hand are commonly executed in the treatment of fractures, ligament injuries, and less commonly in the resection of bony tumors. Careful design and execution of these surgical approaches translates into superior functional and aesthetic outcomes. We have provided a thorough review of commonly used approaches to the hand by evaluating each of these approaches in the context of core principles including safety, versatility, preservation of stability, and aesthetic outcomes. PMID:25440073

  1. [Pulmonary Echinococcosis: Surgical Aspects].

    PubMed

    Eichhorn, M E; Hoffmann, H; Dienemann, H

    2015-10-01

    Pulmonary cystic echinococcosis is a very rare disease in Germany. It is caused by the larvae of the dog tapeworm (echinococcus granulosus). The liver is the most affected organ, followed by the lungs. Surgery remains the main therapeutic approach for pulmonary CE. Whenever possible, parenchyma-preserving lung surgery should be preferred over anatomic lung resections. To ensure best therapeutic results, surgery needs to be performed under precise consideration of important infectiological aspects and patients should be treated in specialised centres based on interdisciplinary consensus. In addition to surgical aspects, this review summarises special infectiological features of this disease, which are crucial to the surgical approach. PMID:26351761

  2. Effect of organic acid treatments on microbial safety and overall acceptability of fresh-cut melon cubes

    Technology Transfer Automated Retrieval System (TEKTRAN)

    There is much interest in developing effective minimal processing methodologies for fruits and vegetables that would enhance the microbial safety and not change overall acceptability. In this study, several organic acids (EDTA, nisin, sorbic acid and sodium lactate) generally regarded as safe (GRAS)...

  3. Surgical Procedures for Vestibular Dysfunction

    MedlinePlus

    ... Rated Nonprofit! Volunteer. Donate. Review. Surgical Procedures for Vestibular Dysfunction When is surgery necessary? When medical treatment ... organ (cochlea) is also sacrificed with this procedure. Vestibular nerve section A vestibular nerve section is a ...

  4. A systematic review of minimally invasive surgical treatment for atrial fibrillation: a comparison of the Cox-Maze procedure, beating-heart epicardial ablation, and the hybrid procedure on safety and efficacy.

    PubMed

    Je, Hyung Gon; Shuman, Deborah J; Ad, Niv

    2015-10-01

    There is a growing trend to perform off-bypass surgical ablation for atrial fibrillation (AF) because it is perceived to be safer and more effective than the Cox-Maze procedure with cardiopulmonary bypass (CPB) support. In this systematic review, we compared three minimally invasive stand-alone surgical ablation procedures for AF: the endocardial Cox-Maze procedure, epicardial surgical ablation and a hybrid epicardial surgical and catheter-based endocardial ablation procedure (hybrid procedure). Relevant studies were identified in MEDLINE and the Cochrane Database of Systematic Reviews according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From 565 initial studies, 37 were included in this review. The total number of patients across all studies was 1877 (range 10-139). Two studies reported on endocardial Cox-Maze procedures (n = 145), 26 reported on epicardial surgical ablation (n = 1382) and 9 reported on hybrid surgical ablation (n = 350). For minimally invasive Cox-Maze, epicardial and hybrid groups, operative mortality rates were 0, 0.5 and 0.9%, perioperative permanent pacemaker insertion rates were 3.5, 2.7 and 1.5%, incidence of conversion to median sternotomy was 0, 2.4 and 2.5%, and reoperation for bleeding was 1.0, 1.5 and 2.2%, with mean length of stay (days) of 5.4, 6.0 and 4.6, respectively. At 12 months, rates of sinus rhythm restoration were 93, 80 and 70%, and sinus restoration without anti-arrhythmic medications was 87, 72 and 71%, for Cox-Maze, epicardial and hybrid procedures, respectively. Of the three procedures, the minimally invasive Cox-Maze procedure with CPB support was most effective for the treatment of stand-alone AF and had important safety advantages in conversion to sternotomy and major bleeding. The minimally invasive Cox-Maze procedure with CPB support also demonstrated the potential for a higher success rate 12 months following the procedure. PMID:25567961

  5. Survival Analyses for Patients With Surgically Resected Pancreatic Neuroendocrine Tumors by World Health Organization 2010 Grading Classifications and American Joint Committee on Cancer 2010 Staging Systems

    PubMed Central

    Yang, Min; Ke, Neng-wen; Zeng, Lin; Zhang, Yi; Tan, Chun-lu; Zhang, Hao; Mai, Gang; Tian, Bo-le; Liu, Xu-bao

    2015-01-01

    Abstract In 2010, World Health Organization (WHO) reclassified pancreatic neuroendocrine tumors (p-NETs) into 4 main groups: neuroendocrine tumor G1 (NET G1), neuroendocrine tumor G2 (NET G2), neuroendocrine carcinoma G3 (NEC G3), mixed adeno and neuroendocrine carcinoma (MANEC). Clinical value of these newly updated WHO grading criteria has not been rigorously validated. The authors aimed to evaluate the clinical consistency of the new 2010 grading classifications by WHO and the 2010 tumor-node metastasis staging systems by American Joint Committee on Cancer (AJCC) on survivals for patients with surgically resected p-NETs. Moreover, the authors would validate the prognostic value of both criteria for p-NETs. The authors retrospectively collected the clinicopathologic data of 120 eligible patients who were all surgically treated and histopathologically diagnosed as p-NETs from January 2004 to February 2014 in our single institution. The new WHO criteria were assigned to 4 stratified groups with a respective distribution of 62, 35, 17, and 6 patients. Patients with NET G1 or NET G2 obtained a statistically better survival compared with those with NEC G3 or MANEC (P < 0.001). Survivals of NET G1 was also better than those of NET G2 (P = 0.023), whereas difference of survivals between NEC G3 and MANEC present no obvious significance (P = 0.071). The AJCC 2010 staging systems were respectively defined in 61, 36, 12, and 11 patients for each stage. Differences of survivals of stage I with stage III and IV were significant (P < 0.001), as well as those of stage II with III and IV (P < 0.001); whereas comparisons of stage I with stage II and stage III with IV were not statistically significant (P = 0.129, P = 0.286; respectively). Together with radical resection, these 2 systems were both significant in univariate and multivariate analysis (P < 0.05). The newly updated WHO 2010 grading classifications and the AJCC 2010 staging systems could

  6. Survival Analyses for Patients With Surgically Resected Pancreatic Neuroendocrine Tumors by World Health Organization 2010 Grading Classifications and American Joint Committee on Cancer 2010 Staging Systems.

    PubMed

    Yang, Min; Ke, Neng-wen; Zeng, Lin; Zhang, Yi; Tan, Chun-lu; Zhang, Hao; Mai, Gang; Tian, Bo-le; Liu, Xu-bao

    2015-12-01

    In 2010, World Health Organization (WHO) reclassified pancreatic neuroendocrine tumors (p-NETs) into 4 main groups: neuroendocrine tumor G1 (NET G1), neuroendocrine tumor G2 (NET G2), neuroendocrine carcinoma G3 (NEC G3), mixed adeno and neuroendocrine carcinoma (MANEC). Clinical value of these newly updated WHO grading criteria has not been rigorously validated. The authors aimed to evaluate the clinical consistency of the new 2010 grading classifications by WHO and the 2010 tumor-node metastasis staging systems by American Joint Committee on Cancer (AJCC) on survivals for patients with surgically resected p-NETs. Moreover, the authors would validate the prognostic value of both criteria for p-NETs.The authors retrospectively collected the clinicopathologic data of 120 eligible patients who were all surgically treated and histopathologically diagnosed as p-NETs from January 2004 to February 2014 in our single institution. The new WHO criteria were assigned to 4 stratified groups with a respective distribution of 62, 35, 17, and 6 patients. Patients with NET G1 or NET G2 obtained a statistically better survival compared with those with NEC G3 or MANEC (P < 0.001). Survivals of NET G1 was also better than those of NET G2 (P = 0.023), whereas difference of survivals between NEC G3 and MANEC present no obvious significance (P = 0.071). The AJCC 2010 staging systems were respectively defined in 61, 36, 12, and 11 patients for each stage. Differences of survivals of stage I with stage III and IV were significant (P < 0.001), as well as those of stage II with III and IV (P < 0.001); whereas comparisons of stage I with stage II and stage III with IV were not statistically significant (P = 0.129, P = 0.286; respectively). Together with radical resection, these 2 systems were both significant in univariate and multivariate analysis (P < 0.05).The newly updated WHO 2010 grading classifications and the AJCC 2010 staging systems could consistently reflect the clinical outcome

  7. Improving surgical weekend handover

    PubMed Central

    Culwick, Caroline; Devine, Chris; Coombs, Catherine

    2014-01-01

    Effective handovers are vital to patient safety and continuity of care, and this is recognised by several national bodies including the GMC. The existing model at Great Western Hospital (GWH) involved three general surgical teams and a urology team placing their printed patient lists, complete with weekend jobs, in a folder for the on-call team to collect at the weekend. We recognised a need to reduce time searching for patients, jobs and reviews, and to streamline weekend ward rounds. A unified weekend list ordering all surgical patients by ward and bed number was introduced. Discrepancies in the layout of each team's weekday list necessitated the design of a new weekday list to match the weekend list to facilitate the easy transfer of information between the two lists. A colour coding system was also used to highlight specific jobs. Prior to this improvement project only 7.1% of those polled were satisfied with the existing system, after a series of interventions satisfaction increased to 85.7%. The significant increase in overall satisfaction with surgical handover following the introduction of the unified weekend list is promising. Locating patients and identifying jobs is easier and weekend ward rounds can conducted in a more logical and timely fashion. It has also helped facilitate the transition to consultant ward rounds of all surgical inpatients at the weekends with promising feedback from a recent consultants meeting. PMID:26734294

  8. [Management, quality of health and occupational safety and hospital organization: is integration possible?].

    PubMed

    Corrao, Carmela Romana Natalina

    2011-01-01

    The evolution of the national and European legislation has progressively transformed the working environments into organized environments. Specific models for its management are being proposed, which should be integrated into general management strategies. In the case of hospitals this integration should consider the peculiar organizational complexity, where the management of the occupational risk needs to be integrated with clinical risk management and economic risk management. Resources management should also consider that Occupational Medicine has not a direct monetary benefit for the organisation, but only indirect health consequences in terms of reduction of accidents and occupational diseases. The deep and simultaneous analysis of the current general management systems and the current management methods of occupational safety and health protection allows one to hyphotesise a possible integration between them. For both of them the Top Management is the main responsible of the quality management strategies and the use of specific documents in the managerial process, such as the document of risks evaluation in the occupational management and the quality manual in the general management, is of paramount importance. An integrated management has also the scope to pursue a particular kind of quality management, where ethics and job satisfaction are innovative, as established by recent European guidelines, management systems and national legislations. PMID:21468157

  9. [Emission characteristics and safety evaluation of volatile organic compounds in manufacturing processes of automotive coatings].

    PubMed

    Zeng, Pei-Yuan; Li, Jian-Jun; Liao, Dong-Qi; Tu, Xiang; Xu, Mei-Ying; Sun, Guo-Ping

    2013-12-01

    Emission characteristics of volatile organic compounds (VOCs) were investigated in an automotive coating manufacturing enterprise. Air samples were taken from eight different manufacturing areas in three workshops, and the species of VOCs and their concentrations were measured by gas chromatography-mass spectrometry (GC-MS). Safety evaluation was also conducted by comparing the concentration of VOCs with the permissible concentration-short term exposure limit (PC-STEL) regulated by the Ministry of Health. The results showed that fifteen VOCs were detected in the indoor air of the automotive coatings workshop, including benzene, toluene, ethylbenzene, xylene, ethyl acetate, butyl acetate, methyl isobutyl ketone, propylene glycol monomethyl ether acetate, trimethylbenzene and ethylene glycol monobutyl ether, Their concentrations widely ranged from 0.51 to 593.14 mg x m(-3). The concentrations of TVOCs were significantly different among different manufacturing processes. Even in the same manufacturing process, the concentrations of each component measured at different times were also greatly different. The predominant VOCs of indoor air in the workshop were identified to be ethylbenzene and butyl acetate. The concentrations of most VOCs exceeded the occupational exposure limits, so the corresponding control measures should be taken to protect the health of the workers. PMID:24640895

  10. [Safe surgery checklist: analysis of the safety and communication of teams from a teaching hospital].

    PubMed

    Pancieri, Ana Paula; Santos, Bruna Pegorer; de Avila, Marla Andréia Garcia; Braga, Eliana Mara

    2013-03-01

    This study aimed to apply the WHO surgical safety checklist in the surgical specialties of a university hospital and to evaluate the opinion of the team regarding the influence of its application on the safety of the surgical process and on the interpersonal communication of the team. It is a descriptive, analytical qualitative field study conducted in the surgical center of a university hospital Data were collected by applying the checklist in a total of 30 surgeries. The researcher conducted its application in three phases, and then members of the surgical team were invited to voluntarily participate in the study, signifying their agreement to participate by signing an informed consent form and answering guiding questions. Bardin's Content Analysis Method was used to organize and analyze the data. The subjects did not notice any changes in their interpersonal communication when using the checklist; however, they gave suggestions and reported that its use provided greater safety to the procedure. PMID:23781726

  11. Flammable Gas Safety Program: actual waste organic analysis FY 1996 progress report; Flammable Gas Safety Program: actual waste organic analysis FY 1996 progress report

    SciTech Connect

    Clauss, S.A.; Grant, K.E.; Hoopes, V.; Mong, G.M.; Rau, J.; Steele, R.; Wahl, K.H.

    1996-09-01

    This report describes the status of optimizing analytical methods to account for the organic components in Hanford waste tanks, with emphasis on tanks assigned to the Flammable Gas Watch List. The methods developed are illustrated by their application to samples from Tanks 241-SY-103 and 241-S-102. Capability to account for organic carbon in Tank SY-101 was improved significantly by improving techniques for isolating organic constituents relatively free from radioactive contamination and by improving derivatization methodology. The methodology was extended to samples from Tank SY-103 and results documented in this report. Results from analyzing heated and irradiated SY-103 samples (Gas Generation Task) and evaluating methods for analyzing tank waste directly for chelators and chelator fragments are also discussed.

  12. Organic Tank Safety Project: development of a method to measure the equilibrium water content of Hanford organic tank wastes and demonstration of method on actual waste

    SciTech Connect

    Scheele, R.D.; Bredt, P.R.; Sell, R.L.

    1996-09-01

    Some of Hanford`s underground waste storage tanks contain Organic- bearing high level wastes that are high priority safety issues because of potentially hazardous chemical reactions of organics with inorganic oxidants in these wastes such as nitrates and nitrites. To ensure continued safe storage of these wastes, Westinghouse Hanford Company has placed affected tanks on the Organic Watch List and manages them under special rules. Because water content has been identified as the most efficient agent for preventing a propagating reaction and is an integral part of the criteria developed to ensure continued safe storage of Hanford`s organic-bearing radioactive tank wastes, as part of the Organic Tank Safety Program the Pacific Northwest National Laboratory developed and demonstrated a simple and easily implemented procedure to determine the equilibrium water content of these potentially reactive wastes exposed to the range of water vapor pressures that might be experienced during the wastes` future storage. This work focused on the equilibrium water content and did not investigate the various factors such as @ ventilation, tank surface area, and waste porosity that control the rate that the waste would come into equilibrium, with either the average Hanford water partial pressure 5.5 torr or other possible water partial pressures.

  13. Surgical Simulation and Competency.

    PubMed

    Kim-Fine, Shunaha; Brennand, Erin A

    2016-09-01

    Simulation in surgical training is playing an increasingly important role as postgraduate medical education programs navigate an environment of increasing costs of education, increased attention on patient safety, and new duty hour restrictions. In obstetrics and gynecology, simulation has been used to teach many procedures; however, it lacks a standardized curriculum. Several different simulators exist for teaching various routes and aspects of hysterectomy. This article describes how a formal framework of increasing levels of competencies can be applied to simulation in teaching the procedure of hysterectomy. PMID:27521885

  14. Thoracoscopy: a collaborative surgical approach.

    PubMed

    Brand, A F

    1995-07-01

    Perioperative nurses, surgeons, anesthesiologists, certified registered nurse anesthetists, and pharmacists are meeting the challenge of decreasing thoracic surgical patients' length of hospital stay with thoracoscopy. This innovative alternative to traditional thoracotomy procedures has been achieved through an attentive team approach using the fundamental perioperative skills of assessment, positioning, safety, and sharing of knowledge. PMID:7647761

  15. Driving Surgical Quality Using Operative Video.

    PubMed

    O'Mahoney, Paul R A; Yeo, Heather L; Lange, Marilyne M; Milsom, Jeffrey W

    2016-08-01

    Recent evidence suggests surgical quality may be demonstrated and evaluated using video capture during surgery. Operative video documentation may also aid in quality improvement initiatives. We discuss how operative video has the potential to help improve patient outcomes and increase professional accountability, patient safety, and surgical quality. PMID:27076573

  16. Credentialing of surgical skills centers.

    PubMed

    Sachdeva, Ajit K

    2011-01-01

    Major imperatives regarding quality of patient care and patient safety are impacting surgical care and surgical education. Also, significant emphasis continues to be placed on education and training to achieve proficiency, expertise, and mastery in surgery. Simulation-based surgical education and training can be of immense help in acquiring and maintaining surgical skills in safe environments without exposing patients to risk. Opportunities for repetition of tasks can be provided to achieve pre-established standards, and knowledge and skills can be verified using valid and reliable assessment methods. Also, expertise and mastery can be attained through repeated practice, specific feedback, and establishment of progressively higher learning goals. Simulation-based education and training can help surgeons maintain their skills in infrequently performed procedures and regain proficiency in procedures they have not performed for a period of time. In addition, warm-ups and surgical rehearsals in simulated environments should enhance performance in real settings. Major efforts are being pursued to advance the field of simulation-based surgical education. New education and training models involving validation of knowledge and skills are being designed for practicing surgeons. A competency-based national surgery resident curriculum was recently launched and is undergoing further enhancements to address evolving education and training needs. Innovative simulation-based surgical education and training should be offered at state-of-the-art simulation centers, and credentialing and accreditation of these centers are key to achieving their full potential. PMID:21549986

  17. The Surgical Treatment of Mycetoma

    PubMed Central

    Suleiman, Suleiman Hussein; Wadaella, EL Sammani; Fahal, Ahmed Hassan

    2016-01-01

    Surgical intervention is an integral component in the diagnosis and management of mycetoma. Surgical treatment is indicated for small, localised lesions and massive lesions to reduce the mycetoma load and to enable better response to medical therapy. It is also a life-saving procedure in patients with massive disease and sepsis. Surgical options for mycetoma treatment range from a wide local surgical excision to repetitive debridement excisions to amputation of the affected part. Adequate anaesthesia, a bloodless field, wide local excision with adequate safety margins in a suitable surgical facility, and expert surgeons are mandatory to achieve the best surgical outcome. Surgical intervention in mycetoma is associated with considerable morbidity, deformities, and disabilities, particularly in advanced disease. These complications can be reduced by educating patients to seek medical advice earlier when the lesion is small, localised, and amenable to surgery. There is no evidence for mycetoma hospital cross infection. This communication is based on the authors’ experience in managing over 7,200 mycetoma patients treated at the Mycetoma Research Centre, University of Khartoum, Sudan. PMID:27336736

  18. Field Test of the World Health Organization Multi-Professional Patient Safety Curriculum Guide

    PubMed Central

    Farley, Donna; Zheng, Hao; Rousi, Eirini; Leotsakos, Agnès

    2015-01-01

    Introduction Although the importance of training in patient safety has been acknowledged for over a decade, it remains under-utilized and under-valued in most countries. WHO developed the Multi-professional Patient Safety Curriculum Guide to provide schools with the requirements and tools for incorporating patient safety in education. It was field tested with 12 participating schools across the six WHO regions, to assess its effectiveness for teaching patient safety to undergraduate and graduate students in a global variety of settings. Methods The evaluation used a combined prospective/retrospective design to generate formative information on the experiences of working with the Guide and summative information on the impacts of the Guide. Using stakeholder interviews and student surveys, data were gathered from each participating school at three times: the start of the field test (baseline), soon after each school started teaching, and soon after each school finished teaching. Results Stakeholders interviewed were strongly positive about the Guide, noting that it emphasized universally important patient safety topics, was culturally appropriate for their countries, and gave credibility and created a focus on patient safety at their schools. Student perceptions and attitudes regarding patient safety improved substantially during the field test, and their knowledge of the topics they were taught doubled, from 10.7% to 20.8% of correct answers on the student survey. Discussion This evaluation documented the effectiveness of the Curriculum Guide, for both ease of use by schools and its impacts on improving the patient safety knowledge of healthcare students. WHO should be well positioned to refine the contents of the Guide and move forward in encouraging broader use of the Guide globally for teaching patient safety. PMID:26406893

  19. A Registry for Evaluation of Efficiency and Safety of Surgical Treatment of Cartilage Defects: The German Cartilage Registry (KnorpelRegister DGOU)

    PubMed Central

    2016-01-01

    Background The need for documentation in cartilage defects is as obvious as in other medical specialties. Cartilage defects can cause significant pain, and lead to reduced quality of life and loss of function of the affected joint. The risk of developing osteoarthritis is high. Therefore, the socioeconomic burden of cartilage defects should not be underestimated. Objective The objective of our study was to implement and maintain a registry of all patients undergoing surgical treatment of cartilage defects. Methods We designed this multicenter registry for adults whose cartilage defects of a knee, ankle, or hip joint are treated surgically. The registry consists of two parts: one for the physician and one for the patient. Data for both parts will be gathered at baseline and at 6-, 12-, 24-, 36-, 60-, and 120-month follow-ups. Results To date, a wide range of German, Swiss, and Austrian trial sites are taking part in the German Cartilage Registry, soon to be followed by further sites. More than 2124 (as of January 31, 2016) cases are already documented and the first publications have been released. Conclusions The German Cartilage Registry addresses fundamental issues regarding the current medical care situation of patients with cartilage defects of knee, ankle, and hip joints. In addition, the registry will help to identify various procedure-specific complications, along with putative advantages and disadvantages of different chondrocyte products. It provides an expanding large-scale, unselected, standardized database for cost and care research for further retrospective studies. Trial Registration German Clinical Trials Register: DRKS00005617; https://drks-neu.uniklinik-freiburg.de/ drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00005617 (Archived by WebCite at http://www.webcitation.org/6hbFqSws0) PMID:27357998

  20. Developing Natural Solutions to Reducing Food Safety Pathogens in Organically Raised Poultry

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Organic poultry production is one of the fastest growing segments of organic agriculture with a 20% increase/yr since the establishment of the National Organic Program (NOP). Restrictions on prophylactic antibiotics used for conventional poultry production raise unique challenges for organic produce...

  1. Patient Safety in Interventional Radiology: A CIRSE IR Checklist

    SciTech Connect

    Lee, M. J.; Fanelli, F.; Haage, P.; Hausegger, K.; Lienden, K. P. Van

    2012-04-15

    Interventional radiology (IR) is an invasive speciality with the potential for complications as with other invasive specialities. The World Health Organization (WHO) produced a surgical safety checklist to decrease the morbidity and mortality associated with surgery. The Cardiovascular and Interventional Society of Europe (CIRSE) set up a task force to produce a checklist for IR. Use of the checklist will, we hope, reduce the incidence of complications after IR procedures. It has been modified from the WHO surgical safety checklist and the RAD PASS from Holland.

  2. Improving produce safety by stabilizing chlorine in washing solutions with high organic loads

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The need for technologies to protect our nation’s food supply and support sustained growth of the produce industry has never been more urgent. The produce industry currently faces a major potential food safety problem, since the chlorine needed to prevent pathogen survival is depleted during commer...

  3. 77 FR 26280 - Patient Safety Organizations: Voluntary Relinquishment From CareRise LLC

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-03

    ... Relinquishment From CareRise LLC AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS. ACTION: Notice of Delisting. SUMMARY: AHRQ has accepted a notification of voluntary relinquishment from CareRise LLC... quality of health care delivery. HHS issued the Patient Safety and Quality Improvement Final Rule...

  4. Improving Cardiac Surgical Care: A Work Systems Approach

    PubMed Central

    Wiegmann, Douglas A.; Eggman, Ashley A.; ElBardissi, Andrew W.; Henrickson, Sarah E.; Sundt, Thoralf M.

    2010-01-01

    Over the past 50 years, significant improvements in cardiac surgical care have been achieved. Nevertheless, surgical errors that significantly impact patient safety continue to occur. In order to further improve surgical outcomes, patient safety programs must focus on rectifying work system factors in the operating room (OR) that negatively impact the delivery of reliable surgical care. The goal of this paper is to provide an integrative review of specific work system factors in the OR that may directly impact surgical care processes, as well as the subsequent recommendations that have been put forth to improve surgical outcomes and patient safety. The important role that surgeons can play in facilitating work system changes in the OR is also discussed. The paper concludes with a discussion of the challenges involved in assessing the impact that interventions have on improving surgical care. Opportunities for future research are also highlighted throughout the paper. PMID:20202623

  5. Improving cardiac surgical care: a work systems approach.

    PubMed

    Wiegmann, Douglas A; Eggman, Ashley A; Elbardissi, Andrew W; Parker, Sarah Henrickson; Sundt, Thoralf M

    2010-09-01

    Over the past 50 years, significant improvements in cardiac surgical care have been achieved. Nevertheless, surgical errors that significantly impact patient safety continue to occur. In order to further improve surgical outcomes, patient safety programs must focus on rectifying work system factors in the operating room (OR) that negatively impact the delivery of reliable surgical care. The goal of this paper is to provide an integrative review of specific work system factors in the OR that may directly impact surgical care processes, as well as the subsequent recommendations that have been put forth to improve surgical outcomes and patient safety. The important role that surgeons can play in facilitating work system changes in the OR is also discussed. The paper concludes with a discussion of the challenges involved in assessing the impact that interventions have on improving surgical care. Opportunities for future research are also highlighted throughout the paper. PMID:20202623

  6. Safety and efficacy of levobupivacaine for postoperative pain relief after the surgical removal of impacted third molars: a comparison with lignocaine and adrenaline.

    PubMed

    Rood, J P; Coulthard, P; Snowdon, A T; Gennery, B A

    2002-12-01

    In a randomised, double-blind placebo-controlled single-centre study we compared the efficacy and safety of 0.75% levobupivacaine (without vasoconstrictor) with 2% lignocaine (with adrenaline 1:80,000) and with placebo for postoperative pain relief in 93 patients having day surgery under general anaesthesia for the removal of impacted mandibular third molars. Premedication and preoperative analgesics were not prescribed, although a short-acting opioid analgesic agent was allowed if required during the anaesthetic procedure. Patients were asked to keep a diary card for 2 days after discharge from hospital. The primary endpoint was the number of patients who requested analgesia within 2 h of completion of the operation. In total, 16 (53%) of patients given levobupivacaine requested analgesia compared with 22 (71%) given lignocaine and 23 (72%) given placebo. Patients given levobupivacaine had lower maximum visual analogue pain scores (VAS) and took longer to request rescue medication (P=0.045 compared with lignocaine). Fewer patients after levobupivacaine n=20 (7%) than after lignocaine n=7 (23%) or placebo n=5 (16%) experienced adverse events. Levobupivacaine seems to be a suitable alternative local anaesthetic to lignocaine with adrenaline for pain control after oral operations. PMID:12464207

  7. Animal study assessing safety of an acoustic coupling fluid that holds the potential to avoid surgically induced artifacts in 3D ultrasound guided operations

    PubMed Central

    2014-01-01

    Background Use of ultrasound in brain tumor surgery is common. The difference in attenuation between brain and isotonic saline may cause artifacts that degrade the ultrasound images, potentially affecting resection grades and safety. Our research group has developed an acoustic coupling fluid that attenuates ultrasound energy like the normal brain. We aimed to test in animals if the newly developed acoustic coupling fluid may have harmful effects. Methods Eight rats were included for intraparenchymal injection into the brain, and if no adverse reactions were detected, 6 pigs were to be included with injection of the coupling fluid into the subarachnoid space. Animal behavior, EEG registrations, histopathology and immunohistochemistry were used in assessment. Results In total, 14 animals were included, 8 rats and 6 pigs. We did not detect any clinical adverse effects, seizure activity on EEG or histopathological signs of tissue damage. Conclusion The novel acoustic coupling fluid intended for brain tumor surgery appears safe in rats and pigs under the tested circumstances. PMID:24666721

  8. Organic tank safety project: Preliminary results of energetics and thermal behavior studies of model organic nitrate and/or nitrite mixtures and a simulated organic waste

    SciTech Connect

    Scheele, R.D.; Sell, R.L.; Sobolik, J.L.; Burger, L.L.

    1995-08-01

    As a result of years of production and recovery of nuclear defense materials and subsequent waste management at the Hanford Site, organic-bearing radioactive high-level wastes (HLW) are currently stored in large (up to 3. ML) single-shell storage tanks (SSTs). Because these wastes contain both fuels (organics) and the oxidants nitrate and nitrite, rapid energetic reactions at certain conditions could occur. In support of Westinghouse Hanford Company`s (WHC) efforts to ensure continued safe storage of these organic- and oxidant-bearing wastes and to define the conditions necessary for reactions to occur, we measured the thermal sensitivities and thermochemical and thermokinetic properties of mixtures of selected organics and sodium nitrate and/or nitrite and a simulated Hanford organic-bearing waste using thermoanalytical technologies. These thermoanalytical technologies are used by chemical reactivity hazards evaluation organizations within the chemical industry to assess chemical reaction hazards.

  9. The Efficacy and Safety of Knotless Barbed Sutures in the Surgical Field: A Systematic Review and Meta-analysis of Randomized Controlled Trials

    PubMed Central

    Lin, Yifei; Lai, Sike; Huang, Jin; Du, Liang

    2016-01-01

    The knotless barbed suture is an innovative type of suture that can accelerate the placement of sutures and eliminate knot tying. However, the outcomes of previous studies are still confounding. This study reviewed the application of different types of barbed sutures in different surgeries. We searched PubMed, EMBASE, CENTRAL and ClinicalTrials.gov to identify randomized controlled trials (RCTs) addressing the application of barbed sutures up to Feb. 2015. Two reviewers independently screened the literature and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. Sensitivity analysis and subgroup analysis was performed. Seventeen RCTs (low to moderate risk of bias) involving 1992 patients were included. Compared with conventional sutures, the barbed suture could reduce suture time (SMD=−0.95, 95%CI −1.43 to −0.46, P = 0.0001) and the operative time (SMD=−0.28, 95%CI −0.46 to −0.10, P = 0.003), not significantly increase the estimated blood loss (SMD=−0.09, 95%CI −0.52 to 0.35, P = 0.70), but could lead to more postoperative complications (OR = 1.43, 95%CI 1.05 to 1.96, P = 0.03), These results varied in subgroups. Thus, barbed sutures are effective in reducing the suture and operative time, but the safety evidences are still not sufficient. It need be evaluated based on special surgeries and suture types before put into clinical practice. PMID:27005688

  10. Ergonomics support for local initiative in improving safety and health at work: International Labour Organization experiences in industrially developing countries.

    PubMed

    Kawakami, T; Kogi, K

    2005-04-15

    Ergonomics has played essential roles in the technical cooperation activities of the International Labour Organization (ILO) in occupational safety and health in industrially developing countries. Ergonomics support focusing on practical day-to-day needs at the grass-root workplace has strengthened the local initiative in improving safety and health. Practical action-tools such as ergonomics checklists, local good example photos and group discussions have assisted workers and employers in identifying feasible solutions using locally available resources. Direct participation of workers and employers has been promoted in ergonomics training aimed at immediate solutions. ILO Guidelines on Occupational Safety and Health Management Systems have played increasingly important roles in the systematic planning of local improvement actions. Policy-level programmes to develop network support mechanisms to the grass-root workplace were essential for following up and sustaining local achievements. Practical ergonomics support tools, such as action checklists and low-cost improvement guides, should be developed and widely applied so as to reach grass-root levels and help local people create safer and healthier workplaces. PMID:16040528

  11. Using Organization Risk Analyzer (ORA) to Explore the Relationship of Nursing Unit Communication to Patient Safety and Quality Outcomes

    PubMed Central

    Effken, Judith A.; Carley, Kathleen M.; Gephart, Sheila; Verran, Joyce A.; Bianchi, Denise; Reminga, Jeff; Brewer, Barbara

    2011-01-01

    Purpose We used Organization Risk Analyzer (ORA), a dynamic network analysis tool, to identify patient care unit communication patterns associated with patient safety and quality outcomes. Although ORA had previously had limited use in healthcare, we felt it could effectively model communication on patient care units. Methods Using a survey methodology, we collected communication network data from nursing staff on seven patient care units on two different days. Patient outcome data were collected via a separate survey. Results of the staff survey were used to represent the communication networks for each unit in ORA. We then used ORA's analysis capability to generate communication metrics for each unit. ORA's visualization capability was used to better understand the metrics. Results We identified communication patterns that correlated with two safety (falls and medication errors) and five quality (e.g., symptom management, complex self care, and patient satisfaction) outcome measures. Communication patterns differed substantially by shift. Conclusion The results demonstrate the utility of ORA for healthcare research and the relationship of nursing unit communication patterns to patient safety and quality outcomes. PMID:21536492

  12. How trust in institutions and organizations builds general consumer confidence in the safety of food: a decomposition of effects.

    PubMed

    de Jonge, J; van Trijp, J C M; van der Lans, I A; Renes, R J; Frewer, L J

    2008-09-01

    This paper investigates the relationship between general consumer confidence in the safety of food and consumer trust in institutions and organizations. More specifically, using a decompositional regression analysis approach, the extent to which the strength of the relationship between trust and general confidence is dependent upon a particular food chain actor (for example, food manufacturers) is assessed. In addition, the impact of specific subdimensions of trust, such as openness, on consumer confidence are analyzed, as well as interaction effects of actors and subdimensions of trust. The results confirm previous findings, which indicate that a higher level of trust is associated with a higher level of confidence. However, the results from the current study extend on previous findings by disentangling the effects that determine the strength of this relationship into specific components associated with the different actors, the different trust dimensions, and specific combinations of actors and trust dimensions. The results show that trust in food manufacturers influences general confidence more than trust in other food chain actors, and that care is the most important trust dimension. However, the contribution of a particular trust dimension in enhancing general confidence is actor-specific, suggesting that different actors should focus on different trust dimensions when the purpose is to enhance consumer confidence in food safety. Implications for the development of communication strategies that are designed to regain or maintain consumer confidence in the safety of food are discussed. PMID:18450326

  13. Cognitive decision errors and organization vulnerabilities in nuclear power plant safety management: Modeling using the TOGA meta-theory framework

    SciTech Connect

    Cappelli, M.; Gadomski, A. M.; Sepiellis, M.; Wronikowska, M. W.

    2012-07-01

    In the field of nuclear power plant (NPP) safety modeling, the perception of the role of socio-cognitive engineering (SCE) is continuously increasing. Today, the focus is especially on the identification of human and organization decisional errors caused by operators and managers under high-risk conditions, as evident by analyzing reports on nuclear incidents occurred in the past. At present, the engineering and social safety requirements need to enlarge their domain of interest in such a way to include all possible losses generating events that could be the consequences of an abnormal state of a NPP. Socio-cognitive modeling of Integrated Nuclear Safety Management (INSM) using the TOGA meta-theory has been discussed during the ICCAP 2011 Conference. In this paper, more detailed aspects of the cognitive decision-making and its possible human errors and organizational vulnerability are presented. The formal TOGA-based network model for cognitive decision-making enables to indicate and analyze nodes and arcs in which plant operators and managers errors may appear. The TOGA's multi-level IPK (Information, Preferences, Knowledge) model of abstract intelligent agents (AIAs) is applied. In the NPP context, super-safety approach is also discussed, by taking under consideration unexpected events and managing them from a systemic perspective. As the nature of human errors depends on the specific properties of the decision-maker and the decisional context of operation, a classification of decision-making using IPK is suggested. Several types of initial situations of decision-making useful for the diagnosis of NPP operators and managers errors are considered. The developed models can be used as a basis for applications to NPP educational or engineering simulators to be used for training the NPP executive staff. (authors)

  14. Data quality objective to support resolution of the organic fuel rich tank safety issue

    SciTech Connect

    Buckley, L.L.

    1995-04-28

    During years of Hanford process history, large quantities of complexants used in waste management operations as well as an unknown quantity of degradation products of the solvents used in fuel reprocessing and metal recovery were added to man of the 149 single-shell tanks. These waste tanks also contain a presumed stoichiometric excess of sodium nitrate/nitrite oxidizers, sufficient to exothermically oxidize the organic compounds if suitably initiated. This DQO identifies the questions that must be answered to appropriately disposition organic watchlist tanks, identifies a strategy to deal with false positive or negative judgements associated with analytical uncertainty, and list the analytes of concern to support dealing with organic watchlist concerns. Uncertainties associated with both assay limitations and matrix effects complicate selection of analytes. This results in requiring at least two independent measures of potential fuel reactivity.

  15. Hydrogen safety project chemical analysis support task: Window ``C`` semivolatile organic analysis

    SciTech Connect

    Gillespie, B.M.; Stromatt, R.W.; Hoppe, E.W.

    1992-03-01

    Analysis of four samples for semivolatile organic compounds by gas chromatography/mass spectrometry is the subject of this report. Two of the samples contained a significant amount of liquid. These two samples were partitioned into the solid and liquid phases. The solid and liquid phases were analyzed separately.

  16. Hydrogen safety project chemical analysis support task: Window C'' semivolatile organic analysis

    SciTech Connect

    Gillespie, B.M.; Stromatt, R.W.; Hoppe, E.W.

    1992-03-01

    Analysis of four samples for semivolatile organic compounds by gas chromatography/mass spectrometry is the subject of this report. Two of the samples contained a significant amount of liquid. These two samples were partitioned into the solid and liquid phases. The solid and liquid phases were analyzed separately.

  17. An Analysis of Whitewater Rafting Safety Data: Risk Management for Programme Organizers

    ERIC Educational Resources Information Center

    Hunter, I. Roy

    2007-01-01

    Many outdoor organizations integrate whitewater rafting into their programmes. Often this is accomplished by contracting with a whitewater outfitter. This paper analyses rafting accident data collected by the American Canoe Association in an effort to suggest ways in which programmes can better manage risk while contracting with outfitters for…

  18. Organic horticulture, compost, and season-extending tunnels: Food Safety and crop quality

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Consumer demand for fresh, local, organic produce continues to increase in the U.S. and internationally. Consumers and growers often form direct market links that reinforce consumer confidence that produce contains no pesticide or agrichemical residues and is at its peak quality, flavor, and freshn...

  19. Safety assessment of genetically modified organisms of plant origin in the Russian Federation.

    PubMed

    Tyshko, Nadezhda V; Aksyuk, Irina N; Tutelyan, Victor A

    2007-07-01

    The beginning of the 21st century is characterized by growing interest in the problems of biosafety, which are determined, on the one hand, by the wide use of novel biotechnologies and the necessity to develop the adequate precautionary measures, and, on the other hand, by the objective threat of bioterrorism. Therefore, improvement of the estimation system for genetically modified (GM) sources of food and strengthening the control of their circulation are the urgent problems of modern biology and medicine. Russia is one of the countries where the estimation system of food products obtained from the GM sources is rather efficient. The key features of this system are the complex toxicological and epidemiological examinations. One of the main parts of GM food safety assessment is based upon detection of their potentially toxic properties, which could provoke unintended effects of the genetic modification. PMID:17526054

  20. Simulation in Surgical Education

    PubMed Central

    de Montbrun, Sandra L.; MacRae, Helen

    2012-01-01

    The pedagogical approach to surgical training has changed significantly over the past few decades. No longer are surgical skills solely acquired through a traditional apprenticeship model of training. The acquisition of many technical and nontechnical skills is moving from the operating room to the surgical skills laboratory through the use of simulation. Many platforms exist for the learning and assessment of surgical skills. In this article, the authors provide a broad overview of some of the currently available surgical simulation modalities including bench-top models, laparoscopic simulators, simulation for new surgical technologies, and simulation for nontechnical surgical skills. PMID:23997671

  1. Electronic surgical record management.

    PubMed

    Rockman, Justin

    2010-01-01

    This paper explores the challenges surgical practices face in coordinating surgeries and how the electronic surgical record management (ESRM) approach to surgical coordination can solve these problems and improve efficiency. Surgical practices continue to experience costly inefficiencies when managing surgical coordination. Application software like practice management and electronic health record systems have enabled practices to "go digital" for their administrative, financial, and clinical data. However, surgical coordination is still a manual and labor-intensive process. Surgical practices need to create a central and secure record of their surgeries. When surgical data are inputted once only and stored in a central repository, the data are transformed into active information that can be outputted to any form, letter, calendar, or report. ESRM is a new approach to surgical coordination. It enables surgical practices to automate and streamline their processes, reduce costs, and ensure that patients receive the best possible care. PMID:20480775

  2. Organic chemical aging mechanisms: An annotated bibliography. Waste Tank Safety Program

    SciTech Connect

    Samuels, W.D.; Camaioni, D.M.; Nelson, D.A.

    1993-09-01

    An annotated bibliography has been compiled of the potential chemical and radiological aging mechanisms of the organic constituents (non-ferrocyanide) that would likely be found in the UST at Hanford. The majority of the work that has been conducted on the aging of organic chemicals used for extraction and processing of nuclear materials has been in conjunction with the acid or PUREX type processes. At Hanford the waste being stored in the UST has been stabilized with caustic. The aging factors that were used in this work were radiolysis, hydrolysis and nitrite/nitrate oxidation. The purpose of this work was two-fold: to determine whether or not research had been or is currently being conducted on the species associated with the Hanford UST waste, either as a mixture or as individual chemicals or chemical functionalities, and to determine what areas of chemical aging need to be addressed by further research.

  3. Organic tanks safety program, FY97 waste aging studies. Revision 1

    SciTech Connect

    Camaioni, D.M.; Samuels, W.D.; Linehan, J.C.; Sharma, A.K.; Hogan, M.O.; Lilga, M.A.; Clauss, S.A.; Wahl, K.L.; Campbell, J.A.

    1998-02-01

    To model tank waste aging and interpret tank waste speciation results, the authors began measuring the reactivity of organic complexants and related compounds towards radiation-induced oxidation reactions. Because of the high efficiency of scavenging of the primary radicals of water radiolysis by nitrate and nitrite ion, the major radiolytically-generated radicals in these solutions, and in Hanford tank wastes, are NO{sub 2}, NO and O{sup {minus}}. Prior to this effort, little quantitative information existed for the reactions of these radicals with organic compounds such as those that were used in Hanford processes. Therefore, modeling of actual waste aging, or even simulated waste aging, was not feasible without measuring reactivities and determining reaction paths. The authors have made the first rate measurements of complexant aging and determined some of their degradation products.

  4. 101-SY Hydrogen Safety Project chemical analysis support: Window C'' total organic carbon analysis

    SciTech Connect

    Gillespie, B.M.; Stromatt, R.W.; Baldwin, D.L.; Hoopes, F.V.

    1992-01-01

    Core samples taken from Hanford double-shell waste tank 101-SY during Window C'' (after the May 1991 gas release event) were analyzed for total organic carbon by the staff of the Analytical Chemistry Laboratory at Pacific Northwest Laboratory. The procedure uses the oxidation/extraction method of hot acid persulfate oxidation. Evolved CO{sub 2} is measured by a UIC Coulometric Carbon Analyzer coulometry detector. Samples are acidified with heated sulfuric acid to drive off all inorganic carbonate carbon as CO{sub 2}. Excess potassium persulfate oxidant, along with a silver catalyst, is then added to the heated sulfuric acid solution. All organic carbon is oxidized to CO{sub 2}, swept away by the carrier gas to the Coulometrics Analyzer, and the results calculated and displayed directly as {mu}g carbon titrated.

  5. 101-SY Hydrogen Safety Project chemical analysis support: Window ``C`` total organic carbon analysis

    SciTech Connect

    Gillespie, B.M.; Stromatt, R.W.; Baldwin, D.L.; Hoopes, F.V.

    1992-01-01

    Core samples taken from Hanford double-shell waste tank 101-SY during Window ``C`` (after the May 1991 gas release event) were analyzed for total organic carbon by the staff of the Analytical Chemistry Laboratory at Pacific Northwest Laboratory. The procedure uses the oxidation/extraction method of hot acid persulfate oxidation. Evolved CO{sub 2} is measured by a UIC Coulometric Carbon Analyzer coulometry detector. Samples are acidified with heated sulfuric acid to drive off all inorganic carbonate carbon as CO{sub 2}. Excess potassium persulfate oxidant, along with a silver catalyst, is then added to the heated sulfuric acid solution. All organic carbon is oxidized to CO{sub 2}, swept away by the carrier gas to the Coulometrics Analyzer, and the results calculated and displayed directly as {mu}g carbon titrated.

  6. Organic tanks safety program waste aging studies. Final report, Revision 1

    SciTech Connect

    Camaioni, D.M.; Samuels, W.D.; Linehan, J.C.

    1998-09-01

    Uranium and plutonium production at the Hanford Site produced large quantities of radioactive byproducts and contaminated process chemicals that are stored in underground tanks awaiting treatment and disposal. Having been made strongly alkaline and then subjected to successive water evaporation campaigns to increase storage capacity, the wastes now exist in the physical forms of saltcakes, metal oxide sludges, and aqueous brine solutions. Tanks that contain organic process chemicals mixed with nitrate/nitrite salt wastes might be at risk for fuel-nitrate combustion accidents. This project started in fiscal year 1993 to provide information on the chemical fate of stored organic wastes. While historical records had identified the organic compounds originally purchased and potentially present in wastes, aging experiments were needed to identify the probable degradation products and evaluate the current hazard. The determination of the rates and pathways of degradation have facilitated prediction of how the hazard changes with time and altered storage conditions. Also, the work with aged simulated waste contributed to the development of analytical methods for characterizing actual wastes. Finally, the results for simulants provide a baseline for comparing and interpreting tank characterization data.

  7. Diagnostic, treatment, and surgical imaging in epilepsy.

    PubMed

    Nagae, Lidia Mayumi; Lall, Neil; Dahmoush, Hisham; Nyberg, Eric; Mirsky, David; Drees, Cornelia; Honce, Justin M

    2016-01-01

    Dedicated epilepsy centers are growing in hospitals throughout the USA and abroad, with a continuously increasing role of imaging in multidisciplinary meetings. Imaging is paramount in diagnosis, treatment, and surgical decision-making in lesional and nonlesional epileptic disease. Besides being up-to-date with technical developments in imaging that may make an impact in patient care, familiarity with clinical and surgical aspects of epilepsy is fundamental to better understanding of patient management. The present article intends to revisit diagnostic, therapeutic, and surgical imaging in epilepsy. Finally, with the increase in frequency of epilepsy management-related procedures and their hardware, MRI safety issues are discussed. PMID:27317207

  8. Potential impact on food safety and food security from persistent organic pollutants in top soil improvers on Mediterranean pasture.

    PubMed

    Brambilla, G; Abate, V; Battacone, G; De Filippis, S P; Esposito, M; Esposito, V; Miniero, R

    2016-02-01

    The organic carbon of biosolids from civil wastewater treatment plants binds persistent organic pollutants (POPs), such as polychlorodibenzo -dioxins and -furans (PCDD/Fs), dioxin and non-dioxin -like polychlorobiphenyls (DL and NDL-PCBs), polybrominated diphenyl ethers (PBDEs), and perfluorooctane sulfonic acid (PFOS). The use of such biosolids, derived digestates and composts as top soil improvers (TSIs) may transfer POPs into the food chain. We evaluated the potential carry-over of main bioavailable congeners from amended soil-to-milk of extensive farmed sheep. Such estimates were compared with regulatory limits (food security) and human intakes (food safety). The prediction model was based on farming practices, flocks soil intake, POPs toxicokinetics, and dairy products intake in children, of the Mediterranean area. TSI contamination ranged between 0.20-113 ng WHO-TEQ/kg dry matter for PCDD/Fs and DL-PCBs (N = 56), 3.40-616 μg/kg for ∑6 NDL-PCBs (N = 38), 0.06-17.2 and 0.12-22.3 μg/kg for BDE no. 47 and no. 99, 0.872-89.50 μg/kg for PFOS (N = 27). For a 360 g/head/day soil intake of a sheep with an average milk yield of 2.0 kg at 6.5% of fat percentage, estimated soil quality standards supporting milk safety and security were 0.75 and 4.0 ng WHO-TEQ/kg for PCDD/Fs and DL-PCBs, and 3.75 and 29.2 μg/kg for ∑6 NDL-PCBs, respectively. The possibility to use low-contaminated TSIs to maximize agriculture benefits and if the case, to progressively mitigate highly contaminated soils is discussed. PMID:26610287

  9. Encapsulation process sterilizes and preserves surgical instruments

    NASA Technical Reports Server (NTRS)

    Montgomery, L. C.; Morelli, F. A.

    1964-01-01

    Ethylene oxide is blended with an organic polymer to form a sterile material for encapsulating surgical instruments. The material does not bond to metal and can be easily removed when the instruments are needed.

  10. Surgical Approaches to Chronic Pancreatitis

    PubMed Central

    Hartmann, Daniel; Friess, Helmut

    2015-01-01

    Chronic pancreatitis is a progressive inflammatory disease resulting in permanent structural damage of the pancreas. It is mainly characterized by recurring epigastric pain and pancreatic insufficiency. In addition, progression of the disease might lead to additional complications, such as pseudocyst formation or development of pancreatic cancer. The medical and surgical treatment of chronic pancreatitis has changed significantly in the past decades. With regard to surgical management, pancreatic head resection has been shown to be a mainstay in the treatment of severe chronic pancreatitis because the pancreatic head mass is known to trigger the chronic inflammatory process. Over the years, organ-preserving procedures, such as the duodenum-preserving pancreatic head resection and the pylorus-preserving Whipple, have become the surgical standard and have led to major improvements in pain relief, preservation of pancreatic function, and quality of life of patients. PMID:26681935

  11. The management of health and safety hazards in tourist resorts. World Tourism Organization.

    PubMed

    Phillip, R; Hodgkinson, G

    1994-01-01

    The enjoyment of a holiday has to do with landscape, buildings, people, and their activities. For truly sustainable development, these components need to become better integrated. Ways of achieving this were discussed at the IVth World Health Organization International Conference on Tourist Health, Rimini, Italy, in May 1994. It was agreed that attention to the health enhancing aspects of each component in the built environment is essential. Risks to health from man-made hazards in tourist resorts therefore need to be eliminated where possible, or otherwise minimised, contained or controlled. A systematic approach is outlined here in which owners, managers, operators, workers and users all have responsibilities and in which occupational physicians can contribute. PMID:7842235

  12. Solidifying Safety

    NASA Technical Reports Server (NTRS)

    Covault, Craig

    2003-01-01

    Contents include the following: 1. Solidifying Safety: NASA s new safety organization spools up, as the 1SS program grapples with long-term risk. 2. Earth to Orbit O'Keefe telling skeptical lawmakers Orbital Space Plan (OSP) will cover exploration vision. China's rapid pace.

  13. Evaluation of World Health Organization Multi-Professional Patient Safety Curriculum Topics in Nursing Education: Pre-test, post-test, none-experimental study.

    PubMed

    Mansour, Mansour; Skull, Alice; Parker, Michael

    2015-01-01

    The Multi-professional Patient Safety Curriculum Guide was launched by the World Health Organization to develop a patient safety-friendly curriculum in health education. The aim of this study was to evaluate the impact of teaching related to two topics from the Patient Safety Curriculum Guide on student nurses' knowledge and attitudes toward patient safety. A pretest, posttest, nonexperimental design was used. Patient safety education questionnaires were distributed to a convenience sample of 181 nursing students before the intervention, and 141 questionnaires after the intervention in one university in the East of England. The intervention consisted of two face-to-face lectures and one facilitated group work discussion. Seventy-one responses from pre- and posttest stages were matched. Paired t test, McNemar's test, and frequency measures were used for data analysis. The findings suggest that there are statistically significant differences in the subscales of the error and patient safety and personal influence over safety. The differences in the students' answers on patient safety knowledge before and after the interventions were not statistically significant. Although the student nurses highly commended the teaching delivered in this study, the use of experimental design in future curriculum evaluation may provide a more complementary insight to the findings of this study. PMID:26428349

  14. Surgical treatments for vaginal apical prolapse.

    PubMed

    Kong, Mi Kyung; Bai, Sang Wook

    2016-07-01

    Pelvic organ prolapse is a common condition, occurring in up to 11% of women in the United States. Often, pelvic organ prolapse recurs after surgery; when it recurs after hysterectomy, it frequently presents as vaginal apical prolapse. There are many different surgical treatments for vaginal apical prolapse; among them, abdominal sacral colpopexy is considered the gold standard. However, recent data reveal that other surgical procedures also result in good outcome. This review discusses the various surgical treatments for vaginal apical prolapse including their risks and benefits. PMID:27462591

  15. Surgical treatments for vaginal apical prolapse

    PubMed Central

    Kong, Mi Kyung

    2016-01-01

    Pelvic organ prolapse is a common condition, occurring in up to 11% of women in the United States. Often, pelvic organ prolapse recurs after surgery; when it recurs after hysterectomy, it frequently presents as vaginal apical prolapse. There are many different surgical treatments for vaginal apical prolapse; among them, abdominal sacral colpopexy is considered the gold standard. However, recent data reveal that other surgical procedures also result in good outcome. This review discusses the various surgical treatments for vaginal apical prolapse including their risks and benefits. PMID:27462591

  16. Abortion - surgical - aftercare

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000658.htm Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  17. State-of-the-art of 3D cultures (organs-on-a-chip) in safety testing and pathophysiology.

    PubMed

    Alépée, Natalie; Bahinski, Anthony; Daneshian, Mardas; De Wever, Bart; Fritsche, Ellen; Goldberg, Alan; Hansmann, Jan; Hartung, Thomas; Haycock, John; Hogberg, Helena; Hoelting, Lisa; Kelm, Jens M; Kadereit, Suzanne; McVey, Emily; Landsiedel, Robert; Leist, Marcel; Lübberstedt, Marc; Noor, Fozia; Pellevoisin, Christian; Petersohn, Dirk; Pfannenbecker, Uwe; Reisinger, Kerstin; Ramirez, Tzutzuy; Rothen-Rutishauser, Barbara; Schäfer-Korting, Monika; Zeilinger, Katrin; Zurich, Marie-Gabriele

    2014-01-01

    Integrated approaches using different in vitro methods in combination with bioinformatics can (i) increase the success rate and speed of drug development; (ii) improve the accuracy of toxicological risk assessment; and (iii) increase our understanding of disease. Three-dimensional (3D) cell culture models are important building blocks of this strategy which has emerged during the last years. The majority of these models are organotypic, i.e., they aim to reproduce major functions of an organ or organ system. This implies in many cases that more than one cell type forms the 3D structure, and often matrix elements play an important role. This review summarizes the state of the art concerning commonalities of the different models. For instance, the theory of mass transport/metabolite exchange in 3D systems and the special analytical requirements for test endpoints in organotypic cultures are discussed in detail. In the next part, 3D model systems for selected organs--liver, lung, skin, brain--are presented and characterized in dedicated chapters. Also, 3D approaches to the modeling of tumors are presented and discussed. All chapters give a historical background, illustrate the large variety of approaches, and highlight up- and downsides as well as specific requirements. Moreover, they refer to the application in disease modeling, drug discovery and safety assessment. Finally, consensus recommendations indicate a roadmap for the successful implementation of 3D models in routine screening. It is expected that the use of such models will accelerate progress by reducing error rates and wrong predictions from compound testing. PMID:25027500

  18. Safety in the Workplace.

    ERIC Educational Resources Information Center

    Shaw, Richard

    1999-01-01

    Addresses workplace safety needs and tips for helping an organization achieve a high level of safety. Tips include showing administration commitment, establishing retribution-free reporting of safety problems and violations, rewarding excellent safety effort, and allowing no compromises in following safety procedures. (GR)

  19. Exploring the Effects of Cultural Variables in the Implementation of Behavior-Based Safety in Two Organizations

    ERIC Educational Resources Information Center

    Bumstead, Alaina; Boyce, Thomas E.

    2005-01-01

    The present case study examines how culture can influence behavior-based safety in different organizational settings and how behavior-based safety can impact different organizational cultures. Behavior-based safety processes implemented in two culturally diverse work settings are described. Specifically, despite identical implementation plans,…

  20. Maintaining surgical skills for military general surgery: the potential role for multivisceral organ retrieval in military general surgery training and practice.

    PubMed

    O'Reilly, David; Lordan, J; Streets, C; Midwinter, M; Mirza, D

    2016-08-01

    The closure of the Medical Treatment facility in Camp BASTION and the return to contingency operations presents a new challenge in training and maintaining the skills of military surgeons. Multivisceral organ retrieval presents a unique opportunity to practice some of the more unusual techniques required in military surgery in the National Health Service. This article details the experience that organ retrieval offers and matches this to the needs of military surgeons. National Organ Retrieval Service teams need skilled surgeons, and a mutually beneficial partnership is in prospect. PMID:26243807

  1. [Characteristics of dissolved organic matter in A/DAT-IAT system for municipal wastewater treatment based on ecological safety].

    PubMed

    Yang, Sai; Zhou, Qi-Xing; Hua, Tao

    2014-02-01

    To ensure the water-quality safety and harmlessness of effluent from municipal wastewater, based on the lab-scale improved SBR-A/DAT-IAT process, dissolved organic matter (DOM) in municipal wastewater, demand aeration tank (DAT) supernatant and final effluent were classified and separated by applying the ultrafiltration membranes, and indexes such as TOC, UV254, 3D-EEM and toxicity were measured, to find out the sources of the toxic substances. The results showed that the lab-scale A/DAT-IAT process performed well on each molecular-weight fraction of DOM. The main composition in the effluent was humic-like substance. Along the process, The DOM distribution presented a trend of shifting to high molecular weight. Meanwhile, the aromaticity of DOM in the fraction with relative molecular weight below 1 x 10(3) increased significantly, leading to the increase in the reactivity of effluent with chlorine, which then increased the risk of disinfection by-products. In the raw wastewater, the toxic effects were originated from the fraction with relative molecular weight below 1 x 10(3), although the toxic effects were still originated from the same fraction in the effluent, they came from the biological treatment itself instead of the raw wastewater. Based on the analysis of TOC, UV254, 3D-EEM and toxicity, the removal of low molecular-weight humic-like substance should be emphasized to achieve the effluent organic emissions standards and to control the risk of chlorination by-products and toxicity. Therefore, future studies should focus on the removal of this fraction of DOM by adjusting technological parameters or adding a targeted processing unit. PMID:24812958

  2. Exposing Exposure: Enhancing Patient Safety through Automated Data Mining of Nuclear Medicine Reports for Quality Assurance and Organ Dose Monitoring

    PubMed Central

    Ikuta, Ichiro; Wasser, Elliot J.; Warden, Graham I.; Gerbaudo, Victor H.; Khorasani, Ramin

    2012-01-01

    Purpose: To develop and validate an open-source informatics toolkit capable of creating a radiation exposure data repository from existing nuclear medicine report archives and to demonstrate potential applications of such data for quality assurance and longitudinal patient-specific radiation dose monitoring. Materials and Methods: This study was institutional review board approved and HIPAA compliant. Informed consent was waived. An open-source toolkit designed to automate the extraction of data on radiopharmaceuticals and administered activities from nuclear medicine reports was developed. After iterative code training, manual validation was performed on 2359 nuclear medicine reports randomly selected from September 17, 1985, to February 28, 2011. Recall (sensitivity) and precision (positive predictive value) were calculated with 95% binomial confidence intervals. From the resultant institutional data repository, examples of usage in quality assurance efforts and patient-specific longitudinal radiation dose monitoring obtained by calculating organ doses from the administered activity and radiopharmaceutical of each examination were provided. Results: Validation statistics yielded a combined recall of 97.6% ± 0.7 (95% confidence interval) and precision of 98.7% ± 0.5. Histograms of administered activity for fluorine 18 fluorodeoxyglucose and iodine 131 sodium iodide were generated. An organ dose heatmap which displays a sample patient’s dose accumulation from multiple nuclear medicine examinations was created. Conclusion: Large-scale repositories of radiation exposure data can be extracted from institutional nuclear medicine report archives with high recall and precision. Such repositories enable new approaches in radiation exposure patient safety initiatives and patient-specific radiation dose monitoring. © RSNA, 2012 PMID:22627599

  3. An analysis of methodologies that can be used to validate if a perioperative surgical home improves the patient-centeredness, evidence-based practice, quality, safety, and value of patient care.

    PubMed

    Vetter, Thomas R; Ivankova, Nataliya V; Goeddel, Lee A; McGwin, Gerald; Pittet, Jean-Francois

    2013-12-01

    Approximately 80 million inpatient and outpatient surgeries are performed annually in the United States. Widely variable and fragmented perioperative care exposes these surgical patients to lapses in expected standard of care, increases the chance for operational mistakes and accidents, results in unnecessary and potentially detrimental care, needlessly drives up costs, and adversely affects the patient healthcare experience. The American Society of Anesthesiologists and other stakeholders have proposed a more comprehensive model of perioperative care, the Perioperative Surgical Home (PSH), to improve current care of surgical patients and to meet the future demands of increased volume, quality standards, and patient-centered care. To justify implementation of this new healthcare delivery model to surgical colleagues, administrators, and patients and maintain the integrity of evidenced-based practice, the nascent PSH model must be rigorously evaluated. This special article proposes comparative effectiveness research aims or objectives and an optimal study design for the novel PSH model. PMID:24005578

  4. Measuring radioactive noble gases by absorption in polycarbonates and other organics: From radon indoors to nuclear safety

    NASA Astrophysics Data System (ADS)

    Pressyanov, Dobromir S.

    2013-07-01

    The report summarizes recent research and practice of using materials with high absorption ability to noble gases to measure their radioactive isotopes. Most of the studies employ bisphenol-A based polycarbonates, because of their remarkably high absorption ability to noble gases. This is the material of which commercial CDs/DVDs are made and they may serve as serendipitous, already available in dwellings, radon and thoron detectors. We present the essence of the gathered experimental evidence that the CD/DVD method can successfully address some long-lasted problems in radon dosimetry: The first is making sufficiently precise retrospective 222Rn dosimetry for the purposes of epidemiological studies and risk estimation. The second is rapid identification of buildings with radon problem. We demonstrate how this can be used to develop an integrated approach to the radon problem. Within this approach detection, diagnostic and mitigation are considered as an unified whole, and the interval between the decision to provide disks for analysis and the complete mitigation of the building, if radon problem is identified, is short. Besides radon and thoron, bisphenol-A based polycarbonates were successfully used to measure 85Kr and 133Xe for the purposes of the effluents control and nuclear safety of nuclear installations. The perspectives to employ other organic materials in which noble gases are highly soluble for measurement of their radioactive isotopes are also discussed.

  5. Surgical treatment of microprolactinomas: pros.

    PubMed

    Salvatori, Roberto

    2014-12-01

    Medical therapy with dopaminergic agonists (DAs) has been used for several decades for the treatment of both micro- and macroprolactinomas, without much differentiation between the two conditions. While most cases respond well to DAs in terms of prolactin normalization and control of tumor growth, DAs are often needed for many years, or even for lifetime. Concerns have been raised recently about the possible side effects of long-term use of these medications on the anatomy and function of the heart valves. While macroprolactinomas are rarely surgically curable, pituitary surgery in expert hands is a safe and effective method to permanently cure microprolactinomas, with long-term cure rates around 70 %. In this article, I will review the data on safety of DAs an on the effectiveness and safety of surgery, and I will make an argument that surgery should be offered as a possible therapy to microprolactinoma patients, provided that an experienced pituitary neurosurgeon is available. PMID:24829036

  6. Long-term organ damage accrual and safety in patients with SLE treated with belimumab plus standard of care

    PubMed Central

    Urowitz, M; van Vollenhoven, R; Aranow, C; Fettiplace, J; Oldham, M; Wilson, B; Molta, C; Roth, D; Gordon, D

    2016-01-01

    Objective To examine long-term organ damage and safety following treatment with belimumab plus standard of care (SoC) in patients with systemic lupus erythematosus (SLE). Methods Pooled data were examined from two ongoing open-label studies that enrolled patients who completed BLISS-52 or BLISS-76. Patients received belimumab every four weeks plus SoC. SLICC Damage Index (SDI) values were assessed every 48 weeks (study years) following belimumab initiation (baseline). The primary endpoint was change in SDI from baseline at study years 5–6. Incidences of adverse events (AEs) were reported for the entire study period. Results The modified intent-to-treat (MITT) population comprised 998 patients. At baseline, 940 (94.2%) were female, mean (SD) age was 38.7 (11.49) years, and disease duration was 6.7 (6.24) years. The mean (SD) SELENA-SLEDAI and SDI scores were 8.2 (4.18) and 0.7 (1.19), respectively; 411 (41.2%) patients had organ damage (SDI = 1: 235 (23.5%); SDI ≥ 2: 176 (17.6%)) prior to belimumab. A total of 427 (42.8%) patients withdrew overall; the most common reasons were patient request (16.8%) and AEs (8.5%). The mean (SD) change in SDI was +0.2 (0.48) at study years 5–6 (n = 403); 343 (85.1%) patients had no change from baseline in SDI score (SDI +1: 46 (11.4%), SDI +2: 13 (3.2%), SDI +3: 1 (0.2%)). Of patients without organ damage at baseline, 211/241 (87.6%) had no change in SDI and the mean change (SD) in SDI was +0.2 (0.44). Of patients with organ damage at baseline, 132/162 (81.5%) had no change in SDI and the mean (SD) change in SDI was +0.2 (0.53). The probability of not having a worsening in SDI score was 0.88 (95% CI: 0.85, 0.91) and 0.75 (0.67, 0.81) in those without and with baseline damage, respectively (post hoc analysis). Drug-related AEs were reported for 433 (43.4%) patients; infections/infestations (282, 28.3%) and gastrointestinal disorders (139, 13.9%) were the most common. Conclusion Patients with SLE treated with long

  7. The MAVID heart holder: a demonstration device to anchor cadaver hearts for surgical simulation and practical education.

    PubMed

    Mavroudis, Constantine; Idriss, Rachid; Klaus, Kristen E

    2015-12-01

    Performing open heart surgery involves learning challenging techniques and a need for realistic training models to achieve and maintain a high level of surgical skills. The MAVID heart holder is an organ holder primarily designed to hold the heart in its anatomic position for the purpose of surgical simulation and education, thereby closing the gap between surgical performance in the laboratory and in the operating room. The device is simple to use, can be adjusted to organ size, and has the necessary instrumentation to be used with any solid organ. The MAVID heart holder also provides a platform for presentation and assists in advancing the research sphere. The advantage over other existing models is that the MAVID heart holder uses real tissue and does not distort the organ at the attachment sites. Further, it offers superior stability as well as the ability to manipulate the organ during presentation and dissection. Training with the MAVID heart holder has the potential to shorten training time to acquire surgical skills and proficiency before performing these techniques in the operating room and in so doing enhance patient safety. PMID:26675615

  8. Ethical issues in surgical innovation.

    PubMed

    Miller, Megan E; Siegler, Mark; Angelos, Peter

    2014-07-01

    Innovation is responsible for most advances in the field of surgery. Innovative approaches to solving clinical problems have significantly decreased morbidity and mortality for many surgical procedures, and have led to improved patient outcomes. While innovation is motivated by the surgeon's expectation that the new approach will be beneficial to patients, not all innovations are successful or result in improved patient care. The ethical dilemma of surgical innovation lies in the uncertainty of whether a particular innovation will prove to be a "good thing." This uncertainty creates challenges for surgeons, patients, and the healthcare system. By its very nature, innovation introduces a potential risk to patient safety, a risk that may not be fully known, and it simultaneously fosters an optimism bias. These factors increase the complexity of informed consent and shared decision making for the surgeon and the patient. Innovative procedures and their associated technology raise issues of cost and resource distribution in the contemporary, financially conscious, healthcare environment. Surgeons and institutions must identify and address conflicts of interest created by the development and application of an innovation, always preserving the best interest of the patient above the academic or financial rewards of success. Potential strategies to address the challenges inherent in surgical innovation include collecting and reporting objective outcomes data, enhancing the informed consent process, and adhering to the principles of disclosure and professionalism. As surgeons, we must encourage creativity and innovation while maintaining our ethical awareness and responsibility to patients. PMID:24728580

  9. Humanitarian Surgical Missions: Planning for Success.

    PubMed

    Boston, Mark; Horlbeck, Drew

    2015-09-01

    Humanitarian surgical missions can provide much needed care for those who are otherwise unable to receive such care because of limited local health care resources and cost. These missions also offer excellent training opportunities and can be life-changing experiences for those who participate in them. A successful humanitarian surgical mission requires careful planning and coordination and can be challenging for those tasked with the responsibilities to organize and lead these missions. This article addresses many of the issues and challenges encountered when planning and leading humanitarian surgical missions and offers a template to be used by those who take on these challenges. PMID:26059533

  10. Healthcare associated infection: novel strategies and antimicrobial implants to prevent surgical site infection

    PubMed Central

    Leaper, David; McBain, Andrew J; Kramer, Axel; Assadian, Ojan; Sanchez, Jose Luis Alfonso; Lumio, Jukka; Kiernan, Martin

    2010-01-01

    This report is based on a Hygienist Panel Meeting held at St Anne's Manor, Wokingham on 24–25 June 2009. The panel agreed that greater use should be made of antiseptics to reduce reliance on antibiotics with their associated risk of antibiotic resistance. When choosing an antiseptic for clinical use, the Biocompatibility Index, which considers both the microbiocidal activity and any cytotoxic effects of an antiseptic agent, was considered to be a useful tool. The need for longer and more proactive post-discharge surveillance of surgical patients was also agreed to be a priority, especially given the current growth of day-case surgery. The introduction of surgical safety checklists, such as the World Health Organization's Safe Surgery Saves Lives initiative, is a useful contribution to improving safety and prevention of SSIs and should be used universally. Considering sutures as ‘implants’, with a hard or non-shedding surface to which micro-organisms can form biofilm and cause surgical site infections, was felt to be a useful concept. PMID:20819330

  11. Talus fractures: surgical principles.

    PubMed

    Rush, Shannon M; Jennings, Meagan; Hamilton, Graham A

    2009-01-01

    Surgical treatment of talus fractures can challenge even the most skilled foot and ankle surgeon. Complicated fracture patterns combined with joint dislocation of variable degrees require accurate assessment, sound understanding of principles of fracture care, and broad command of internal fixation techniques needed for successful surgical care. Elimination of unnecessary soft tissue dissection, a low threshold for surgical reduction, liberal use of malleolar osteotomy to expose body fracture, and detailed attention to fracture reduction and joint alignment are critical to the success of treatment. Even with the best surgical care complications are common and seem to correlate with injury severity and open injuries. PMID:19121756

  12. American Pediatric Surgical Association

    MedlinePlus

    ... Curricula Membership + Members Join APSA Careers Surgical Practice Management In Memoriam About APSA + APSA Mission Awards APSA Leadership Committees Alliances APSA Foundation Third-Party Advertising Disclaimer ...

  13. Surgical Travellers: Tapestry to Bayeux

    PubMed Central

    Hedley-Whyte, John; Milamed, Debra R

    2014-01-01

    The planning for surgery in war was revisited in 1937 when Ian Fraser was elected a member of the Surgical Travellers. At their 1938 Surgical Travellers meeting in Vienna, Ian and Eleanor Fraser were evicted from their hotel room by the Nazis. The 1939 meeting in Belfast discussed the organization of surgery and the conduct of Emergency Medical Service Hospitals in the United Kingdom; the vast majority were to be under civilian government and military control. From 1943 lengthy and informative organizational meetings were held at least monthly under the chairmanship of Sir Alexander Hood, KBE, Head of the RAMC. Surgical Consultants, now Major Generals, Brigadiers or Full Colonels in the British and U.S. Armies stationed in the UK, prepared for the invasion of Europe. The allocation of medical, surgical, nursing and auxiliary responsibilities was delineated. Liaison with the RAF and US Army Air Force was close as it was with the proposed leaders, Ulstermen Brooke and Montgomery. Montgomery chose Arthur Porritt as Surgeon in Chief to Supreme Headquarters Allied Expeditionary Force (SHAEF), and Eisenhower, General Albert W. Kenner. Just after D-Day, Porritt met Ian Fraser, who had waded in on Arromanches Beach. The triage and evacuation plans for Allied casualties had been controversial, particularly as regards Landing Ship Tanks (LSTs). The dispute with the Hood-selected surgeons on one side, against medical and surgical deployment of LSTs, and Admiral Ernest King and Winston Churchill on the other, favouring LST use for surgery and evacuation. King and Churchill were correct but total Allied air superiority allowed wide use of many of the Allies' Dakotas; 10,000 DC-3s were eventually in service. Supported by forty Allied combat planes to each Luftwaffe, the dispute about Landing Ship Tank use in about a fortnight became moot. The multifaceted role of the Princess Royal in the Emergency Medical Services of the United Kingdom and her close liaison with the Consultant

  14. Surgical travellers: tapestry to Bayeux.

    PubMed

    Hedley-Whyte, John; Milamed, Debra R

    2014-09-01

    The planning for surgery in war was revisited in 1937 when Ian Fraser was elected a member of the Surgical Travellers. At their 1938 Surgical Travellers meeting in Vienna, Ian and Eleanor Fraser were evicted from their hotel room by the Nazis. The 1939 meeting in Belfast discussed the organization of surgery and the conduct of Emergency Medical Service Hospitals in the United Kingdom; the vast majority were to be under civilian government and military control. From 1943 lengthy and informative organizational meetings were held at least monthly under the chairmanship of Sir Alexander Hood, KBE, Head of the RAMC. Surgical Consultants, now Major Generals, Brigadiers or Full Colonels in the British and U.S. Armies stationed in the UK, prepared for the invasion of Europe. The allocation of medical, surgical, nursing and auxiliary responsibilities was delineated. Liaison with the RAF and US Army Air Force was close as it was with the proposed leaders, Ulstermen Brooke and Montgomery. Montgomery chose Arthur Porritt as Surgeon in Chief to Supreme Headquarters Allied Expeditionary Force (SHAEF), and Eisenhower, General Albert W. Kenner. Just after D-Day, Porritt met Ian Fraser, who had waded in on Arromanches Beach. The triage and evacuation plans for Allied casualties had been controversial, particularly as regards Landing Ship Tanks (LSTs). The dispute with the Hood-selected surgeons on one side, against medical and surgical deployment of LSTs, and Admiral Ernest King and Winston Churchill on the other, favouring LST use for surgery and evacuation. King and Churchill were correct but total Allied air superiority allowed wide use of many of the Allies' Dakotas; 10,000 DC-3s were eventually in service. Supported by forty Allied combat planes to each Luftwaffe, the dispute about Landing Ship Tank use in about a fortnight became moot. The multifaceted role of the Princess Royal in the Emergency Medical Services of the United Kingdom and her close liaison with the Consultant

  15. [THE PRINCIPLES OF ORGANIZATION AND TREATMENT FOR SORTING OF WOUNDED PERSONS WITH A COMBAT SURGICAL TRAUMA OF EXTREMITIES ON THE IV LEVEL OF THE MEDICAL CARE PROVISION].

    PubMed

    Korohl, S O; Zherdev, I I; Domanskiy, A M

    2015-12-01

    Experience of medical sorting of 434 injured persons with a gun-shot woundings of extremities in 2014-2015 yrs is adduced. The principles of organization and treatment for medical sorting of wounded persons were elaborated. Prognostic intrahospital, diagnostic and evacuation--transport sorting was introduced in wounded persons in the IV level hospital, concerning severity of traumatic shock and prognosis of their survival. PMID:27025033

  16. The surgically induced stress response.

    PubMed

    Finnerty, Celeste C; Mabvuure, Nigel Tapiwa; Ali, Arham; Kozar, Rosemary A; Herndon, David N

    2013-09-01

    The stress response to surgery, critical illness, trauma, and burns encompasses derangements of metabolic and physiological processes that induce perturbations in the inflammatory, acute phase, hormonal, and genomic responses. Hypermetabolism and hypercatabolism result, leading to muscle wasting, impaired immune function and wound healing, organ failure, and death. The surgery-induced stress response is largely similar to that triggered by traumatic injuries; the duration of the stress response, however, varies according to the severity of injury (surgical or traumatic). This spectrum of injuries and insults ranges from small lacerations to severe insults such as large poly-traumatic and burn injuries. Burn injuries provide an extreme model of trauma induced stress responses that can be used to study the long-term effects of a prolonged stress response. Although the stress response to acute trauma evolved to confer improved chances of survival following injury, in modern surgical practice the stress response can be detrimental. PMID:24009246

  17. The Surgically Induced Stress Response

    PubMed Central

    Finnerty, Celeste C.; Mabvuure, Nigel Tapiwa; Ali, Arham; Kozar, Rosemary A.; Herndon, David N.

    2013-01-01

    The stress response to surgery, critical illness, trauma, and burns encompasses derangements of metabolic and physiological processes which induce perturbations in the inflammatory, acute phase, hormonal, and genomic responses. Hypermetabolism and hypercatabolism result, leading to muscle wasting, impaired immune function and wound healing, organ failure, and death. The surgery-induced stress response is largely similar to that triggered by traumatic injuries; the duration of the stress response, however, varies according to the severity of injury (surgical or traumatic). This spectrum of injuries and insults ranges from small lacerations to severe insults such as large poly-traumatic and burn injuries. Although the stress response to acute trauma evolved to improve chances of survival following injury, in modern surgical practice the stress response can be detrimental. PMID:24009246

  18. Management of Pelvic Organ Prolapse

    PubMed Central

    Choi, Kyung Hwa

    2014-01-01

    Quality of life is adversely affected by pelvic organ prolapse, the prevalence of which is increasing because of the persistently growing older population. Today, the tension-free vaginal mesh kit has grown in popularity owing to its comparable cure rate to traditional reconstructive surgery and the feasibility of an early return to normal life. However, significant debate remains over the long-term cure rate and the safety of tension-free vaginal mesh in the United States. The U.S. Food and Drug Administration recommends obtaining informed consent about the safety and cure rate when the patient chooses surgery using the tension-free vaginal mesh kit or meshes before surgery. The goal of surgery for pelvic organ prolapse is the restoration of anatomic defects. This review article provides an overview of basic surgical techniques and the results, advantages, and disadvantages of surgery for pelvic organ prolapse. PMID:25405010

  19. Hand Safety

    MedlinePlus

    ... en gatillo See More... Hand Anatomy Hand Safety Fireworks Safety Lawnmower Safety Snowblower safety Pumpkin Carving Gardening ... en gatillo See More... Hand Anatomy Hand Safety Fireworks Safety Lawnmower Safety Snowblower safety Pumpkin Carving Gardening ...

  20. Hand Safety

    MedlinePlus

    ... Fireworks Safety Lawnmower Safety Snowblower safety Pumpkin Carving Gardening Safety Turkey Carving Removing a Ring Español Artritis ... Fireworks Safety Lawnmower Safety Snowblower safety Pumpkin Carving Gardening Safety Turkey Carving Removing a Ring Español Artritis ...

  1. Deriving DICOM surgical extensions from surgical workflows

    NASA Astrophysics Data System (ADS)

    Burgert, O.; Neumuth, T.; Gessat, M.; Jacobs, S.; Lemke, H. U.

    2007-03-01

    The generation, storage, transfer, and representation of image data in radiology are standardized by DICOM. To cover the needs of image guided surgery or computer assisted surgery in general one needs to handle patient information besides image data. A large number of objects must be defined in DICOM to address the needs of surgery. We propose an analysis process based on Surgical Workflows that helps to identify these objects together with use cases and requirements motivating for their specification. As the first result we confirmed the need for the specification of representation and transfer of geometric models. The analysis of Surgical Workflows has shown that geometric models are widely used to represent planned procedure steps, surgical tools, anatomical structures, or prosthesis in the context of surgical planning, image guided surgery, augmented reality, and simulation. By now, the models are stored and transferred in several file formats bare of contextual information. The standardization of data types including contextual information and specifications for handling of geometric models allows a broader usage of such models. This paper explains the specification process leading to Geometry Mesh Service Object Pair classes. This process can be a template for the definition of further DICOM classes.

  2. Surgical Technology Program Guide.

    ERIC Educational Resources Information Center

    Georgia Univ., Athens. Dept. of Vocational Education.

    This surgical technology program guide presents the standard curriculum for technical institutes in Georgia. The curriculum addresses the minimum competencies for a surgical technology program. The program guide is designed to relate primarily to the development of those skills needed by individuals in the field to provide services in the…

  3. 13th Meeting of the Scientific Group on Methodologies for the Safety Evaluation of Chemicals (SGOMSEC): alternative testing methodologies for organ toxicity.

    PubMed Central

    Spielmann, H; Bochkov, N P; Costa, L; Gribaldo, L; Guillouzo, A; Heindel, J J; Karol, M; Parchment, R; Pfaller, W; Peraita, P P; Zacharewski, T

    1998-01-01

    In the past decade in vitro tests have been developed that represent a range of anatomic structure from perfused whole organs to subcellular fractions. To assess the use of in vitro tests for toxicity testing, we describe and evaluate the current status of organotypic cultures for the major target organs of toxic agents. This includes liver, kidney, neural tissue, the hematopoietic system, the immune system, reproductive organs, and the endocrine system. The second part of this report reviews the application of in vitro culture systems to organ specific toxicity and evaluates the application of these systems both in industry for safety assessment and in government for regulatory purposes. Members of the working group (WG) felt that access to high-quality human material is essential for better use of in vitro organ and tissue cultures in the risk assessment process. Therefore, research should focus on improving culture techniques that will allow better preservation of human material. The WG felt that it is also important to develop and make available relevant reference compounds for toxicity assessment in each organ system, to organize and make available via the Internet complete in vivo toxicity data, including human data, containing dose, end points, and toxicokinetics. The WG also recommended that research should be supported to identify and to validate biological end points for target organ toxicity to be used in alternative toxicity testing strategies. PMID:9599689

  4. Organizations.

    ERIC Educational Resources Information Center

    Aviation/Space, 1980

    1980-01-01

    This is a list of aerospace organizations and other groups that provides educators with assistance and information in specific areas. Both government and nongovernment organizations are included. (Author/SA)

  5. Multiscale Surgical Telerobots

    SciTech Connect

    Miles, R R; Seward, K P; Benett, W J; Tendick, F; Bentley, L; Stephan, P L

    2002-01-23

    A project was undertaken to improve robotic surgical tools for telerobotic minimally invasive surgery. The major objectives were to reduce the size of the tools to permit new surgical procedures in confined spaces such as the heart and to improve control of surgical tools by locating positional sensors and actuators at the end effector rather than external to the patient as is currently the state of the technology. A new compact end-effector with wrist-like flexibility was designed. Positional sensors based on MEMS microfabrication techniques were designed.

  6. Surgical progress: surgical management of infective endocarditis.

    PubMed Central

    Mills, S A

    1982-01-01

    Infective endocarditis of bacterial or fungal origin may arise in either the left or the right heart and can involve both natural and prosthetic valves. The diagnosis is based primarily upon clinical criteria and positive blood cultures, but serial electrocardiograms, fluoroscopy, and two-dimensional echocardiograms may also be helpful. The initial treatment should consist of antibiotic therapy and is itself often adequate in effecting cure. However, careful observation during antibiotic treatment is mandatory, since the development of congestive heart failure due to valvular obstruction or destruction can be an indication for surgical intervention. Other surgical indications include a failure to respond to antibiotic therapy, pulmonary or systemic emboli, evidence of abscess involving the valvular ring (particularly prevalent with prosthetic valve endocarditis), Brucella infection, and the onset of conduction disturbances. The goals of surgical treatment are removal of infective tissue, restoration of valve function, and correction of associated mechanical disorders. The results are surprisingly good, especially for a condition of this severity. Images Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. PMID:7065743

  7. TWRS safety program plan

    SciTech Connect

    Calderon, L.M., Westinghouse Hanford

    1996-08-01

    Management of Nuclear Safety, Industrial Safety, Industrial Hygiene, and Fire Protection programs, functions, and field support resources for Tank Waste Remediation Systems (TWRS) has, until recently, been centralized in TWRS Safety, under the Emergency, Safety, and Quality organization. Industrial hygiene technician services were also provided to support operational needs related to safety basis compliance. Due to WHC decentralization of safety and reengineering efforts in West Tank Farms, staffing and safety responsibilities have been transferred to the facilities. Under the new structure, safety personnel for TWRS are assigned directly to East Tank Farms, West Tank Farms, and a core Safety Group in TWRS Engineering. The Characterization Project Operations (CPO) safety organization will remain in tact as it currently exists. Personnel assigned to East Tank Farms, West Tank Farms, and CPO will perform facility-specific or project-specific duties and provide field implementation of programs. Those assigned to the core group will focus on activities having a TWRS-wide or programmatic focus. Hanford-wide activities will be the responsibility of the Safety Center of Expertise. In order to ensure an effective and consistent safety program for TWRS under the new organization program functions, goals, organizational structure, roles, responsibilities, and path forward must be clearly established. The purpose of the TWRS Safety Program Plan is to define the overall safety program, responsibilities, relationships, and communication linkages for safety personnel under the new structure. In addition, issues associated with reorganization transition are addressed, including training, project ownership, records management, and dissemination of equipment. For the purpose of this document ``TWRS Safety`` refers to all safety professionals and technicians (Industrial Safety, Industrial Hygiene, Fire Protection, and Nuclear Safety) within the TWRS organization, regardless of their

  8. Non-surgical organ preservation strategies for locally advanced laryngeal tumors: what is the Italian attitude? Results of a national survey on behalf of AIRO and AIOM.

    PubMed

    Alterio, D; Franco, P; Numico, G; Licitra, L; Cossu Rocca, M; Ferrari, A; Pinto, C; Russi, E G; Ricardi, U; Jereczek Fossa, B A

    2016-07-01

    Chemoradiotherapy is the treatment mostly used as organ preservation (OP) strategy worldwide in advanced laryngo-hypopharyngeal cancer. Due to the not homogeneous results of the literature data regarding the pre-treatment assessment and treatment schedule in this setting of patients, the Italian societies of radiation oncology and medical oncology surveyed (by an online survey) their memberships regarding the Italian attitude on larynx preservation in clinical practice. The survey outline addressed different items such as: demographics (11 items), pre-treatment evaluation (12 items), treatment schedules (10 items) and outcomes (3 items). The survey was filled in by 116 clinical oncologists (64 % radiation and 36 % medical oncologists). Results highlighted that pretreatment evaluation was not homogeneous among the respondents. The treatment of choice for the OP program resulted the concurrent chemoradiotherapy (66 %). Induction chemotherapy was proposed mostly in case of aggressive tumors such as advanced stage (T4 or N3) and/or unfavorable primary sites (hypopharynx). Moreover, after induction chemotherapy, for responders patients most participants (46 %) proposed concurrent chemoradiotherapy, while 18 and 19 % proposed radiotherapy alone or radiotherapy and cetuximab, respectively. For patients with stable disease after induction chemotherapy, the respondents declared to suggest surgery, radiotherapy and cetuximab or radiotherapy alone in 38, 32 and 15 % of cases, respectively. Results of the present survey highlighted the variability of therapeutic approaches offered in clinical practice for patients candidate to a larynx OP program. Analysis of abovementioned results may give the chance to modify some clinical attitudes and create the background for future clinical investigation in this field. PMID:27290695

  9. Surgical wound infection surveillance.

    PubMed

    Lee, J T

    2003-12-01

    Measuring the frequency of a defined outcome flaw for a series of patients undergoing operative procedures generates information for performance evaluation. Such data influence decisions to improve care if used responsibly. Wound infection (WI), bacterial invasion of the incision, is the most common infectious complication of surgical care and WI prevention has value because the complication affects economic, patient satisfaction, and patient functional status outcomes. WI frequency, one kind of surgical outcome flaw rate, is traditionally used to judge one aspect of surgical care quality. At the author's institution, global WI surveillance was conducted without interruption for 20 years. Results for 85,260 consecutive inpatient operations performed during the period showed that secular changes in infection rates occurred but were not necessarily caused by surgical care quality decrements. PMID:14750065

  10. Biocompatibility of surgical implants

    NASA Technical Reports Server (NTRS)

    Kaelble, D. H.

    1979-01-01

    Method of selecting biocompatible materials for surgical implants uses fracture mechanic relationships and surface energies of candidate materials in presence of blood plasma. Technique has been used to characterize 190 materials by parameters that reflect their biocompatibility.

  11. Guide to Surgical Specialists

    MedlinePlus

    ... may also deal with the liver, urinary, and female reproductive systems if they are involved with primary intestinal disease. ... The focus for this specialty is on the female reproductive system, including performing surgical procedures, managing the care of ...

  12. Hernia Surgical Mesh Implants

    MedlinePlus

    ... Surgical Clinics of North America; 83(5):1045-51, v-vi. 2 . http://www.facs.org/public_ ... FDA Contact FDA Browse by Product Area Product Areas back Food Drugs Medical Devices Radiation-Emitting Products ...

  13. Surgical Treatments for Fibroids

    MedlinePlus

    ... Clinical Trials Resources and Publications Surgical Treatments for Fibroids Skip sharing on social media links Share this: ... If you have moderate or severe symptoms of fibroids, surgery may be the best treatment for you. ...

  14. Urogynecologic Surgical Mesh Implants

    MedlinePlus

    ... Boston Scientific's urogynecologic surgical mesh may contain counterfeit raw material. We are examining these allegations to determine any ... are currently not aware that the alleged counterfeit raw material contributes to adverse events associated with these products. ...

  15. Surgical Ablation of Atrial Fibrillation.

    PubMed

    Ramlawi, Basel; Abu Saleh, Walid K

    2015-01-01

    The Cox-maze procedure for the restoration of normal sinus rhythm, initially developed by Dr. James Cox, underwent several iterations over the years. The main concept consists of creating a series of transmural lesions in the right and left atria that disrupt re-entrant circuits responsible for propagating the abnormal atrial fibrillation rhythm. The left atrial appendage is excluded as a component of the Maze procedure. For the first three iterations of the Cox- maze procedure, these lesions were performed using a surgical cut-and-sew approach that ensured transmurality. The Cox-Maze IV is the most currently accepted iteration. It achieves the same lesion set of the Cox- maze III but uses alternative energy sources to create the transmural lesions, potentially in a minimally invasive approach on the beating heart. High-frequency ultrasound, microwave, and laser energy have all been used with varying success in the past. Today, bipolar radiofrequency heat or cryotherapy cooling are the most accepted sources for creating linear lesions with consistent safety and transmurality. The robust and reliable nature of these energy delivery methods has yielded a success rate reaching 90% freedom from atrial fibrillation at 12 months. Such approaches offer a significant long-term advantage over catheter-based ablation, especially in patients having longstanding, persistent atrial fibrillation with characteristics such as dilated left atrial dimensions, poor ejection fraction, and failed catheter ablation. Based on these improved results, there currently is significant interest in developing a hybrid ablation strategy that incorporates the superior transmural robust lesions of surgical ablation, the reliable stroke prevention potential of epicardial left atrial appendage exclusion, and sophisticated mapping and confirmatory catheter-based ablation technology. Such a minimally invasive hybrid strategy for ablation may lead to the development of multidisciplinary "Afib teams" to

  16. Novel surgical options for gastroesophageal reflux disease.

    PubMed

    Chiu, Jenny; Soffer, Edy

    2015-07-01

    There are limited options to patients with gastroesophageal reflux disease (GERD) who are not satisfied with acid suppression therapy. Fundoplication, the standard surgical procedure for GERD, is effective but is associated with adverse side effects and has thus been performed less frequently, creating a need for alternative surgical interventions that are effective, yet less invasive and reversible. Lately, two such interventions were developed: the magnetic sphincter augmentation and electrical stimulation of the lower esophageal sphincter. Human studies describing safety and efficacy over a follow-up period of a number of years have been published, documenting efficacy and safety of these interventions. Future studies should clarify the role of these procedures in the spectrum of GERD therapy. PMID:25947638

  17. [Surgical laboratory in pregraduate medicine.

    PubMed

    Tapia-Jurado, Jesús

    2011-01-01

    Surgical laboratory in pregraduate students in medicine is beneficial and improves learning processes in cognitive aspects and skills acquisition. It is also an early initiation into scientific research. The laboratory is the introductory pathway into basic concepts of medical science (meaningful learning). It is also where students gain knowledge in procedures and abilities to obtain professional skills, an interactive teacher-student process. Medicine works rapidly to change from an art to a science. This fact compromises all schools and medical faculties to analyze their actual lesson plans. Simulators give students confidence and ability and save time, money and resources, eliminating at the same time the ethical factor of using live animals and the fear of patient safety. Multimedia programs may give a cognitive context evolving logically with an explanation based on written and visual animation followed by a clinical problem and its demonstration in a simulator, all before applying knowledge to the patient. PMID:21477522

  18. Smart surgical tool

    NASA Astrophysics Data System (ADS)

    Huang, Huan; Yang, Lih-Mei; Bai, Shuang; Liu, Jian

    2015-02-01

    A laser-induced breakdown spectroscopy (LIBS) guided smart surgical tool using a femtosecond fiber laser is developed. This system provides real-time material identification by processing and analyzing the peak intensity and ratio of atomic emissions of LIBS signals. Algorithms to identify emissions of different tissues and metals are developed and implemented into the real-time control system. This system provides a powerful smart surgical tool for precise robotic microsurgery applications with real-time feedback and control.

  19. Pelvic Organ Prolapse

    MedlinePlus

    ... Prosthetics Urogynecologic Surgical Mesh Implants Pelvic Organ Prolapse (POP) Share Tweet Linkedin Pin it More sharing options ... What is Pelvic Organ Prolapse? Pelvic organ prolapse (POP) occurs when the tissue and muscles of the ...

  20. Launch Services Safety Overview

    NASA Technical Reports Server (NTRS)

    Loftin, Charles E.

    2008-01-01

    NASA/KSC Launch Services Division Safety (SA-D) services include: (1) Assessing the safety of the launch vehicle (2) Assessing the safety of NASA ELV spacecraft (S/C) / launch vehicle (LV) interfaces (3) Assessing the safety of spacecraft processing to ensure resource protection of: - KSC facilities - KSC VAFB facilities - KSC controlled property - Other NASA assets (4) NASA personnel safety (5) Interfacing with payload organizations to review spacecraft for adequate safety implementation and compliance for integrated activities (6) Assisting in the integration of safety activities between the payload, launch vehicle, and processing facilities

  1. Characterization of aerosols produced by surgical procedures

    SciTech Connect

    Yeh, H.C.; Muggenburg, B.A.; Lundgren, D.L.; Guilmette, R.A.; Snipes, M.B.; Jones, R.K.; Turner, R.S.

    1994-07-01

    In many surgeries, especially orthopedic procedures, power tools such as saws and drills are used. These tools may produce aerosolized blood and other biological material from bone and soft tissues. Surgical lasers and electrocautery tools can also produce aerosols when tissues are vaporized and condensed. Studies have been reported in the literature concerning production of aerosols during surgery, and some of these aerosols may contain infectious material. Garden et al. (1988) reported the presence of papilloma virus DNA in the fumes produced from laser surgery, but the infectivity of the aerosol was not assessed. Moon and Nininger (1989) measured the size distribution and production rate of emissions from laser surgery and found that particles were generally less than 0.5 {mu}m diameter. More recently there has been concern expressed over the production of aerosolized blood during surgical procedures that require power tools. In an in vitro study, the production of an aerosol containing the human immunodeficiency virus (HIV) was reported when power tools were used to cut tissues with blood infected with HIV. Another study measured the size distribution of blood aerosols produced by surgical power tools and found blood-containing particles in a number of size ranges. Health care workers are anxious and concerned about whether surgically produced aerosols are inspirable and can contain viable pathogens such as HIV. Other pathogens such as hepatitis B virus (HBV) are also of concern. The Occupational Safety and Health funded a project at the National Institute for Inhalation Toxicology Research Institute to assess the extent of aerosolization of blood and other tissues during surgical procedures. This document reports details of the experimental and sampling approach, methods, analyses, and results on potential production of blood-associated aerosols from surgical procedures in the laboratory and in the hospital surgical suite.

  2. Student and Teacher Safety in Chicago Public Schools: The Roles of Community Context and School Social Organization

    ERIC Educational Resources Information Center

    Steinberg, Matthew P.; Allensworth, Elaine; Johnson, David W.

    2011-01-01

    In schools across the country, students routinely encounter a range of safety issues--from overt acts of violence and bullying to subtle intimidation and disrespect. Though extreme incidents such as school shootings tend to attract the most attention, day-to-day incidents such as gossip, hallway fights, and yelling matches between teachers and…

  3. 75 FR 54804 - Safety and Health Management Programs for Mines

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-09

    ...: Academia; safety and health professionals; industry organizations; worker organizations; and government..., safety and health professionals, industry organizations, worker organizations, and government agencies to... programs, including: The Occupational Safety and Health Administration's (OSHA's) Voluntary...

  4. Organics.

    ERIC Educational Resources Information Center

    Chian, Edward S. K.; DeWalle, Foppe B.

    1978-01-01

    Presents water analysis literature for 1978. This review is concerned with organics, and it covers: (1) detergents and surfactants; (2) aliphatic and aromatic hydrocarbons; (3) pesticides and chlorinated hydrocarbons; and (4) naturally occurring organics. A list of 208 references is also presented. (HM)

  5. Organizers.

    ERIC Educational Resources Information Center

    Callison, Daniel

    2000-01-01

    Focuses on "organizers," tools or techniques that provide identification and classification along with possible relationships or connections among ideas, concepts, and issues. Discusses David Ausubel's research and ideas concerning advance organizers; the implications of Ausubel's theory to curriculum and teaching; "webbing," a specific…

  6. New comprehensive surgical curriculum of pre-graduate surgical education

    PubMed Central

    Łaski, Dariusz; Makarewicz, Wojciech; Proczko, Monika; Gruca, Zbigniew; Śledziński, Zbigniew

    2013-01-01

    Introduction Surgical education has become one of the most important directions in modern surgery evolution. To meet growing need for appropriate training in laparoscopic and, even more importantly, classic surgical skills, a curriculum involving contemporary tuition methods is needed. Advanced, structuralised training, which includes advanced technologies like virtual reality training, video coaching and motivative aspects of competition, seems to be important for an adequate education programme. Material and methods In academic years 2009/2010 and 2010/2011 the Department of General, Endocrine and Transplant Surgery of the Medical University of Gdansk together with the Pomeranian Foundation for Progress in Surgery organized 4480 h of training in that area of classic (2744) and laparoscopic (1736) skills. Both groups were involved in the programme of training in which the two most important aspects were reliable evaluation of the results and effective motivation to work. Skill evaluation at different stages of the programme were based on completion time and quality measurements. Apart from that, at the end of the course, the participants completed a questionnaire on their subjective perspective on this innovative curriculum, the quality and stability of the skills they obtained. Results In both arms of the programme (laparoscopic and classic) a statistically significant improvement was obtained as early as after the second and third sessions in half of the exercises. The acquired skills were stable over time, as proved by the plateau of completion time achieved in 11 out of 12 exercises. The results of the post-training questionnaire revealed that the participants were very satisfied with the structuralised form of training and appreciated the motivational role of competition. Conclusions Contemporary surgical training should be organized as a systematic, well-evaluated and goal-oriented programme similar to the one proposed by our team. The use of contemporary

  7. The surgical management of peritoneal dialysis catheters.

    PubMed Central

    Brook, Nicholas R.; White, Steven A.; Waller, Julian R.; Nicholson, Michael L.

    2004-01-01

    Peritoneal dialysis is a safe and effective form of renal-replacement therapy. Its use is increasing as the gap widens between the number of patients waiting for renal transplants and the number of available organs. This article reviews the surgical considerations and complications of peritoneal dialysis that may present to general surgeons. PMID:15140305

  8. Lifebox: A Global Patient Safety Initiative.

    PubMed

    Enright, Angela; Merry, Alan; Walker, Isabeau; Wilson, Iain

    2016-06-15

    The safety of anesthesia was dramatically improved by the introduction of pulse oximetry. This technology was rapidly adopted by anesthesiologists and made a standard of practice in many countries. In 2007, during development of the Surgical Safety Checklist, the World Health Organization recommended a pulse oximeter as a monitor for all patients undergoing anesthesia. However, clinicians in low- and middle-income countries lack access to basic anesthesia equipment, including pulse oximeters. The Lifebox Foundation was formed to determine how a suitable oximeter could be made available to anesthesia providers in these countries. Almost 11,000 oximeters have been delivered in 90 countries, with education courses completed in over 50 countries. PMID:27301049

  9. 3D Surgical Simulation

    PubMed Central

    Cevidanes, Lucia; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael

    2009-01-01

    This paper discusses the development of methods for computer-aided jaw surgery. Computer-aided jaw surgery allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery (CAS) system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3D surface models from Cone-beam CT (CBCT), dynamic cephalometry, semi-automatic mirroring, interactive cutting of bone and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intra-operative guidance. The system provides further intra-operative assistance with the help of a computer display showing jaw positions and 3D positioning guides updated in real-time during the surgical procedure. The CAS system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training and assessing the difficulties of the surgical procedures prior to the surgery. CAS has the potential to make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. Supported by NIDCR DE017727, and DE018962 PMID:20816308

  10. Review of Influential Articles in Surgical Education: 2002–2012

    PubMed Central

    Wohlauer, Max V.; George, Brian; Lawrence, Peter F.; Pugh, Carla M.; Van Eaton, Erik G.; DaRosa, Debra

    2013-01-01

    Background Exploring the trends in surgical education research offers insight into concerns, developments, and questions researchers are exploring that are relevant to teaching and learning in surgical specialties. Objective We conducted a review of the surgical education literature published between 2002 and 2012. The purpose was 2-fold: to provide an overview of the most frequently cited articles in the field of surgical education during the last decade and to describe the study designs and themes featured in these articles. Methods Articles were identified through Web of Science by using “surgical education” and “English language” as search terms. Using a feature in Web of Science, we tracked the number of citations of any publication. Of the 800 articles produced by the initial search, we initially selected 23 articles with 45 or more citations, and ultimately chose the 20 articles that were most frequently cited for our analysis. Results Analysis of the most frequently cited articles published in US journals between the years 2002–2012 identified 7 research themes and presented them in order of frequency with which they appear: use of simulation, issues in student/resident assessment, specialty choice, patient safety, team training, clinical competence assessment, and teaching the clinical sciences, with surgical simulation being the central theme. Researchers primarily used descriptive methods. Conclusions Popular themes in surgical education research illuminate the information needs of surgical educators as well as topics of high interest to the surgical community. PMID:24404263

  11. Surgical bleeding in microgravity

    NASA Technical Reports Server (NTRS)

    Campbell, M. R.; Billica, R. D.; Johnston, S. L. 3rd

    1993-01-01

    A surgical procedure performed during space flight would occur in a unique microgravity environment. Several experiments performed during weightlessness in parabolic flight were reviewed to ascertain the behavior of surgical bleeding in microgravity. Simulations of bleeding using dyed fluid and citrated bovine blood, as well as actual arterial and venous bleeding in rabbits, were examined. The high surface tension property of blood promotes the formation of large fluid domes, which have a tendency to adhere to the wound. The use of sponges and suction will be adequate to prevent cabin atmosphere contamination with all bleeding, with the exception of temporary arterial droplet streams. The control of the bleeding with standard surgical techniques should not be difficult.

  12. Surgical approaches for liver metastases in carcinoid tumors

    PubMed Central

    Saeed, Ahmad; Buell, Joseph

    2015-01-01

    Liver is the commonest site for metastasis in patients with neuroendocrine tumors (NETs); it occurs in 45-95% of patients. Available treatment options include surgical resection, liver transplantation, chemotherapy and biotherapy. Surgery is the gold standard for curative therapy. Typically, a multidisciplinary approach is a cornerstone for decision making while dealing with this aggressive disease. This review will focus on the performance and safety of open, laparoscopic, and liver transplant surgical approaches in NETs patients with liver metastases. PMID:26425458

  13. Surgical prosthetic treatment

    PubMed Central

    Carulli, Christian; Matassi, Fabrizio; Civinini, Roberto; Villano, Marco; Innocenti, Massimo

    2010-01-01

    Fragility fractures typically occur in elderly patients related principally to osteoporosis. A significative percentage of these fractures have to be treated surgically but comorbilities are often present, and need to be grossly stabilized before surgery. However, there is for these fractures a high rate of morbidity and mortality at short-term. Moreover, patients affected by a fragility fracture are at risk for another fragility fracture later in life. The Authors present an overview of the main patterns of proximal femoral fractures, underlining the peculiar features and choices of surgical treatment, and relating to specific indications and results of each treatment. PMID:22461289

  14. Surgical forceps techniques.

    PubMed

    Malden, N

    2001-01-01

    This paper considers two new elevator and dental forceps techniques for the atraumatic removal of teeth to avoid a surgical procedure where possible. The techniques described should be applicable in relatively well defined but commonly occurring situations. The two techniques involve the unconventional use of conventional dental extraction forceps, with the aim of facilitating removal of the retained roots of certain teeth: the first for incisors, canines and premolars and the second for lower first molars. The term 'surgical forceps technique's is tentatively put forward as a description of these hybrid procedures. PMID:11819949

  15. Nuclear safety

    NASA Technical Reports Server (NTRS)

    Buden, D.

    1991-01-01

    Topics dealing with nuclear safety are addressed which include the following: general safety requirements; safety design requirements; terrestrial safety; SP-100 Flight System key safety requirements; potential mission accidents and hazards; key safety features; ground operations; launch operations; flight operations; disposal; safety concerns; licensing; the nuclear engine for rocket vehicle application (NERVA) design philosophy; the NERVA flight safety program; and the NERVA safety plan.

  16. [Therapy of both surgical and non-surgical related complication of gastric cancer for the elderly].

    PubMed

    Li, Yong; Zheng, Jiabin

    2016-05-01

    Gastric cancer is one of the most common digestive malignant tumors. More and more elderly gastric cancer patients are diagnosed and need to undergo surgical treatment as the population ages. Since the elderly patients decrease in organ function and increase in internal diseases, the tolerance to anesthesia and surgery is poor. As a result, the incidence of surgical and postoperative complications is obviously higher. Complications can be divided into surgical complications and non-surgical related complications. Surgical complications consist mainly of hemorrhage, anastomotic leakage, anastomotic dehiscence and intestinal obstruction, while non-surgical related complications include deep venous thrombosis, pulmonary infection, anesthesia-related complication, abdominal infection, urinary infection, incision infection, poor wound healing, gastroparesis, gastroesophageal reflux disease, dumping syndrome and so on. Hence, we should consider more about the elderly patients' physical condition instead of the extent of radical operation. To reduce complications, we should evaluate the organ function and take an active role in underlying diseases before operation. Meanwhile, high quality nursing, powerful analgesia, anti-inflammation, keeping water electrolyte balance and nutrition support are also required postoperatively. Moreover, laparoscopic surgery and enhanced recovery after surgery (ERAS) can reduce the postoperative complications in elderly patients with gastric cancer as well. Further prospective randomized controlled trials about elderly gastric cancer should be carried out in the future, which can provide advanced evidences for treatment. PMID:27215514

  17. Safety Control and Safety Education at Technical Institutes

    NASA Astrophysics Data System (ADS)

    Iino, Hiroshi

    The importance of safety education for students at technical institutes is emphasized on three grounds including safety of all working members and students in their education, research and other activities. The Kanazawa Institute of Technology re-organized the safety organization into a line structure and improved safety minds of all their members and now has a chemical materials control system and a set of compulsory safety education programs for their students, although many problems still remain.

  18. Surgical Risks Associated with Winter Sport Tourism

    PubMed Central

    Sanchez, Stéphane; Payet, Cécile; Lifante, Jean-Christophe; Polazzi, Stéphanie; Chollet, François; Carty, Matthew J; Duclos, Antoine

    2015-01-01

    Background Mass tourism during winter in mountain areas may cause significant clustering of body injuries leading to increasing emergency admissions at hospital. We aimed at assessing if surgical safety and efficiency was maintained in this particular context. Methods We selected all emergency admissions of open surgery performed in French hospitals between 2010 and 2012. After identifying mountain areas with increasing volume of surgical stays during winter, we considered seasonal variations in surgical outcomes using a difference-in-differences study design. We computed multilevel regressions to evaluate whether significant increase in emergency cases had an effect on surgical mortality, complications and length of stay. Clustering effect of patients within hospitals was integrated in analysis and surgical outcomes were adjusted for both patient and hospital characteristics. Results A total of 381 hospitals had 559,052 inpatient stays related to emergency open surgery over 3 years. Compared to other geographical areas, a significant peak of activity was noted during winter in mountainous hospitals (Alps, Pyrenees, Vosges), ranging 6-77% volume increase. Peak was mainly explained by tourists’ influx (+124.5%, 4,351/3,496) and increased need for orthopaedic procedures (+36.8%, 4,731/12,873). After controlling for potential confounders, patients did not experience increased risk for postoperative death (ratio of OR 1.01, 95%CI 0.89-1.14, p = 0.891), thromboembolism (0.95, 0.77-1.17, p = 0.621) or sepsis (0.98, 0.85-1.12, p = 0.748). Length of stay was unaltered (1.00, 0.99-1.02, p = 0.716). Conclusion Surgical outcomes are not compromised during winter in French mountain areas despite a substantial influx of major emergencies. PMID:25970625

  19. Surgical Technician Curriculum.

    ERIC Educational Resources Information Center

    EASTCONN Regional Educational Services Center, North Windham, CT.

    This curriculum guide, developed for 10-month postsecondary programs in Connecticut, outlines a program for training surgical technicians. The program is divided into two components, didactic and clinical. Following a list of six general objectives of the program, the guide provides a curriculum outline by major areas with the number of hours…

  20. Surgical Technology Curriculum.

    ERIC Educational Resources Information Center

    Connecticut State Dept. of Education, Hartford. Div. of Vocational-Technical Schools.

    This curriculum guide contains materials for a 10-month postsecondary program to educate qualified adults to function as surgical technicians in association with surgeons and nurses in operating rooms and delivery rooms. The program provides for both a didactic and a clinical component. Contents include general information, a listing of major…

  1. Surgical wound care - open

    MedlinePlus

    Surgical incision care; Open wound care ... your wound again with sutures, you need to care for it at home, since it may take ... Your health care provider will tell you how often to change your dressing . To prepare for the dressing change: Clean your ...

  2. Organic reactivity analysis in Hanford single-shell tanks: Experimental and modeling basis for an expanded safety criterion

    SciTech Connect

    Fauske, H.; Grigsby, J.M.; Turner, D.A.; Babad, H.; Meacham, J.E.

    1996-01-01

    De-spite demonstrated safe storage in terms of chemical stability of the Hanford high level waste for many decades, including decreasing waste temperatures and continuing aging of chemicals to less energetic states, concerns continue relative to assurance of long-term safe storage. Review of potential chemical safety hazards has been of particular recent interest in response to serious incidents within the Nuclear Weapons Complexes in the former Soviet Union (the 1957 Kyshtym and the 1993 Tomsk-7 incidents). Based upon an evaluation of the extensive new information and understanding that have developed over the last few years, it is concluded that the Hanford waste is stored safely and that concerns related to potential chemical safety hazards are not warranted. Spontaneous bulk runaway reactions of the Kyshtym incident type and other potential condensed-phase propagating reactions can be ruled out by assuring appropriate tank operating controls are in place and by limiting tank intrusive activities. This paper summarizes the technical basis for this position.

  3. Sawbones laboratory in orthopedic surgical training

    PubMed Central

    Hetaimish, Bandar M.

    2016-01-01

    Sawbones are artificial bones designed to simulate the bone architecture, as well as the bone’s physical properties. The incorporation of sawbones simulation laboratories in many orthopedic training programs has provided the residents with flexibility in learning and scheduling that align with their working hour limitations. This review paper deliberates the organization of sawbones simulation in orthopedic surgical training to enhance trainee’s future learning. In addition, it explores the implications of sawbones simulation in orthopedic surgical teaching and evaluation. It scrutinizes the suitability of practicing on sawbones at the simulation laboratory to improve orthopedic trainee’s learning. This will be followed with recommendations for future enhancement of sawbones simulation-based learning in orthopedic surgical training. PMID:27052276

  4. Surgical Ablation of Atrial Fibrillation

    PubMed Central

    Ramlawi, Basel; Abu Saleh, Walid K.

    2015-01-01

    The Cox-maze procedure for the restoration of normal sinus rhythm, initially developed by Dr. James Cox, underwent several iterations over the years. The main concept consists of creating a series of transmural lesions in the right and left atria that disrupt re-entrant circuits responsible for propagating the abnormal atrial fibrillation rhythm. The left atrial appendage is excluded as a component of the Maze procedure. For the first three iterations of the Cox- maze procedure, these lesions were performed using a surgical cut-and-sew approach that ensured transmurality. The Cox-Maze IV is the most currently accepted iteration. It achieves the same lesion set of the Cox- maze III but uses alternative energy sources to create the transmural lesions, potentially in a minimally invasive approach on the beating heart. High-frequency ultrasound, microwave, and laser energy have all been used with varying success in the past. Today, bipolar radiofrequency heat or cryotherapy cooling are the most accepted sources for creating linear lesions with consistent safety and transmurality. The robust and reliable nature of these energy delivery methods has yielded a success rate reaching 90% freedom from atrial fibrillation at 12 months. Such approaches offer a significant long-term advantage over catheter-based ablation, especially in patients having longstanding, persistent atrial fibrillation with characteristics such as dilated left atrial dimensions, poor ejection fraction, and failed catheter ablation. Based on these improved results, there currently is significant interest in developing a hybrid ablation strategy that incorporates the superior transmural robust lesions of surgical ablation, the reliable stroke prevention potential of epicardial left atrial appendage exclusion, and sophisticated mapping and confirmatory catheter-based ablation technology. Such a minimally invasive hybrid strategy for ablation may lead to the development of multidisciplinary “Afib teams

  5. Organization of research team for nano-associated safety assessment in effort to study nanotoxicology of zinc oxide and silica nanoparticles.

    PubMed

    Kim, Yu-Ri; Park, Sung Ha; Lee, Jong-Kwon; Jeong, Jayoung; Kim, Ja Hei; Meang, Eun-Ho; Yoon, Tae Hyun; Lim, Seok Tae; Oh, Jae-Min; An, Seong Soo A; Kim, Meyoung-Kon

    2014-01-01

    Currently, products made with nanomaterials are used widely, especially in biology, bio-technologies, and medical areas. However, limited investigations on potential toxicities of nanomaterials are available. Hence, diverse and systemic toxicological data with new methods for nanomaterials are needed. In order to investigate the nanotoxicology of nanoparticles (NPs), the Research Team for Nano-Associated Safety Assessment (RT-NASA) was organized in three parts and launched. Each part focused on different contents of research directions: investigators in part I were responsible for the efficient management and international cooperation on nano-safety studies; investigators in part II performed the toxicity evaluations on target organs such as assessment of genotoxicity, immunotoxicity, or skin penetration; and investigators in part III evaluated the toxicokinetics of NPs with newly developed techniques for toxicokinetic analyses and methods for estimating nanotoxicity. The RT-NASA study was carried out in six steps: need assessment, physicochemical property, toxicity evaluation, toxicokinetics, peer review, and risk communication. During the need assessment step, consumer responses were analyzed based on sex, age, education level, and household income. Different sizes of zinc oxide and silica NPs were purchased and coated with citrate, L-serine, and L-arginine in order to modify surface charges (eight different NPs), and each of the NPs were characterized by various techniques, for example, zeta potentials, scanning electron microscopy, and transmission electron microscopy. Evaluation of the "no observed adverse effect level" and systemic toxicities of all NPs were performed by thorough evaluation steps and the toxicokinetics step, which included in vivo studies with zinc oxide and silica NPs. A peer review committee was organized to evaluate and verify the reliability of toxicity tests, and the risk communication step was also needed to convey the current findings

  6. Organization of research team for nano-associated safety assessment in effort to study nanotoxicology of zinc oxide and silica nanoparticles

    PubMed Central

    Kim, Yu-Ri; Park, Sung Ha; Lee, Jong-Kwon; Jeong, Jayoung; Kim, Ja Hei; Meang, Eun-Ho; Yoon, Tae Hyun; Lim, Seok Tae; Oh, Jae-Min; An, Seong Soo A; Kim, Meyoung-Kon

    2014-01-01

    Currently, products made with nanomaterials are used widely, especially in biology, bio-technologies, and medical areas. However, limited investigations on potential toxicities of nanomaterials are available. Hence, diverse and systemic toxicological data with new methods for nanomaterials are needed. In order to investigate the nanotoxicology of nanoparticles (NPs), the Research Team for Nano-Associated Safety Assessment (RT-NASA) was organized in three parts and launched. Each part focused on different contents of research directions: investigators in part I were responsible for the efficient management and international cooperation on nano-safety studies; investigators in part II performed the toxicity evaluations on target organs such as assessment of genotoxicity, immunotoxicity, or skin penetration; and investigators in part III evaluated the toxicokinetics of NPs with newly developed techniques for toxicokinetic analyses and methods for estimating nanotoxicity. The RT-NASA study was carried out in six steps: need assessment, physicochemical property, toxicity evaluation, toxicokinetics, peer review, and risk communication. During the need assessment step, consumer responses were analyzed based on sex, age, education level, and household income. Different sizes of zinc oxide and silica NPs were purchased and coated with citrate, L-serine, and L-arginine in order to modify surface charges (eight different NPs), and each of the NPs were characterized by various techniques, for example, zeta potentials, scanning electron microscopy, and transmission electron microscopy. Evaluation of the “no observed adverse effect level” and systemic toxicities of all NPs were performed by thorough evaluation steps and the toxicokinetics step, which included in vivo studies with zinc oxide and silica NPs. A peer review committee was organized to evaluate and verify the reliability of toxicity tests, and the risk communication step was also needed to convey the current

  7. The Human Microbiome and Surgical Disease

    PubMed Central

    Morowitz, Michael J.; Babrowski, Trissa; Carlisle, Erica M.; Olivas, Andrea; Romanowski, Kathleen S.; Seal, John B.; Liu, Donald C.; Alverdy, John C.

    2015-01-01

    Objective The purpose of this review article is to summarize what is currently known about microbes associated with the human body and to provide examples of how this knowledge impacts the care of surgical patients. Background Pioneering research over the past decade has demonstrated that human beings live in close, constant contact with dynamic communities of microbial organisms. This new reality has wide-ranging implications for the care of surgical patients. Methods and Results Recent advances in the culture-independent study of the human microbiome are reviewed. To illustrate the translational relevance of these studies to surgical disease, we discuss in detail what is known about the role of microbes in the pathogenesis of obesity, gastrointestinal malignancies, Crohn disease, and perioperative complications including surgical site infections and sepsis. The topics of mechanical bowel preparation and perioperative antibiotics are also discussed. Conclusions Heightened understanding of the microbiome in coming years will likely offer opportunities to refine the prevention and treatment of a wide variety of surgical conditions. PMID:21422915

  8. Quality of Care is Similar for Safety-Net and Non-Safety-Net Hospitals

    MedlinePlus

    ... Safety Organization (PSO) Program Quality Measure Tools & Resources Tools & Resources Value Surveys on Patient Safety Culture Hospital Survey on Patient Safety Culture Medical Office Survey on Patient Safety Culture Nursing Home Survey ...

  9. Back to basics: implementing the surgical checklist.

    PubMed

    Spruce, Lisa

    2014-11-01

    Surgery is complex and technically demanding for all team members. Surgical checklists have been implemented with different degrees of success in the perioperative setting. There is a wealth of evidence that they are effective at preventing patient safety events and helping team members master the complexities of modern health care. Implementation is key to successful use of the surgical checklist in all invasive procedural settings. Key strategies for successful checklist implementation include establishing a multidisciplinary team to implement the checklist, involving surgeon leaders, pilot testing the checklist, incorporating feedback from team members to improve the process, recognizing and addressing barriers to implementation, and offering coaching and continuous feedback to team members who use the checklist. Using these strategies will give the perioperative nurse, department leaders, and surgeons the tools to implement a successful checklist. PMID:25443117

  10. [Surgical training with simulators in training centers].

    PubMed

    Rodríguez-García, José Ignacio; Turienzo-Santos, Estrella; Vigal-Brey, Guillermo; Brea-Pastor, Agustín

    2006-06-01

    The development of new endoscopic procedures and minimally-invasive surgical interventions has led the methodology used to date to be questioned. Greater demand for safety by patients, the growth of the health budget and the reduced time available for training have led to the proliferation of centers with accredited personnel in which the knowledge and surgical skills necessary for the controlled incorporation of these techniques can be acquired. Simulators are available for the learning of both digestive endoscopy and laparoscopic techniques. These simulators are more or less dynamic, virtual, with viscera or mixed; even live animals can be used. Thus, the various techniques can be incorporated into clinical practice safely and effectively and at a reasonable cost. Simulators also allow evaluation and follow-up of the skills acquired. PMID:16768997

  11. Spacecraft surgical scrub system

    NASA Technical Reports Server (NTRS)

    Abbate, M.

    1980-01-01

    Ease of handling and control in zero gravity and minimizing the quantity of water required were prime considerations. The program tasks include the selection of biocidal agent from among the variety used for surgical scrub, formulation of a dispensing system, test, and delivery of flight dispensers. The choice of an iodophore was based on effectiveness on single applications, general familiarity among surgeons, and previous qualification for space use. The delivery system was a choice between the squeeze foamer system and impregnated polyurethane foam pads. The impregnated foam pad was recommended because it is a simpler system since the squeeze foamer requires some applicator to effectively clean the skin surfaces, whereas the form pad is the applicator and agent combined. Testing demonstrated that both systems are effective for use as surgical scrubs.

  12. Postthrombotic Syndrome: Surgical Possibilities

    PubMed Central

    Khanna, Ajay K.; Singh, Shivanshu

    2012-01-01

    Postthrombotic syndrome (PTS) is a late outcome of deep vein thrombosis characterized by cramping pain, swelling, hyperpigmentation, eczema, lipodermatosclerosis, and ulceration in the leg due to increased venous outflow resistance and reflux venous flow. Newer surgical and endovascular interventions have a promising result in the management of postthrombotic syndrome. Early surgical or endovascular interventions in appropriately selected patients may decrease the incidence of recurrent ulceration and skin changes and provide a better quality of life. Duplex and IVUS (intravenous ultrasound) along with venography serve as cornerstone investigative tools for assessment of reflux and obstruction. Venous obstruction, if present, should be addressed earlier than reflux. It requires endovenous stenting, endophlebectomy, or open bypass procedures. Venous stripping, foam sclerotherapy, radiofrequency, or laser ablation are used to abolish superficial venous reflux. Valvuloplasty procedures are useful for incompetent but intact deep venous valves, while transposition or axillary vein autotransplantation is done for completely destroyed valves. PMID:22084674

  13. Surgical management of presbyopia

    PubMed Central

    Torricelli, André AM; Junior, Jackson B; Santhiago, Marcony R; Bechara, Samir J

    2012-01-01

    Presbyopia, the gradual loss of accommodation that becomes clinically significant during the fifth decade of life, is a physiologic inevitability. Different technologies are being pursued to achieve surgical correction of this disability; however, a number of limitations have prevented widespread acceptance of surgical presbyopia correction, such as optical and visual distortion, induced corneal ectasia, haze, anisometropy with monovision, regression of effect, decline in uncorrected distance vision, and the inherent risks with invasive techniques, limiting the development of an ideal solution. The correction of the presbyopia and the restoration of accommodation are considered the final frontier of refractive surgery. The purpose of this paper is to provide an update about current procedures available for presbyopia correction, their advantages, and disadvantages. PMID:23055664

  14. Mentoring in surgical training.

    PubMed

    Rashid, Prem; Narra, Maruthi; Woo, Henry

    2015-04-01

    Surgical mentors have helped trainees develop fulfilling and academically productive careers, while supervisors are formally assigned to impart skills and oversee training. This paper reviews the comparative roles of the supervisor and mentor and how they overlap, while exploring the impact of the 'unknown' mentor. While the supervisor's role in directing the student is formally recognized, the mentee will personally select a mentor who successfully models the career and life balance to which the mentee aspires. The unknown mentor is known only to the mentee. The mentee's commitment to communicating with both mentor and supervisor is crucial to success. Better processes can be used to guide the mentor relationship. Confusion between the two roles - mentor and supervisor - is due to their complementary nature as well as an overlap in roles. Both remain essential to the growth and development of the surgical trainee. The unknown mentor could give detached advice and guidance to the student, while acting as a positive role model. PMID:25649003

  15. Investing in a Surgical Outcomes Auditing System

    PubMed Central

    Bermudez, Luis; Trost, Kristen; Ayala, Ruben

    2013-01-01

    Background. Humanitarian surgical organizations consider both quantity of patients receiving care and quality of the care provided as a measure of success. However, organizational efficacy is often judged by the percent of resources spent towards direct intervention/surgery, which may discourage investment in an outcomes monitoring system. Operation Smile's established Global Standards of Care mandate minimum patient followup and quality of care. Purpose. To determine whether investment of resources in an outcomes monitoring system is necessary and effectively measures success. Methods. This paper analyzes the quantity and completeness of data collected over the past four years and compares it against changes in personnel and resources assigned to the program. Operation Smile began investing in multiple resources to obtain the missing data necessary to potentially implement a global Surgical Outcomes Auditing System. Existing personnel resources were restructured to focus on postoperative program implementation, data acquisition and compilation, and training materials used to educate local foundation and international employees. Results. An increase in the number of postoperative forms and amount of data being submitted to headquarters occurred. Conclusions. Humanitarian surgical organizations would benefit from investment in a surgical outcomes monitoring system in order to demonstrate success and to ameliorate quality of care. PMID:23401763

  16. Investing in a surgical outcomes auditing system.

    PubMed

    Bermudez, Luis; Trost, Kristen; Ayala, Ruben

    2013-01-01

    Background. Humanitarian surgical organizations consider both quantity of patients receiving care and quality of the care provided as a measure of success. However, organizational efficacy is often judged by the percent of resources spent towards direct intervention/surgery, which may discourage investment in an outcomes monitoring system. Operation Smile's established Global Standards of Care mandate minimum patient followup and quality of care. Purpose. To determine whether investment of resources in an outcomes monitoring system is necessary and effectively measures success. Methods. This paper analyzes the quantity and completeness of data collected over the past four years and compares it against changes in personnel and resources assigned to the program. Operation Smile began investing in multiple resources to obtain the missing data necessary to potentially implement a global Surgical Outcomes Auditing System. Existing personnel resources were restructured to focus on postoperative program implementation, data acquisition and compilation, and training materials used to educate local foundation and international employees. Results. An increase in the number of postoperative forms and amount of data being submitted to headquarters occurred. Conclusions. Humanitarian surgical organizations would benefit from investment in a surgical outcomes monitoring system in order to demonstrate success and to ameliorate quality of care. PMID:23401763

  17. An analysis of the value of marketing to non-profit organizations: the case of child safety.

    PubMed

    Razis, V; Razis, N

    1993-01-01

    This paper considers a broad spectrum of literature concerning the limitations and value of applying marketing management principles from the private sector to public or non-profit organizations. The Child Accident Prevention Foundation of Southern Africa is used as a principle case-study. The authors conclude that there is much to be gained from applying a more systematic approach, providing one adapts business strategies to more complex social environments and objectives. Since both marketing and social issues share the challenge of 'sensitivity serving and satisfying human needs,' (Kotler, 1983 p 272) there are also some instances where business can learn from the experience of social organizations in attempts to influence human behavior. PMID:10132850

  18. Efficacy and safety of human fibrinogen-thrombin patch (Tachosil®) in the management of diffuse bleeding after chest wall and spinal surgical resection for aggressive thoracic neoplasms

    PubMed Central

    Guerrera, Francesco; Sandri, Alberto; Zenga, Francesco; Lanza, Giovanni Vittorio; Ruffini, Enrico; Bora, Giulia; Lyberis, Paraskevas; Solidoro, Paolo; Oliaro, Alberto

    2016-01-01

    Diffuse bleeding after chest wall and spine resection represents a major problem in General Thoracic Surgery. Several fibrin sealants (FS) have been developed over the years and their use has been gradually increasing over time, becoming an important aid to the surgeons, justifying their use across numerous fields of surgery due to its valid haemostatic properties. Among the several FS available, TachoSil® (Takeda Austria GmbH, Linz, Austria) stands out for its haemostatic and aerostatic properties, the latter being demonstrated even in high-risk patients after pulmonary resections for primary lung cancers. Several papers available in literature demonstrated TachoSil®’s effectiveness in controlling intraoperative and postoperative bleeding in different surgical branches, including hepatic and pancreatic surgery, as well as cardiac and thoracic surgery. However, the use of TachoSil® to control diffuse bleeding following major resections for advanced lung cancers, with requirement of chest wall and vertebral body resection for oncological radicality, was never published so far. In this paper, we report three cases of pulmonary lobectomy associated to chest wall resection and haemivertebrectomy for primary malignant lung neoplasms and for a recurrence of malignant solitary fibrous tumour of the pleura in which we used TachoSil©, which demonstrated its efficacy in controlling diffuse bleeding following resection. PMID:26904247

  19. Guideline implementation: Surgical attire.

    PubMed

    Cowperthwaite, Liz; Holm, Rebecca L

    2015-02-01

    Surgical attire helps protect patients from microorganisms that may be shed from the hair and skin of perioperative personnel. The updated AORN "Guideline for surgical attire" provides guidance on scrub attire, shoes, head coverings, and masks worn in the semirestricted and restricted areas of the perioperative setting, as well as how to handle personal items (eg, jewelry, backpacks, cell phones) that may be taken into the perioperative suite. This article focuses on key points of the guideline to help perioperative personnel adhere to facility policies and regulatory requirements for attire. The key points address the potential benefits of wearing scrub attire made of antimicrobial fabric, covering the arms when in the restricted area of the surgical suite, removing or confining jewelry when wearing scrub attire, disinfecting personal items that will be taken into the perioperative suite, and sending reusable attire to a health care-accredited laundry facility after use. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. PMID:25645036

  20. Robotic surgical training.

    PubMed

    Ben-Or, Sharon; Nifong, L Wiley; Chitwood, W Randolph

    2013-01-01

    In July 2000, the da Vinci Surgical System (Intuitive Surgical, Inc) received Food and Drug Administration approval for intracardiac applications, and the first mitral valve repair was done at the East Carolina Heart Institute in May 2000. The system is now approved and used in many surgical specialties. With this disruptive technology and accepted use, surgeons and hospitals are seeking the most efficacious training pathway leading to safe use and responsible credentialing.One of the most important issues related to safe use is assembling the appropriate team of professionals involved with patient care. Moreover, proper patient selection and setting obtainable goals are also important.Creation and maintenance of a successful program are discussed in the article focusing on realistic goals. This begins with a partnership between surgeon leaders, hospital administrators, and industry support. Through this partnership, an appropriate training pathway and clinical pathway for success can be outlined. A timeline can then be created with periods of data analysis and adjustments as necessary. A successful program is attainable by following this pathway and attending to every detail along the journey. PMID:23528718

  1. Allergy to Surgical Implants.

    PubMed

    Pacheco, Karin A

    2015-01-01

    Surgical implants have a wide array of therapeutic uses, most commonly in joint replacements, but also in repair of pes excavatum and spinal disorders, in cardiac devices (stents, patches, pacers, valves), in gynecological implants, and in dentistry. Many of the metals used are immunologically active, as are the methacrylates and epoxies used in conjunction with several of these devices. Allergic responses to surgical components can present atypically as failure of the device, with nonspecific symptoms of localized pain, swelling, warmth, loosening, instability, itching, or burning; localized rash is infrequent. Identification of the specific metal and cement components used in a particular implant can be difficult, but is crucial to guide testing and interpretation of results. Nickel, cobalt, and chromium remain the most common metals implicated in implant failure due to metal sensitization; methacrylate-based cements are also important contributors. This review will provide a guide on how to assess and interpret the clinical history, identify the components used in surgery, test for sensitization, and provide advice on possible solutions. Data on the pathways of metal-induced immune stimulation are included. In this setting, the allergist, the dermatologist, or both have the potential to significantly improve surgical outcomes and patient care. PMID:26362550

  2. [Surgical treatment of syringomyelia].

    PubMed

    Abe, T; Okuda, Y; Nagashima, H; Isojima, A; Tani, S

    1995-12-01

    Eighty cases of surgically treated syringomyelia were retrospectively reviewed. The cases were classified into following 4 types, type 1: syringomyelia with Chiari malformation (54 cases), type 2: syringomyelia with basal arachnoiditis (15 cases), type 3: syringomyelia with an obstruction of the foramen Magendie (1 case), and type 4: syringomyelia with spinal arachnoiditis (14 cases). Foramen magnum decompression (FMD) was performed in patients with type 1, in type 2 fourth ventricle-subarachnoid shunt was additionally performed. Gardner's operation was performed in patients with type 3. Syrinx-peritoneal shunt was performed in patients with type 4. Surgical procedures for syringomyelia which we selected were thought to be appropriate, based on postoperative syrinx collapse rate in MRI. However, postoperative clinical course was much different in each type of syringomyelia after the collapse of syrinx had been equally achieved. Neurological disorders were stopped in deterioration after surgery in all cases of type 1. However, motor weakness was still deteriorated in half cases of type 2, and in 60% of type 4. When clinical severity of the patients with type 1 and 2, based on the distribution of dissociated sensory loss and motor weakness, were classified into 5 grades. The rate of improvement of patient's symptoms and signs was higher in the lower grades. We concluded that a surgical treatment for syringomyelia was essentially a preventive one, therefore it should be done in early stage of disorders. PMID:8752412

  3. Surgical residency training and international volunteerism: a national survey of residents from 2 surgical specialties

    PubMed Central

    Matar, Wadih Y.; Trottier, Daniel C.; Balaa, Fady; Fairful-Smith, Robin; Moroz, Paul

    2012-01-01

    Background Many low- and middle-income countries (LMICs) lack basic surgical resources, resulting in avoidable disability and mortality. Recently, residents in surgical training programs have shown increasing interest in overseas elective experiences to assist surgical programs in LMICs. The purpose of this study was to survey Canadian surgical residents about their interest in international volunteerism. Methods We sent a web-based survey to all general and orthopedic surgery residents enrolled in surgical training programs in Canada. The survey assessed residents’ interests, attitudes and motivations, and perceived barriers and aids with respect to international volunteerism. Results In all, 361 residents completed the survey for a response rate of 38.0%. Half of the respondents indicated that the availability of an international surgery elective would have positively influenced their selection of a residency program. Excluding the 18 residents who had volunteered during residency, 63.8% of the remaining residents confirmed an interest in international volunteering with “contributing to an important cause,” “teaching” and “tourism/cultural enhancement” as the leading reasons for their interest. Perceived barriers included “lack of financial support” and “lack of available organized opportunities.” All (100%) respondents who had done an international elective during residency confirmed that they would pursue such work in the future. Conclusion Administrators of Canadian surgical programs should be aware of strong resident interest in global health care and accordingly develop opportunities by encouraging faculty mentorships and resources for global health teaching. PMID:22854155

  4. Suppression of Surgeons' Bacterial Hand Flora during Surgical Procedures with a New Antimicrobial Surgical Glove

    PubMed Central

    Kramer, Axel; Ouriel, Kenneth; Suchomel, Miranda; McLaws, Mary-Louise; Rottman, Martin; Leaper, David; Assadian, Afshin

    2014-01-01

    Abstract Background: Perforations of surgical gloves are common and increase with the duration of glove wear. Skin flora, re-grown after pre-operative disinfection of the hands, may contaminate a surgical site. An antimicrobial surgical glove with chlorhexidine on its inner surface has been developed. We hypothesized that by suppressing the re-growth of skin flora during the complete course of a surgical procedure, antimicrobial gloves may reduce the risk of surgical site contamination in the event of an intra-operative glove breach. Methods: We conducted a randomized, double-blind, single-center trial, to measure any differences in the bacterial skin populations of surgeons' hands during surgical procedures done with antimicrobial and non-antimicrobial surgical gloves [ISRCTN71391952]. In this study, 25 pairs of gloves were retrieved from 14 surgeons who donned them randomly on their dominant or non-dominant hand. The number of bacteria retrieved from glove fluid was measured and expressed as colony forming units (CFU)/mL. Results: The median cfu/mL of antimicrobial gloves was 0.00 (LQ: 0.00 CFU/mL; UQ: 0.00 cfu/mL), with a mean log10 cfu/mL=0.02 (range: 0.00–0.30). The median CFU/mL of non-antimicrobial gloves was 54.00 (LQ: 3.00 cfu/mL; UQ: 100.00 cfu/mL) with a mean log10 CFU/mL=1.32 (range: 0.00–2.39). After a mean operating time of 112 min, the difference in the log10 CFU/mL was 1.30 (p<0.001). Conclusions: A new antimicrobial surgical glove suppressed surgeons' hand flora during operative procedures. In the event of a glove breach, the use of such a glove may have the potential to prevent bacterial contamination of a sterile surgical site, thereby decreasing the risk of surgical site infection (SSI) and increasing patient safety. Further clinical studies are needed to confirm this concept. PMID:24116857

  5. Impact of North Atlantic Treaty Organization Policies and Procedures on Combined Medical Operations: Food and Water Safety and Veterinary Support.

    PubMed

    Stevenson, Timothy H; Chevalier, Nicole A; Scher, Gregory R; Burke, Ronald L

    2016-01-01

    Effective multilateral military operations such as those conducted by the North Atlantic Treaty Organization (NATO) require close cooperation and standardization between member nations to ensure interoperability. Failure to standardize policies, procedures, and doctrine prior to the commencement of military operations will result in critical interoperability gaps, which jeopardize the health of NATO forces and mission success. To prevent these gaps from occurring, US forces must be actively involved with NATO standardization efforts such as the Committee of the Chiefs of Medical Services to ensure US interests are properly represented when NATO standards are developed and US doctrine and procedures will meet the established NATO requirements. PMID:27215889

  6. Transition from Training to Surgical Practice.

    PubMed

    Cogbill, Thomas H; Shapiro, Stephen B

    2016-02-01

    Surgical training graduates require a period of adjustment as they transform from trainees to experienced surgeons. Making a smooth transition is important for patient safety and new surgeon success. A subset of current graduates does not feel confident to enter directly into practice. Residency design with curriculum refocus, credentialing to encourage graded responsibility, and increased operative exposure is necessary. Onboarding programs should include formal mentoring, career counseling, proctoring by senior surgeons, and objective review of outcomes. The ACS developed a one-year TTP program to provide independent decision-making, operative autonomy, mentoring by senior surgeons, and practice management experience. PMID:26612017

  7. History and future of human cadaver preservation for surgical training: from formalin to saturated salt solution method.

    PubMed

    Hayashi, Shogo; Naito, Munekazu; Kawata, Shinichi; Qu, Ning; Hatayama, Naoyuki; Hirai, Shuichi; Itoh, Masahiro

    2016-01-01

    Traditionally, surgical training meant on-the-job training with live patients in an operating room. However, due to advancing surgical techniques, such as minimally invasive surgery, and increasing safety demands during procedures, human cadavers have been used for surgical training. When considering the use of human cadavers for surgical training, one of the most important factors is their preservation. In this review, we summarize four preservation methods: fresh-frozen cadaver, formalin, Thiel's, and saturated salt solution methods. Fresh-frozen cadaver is currently the model that is closest to reality, but it also presents myriad problems, including the requirement of freezers for storage, limited work time because of rapid putrefaction, and risk of infection. Formalin is still used ubiquitously due to its low cost and wide availability, but it is not ideal because formaldehyde has an adverse health effect and formalin-embalmed cadavers do not exhibit many of the qualities of living organs. Thiel's method results in soft and flexible cadavers with almost natural colors, and Thiel-embalmed cadavers have been appraised widely in various medical disciplines. However, Thiel's method is relatively expensive and technically complicated. In addition, Thiel-embalmed cadavers have a limited dissection time. The saturated salt solution method is simple, carries a low risk of infection, and is relatively low cost. Although more research is needed, this method seems to be sufficiently useful for surgical training and has noteworthy features that expand the capability of clinical training. The saturated salt solution method will contribute to a wider use of cadavers for surgical training. PMID:26670696

  8. [Low-temperature sterilization for the surgical infection prophylaxis].

    PubMed

    Kornev, I I; Baranov, G A; Ul'ianov, V I

    2011-01-01

    The comparative characteristic of the accepted methods of low-temperature sterilization of medical equipment is given. Special attention is devoted to the surgical infection prophylaxis. The efficacy, expediency and safety of gas sterilization with ethilenoxide is proved. Plasmic methods of sterilization is recommended for use together with other methods of low-temperature sterilization. PMID:21716218

  9. The retained surgical sponge.

    PubMed Central

    Kaiser, C W; Friedman, S; Spurling, K P; Slowick, T; Kaiser, H A

    1996-01-01

    OBJECTIVE. A review was performed to investigate the frequency of occurrence and outcome of patients who have retained surgical sponges. METHODS. Closed case records from the files of the Medical Professional Mutual Insurance Company (ProMutual, Boston, MA) involving a claim of retained surgical sponges were reviewed for a 7-year period. RESULTS. Retained sponges occurred in 40 patients, comprising 48% of all closed claims for retained foreign bodies. A falsely correct sponge count after an abdominal procedure was documented in 76% of these claims. Ten percent of claims involved vaginal deliveries and minor non-body cavity procedures, for which no sponge count was performed. Total indemnity payments were $2,072,319, and defense costs were $572,079. In three cases, the surgeon was deemed responsible by the court despite the nursing staff's admitting liability and evidence presented that the surgeon complied completely with the standard of care. A wide range of indemnity payments was made despite a remarkable similarity of outcome in the patients studied. CONCLUSIONS. Despite the rarity of the reporting of a retained surgical sponge, this occurrence appears to be encountered more commonly than generally is appreciated. Operating teams should ensure that sponges be counted for all vaginal and any incisional procedures at risk for retaining a sponge. In addition, the surgeon should not unquestioningly accept correct count reports, but should develop the habit of performing a brief but thorough routine postprocedure wound/body cavity exploration before wound closure. The strikingly similar outcome for most patients would argue for a standardized indemnity payment being made without the need for adversarial legal procedures. PMID:8678622

  10. Growth and Expansion of the International Criticality Safety Benchmark Evaluation Project and the Newly Organized International Reactor Physics Experiment Evaluation Project

    SciTech Connect

    J. Blair Briggs; Lori Scott; Yolanda Rugama; Enrico Satori

    2007-05-01

    Since ICNC 2003, the International Criticality Safety Benchmark Evaluation Project (ICSBEP) has continued to expand its efforts and broaden its scope. Criticality-alarm / shielding type benchmarks and fundamental physics measurements that are relevant to criticality safety applications are not only included in the scope of the project, but benchmark data are also included in the latest version of the handbook. A considerable number of improvements have been made to the searchable database, DICE and the criticality-alarm / shielding benchmarks and fundamental physics measurements have been included in the database. There were 12 countries participating on the ICSBEP in 2003. That number has increased to 18 with recent contributions of data and/or resources from Brazil, Czech Republic, Poland, India, Canada, and China. South Africa, Germany, Argentina, and Australia have been invited to participate. Since ICNC 2003, the contents of the “International Handbook of Evaluated Criticality Safety Benchmark Experiments” have increased from 350 evaluations (28,000 pages) containing benchmark specifications for 3070 critical or subcritical configurations to 442 evaluations (over 38,000 pages) containing benchmark specifications for 3957 critical or subcritical configurations, 23 criticality-alarm-placement / shielding configurations with multiple dose points for each, and 20 configurations that have been categorized as fundamental physics measurements that are relevant to criticality safety applications in the 2006 Edition of the ICSBEP Handbook. Approximately 30 new evaluations and 250 additional configurations are expected to be added to the 2007 Edition of the Handbook. Since ICNC 2003, a reactor physics counterpart to the ICSBEP, The International Reactor Physics Experiment Evaluation Project (IRPhEP) was initiated. Beginning in 1999, the IRPhEP was conducted as a pilot activity by the by the Organization of Economic Cooperation and Development (OECD) Nuclear Energy

  11. Resistance profiles in surgical-site infection.

    PubMed

    Lenz, Andreas M; Fairweather, Mark; Cheadle, William G

    2008-08-01

    Surgical-site infections (SSIs) remain a common complication, affecting some 5% of patients undergoing surgical procedures and can sometimes present a major challenge after surgery with life-threatening septic illness. The appearance of organisms that are often resistant to common antibiotic treatment is of great concern. Staphylococcus aureus is the organism most commonly recovered from infected surgical wounds, and usually contaminates wounds from the patients own skin. SSIs occur despite appropriate skin disinfection, sterilization of instruments, use of gown and gloves, appropriate sterile technique and prophylactic antimicrobials. In fact, it is difficult to maintain a sterile field over time, and most wounds become contaminated throughout the course of surgery. Methicillin-resistant S. aureus (MRSA) first arose in the hospital setting, but have more recently evolved in the community. Such community-acquired MRSA are genetically different and seem to be even more virulent owing to genes that encode virulence factors, such as staphylococcal cassette chromosome mec type IV and Panton-Valentine leukocidin. The purpose of this review is to summarize characteristics of frequently isolated bacterial strains from SSIs. The focus will be on Gram-positive organisms because of their increasing prevalence in SSIs and their high potential to develop resistance against several antibiotic agents, including vancomycin. PMID:18651816

  12. [Psychotic states after surgical interventions (based on observations in the resuscitation department of a surgical clinic)].

    PubMed

    Eskin, S I

    1996-01-01

    At the resuscitation department, 21 patients with psychotic states after surgical intervention were followed up. Time of origination of psychoses following surgical intervention was ascertained together with their duration. There were no cases of development of organic psychoses. Narcosis is considered to be unimportant in the etiology of psychoses as are its particular features. The following items are contributing factors: dread of operation, intense pain in the immediate period after the operation. The incidence of different psychotic syndromes is indicated, the necessity to carry out ultimate investigations is substantiated. PMID:9072232

  13. Providing care for critically ill surgical patients: challenges and recommendations.

    PubMed

    Tisherman, Samuel A; Kaplan, Lewis; Gracias, Vicente H; Beilman, Gregory J; Toevs, Christine; Byrnes, Matthew C; Coopersmith, Craig M

    2013-07-01

    Providing optimal care for critically ill and injured surgical patients will become more challenging with staff shortages for surgeons and intensivists. This white paper addresses the historical issues behind the present situation, the need for all intensivists to engage in dedicated critical care per the intensivist model, and the recognition that intensivists from all specialties can provide optimal care for the critically ill surgical patient, particularly with continuing involvement by the surgeon of record. The new acute care surgery training paradigm (including trauma, surgical critical care, and emergency general surgery) has been developed to increase interest in trauma and surgical critical care, but the number of interested trainees remains too few. Recommendations are made for broadening the multidisciplinary training and practice opportunities in surgical critical care for intensivists from all base specialties and for maintaining the intensivist model within acute care surgery practice. Support from academic and administrative leadership, as well as national organizations, will be needed. PMID:23754675

  14. Surgical treatments for osteoarthritis.

    PubMed

    de l'Escalopier, Nicolas; Anract, Philippe; Biau, David

    2016-06-01

    There are two main surgical treatments for osteoarthritis: conservative treatments, where the damaged cartilage is left in place, and radical treatments, where the cartilage is replaced by an artificial endoprosthesis; this latter procedure is termed joint arthroplasty. These treatments are only offered to symptomatic patients. Arthrodesis is yet another surgical intervention in cases of osteoarthritis. It will sacrifice the joint's articular function and is performed on small osteoarthritic joints, such as wrists and ankles, for instance. Osteoarthritis symptoms are usually the consequence of an imbalance between the load applied to a joint and the surface available to support that load. Therefore, conservative treatments will either tend to decrease the load exerted on the joint, such as in a tibial valgus osteotomy for instance, or to improve the articular surface supporting that load. Sometimes, both can be provided at the same time; the peri-acetabular osteotomy for hip dysplasia is an example of such a procedure. Conservative treatments are usually offered to young patients in order to delay, if not avoid, the need for a joint prosthesis. They are usually performed before osteoarthritis appears or at an early stage. Joint arthroplasties have overwhelmingly excellent functional results and today's research is directed towards providing rapid recovery, very long-term stability, and the assurance of a good functionality in extreme conditions. However, complications with joint arthroplasties can be serious with little, if any, reasonable salvage solution. Therefore, these procedures are offered to patients who have failed adequate medical treatment measures. PMID:27185463

  15. Surgical Management of Iatrogenic Pigment Dispersion Glaucoma

    PubMed Central

    Mierlo, Camille Van; Pinto, Luis Abegão

    2015-01-01

    ABSTRACT Introduction: Iatrogenic pigment dispersion syndrome generally originates from a repetitive, mechanical trauma to the pigmented posterior epithelium of the iris. This trauma can arise after intraocular surgery, most commonly due to an abnormal contact between the intraocular lens (IOL) and the iris. Whether surgical removal of this primary insult can lead to a successful intraocular pressure (IOP) control remains unclear. Methods: Case-series. Patients with IOP elevation and clinical signs of pigment dispersion were screened for a diagnosis of iatrogenic IOL-related pigment dispersion. Results: Three patients in which the IOL or the IOL-bag complex caused a pigment dispersion through a repetitive iris chafing were selected. In two cases, replacement of a sulcus-based single-piece IOL (patient 1) or a sub-luxated in-the-bag IOL (patient 2) by an anterior-chamber (AC) iris-fixed IOL led to a sustained decrease in IOP. In the third case, extensive iris atrophy and poor anatomical AC parameters for IOL implantation precluded further surgical intervention. Conclusion: IOL-exchange appears to be a useful tool in the management of iatrogenic pigment dispersion glaucoma due to inappropriate IOL implantation. This cause-oriented approach seems to be effective in controlling IOP, but should be offered only if safety criteria are met. How to cite this article: Van Mierlo C, Abegao Pinto L, Stalmans I. Surgical Management of Iatrogenic Pigment Dispersion Glaucoma. J Curr Glaucoma Pract 2015;9(1):28-32. PMID:26997830

  16. Can Probiotics Improve Your Surgical Outcomes?

    PubMed

    Ward, Tina; Nichols, Misty; Nutter, Julie

    2016-01-01

    Despite ongoing advances in medical technology, postoperative infections and infectious complications continue to be a significant cause of morbidity and mortality. Surgical trauma and prophylactic antibiotics disrupt the balance of the intestinal microbiota and barrier function of the gut, potentiating an enhanced inflammatory response and further immune system depression. With the increasing costs of health care and emergence of multidrug-resistant bacteria, alternative approaches must be explored. Many clinical studies have demonstrated that the use of probiotics, prebiotics, or a combination of both (synbiotics) as a part of innovative strategies can improve outcomes of elective abdominal and gastrointestinal surgical procedures. It has been demonstrated that probiotics play a role in gut barrier improvement and immunomodulation. However, it is evident that additional research is needed including larger, multicenter, randomized controlled trials to validate the safety and efficacy of their use in surgical patients. The purpose of this article is to discuss background of probiotic use in abdominal/gastrointestinal surgery, risk and benefits, clinical relevance for health care providers, and further implications for research. PMID:27254237

  17. [Safety culture: definition, models and design].

    PubMed

    Pfaff, Holger; Hammer, Antje; Ernstmann, Nicole; Kowalski, Christoph; Ommen, Oliver

    2009-01-01

    Safety culture is a multi-dimensional phenomenon. Safety culture of a healthcare organization is high if it has a common stock in knowledge, values and symbols in regard to patients' safety. The article intends to define safety culture in the first step and, in the second step, demonstrate the effects of safety culture. We present the model of safety behaviour and show how safety culture can affect behaviour and produce safe behaviour. In the third step we will look at the causes of safety culture and present the safety-culture-model. The main hypothesis of this model is that the safety culture of a healthcare organization strongly depends on its communication culture and its social capital. Finally, we will investigate how the safety culture of a healthcare organization can be improved. Based on the safety culture model six measures to improve safety culture will be presented. PMID:19998775

  18. The role and validity of surgical simulation.

    PubMed

    Agha, Riaz A; Fowler, Alexander J

    2015-02-01

    In the last three decades, simulation has become a key tool in the training of doctors and the maintenance of patient safety. Simulation offers an immersive, realistic way of learning technical skills. Recent changes to the training schemes in many surgical specialities mean that the hours spent working between senior house officer and consultant have been reduced. This, combined with other pressures (such as reduced operating hours), means that surgery has moved away from its traditional apprenticeship model and toward a competency-based one. Simulation can be a standardized and safe method for training and assessing surgeons. Use of simulation for training has become significant alongside the development of laparoscopic techniques, and evidence suggests that skills obtained in simulation are applicable in real clinical scenarios. Simulation allows trainees to make mistakes, to ask the "what if?" questions, and to learn and reflect on such situations without risking patient safety. Virtual reality simulators have been used to allow experts to plan complicated operations and assess perioperative risks. Most recently, fully immersive simulations, such as those with whole theater teams involved, and patient-centered simulations allow development of other key skills aside from purely technical ones. Use of simulation in isolation from traditional teaching methods will furnish the surgeon in training with skills, but the best time and place to use such skills comes only with experience. In this article we examine the role of simulation in surgical training and its impact in the context of reduced training time. PMID:25692441

  19. The Role and Validity of Surgical Simulation

    PubMed Central

    Agha, Riaz A.; Fowler, Alexander J.

    2015-01-01

    In the last three decades, simulation has become a key tool in the training of doctors and the maintenance of patient safety. Simulation offers an immersive, realistic way of learning technical skills. Recent changes to the training schemes in many surgical specialities mean that the hours spent working between senior house officer and consultant have been reduced. This, combined with other pressures (such as reduced operating hours), means that surgery has moved away from its traditional apprenticeship model and toward a competency-based one. Simulation can be a standardized and safe method for training and assessing surgeons. Use of simulation for training has become significant alongside the development of laparoscopic techniques, and evidence suggests that skills obtained in simulation are applicable in real clinical scenarios. Simulation allows trainees to make mistakes, to ask the “what if?” questions, and to learn and reflect on such situations without risking patient safety. Virtual reality simulators have been used to allow experts to plan complicated operations and assess perioperative risks. Most recently, fully immersive simulations, such as those with whole theater teams involved, and patient-centered simulations allow development of other key skills aside from purely technical ones. Use of simulation in isolation from traditional teaching methods will furnish the surgeon in training with skills, but the best time and place to use such skills comes only with experience. In this article we examine the role of simulation in surgical training and its impact in the context of reduced training time. PMID:25692441

  20. The effects of surgical checklists on morbidity and mortality: a pre- and post-intervention study

    PubMed Central

    Rodrigo-Rincon, I; Martin-Vizcaino, MP; Tirapu-Leon, B; Zabalza-Lopez, P; Zaballos-Barcala, N; Villalgordo-Ortin, P; Abad-Vicente, FJ; Gost-Garde, J

    2015-01-01

    Background Surgical checklists (SCs) have been developed to enhance teamwork and facilitate handovers, thereby improving the safety of surgical patients in health care organisations. The aim of this study was to determine whether the implementation of a 39-item SC reduced mortality and surgical adverse events (AEs) in patients undergoing inpatient surgery. Methods A retrospective pre- and post-intervention study of two cohorts of surgical patients was conducted (n = 1602) in a tertiary teaching hospital. The patients' homogeneity was confirmed by studying 40 comorbidities, 13 analytical determinations and 14 patient- and intervention-related variables. A 39-item SC adapted from one by the World Health Organization was used. The primary endpoint was the occurrence of any AE, including death, within 30 days of the operation. Twenty-three types of AEs were analysed. Results Following implementation of the checklist, the rate of AEs per 100 patients decreased from 31.5% to 26.5% (P = 0.39), the rate of infectious AEs decreased from 13.9 to 9.6 (P = 0.037) and non-infectious AEs decreased from 17.5 to 16.8 (P = 0.82). For non-elective patients, total AEs decreased from 60.4 to 37.0 (P = 0.017). The proportion of patients with one or more AE decreased from 18.1% to 16.2% (P = 0.35), and the death rate at 30 days decreased from 1.5% to 0.9% (P = 0.35). Conclusion The overall AE rate did not decrease significantly between the two periods. However, the rate of infectious AEs and overall AEs in patients with non-elective admissions had statistically significant reductions. Further research is needed to determine how and in which patients SC introduction can work successfully. PMID:25476578

  1. Neuronavigation. Principles. Surgical technique.

    PubMed

    Ivanov, Marcel; Ciurea, Alexandru Vlad

    2009-01-01

    Neuronavigation and stereotaxy are techniques designed to help neurosurgeons precisely localize different intracerebral pathological processes by using a set of preoperative images (CT, MRI, fMRI, PET, SPECT etc.). The development of computer assisted surgery was possible only after a significant technological progress, especially in the area of informatics and imagistics. The main indications of neuronavigation are represented by the targeting of small and deep intracerebral lesions and choosing the best way to treat them, in order to preserve the neurological function. Stereotaxis also allows lesioning or stimulation of basal ganglia for the treatment of movement disorders. These techniques can bring an important amount of confort both to the patient and to the neurosurgeon. Neuronavigation was introduced in Romania around 2003, in four neurosurgical centers. We present our five-years experience in neuronavigation and describe the main principles and surgical techniques. PMID:20108488

  2. Idaho Safety Manual.

    ERIC Educational Resources Information Center

    Idaho State Dept. of Education, Boise. Div. of Vocational Education.

    This manual is intended to help teachers, administrators, and local school boards develop and institute effective safety education as a part of all vocational instruction in the public schools of Idaho. This guide is organized in 13 sections that cover the following topics: introduction to safety education, legislation, levels of responsibility,…

  3. Archetypes for Organisational Safety

    NASA Technical Reports Server (NTRS)

    Marais, Karen; Leveson, Nancy G.

    2003-01-01

    We propose a framework using system dynamics to model the dynamic behavior of organizations in accident analysis. Most current accident analysis techniques are event-based and do not adequately capture the dynamic complexity and non-linear interactions that characterize accidents in complex systems. In this paper we propose a set of system safety archetypes that model common safety culture flaws in organizations, i.e., the dynamic behaviour of organizations that often leads to accidents. As accident analysis and investigation tools, the archetypes can be used to develop dynamic models that describe the systemic and organizational factors contributing to the accident. The archetypes help clarify why safety-related decisions do not always result in the desired behavior, and how independent decisions in different parts of the organization can combine to impact safety.

  4. Surgical training in Guyana: the next generation.

    PubMed

    Cameron, Brian H; Martin, Carlos; Rambaran, Madan

    2015-02-01

    The pioneering surgical training partnership between the Canadian Association of General Surgeons (CAGS) and the University of Guyana has successfully graduated 14 surgeons since 2006. The association has recruited 29 surgeons who have made 75 teaching visits to Guyana, and CAGS involvement has been critical to providing local credibility to the program, organizing the curriculum structure and developing rigorous examinations. The program is now locally sustained, with graduates leading a number of clinical hospital programs. The initial diploma qualification is being reassessed, as other specialties have introduced postgraduate Master of Medicine degree programs. Many graduates are pursuing additional training opportunities overseas, and almost all of those remaining in Guyana have returned to the tertiary centre from the regional hospitals. The program has succeeded in training surgeons and raising the standards of surgical care in Guyana, but broader health system efforts are necessary to retain surgeons in outlying regional hospitals. PMID:25621909

  5. Surgical interventions for primary congenital glaucoma

    PubMed Central

    Ghate, Deepta; Wang, Xue

    2015-01-01

    Background Primary congenital glaucoma (PCG) manifests within the first few years of a child’s life and is not associated with any other systemic or ocular abnormalities. PCG results in considerable morbidity even in developed countries. Several surgical techniques for treating this condition, and lowering the intraocular pressure (IOP) associated with it, have been described. Objectives To compare the effectiveness and safety of different surgical techniques for PCG. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2014, Issue 6), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2014), EMBASE (January 1980 to June 2014), (January 1982 to June 2014), PubMed (January 1946 to June 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov), the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 23 June 2014. Selection criteria We included all randomized and quasi-randomized trials in which different types of surgical interventions were compared in children under five years of age with PCG. Data collection and analysis We used standard methodological procedures specified by The Cochrane Collaboration. Main results We included a total of six trials (four randomized and two quasi-randomized) with 102 eyes in 61 children. Two trials were conducted in the USA and one trial each in Egypt, Israel, Lebanon and Saudi Arabia. All trials included children aged younger than one year when diagnosed with PCG, and followed them for periods ranging from six months to five years. No two trials compared the same pair of surgical interventions, so we did not perform any meta-analysis. One trial

  6. Guideline implementation: surgical instrument cleaning.

    PubMed

    Cowperthwaite, Liz; Holm, Rebecca L

    2015-05-01

    Cleaning, decontaminating, and handling instructions for instruments vary widely based on the type of instrument and the manufacturer. Processing instruments in accordance with the manufacturer's instructions can help prevent damage and keep devices in good working order. Most importantly, proper cleaning and disinfection may prevent transmission of pathogenic organisms from a contaminated device to a patient or health care worker. The updated AORN "Guideline for cleaning and care of surgical instruments" provides guidance on cleaning, decontaminating, transporting, inspecting, and storing instruments. This article focuses on key points of the guideline to help perioperative personnel implement appropriate instrument care protocols in their practice settings. The key points address timely cleaning and decontamination of instruments after use; appropriate heating, ventilation, and air conditioning parameters for the decontamination area; processing of ophthalmic instruments and laryngoscopes; and precautions to take with instruments used in cases of suspected prion disease. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. PMID:25946180

  7. A Comprehensive School Safety Education Program.

    ERIC Educational Resources Information Center

    Gilliland, Lonnie; Gilliland, Lillian

    This report discusses various facets of a school safety education program. It discusses (1) the scope of a school safety education curriculum, (2) the methods of including safety education instruction in a school curriculum, (3) some student safety organizations, (4) the provision of a systemwide program, and (5) the development of safety policies…

  8. Training of breast surgical oncologists.

    PubMed

    Teshome, Mediget; Kuerer, Henry M

    2016-06-01

    Breast surgical oncology is a defined sub-specialty of general surgery with focus on the surgical management of breast disease and malignancy within a multidisciplinary context. Much of the training of breast surgical oncologists in the United States exists within a fellowship training structure with oversight and approval by the Society of Surgical Oncology (SSO). Rapid continuous changes in breast oncology practice have further substantiated dedicated expertise in breast surgical oncology. Training programs are structured to develop proficiency in fellows for advanced surgical techniques and clinical decision-making as well as exposure to the multidisciplinary aspects of breast cancer management. Components of a successful program include an intense multidisciplinary curriculum, engagement in clinical research and attention to strong mentorship. National curriculum and training requirements as well as supplemental resources assist in standardizing the fellowship experience. As surgical training and the field of breast oncology continues to evolve, so do fellowship training programs to ensure high quality breast surgical oncologists equipped to deliver high quality evidence based patient care while continuing to drive future research and trainee education. PMID:27197510

  9. Ablation Technology for the Surgical Treatment of Atrial Fibrillation

    PubMed Central

    Melby, Spencer J.; Schuessler, Richard B.; Damiano, Ralph J.

    2014-01-01

    The Cox maze procedure for the surgical treatment of atrial fibrillation has been simplified from its original cut-and-sew technique. Various energy sources now exist which create linear lines of ablation that can be used to replace the original incisions, greatly facilitating the surgical approach. This review article describes the anatomy of the atria that must be considered in choosing a successful energy source. Furthermore the device characteristics, safety profile, mechanism of tissue injury, and ability to create transmural lesions of the various energy sources that have been used in the Cox maze procedure, along with the strengths and weaknesses of each device is discussed. PMID:23995989

  10. Surgical procedures for voice restoration

    PubMed Central

    Nawka, Tadeus; Hosemann, Werner

    2005-01-01

    Surgical procedures for voice restoration serve to improve oral communication by better vocal function. They comprise of phonomicrosurgery, with direct and indirect access to the larynx; laryngoplasty; laryngeal injections; and surgical laryngeal reinnervation. The basis for modern surgical techniques for voice disorders is the knowledge about the ultrastructure of the vocal folds and the increasing experience of surgeons in voice surgery, while facing high social and professional demands on the voice. Vocal activity limitation and participation restriction has become more important in the artistic and social areas. A number of surgical methods that have been developed worldwide for this reason, are presented in this article. Functional oriented surgery has to meet high standards. The diagnostics of vocal function has to be multi-dimensional in order to determine the indication and the appropriate surgical intervention. PMID:22073062

  11. Safety Teams: An Approach to Engage Students in Laboratory Safety

    ERIC Educational Resources Information Center

    Alaimo, Peter J.; Langenhan, Joseph M.; Tanner, Martha J.; Ferrenberg, Scott M.

    2010-01-01

    We developed and implemented a yearlong safety program into our organic chemistry lab courses that aims to enhance student attitudes toward safety and to ensure students learn to recognize, demonstrate, and assess safe laboratory practices. This active, collaborative program involves the use of student "safety teams" and includes hands-on safety…

  12. Is the surgical knot tying technique associated with a risk for unnoticed glove perforation? An experimental study

    PubMed Central

    2014-01-01

    Background The issue of safety in the surgical procedure has recently been widely and openly discussed at the World Health Organization. The use of latex gloves is the current standard of protection during surgery, as they remain intact throughout the procedure. The present study was designed to evaluate the rate of glove perforation during a two-hand technique using polyester sutures in a controlled experimental study. Methods Hypothesis was that the gloves used during a two-hand technique using polyester suture suffer punctures. We used 150 pairs of gloves during the experiment. Each investigator performed 30 tests always using double gloving. They made five surgical knots on each test over a custom-made table specifically developed for the experiment. Ten tests were done at a time with a week- interval. The Control Group (CG) has 30 pairs of intact surgical gloves. The gloves were tested to impermeability by water filling and leaking was observed at three different times. Statistics relating to the perforation rate were analyzed using the chi-square test. A P value less than 0.05 was considered statistically significant. Results During the experiment there was no loss of gloves by drilling or inadvertent error in performing the impermeability test. No perforations were detected at any time during the impermeability test with the gloves used for sutures. Also, the CG presented no leakage of the liquid used for the test. There was no statistical difference between the groups underwent suture nor between them and the GC. Conclusion Under the studied conditions, the authors’ hypotheses could not be proved. There was no damage to the surgical gloves during the entire experiment. The authors believe that the skin abrasions observed in the ulnar side of the little finger, constant throughout the experiment, must be caused by friction. We feel there is no risk of perforation of surgical gloves during a two-hand technique using polyester suture. PMID:24991234

  13. Automatic Multiple-Needle Surgical Planning of Robotic-Assisted Microwave Coagulation in Large Liver Tumor Therapy

    PubMed Central

    Liu, Shaoli; Xia, Zeyang; Liu, Jianhua; Xu, Jing; Ren, He; Lu, Tong; Yang, Xiangdong

    2016-01-01

    The “robotic-assisted liver tumor coagulation therapy” (RALTCT) system is a promising candidate for large liver tumor treatment in terms of accuracy and speed. A prerequisite for effective therapy is accurate surgical planning. However, it is difficult for the surgeon to perform surgical planning manually due to the difficulties associated with robot-assisted large liver tumor therapy. These main difficulties include the following aspects: (1) multiple needles are needed to destroy the entire tumor, (2) the insertion trajectories of the needles should avoid the ribs, blood vessels, and other tissues and organs in the abdominal cavity, (3) the placement of multiple needles should avoid interference with each other, (4) an inserted needle will cause some deformation of liver, which will result in changes in subsequently inserted needles’ operating environment, and (5) the multiple needle-insertion trajectories should be consistent with the needle-driven robot’s movement characteristics. Thus, an effective multiple-needle surgical planning procedure is needed. To overcome these problems, we present an automatic multiple-needle surgical planning of optimal insertion trajectories to the targets, based on a mathematical description of all relevant structure surfaces. The method determines the analytical expression of boundaries of every needle “collision-free reachable workspace” (CFRW), which are the feasible insertion zones based on several constraints. Then, the optimal needle insertion trajectory within the optimization criteria will be chosen in the needle CFRW automatically. Also, the results can be visualized with our navigation system. In the simulation experiment, three needle-insertion trajectories were obtained successfully. In the in vitro experiment, the robot successfully achieved insertion of multiple needles. The proposed automatic multiple-needle surgical planning can improve the efficiency and safety of robot-assisted large liver tumor

  14. Automatic Multiple-Needle Surgical Planning of Robotic-Assisted Microwave Coagulation in Large Liver Tumor Therapy.

    PubMed

    Liu, Shaoli; Xia, Zeyang; Liu, Jianhua; Xu, Jing; Ren, He; Lu, Tong; Yang, Xiangdong

    2016-01-01

    The "robotic-assisted liver tumor coagulation therapy" (RALTCT) system is a promising candidate for large liver tumor treatment in terms of accuracy and speed. A prerequisite for effective therapy is accurate surgical planning. However, it is difficult for the surgeon to perform surgical planning manually due to the difficulties associated with robot-assisted large liver tumor therapy. These main difficulties include the following aspects: (1) multiple needles are needed to destroy the entire tumor, (2) the insertion trajectories of the needles should avoid the ribs, blood vessels, and other tissues and organs in the abdominal cavity, (3) the placement of multiple needles should avoid interference with each other, (4) an inserted needle will cause some deformation of liver, which will result in changes in subsequently inserted needles' operating environment, and (5) the multiple needle-insertion trajectories should be consistent with the needle-driven robot's movement characteristics. Thus, an effective multiple-needle surgical planning procedure is needed. To overcome these problems, we present an automatic multiple-needle surgical planning of optimal insertion trajectories to the targets, based on a mathematical description of all relevant structure surfaces. The method determines the analytical expression of boundaries of every needle "collision-free reachable workspace" (CFRW), which are the feasible insertion zones based on several constraints. Then, the optimal needle insertion trajectory within the optimization criteria will be chosen in the needle CFRW automatically. Also, the results can be visualized with our navigation system. In the simulation experiment, three needle-insertion trajectories were obtained successfully. In the in vitro experiment, the robot successfully achieved insertion of multiple needles. The proposed automatic multiple-needle surgical planning can improve the efficiency and safety of robot-assisted large liver tumor therapy

  15. [Surgical treatment of lipodystrophies].

    PubMed

    De Mey, A

    1996-09-01

    Esthetic body contouring has become the most common esthetic surgical procedure since the advent of liposuction. The interest in this surgery led us to focus on the physiology of adipose tissue that behaves differently according to its localisation. Besides, a better knowledge of the anatomy of the subcutaneous tissue has helped us to treat the deep and superficial adipose deposits more effectively. Many technical refinements have been proposed in order to improve the results and decrease the risks. Local infiltration allows us to remove large amounts of fat with a minimal blood loss. Syringe aspiration is less traumatic and avoids the purchase of an expensive suction pump. However, although the technique of suction lipectomy looks simple, this procedure can induce important local complications (contour deformities, skin waves, ...) and general complications (pulmonary embolism, fat embolism, cardio-pulmonary decompensation). A rigorous technique, performed by a well trained surgeon in an adequate medical environment is essential to obtain the best results with suction lipectomy. In order to correct excesses of skin on the abdomen or the thighs after an important weight loss, skin excisions will be necessary. In there cases, the scars are often wide and sometimes difficult to hide. PMID:8927853

  16. Surgical force detection probe

    NASA Technical Reports Server (NTRS)

    Tcheng, Ping; Roberts, Paul; Scott, Charles; Prass, Richard

    1991-01-01

    The development progress of a precision electro-mechanical instrument which allows the detection and documentation of the forces and moment applied to human tissue during surgery (under actual operation room conditions), is reported. The pen-shaped prototype probe which measures 1/2 inch in diameter and 7 inches in length was fabricated using an aerodynamic balance. The aerodynamic balance, a standard wind tunnel force and moment sensing transducer, measures the forces and the moments transmitted through the surgeon's hand to the human tissue during surgery. The prototype probe which was fabricated as a development tool was tested successfully. The final version of the surgical force detection probe will be designed based on additional laboratory tests in order to establish the full scale loads. It is expected that the final product will require a simplified aerodynamic balance with two or three force components and one moment component with lighter full scale loads. A signal conditioner was fabricated to process and display the outputs from the prototype probe. This unit will be interfaced with a PC-based data system to provide automatic data acquisition, data processing, and graphics display. The expected overall accuracy of the probe is better than one percent full scale.

  17. [Choledochal cysts: surgical treatment].

    PubMed

    Gogolja, D; Visnjić, S; Milić, Z; Tomić, K; Car, A; Roić, G; Fattorini, I

    2000-03-01

    The excision of the choledochal cyst with bile drainage through intestinal conduit is a standard operative procedure in the surgical management of choledochal cysts. During the last eight years five patients have been treated with this operation at the University Children's Hospital in Zagreb. All the patients were girls aged from two months to twelve years. The classical triad of pain, jaundice and abdominal mass was observed in only one patient, an eight-year-old girl. The only symptom in infancy was jaundice. Diagnosis was made by abdominal ultrasound, bibliography, CT scan with hepatotropic contrast and in older children by ERCP. Four cysts were type Todani I, and one cyst was Todani type II. The complete excision of the choledochal cyst with the Roux-Y jejunal conduit without antireflux valve was performed. There was neither operative morbidity nor mortality. Three months postoperatively the control ultrasonography and liver laboratory tests were without abnormalities. The routine control which followed did not show episodes of cholangitis, lithiasis, lipid malabsorption, blood clotting abnormalities or growth failure. The complete excision of the cyst with Roux-Y hepaticoenterostomy is an operative treatment with good results in infancy and childhood. PMID:10932533

  18. Patient Safety in Surgery

    PubMed Central

    Makary, Martin A.; Sexton, J Bryan; Freischlag, Julie A.; Millman, E Anne; Pryor, David; Holzmueller, Christine; Pronovost, Peter J.

    2006-01-01

    Background: Improving patient safety is an increasing priority for surgeons and hospitals since sentinel events can be catastrophic for patients, caregivers, and institutions. Patient safety initiatives aimed at creating a safe operating room (OR) culture are increasingly being adopted, but a reliable means of measuring their impact on front-line providers does not exist. Methods: We developed a surgery-specific safety questionnaire (SAQ) and administered it to 2769 eligible caregivers at 60 hospitals. Survey questions included the appropriateness of handling medical errors, knowledge of reporting systems, and perceptions of safety in the operating room. MANOVA and ANOVA were performed to compare safety results by hospital and by an individual's position in the OR using a composite score. Multilevel confirmatory factor analysis was performed to validate the structure of the scale at the operating room level of analysis. Results: The overall response rate was 77.1% (2135 of 2769), with a range of 57% to 100%. Factor analysis of the survey items demonstrated high face validity and internal consistency (α = 0.76). The safety climate scale was robust and internally consistent overall and across positions. Scores varied widely by hospital [MANOVA omnibus F (59, 1910) = 3.85, P < 0.001], but not position [ANOVA F (4, 1910) = 1.64, P = 0.16], surgeon (mean = 73.91), technician (mean = 70.26), anesthesiologist (mean = 71.57), CRNA (mean = 71.03), and nurse (mean = 70.40). The percent of respondents reporting good safety climate in each hospital ranged from 16.3% to 100%. Conclusions: Safety climate in surgical departments can be validly measured and varies widely among hospitals, providing the opportunity to benchmark performance. Scores on the SAQ can serve to evaluate interventions to improve patient safety. PMID:16632997

  19. Summertime Safety

    MedlinePlus

    ... Violence & Safety Life Stages & Populations Travelers' Health Workplace Safety & Health Features Media Sign up for Features Get Email Updates ... Submit What's this? Submit Button Past Emails CDC Features Summertime Safety Recommend on Facebook Tweet Share Compartir The feature ...

  20. Drug Safety

    MedlinePlus

    ... over-the-counter drug. The FDA evaluates the safety of a drug by looking at Side effects ... clinical trials The FDA also monitors a drug's safety after approval. For you, drug safety means buying ...

  1. Safety Education.

    ERIC Educational Resources Information Center

    Daniels, James H.; And Others

    1980-01-01

    Five articles in this issue focus on safety education in agricultural laboratories. Topics discussed include teacher liability; elements of a safety instruction program; state and federal safety standards; ground fault current protection; and eye protection requirements and equipment. (SK)

  2. Performance improvement initiative: prevention of surgical site infection (SSI).

    PubMed

    Ng, Wai Khuan; Awad, Nawal

    2015-01-01

    Mafraq Hospital performs an average of 10,000 surgeries every year. The impact of having high volume high risk surgical procedures calls for the need to ensure safe surgery and a prevention of surgical site infection (SSI). SSI represents a significant portion of healthcare-associated infections (HAIs). The impact on morbidity, mortality, and cost of care has resulted in identifying the need to reduce SSI as a top priority to prevent healthcare associated infections. The good news is that the majority of SSIs are preventable. Mafraq Hospital performs a range of surgical procedures that covers 14 surgical specialties. The infection prevention and control team performs surveillance for SSI for all patients who undergo operative procedure included in Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) Operative Procedure Category (40 surgical procedures). Out of the 40 CDC NHSN listed, 33 operative procedures were performed at Mafraq Hospital, of which 17 were reported with SSI for 2013 and 2014. Surgical site infection has implicated an increase average length of stay from seven to 10 additional postoperative hospital days and additional costs of AED 10,000 to AED 100,000/SSI depending on procedure and pathogen. A multidisciplinary team was formed to develop and implement measures to reduce/eliminate surgical site infection, as well as evaluate and monitor compliance. Hence a group of multidisciplinary teams were initiated to analyse the results, find out the gaps, and implement a quality improvement project to correct the deficits. Recommendations for appropriate improvement measures were formed on evidence-based international guidelines from the Institute for Healthcare Improvement (IHI) and CDC. Evidence based practice supports that many of the causes of surgical site infection can be prevented with proper medical attention and care. PMID:26732804

  3. Electrosurgery: principles and safety issues.

    PubMed

    Odell, R C

    1995-09-01

    The use of monopolar electrosurgical energy has been the "gold standard" for the past 50 years. It has diverse capabilities, such as fulguration, precise vaporization, and coaptation of large vessels. Technologic advances in performance and safety have positioned this device as a useful tool in a surgeon's armamentarium. The adaptation of active electrode monitoring for stray energy as a result of insulation failure or capacitive coupling and the use of completely metal trocar cannulas will increase the confidence of the surgeon and the safety of his/ her patient. It is the author's opinion that its use will prove itself in laparoscopy. As with any surgical tool or energy source, education and skill are required. This introduction on the principal of the biophysics of electrical energy on tissue and the safety consideration is a start to further one's understanding of this surgical tool. PMID:8612371

  4. Safety in the sleep laboratory.

    PubMed

    Hobby, Mary Kay

    2006-03-01

    The importance of workplace safety cannot be understated. The safety of employees affects morale, attendance, and workman's compensation. Federal organizations and agencies have provided guidelines to help ensure the health and safety of the technician and the patients who visit the sleep center. This article discusses commonly encountered hazards and ways to address them. PMID:16530650

  5. 21 CFR 878.4100 - Organ bag.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Organ bag. 878.4100 Section 878.4100 Food and... GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4100 Organ bag. (a) Identification. An organ... organ during surgical procedures to prevent moisture loss. (b) Classification. Class I (general...

  6. 21 CFR 878.4100 - Organ bag.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Organ bag. 878.4100 Section 878.4100 Food and... GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4100 Organ bag. (a) Identification. An organ... organ during surgical procedures to prevent moisture loss. (b) Classification. Class I (general...

  7. Violence against surgical residents.

    PubMed Central

    Barlow, C B; Rizzo, A G

    1997-01-01

    Violence against hospital personnel is underreported (less than one in five assaults), and accurate statistics as to the rate of violence against hospital personnel are thus difficult to establish. In the psychiatric discipline, an abundance of information has been published regarding violence in the health care setting, but few studies have examined violence outside psychiatric hospitals or by patients not diagnosed with psychiatric ailments. Using a survey that elicits information about workplace violence, we sought to gauge the prevalence of violent acts affecting general hospital workers who treat victims of violence on a daily basis. The survey was completed by a cohort of surgical staff nationwide (475 responses from 57 residency programs). Two hundred and eighty residents reported having witnessed one or more physical attacks, and 179 reported having been attacked. Violent acts were more likely to be committed in a public hospital than a private institution (P = 0.05). As shown in previous research, most attacks occurred in the emergency room (P = 0.01); the wards and parking lot were next in frequency. Women residents were more likely than men to call hospital security to intervene in a potentially violent situation (P = 0.04), and junior residents (postgraduate years 1-4) were more likely to be attacked than senior residents (> or = 5 years) (P = 0.04). The attacker was most likely to be a young black male between ages 19 and 30 (P = 0.01). We found no statistical relationship between the attacker and the victim regarding sex or race. Of the 475 respondents, 470 reported that they carry a gun themselves or know someone in the hospital environment who carries a gun. Images Figure 1. PMID:9291743

  8. Surgical management of pancreatic neuroendocrine tumors.

    PubMed

    Kimura, Wataru; Tezuka, Koji; Hirai, Ichiro

    2011-10-01

    This study outlines the surgical management and clinicopathological findings of pancreatic neuroendocrine tumors (P-NETs). There are various surgical options, such as enucleation of the tumor, spleen-preserving distal pancreatectomy, distal pancreatectomy with splenectomy, pancreatoduodenectomy, and duodenum-preserving pancreas head resection. Lymph node dissection is performed for malignant cases. New guidelines and classifications have been proposed and are now being used in clinical practice. However, there are still no clear indications for organ-preserving pancreatic resection or lymph node dissection. Hepatectomy is the first choice for liver metastases of well-differentiated neuroendocrine carcinoma without extrahepatic metastases. On the other hand, cisplatin-based combination therapy is performed as first-line chemotherapy for metastatic poorly differentiated neuroendocrine carcinoma. Other treatment options are radiofrequency ablation, transarterial chemoembolization/embolization, and liver transplantation. Systematic chemotherapy and biotherapy, such as that with somatostatin analogue and interferon-α, are used for recurrence after surgery. The precise surgical techniques for enucleation of the tumor and spleen-preserving distal pancreatectomy are described. PMID:21922354

  9. Access to surgical assistance: challenges and perspectives.

    PubMed

    Tostes, Maria Fernanda do Prado; Covre, Eduardo Rocha; Fernandes, Carlos Alexandre Molena

    2016-01-01

    Objective to characterize the access to surgical assistance in Brazil. Method documentary study, with a quantitative approach, developed from information of the Caixa Preta da Saúde [Health Black Box] database, of the Brazilian Medical Association. Results in the one-year period 3773 cases related to health care in Brazil were recorded. There were 458 (12.3%) records on surgical assistance. Of these, most, 339 (74.1%), involved the lack of access in all regions of Brazil. The main access constraint was the prolonged waiting time for surgery. Other constraints were the excessive waiting for medical appointment with experts, doing examinations and cancellation of surgeries. Conclusion the access to surgical assistance, by users of the Brazilian health system, is not widely guaranteed, reinforcing the need for integrated governmental actions, organization of the health care network, management of health care and human resources to overcome the challenges imposed to achieve the Universal Access to Health and Universal Health Coverage. PMID:27027675

  10. Surgical Skills Beyond Scientific Management.

    PubMed

    Whitfield, Nicholas

    2015-07-01

    During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel's attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel-Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice. PMID:26090737

  11. Surgical Skills Beyond Scientific Management

    PubMed Central

    Whitfield, Nicholas

    2015-01-01

    During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel’s attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel–Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice. PMID:26090737

  12. Frequently Asked Questions about Surgical Site Infections

    MedlinePlus

    ... Site Infections What is a Surgical Site Infection (SSI)? Can SSIs be treated? What are some of ... a Surgical Site Infection? A surgical site infection (SSI) is an infection that occurs after surgery in ...

  13. Surgical anatomy of the tracheobronchial tree

    PubMed Central

    Drevet, Gabrielle; Conti, Massimo

    2016-01-01

    Airway surgery is often indicated in the management of benign or malignant pathological processes of the tracheobronchial tree. The surgeon undertaking this type of work has, however, the responsibility of understanding the particular anatomy applicable to these structures and procedures as well as be able to correlate imaging, intraoperative findings and anatomy. These are important considerations if one wants to reduce operative morbidity and improve potential for better long-term results. This paper reviews the most important anatomic features of the tracheobronchial tree putting emphasis on those features that are important to surgeons performing surgical procedures on those organs. PMID:26981262

  14. [Surgical treatment of eyelid tumors].

    PubMed

    Serra, J M; Valiente, E; Paloma, V; Samayoa, V; Ordiales, G; Mesa, F

    1989-01-01

    Our surgical protocol for reconstruction of eyelid's defects after tumor excision is presented. Each technique is applied depending on the site and extension of the lesion and also on the pathologic characteristics of the tumor. PMID:2490181

  15. Essential Tremor (ET): Surgical Options

    MedlinePlus

    ... the ventral intermediate nucleus (VIM) nucleus of the thalamus, located deep in the brain. The wire connects ... ET, DBS of the VIM nucleus of the thalamus is the most commonly used surgical procedure to ...

  16. Surgical Treatment for Falcotentorial Meningiomas.

    PubMed

    Hong, Chang Ki; Hong, Je Beom; Park, Hunho; Moon, Ju Hyung; Chang, Jong Hee; Lee, Kyu Sung; Park, Seoung Woo

    2016-07-01

    Among intracranial meningiomas, falcotentorial meningiomas, occurring at the junction of the falx cerebri and tentorial dural folds, are extremely rare. Because of their deep location, they are surrounded by critical structures, and have been regarded as one of the most challenging lesions for surgical treatment. In this study, we describe our surgical strategy for falcotentorial meningiomas and provide a review of our experience. PMID:27189300

  17. Surgical Treatment for Falcotentorial Meningiomas

    PubMed Central

    Hong, Chang Ki; Hong, Je Beom; Park, Hunho; Moon, Ju Hyung; Chang, Jong Hee; Lee, Kyu Sung

    2016-01-01

    Among intracranial meningiomas, falcotentorial meningiomas, occurring at the junction of the falx cerebri and tentorial dural folds, are extremely rare. Because of their deep location, they are surrounded by critical structures, and have been regarded as one of the most challenging lesions for surgical treatment. In this study, we describe our surgical strategy for falcotentorial meningiomas and provide a review of our experience. PMID:27189300

  18. Innovation in pediatric surgical education.

    PubMed

    Clifton, Matthew S; Wulkan, Mark L

    2015-06-01

    Pediatric surgical training in the United States remained basically unchanged from the model developed by Ladd and Gross in the 1930s until recently. Standardized curriculum and novel evaluation methods are now being implemented. Pediatric Surgical education is currently undergoing a transition to competency-based evaluation and promotion. Unfortunately, there is little data on the efficacy of these changes. This presents an opportunity for further study of how we conduct training, and how we evaluate and promote our trainees. PMID:25976147

  19. Intermittent exotropia: Surgical treatment strategies

    PubMed Central

    Kelkar, Jai Aditya; Gopal, Santhan; Shah, Rachana B; Kelkar, Aditya S

    2015-01-01

    Surgical management of intermittent exotropias (IXTs) is ambiguous, with techniques of management varying widely between institutions. This review aims to examine available literature on the surgical management of IXT. A literature search was performed using PubMed, Web of Knowledge, LILACS, and the University of Liverpool Orthoptic Journals and Conference Transactions Database. All English-language papers published between 1958 and the present day were considered. PMID:26458472

  20. The role of unconscious bias in surgical safety and outcomes.

    PubMed

    Santry, Heena P; Wren, Sherry M

    2012-02-01

    Racial, ethnic, and gender disparities in health outcomes are a major challenge for the US health care system. Although the causes of these disparities are multifactorial, unconscious bias on the part of health care providers plays a role. Unconscious bias occurs when subconscious prejudicial beliefs about stereotypical individual attributes result in an automatic and unconscious reaction and/or behavior based on those beliefs. This article reviews the evidence in support of unconscious bias and resultant disparate health outcomes. Although unconscious bias cannot be entirely eliminated, acknowledging it, encouraging empathy, and understanding patients' sociocultural context promotes just, equitable, and compassionate care to all patients. PMID:22269267

  1. Pediatric orthopedic surgical simulation at Boston Children's Hospital.

    PubMed

    Bae, Donald S; Waters, Peter M

    2016-07-01

    Orthopedic surgical simulation has become an increasing valuable means for optimizing patient care, promoting patient safety, improving education, and fostering clinical research. The purpose of this review was to discuss the rationale for simulation training, describe current simulation efforts within the Department of Orthopaedic Surgery at Boston Children's Hospital, and provide an example of how these simulation efforts touch both patient care and clinical research. PMID:27058820

  2. A Silent Safety Program

    NASA Technical Reports Server (NTRS)

    Goodin, James Ronald

    2006-01-01

    NASA's Columbia Accident Investigation Board (CAIB) referred 8 times to the NASA "Silent Safety Program." This term, "Silent Safety Program" was not an original observation but first appeared in the Rogers Commission's Investigation of the Challenger Mishap. The CAIB on page 183 of its report in the paragraph titled 'Encouraging Minority Opinion,' stated "The Naval Reactor Program encourages minority opinions and "bad news." Leaders continually emphasize that when no minority opinions are present, the responsibility for a thorough and critical examination falls to management. . . Board interviews revealed that it is difficult for minority and dissenting opinions to percolate up through the agency's hierarchy. . ." The first question and perhaps the only question is - what is a silent safety program? Well, a silent safety program may be the same as the dog that didn't bark in Sherlock Holmes' "Adventure of the Silver Blaze" because system safety should behave as a devil's advocate for the program barking on every occasion to insure a critical review inclusion. This paper evaluates the NASA safety program and provides suggestions to prevent the recurrence of the silent safety program alluded to in the Challenger Mishap Investigation. Specifically targeted in the CAM report, "The checks and balances the safety system was meant to provide were not working." A silent system safety program is not unique to NASA but could emerge in any and every organization. Principles developed by Irving Janis in his book, Groupthink, listed criteria used to evaluate an organization's cultural attributes that allows a silent safety program to evolve. If evidence validates Jams's criteria, then Jams's recommendations for preventing groupthink can also be used to improve a critical evaluation and thus prevent the development of a silent safety program.

  3. Systematic review comparing endoscopic, percutaneous and surgical pancreatic pseudocyst drainage

    PubMed Central

    Teoh, Anthony Yuen Bun; Dhir, Vinay; Jin, Zhen-Dong; Kida, Mitsuhiro; Seo, Dong Wan; Ho, Khek Yu

    2016-01-01

    AIM: To perform a systematic review comparing the outcomes of endoscopic, percutaneous and surgical pancreatic pseudocyst drainage. METHODS: Comparative studies published between January 1980 and May 2014 were identified on PubMed, Embase and the Cochrane controlled trials register and assessed for suitability of inclusion. The primary outcome was the treatment success rate. Secondary outcomes included were the recurrence rates, re-interventions, length of hospital stay, adverse events and mortalities. RESULTS: Ten comparative studies were identified and 3 were randomized controlled trials. Four studies reported on the outcomes of percutaneous and surgical drainage. Based on a large-scale national study, surgical drainage appeared to reduce mortality and adverse events rate as compared to the percutaneous approach. Three studies reported on the outcomes of endoscopic ultrasound (EUS) and surgical drainage. Clinical success and adverse events rates appeared to be comparable but the EUS approach reduced hospital stay, cost and improved quality of life. Three other studies compared EUS and esophagogastroduodenoscopy-guided drainage. Both approaches were feasible for pseudocyst drainage but the success rate of the EUS approach was better for non-bulging cyst and the approach conferred additional safety benefits. CONCLUSION: In patients with unfavorable anatomy, surgical cystojejunostomy or percutaneous drainage could be considered. Large randomized studies with current definitions of pseudocysts and longer-term follow-up are needed to assess the efficacy of the various modalities. PMID:27014427

  4. Surgical methods and efficacies for cervicothoracolumbar spinal schwannoma

    PubMed Central

    DENG, QIANG; TIAN, ZHENG; SHENG, WEIBIN; GUO, HAILONG; DAN, MAI ER

    2015-01-01

    The aim of this study was to investigate the surgical methods and efficacies for cervicothoracolumbar spinal schwannoma (CSS). A total of 52 patients who had undergone treatment for schwannoma were retrospectively analyzed. Two methods were employed for the surgical resection of the thoracic and lumbar schwannomas: Type I (posterior midline approach semi-laminectomy with tumor resection and internal fixation with pedicle screws) was used in 24 cases, and type II (posterior midline approach laminectomy with tumor resection and internal fixation with pedicle screws) was used in 26 cases. Two cases of giant cervical schwannoma were treated via anterior-posterior combined surgery. Histopathological examination confirmed the diagnosis of schwannoma in all cases (n=52). The clinical status of the patients was evaluated pre- and postoperatively using the visual analog scale, Oswestry Disability Index and Japanese Orthopedic Association scale, and the scores associated with the two types of surgical method were compared. Within the follow-up period, which lasted between 6 months and 3 years, no recurrence was detected, and such preoperative symptoms as radicular pain and spinal dysfunction were improved significantly. The numbness and hyperesthesia were relieved to different extents. In conclusion, methods of exposing and surgically treating CSS should be selected according to the growth site of the schwannoma in order to reduce the blood loss and surgery duration and to improve the surgical safety. PMID:26668590

  5. Medical Applications of White LEDs for Surgical Operation

    NASA Astrophysics Data System (ADS)

    Shimada, Junichi; Kawakami, Yoichi

    Everywhere in the world, the highest quality and quantity of lighting is required during the surgical operations. However, the surgical approach has had many types and various angles, common ceiling surgical halogen lighting system cannot provide an adequate amount of beams because the surgeons' heads hinder the illuminations from reaching the operation field. The evolution of solid-state-lighting is currently going to be developed due to the progress of white light emitting diodes (LEDs). We proposed and developed the new lighting equipment that is a surgical lighting goggle composed of InGaN-YAG (yttrium aluminum garnet):Ce3+-based white LEDs. Here, we newly design surgical lighting system composed of white LEDs equipped on both sides of goggles. In fact, we have succeeded in the first internal shunt operation in the left forearm using the surgical LED lighting system on 11th Sept 2000. Since the white LEDs used were composed of InGaN-blue-emitters and YAG-yellow-phosphors, the color rendering property was not sufficient in the reddish colors. After our first challenge for medical application of white LEDs, we have been trying to improve the luminance power of white LED, the color rendering in red colors and the spectral distribution of white LED to render inherent color of raw flesh such as skin, blood, fat tissue and internal organs. We have produced new concepts for LED lighting sources and new several generations of LED lighting goggles.

  6. Stroke: indications for emergent surgical intervention.

    PubMed

    Pikus, H J; Heros, R C

    1999-01-01

    As the brain attack message is disseminated throughout our medical community and the awareness of the public increases, neurosurgeons will have the opportunity to treat patients with stroke at a much earlier time in the evolution of the process than we have been accustomed. Are the relatively unimpressive results of acute surgical intervention in patients operated on later in the course of the disease applicable to those who seek medical attention early, within the first few hours of ictus? There is little firm data. However, there is an overwhelming amount of anecdotal and experimental evidence supporting the potential for ultra-early intervention, which frequently should be surgical. New surgical techniques may improve safety and feasibility of emergent operations. In the coming years, diagnostic techniques such as perfusion/diffusion magnetic resonance imaging will allow the clinician to determine who may benefit from intervention. These determinations will be made on physiological data, addressing the issues of tissue viability and degree of compromise of the blood-brain barrier. In the future, the window of opportunity for intervention will not be solely a function of time from ictus or a qualitative impression based on collateral circulation as extrapolated from angiography, transcranial Doppler, or magnetic resonance angiography. These new magnetic resonance imaging techniques, which are beginning to be tested clinically or are still in the developmental stages, will provide the functional data now provided by positron emission tomography and xenon computed tomography, but with improved sensitivity, specificity, and logistical ease. Neurosurgeons have been leaders in stroke care and have provided some of the most important experimental rationale for the brain attack concept. These contributions include demonstration of the ischemic penumbra, the importance of time and potential collateral circulation as factors determining viability of ischemic tissue, and

  7. Safety Auditing and Assessments

    NASA Technical Reports Server (NTRS)

    Goodin, James Ronald (Ronnie)

    2005-01-01

    Safety professionals typically do not engage in audits and independent assessments with the vigor as do our quality brethren. Taking advantage of industry and government experience conducting value added Independent Assessments or Audits benefits a safety program. Most other organizations simply call this process "internal audits." Sources of audit training are presented and compared. A relation of logic between audit techniques and mishap investigation is discussed. An example of an audit process is offered. Shortcomings and pitfalls of auditing are covered.

  8. Exploratory Evaluation of Surgical Skills Mentorship Program Design and Outcomes

    ERIC Educational Resources Information Center

    Gagliardi, Anna R.; Wright, Frances C.

    2010-01-01

    Introduction: There are few opportunities for mentorship of practicing surgeons and no evidence to guide the design of such programs. This study explored outcomes and barriers associated with the design of surgical mentorship programs. Methods: Interviews were held with organizers, mentors, and proteges of 2 programs. Data from 23 participant…

  9. Role of surgical residents in undergraduate surgical education

    PubMed Central

    Pelletier, Marc; Belliveau, Paul

    1999-01-01

    Objectives To identify the role and impact of surgical residents on the various activities of a senior (4th year) surgical clerkship, and to explore students’ perceptions of differences between the teaching behaviours of attending physicians and residents. Design A survey by questionnaire. Setting McGill University, Montreal. Method A 67-item questionnaire was administered to fourth-year medical students at the end of their 8-week surgical clerkship. Analysis of the data was performed using the Wilcoxon signed-rank test, Dunn’s multiple comparison test and mean average. Main outcome measures Overall satisfaction with the clerkship, teaching behaviours and teaching of clinical skills and basic principles. Results Overall satisfaction with the clerkship was 6.31 out of 10. Surgical residents were perceived as being significantly more active than the attending staff in 14 out of 15 teaching behaviours. They were also seen as important in teaching certain clinical skills such as suturing, assisting in the operating room and managing emergency situations. They also contributed significantly to teaching the basic principles of surgery such as infections, surgical bleeding and fluid and electrolytes. On a 10-point scale, students felt that more learning was achieved by independent reading, tutorials and residents’ teaching than by other teaching modalities, including attending physicians’ and nurses’ teaching. Conclusions Medical students perceive surgical residents as being significantly more active in their education process than the attending staff. Residents appear to be responsible for teaching various technical and patient management skills necessary for patient care. Along with independent reading and tutorials, resident teaching contributes a significant portion of the medical student’s acquisition of knowledge and appears to contribute to the students’ choice of surgery as a career. PMID:10593247

  10. Surgical innovation: the ethical agenda

    PubMed Central

    Broekman, Marike L.; Carrière, Michelle E.; Bredenoord, Annelien L.

    2016-01-01

    Abstract The aim of the present article was to systematically review the ethics of surgical innovation and introduce the components of the learning health care system to guide future research and debate on surgical innovation. Although the call for evidence-based practice in surgery is increasingly high on the agenda, most surgeons feel that the format of the randomized controlled trial is not suitable for surgery. Innovation in surgery has aspects of, but should be distinguished from both research and clinical care and raises its own ethical challenges. To answer the question “What are the main ethical aspects of surgical innovation?”, we systematically searched PubMed and Embase. Papers expressing an opinion, point of view, or position were included, that is, normative ethical papers. We included 59 studies discussing ethical aspects of surgical innovation. These studies discussed 4 major themes: oversight, informed consent, learning curve, and vulnerable patient groups. Although all papers addressed the ethical challenges raised by surgical innovation, surgeons hold no uniform view of surgical innovation, and there is no agreement on the distinction between innovation and research. Even though most agree to some sort of oversight, they offer different alternatives ranging from the formation of new surgical innovation committees to establishing national registries. Most agree that informed consent is necessary for innovative procedures and that surgeons should be adequately trained to assure their competence to tackle the learning curve problem. All papers agree that in case of vulnerable patients, alternatives must be found for the informed consent procedure. We suggest that the concept of the learning health care system might provide guidance for thinking about surgical innovation. The underlying rationale of the learning health care system is to improve the quality of health care by embedding research within clinical care. Two aspects of a learning health

  11. Stationary surgical smoke evacuation systems.

    PubMed

    2001-03-01

    Two types of systems are available for evacuating the surgical smoke created by electrosurgery and laser surgery: portable and stationary surgical smoke evacuation systems. While portable systems dominate the market today, stationary systems are an alternative worth considering--even though they are still in their infancy, with fewer than 90 systems installed to date. Stationary systems represent a major commitment on the part of the healthcare facility. Several system components must be installed as part of the physical plant (for instance, within the walls), making the system a permanent fixture in the surgical suite. Installation of these systems is often carried out during building construction or major renovation--although the systems can be cost-effective even if no renovations are planned. For this Evaluation, we tested three stationary systems. All three are adequate to capture surgical smoke and evacuate it from the operating room. These systems are easy to use, are quietter than their portable counterparts, and require minimal user maintenance. They represent an excellent option for most hospitals actively evacuating surgical smoke. In this article, we discuss the factors to consider when selecting from among these systems. We also offer guidance on choosing between stationary systems and portable ones. PMID:11321758

  12. Roles of a hospital for community safety promotion.

    PubMed

    Ah Lee, Choung; Pil Cho, Joon

    2012-01-01

    It is not easy for any health professional to be aware of injury problems and safety issues within their own communities if their main responsibility is not in this field. Health professionals, however, can play an important role in all aspects of injury prevention and safety promotion. This includes not only medical or surgical treatment for the injured patients but also risk assessment, health education, community action, organisational development and advocacy for policy to promote safety at a multi-level in the society. This can be accomplished most efficiently through collaboration with diverse sectors within a community, including hospitals, public health professionals, policy makers, school boards, police departments, fire departments, citizens' coalitions and others. Since 2002, Ajou University School of Medicine and Public Health in Suwon, Korea, has introduced a Safe Community model to many countries in Asia, including Korea, Japan, China, Vietnam, Thailand, among others, which is led by The World Health Organization Collaborating Centre on Community Safety Promotion at Karolinska Institutet, Stockholm, Sweden. PMID:22520035

  13. Modeling of Tool-Tissue Interactions for Computer-Based Surgical Simulation: A Literature Review

    PubMed Central

    Misra, Sarthak; Ramesh, K. T.; Okamura, Allison M.

    2009-01-01

    Surgical simulators present a safe and potentially effective method for surgical training, and can also be used in robot-assisted surgery for pre- and intra-operative planning. Accurate modeling of the interaction between surgical instruments and organs has been recognized as a key requirement in the development of high-fidelity surgical simulators. Researchers have attempted to model tool-tissue interactions in a wide variety of ways, which can be broadly classified as (1) linear elasticity-based, (2) nonlinear (hyperelastic) elasticity-based finite element (FE) methods, and (3) other techniques that not based on FE methods or continuum mechanics. Realistic modeling of organ deformation requires populating the model with real tissue data (which are difficult to acquire in vivo) and simulating organ response in real time (which is computationally expensive). Further, it is challenging to account for connective tissue supporting the organ, friction, and topological changes resulting from tool-tissue interactions during invasive surgical procedures. Overcoming such obstacles will not only help us to model tool-tissue interactions in real time, but also enable realistic force feedback to the user during surgical simulation. This review paper classifies the existing research on tool-tissue interactions for surgical simulators specifically based on the modeling techniques employed and the kind of surgical operation being simulated, in order to inform and motivate future research on improved tool-tissue interaction models. PMID:20119508

  14. Nutrition support in surgical oncology.

    PubMed

    Huhmann, Maureen B; August, David A

    2009-01-01

    This review article, the second in a series of articles to examine the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients, evaluates the evidence related to the use of nutrition support in surgical oncology patients. Cancer patients develop complex nutrition issues. Nutrition support may be indicated in malnourished cancer patients undergoing surgery, depending on individual patient characteristics. As with the first article in this series, this article provides background concerning nutrition issues in cancer patients, as well as discusses the role of nutrition support in the care of surgical cancer patients. The goal of this review is to enrich the discussion contained in the clinical guidelines as they relate to recommendations made for surgical patients, cite the primary literature more completely, and suggest updates to the guideline statements in light of subsequently published studies. PMID:19605805

  15. Fluid handling 2: Surgical applications

    NASA Technical Reports Server (NTRS)

    Billica, Roger; Young, John; Rushing, Doug; Kizzee, Victor D.

    1991-01-01

    The methods proposed for managing fluids and particulate debris during minor surgery on Space Station Freedom (SSF) were investigated and demonstrated. A KC-135 parabolic flight test was performed, in which the flight followed the standard 40 parabola profile with 20 to 25 seconds in near-zero gravity in each parabola. The equipment (suction and laminar flow device) was evaluated. While this equipment performed satisfactorily previously in the dental simulation, the purpose of the current flight was to reconfigure the equipment in support of a minor surgical situation in order to evaluate its efficacy and establish clear requirements for the actual flight hardware. To accomplish the study the Health Maintenance Facility medical restraint system was deployed as for surgical use and mannequin suture arm was restrained to its surface. The surgical area was established as for performing minor surgery with standard tray and suture instruments employed.

  16. Surgical approaches of endobronchial neoplasms

    PubMed Central

    Li, Zhigang; Kougioumtzi, Ioanna; Darwiche, Kaid; Tsakiridis, Kosmas; Katsikogiannis, Nikolaos; Stylianaki, Aikaterini; Kesisis, Georgios; Machairiotis, Nikolaos; Zarogoulidis, Konstantinos

    2013-01-01

    Endobronchial tumors are a rare entity that presents with different pathological findings. The interventional pulmonologist, but also the thoracic surgeon have at their disposal the same techniques for diagnosis, however; the two modalities differentiate in the treatment approach. Diagnosis evaluation should include lymph node evaluation. Minimal invasive techniques under local or general anesthesia are usually preferred by the interventional pulmonologists, whereas in the surgical approach of the thoracic surgeons the general anesthesia is necessary. A more extensive surgical approach either lobotomy or pneumonectomy should be performed in cases with positive intrapulmonary lymph nodes. Carinal reconstruction should be performed skillfully to get a negative proximal margin whenever needed. In the current manuscript we will present the methods of patient evaluation and surgical techniques for the management of these lesions. PMID:24102010

  17. Vaccine Safety

    MedlinePlus

    ... During Pregnancy Frequently Asked Questions about Vaccine Recalls Historical Vaccine Safety Concerns FAQs about GBS and Menactra ... CISA Resources for Healthcare Professionals Evaluation Current Studies Historical Background 2001-12 Publications Technical Reports Vaccine Safety ...

  18. Organizational culture, safety culture, and safety performance at research facilities

    SciTech Connect

    Brown, William S.

    2000-07-30

    Organizational culture surveys of research facilities conducted several years ago and archival occupational injury reports were used to determine whether differences in safety performance are related to general organizational factors or to ''safety culture'' as reflected in specific safety-related dimensions. From among the organizations surveyed, a pair of facilities was chosen that were similar in size and scientific mission while differing on indices of work-related injuries. There were reliable differences in organizational style between the facilities, especially among workers in environment, safety, and health functions; differences between the facilities (and among job categories) on the safety scale were more modest and less regular.

  19. The quality of surgical clerkships.

    PubMed

    Holden, W D

    1985-06-01

    Many of the contours of a surgical clerkship can be designed, implemented, and evaluated with varying degrees of objectivity. The recently established Association for Surgical Education and its expanding membership have performed in an excellent fashion in addressing the objectives, content, process, and evaluation of surgical clerkships. There are several factors that influence the quality of a clerkship that are not readily subjected to measurement but that have a significant impact on the environment and conduct of clerkships. Criticism, mainly from the academic community, has been directed recently to distortions of the learning process and the continuing use of traditional teaching methods that do not serve medical educational programs and students optimally. More attention should be paid to the principle that a surgical clerkship should be designed to provide an elemental comprehension of the major surgical diseases irrespective of how the students will select multiple specialties for their careers. The quality of a clinical teaching program is influenced in a realistic way by the quality of care provided to the patients. The image of the staff, especially the resident staff, plays an important role in affecting students' incentives, the development of self-discipline, their attitudes toward patients and families, and the ultimate selection of careers. As much responsibility as possible for the diagnosis of disease and the care of patients should be given to students under close supervision and always with the best interests of the patients in mind. The environment of medical schools and teaching hospitals is changing rapidly. The corporate practice of medicine will have an impact on the quality of surgical clerkships, we hope not adversely. PMID:4002120

  20. Laser safety eyewear.

    PubMed

    1993-04-01

    In spite of repeated warnings about laser safety practices, as well as the availability of laser safety eyewear (LSE), eye injuries continue to occur during use of surgical lasers, as discussed in the Clinical Perspective, "Laser Energy and Its Dangers to Eyes," preceding this Evaluation. We evaluated 48 models of LSE, including goggles, spectacles, and wraps, from 11 manufacturers. The evaluated models are designed with absorptive lenses that provide protection from CO2 (carbon dioxide), Nd:YAG (neodymium:yttrium-aluminum-garnet), and 532 (frequency-doubled Nd:YAG) surgical laser wavelengths; several models provide multiwavelength protection. (Refer to ECRI's Product Comparison System report on LSE for specifications of other models.) Although most of the evaluated models can adequately protect users from laser energy--provided that the eyewear is used--many models of LSE, especially goggles, are designed with little regard for the needs of actual use (e.g., adequate labeling, no alteration of color perception, sufficient field of vision [FOV], comfort). Because these factors can discourage people from using LSE, we encourage manufacturers to develop new and improved models that will be worn. We based our ratings primarily on the laser protection provided by the optical density (OD) of the lenses; we acknowledge the contribution of Montana Laser Optics Inc., of Bozeman, Montana, in performing our OD testing. We also considered actual-use factors, such as those mentioned above, to be significant. Among the models rated Acceptable is one whose labeled OD is lower than the level we determined to be adequate for use during most laser surgery; however, this model offers protection under specific conditions of use (e.g., for use by spectators some distance from the surgical site, for use during endoscopic procedures) that should be determined by the laser safety officer (LSO). LSE that would put the wearer at risk are rated Unacceptable (e.g., some models are not

  1. Stereolithographic Surgical Template: A Review

    PubMed Central

    Dandekeri, Shilpa Sudesh; Sowmya, M.K.; Bhandary, Shruthi

    2013-01-01

    Implant placement has become a routine modality of dental care.Improvements in surgical reconstructive methods as well as increased prosthetic demands,require a highly accurate diagnosis, planning and placement. Recently,computer-aided design and manufacturing have made it possible to use data from computerised tomography to not only plan implant rehabilitation,but also transfer this information to the surgery.A review on one of this technique called Stereolithography is presented in this article.It permits graphic and complex 3D implant placement and fabrication of stereolithographic surgical templates. Also offers many significant benefits over traditional procedures. PMID:24179955

  2. Surgical management of fecal incontinence.

    PubMed

    Bleier, Joshua I S; Kann, Brian R

    2013-12-01

    The surgical approach to treating fecal incontinence is complex. After optimal medical management has failed, surgery remains the best option for restoring function. Patient factors, such as prior surgery, anatomic derangements, and degree of incontinence, help inform the astute surgeon regarding the most appropriate option. Many varied approaches to surgical management are available, ranging from more conservative approaches, such as anal canal bulking agents and neuromodulation, to more aggressive approaches, including sphincter repair, anal cerclage techniques, and muscle transposition. Efficacy and morbidity of these approaches also range widely, and this article presents the data and operative considerations for these approaches. PMID:24280402

  3. [Surgical therapy of liver echinococcosis].

    PubMed

    Bähr, R; Gaebel, G

    1985-01-01

    There is still no other therapeutic management for echinococcosis of the liver than surgical treatment. Indeed, drug therapy with Mebendazol prevents parasitosis from spreading. However, a complete regression has not been observed hitherto. Surgical procedure is dependent on expansion, localisation and type of echinococcosis. Generally, cystectomy is possible and adequate in case of Echinococcus granulosus, in case of Echinococcus multilocularis with its infiltrating growth, a complete healing can only be attained by lobectomy. With the hilus being invaded and obstructive jaundice proceeding, an improvement can be reached by Mebendazol or a palliative endless drainage tube. PMID:4013541

  4. Stereolithographic surgical template: a review.

    PubMed

    Dandekeri, Shilpa Sudesh; Sowmya, M K; Bhandary, Shruthi

    2013-09-01

    Implant placement has become a routine modality of dental care.Improvements in surgical reconstructive methods as well as increased prosthetic demands,require a highly accurate diagnosis, planning and placement. Recently,computer-aided design and manufacturing have made it possible to use data from computerised tomography to not only plan implant rehabilitation,but also transfer this information to the surgery.A review on one of this technique called Stereolithography is presented in this article.It permits graphic and complex 3D implant placement and fabrication of stereolithographic surgical templates. Also offers many significant benefits over traditional procedures. PMID:24179955

  5. Surgical Management for Fecal Incontinence

    PubMed Central

    Anandam, Joselin L.

    2014-01-01

    Fecal incontinence is a socially debilitating condition that can lead to social isolation, loss of self-esteem and self-confidence, and depression in an otherwise healthy person. After the appropriate clinical evaluation and diagnostic testing, medical management is initially instituted to treat fecal incontinence. Once medical management fails, there are a few surgical procedures that can be considered. This article is devoted to the various surgical options for fecal incontinence including the history, technical details, and studies demonstrating the complication and success rate. PMID:25320569

  6. Surgical management of ectopic pregnancy.

    PubMed

    Stock, Laura; Milad, Magdy

    2012-06-01

    Surgery remains an acceptable, and sometimes necessary, modality for the treatment of ectopic pregnancy. Laparoscopy is the preferred method of access, yet controversy remains regarding the optimal procedure and postoperative management. Generally, salpingostomy is employed with the goal of maintaining fertility, although data to support this tenet are lacking. In most cases, the decision to perform conservative versus radical surgery is on the basis of the patient's history, her desire for future fertility, and surgical findings. The procedures of salpingostomy and salpingectomy, techniques to prevent and control blood loss at the time of surgery, and surgical options for nontubal ectopic pregnancies are reviewed. PMID:22510627

  7. Safety Handbook.

    ERIC Educational Resources Information Center

    Montgomery County Public Schools, Rockville, MD.

    Safety policies, procedures, and related information are presented in this manual to assist school personnel in a continuing program of accident prevention. Chapter 1 discusses safety education and accident prevention in general. Chapter 2 covers traffic regulations relating to school safety patrols, school bus transportation, bicycles, and…

  8. Direction or inertia: the future for regulation of surgical implant devices.

    PubMed

    Habal, M B; Karlan, M S; Leake, D

    1978-01-01

    The time has arrived when certain standards are to be introduced to control the introduction of and appropriate use of surgical implant devices. Now is the time for the professional groups involved in standards and medical device legislation to become active and develop surgical implant device standards to be applicable for the future. A commission could be established to work with FDA in respect to the requirements for surgical implant devices. It is time for the clinical organizations involved in writing consensus standards to cooperate in the introduction of surgical implant device standards. PMID:10316638

  9. Precise control of caval and hepatic vessels: Surgical technique to treat level III caval thrombus concomitant to renal cell carcinoma

    PubMed Central

    Chen, Ming; Xu, Bin; Liu, Ning; Jiang, Hua; Wang, Yiduo; Yang, Yu; Zhang, Xiaowen; Sun, Chao; Liu, Jing; Zhu, Weidong; Chen, Shuqiu

    2015-01-01

    Introduction: We investigated the surgical techniques, safety, and prevention of complications of nephrectomy and removal of tumour thrombus for treating level III inferior vena cava (IVC) concomitant to renal cell carcinoma (RCC). We did this by precise controlling IVC and hepatic vessels without a vascular bypass. Methods: In this series, we included 5 patients with level III IVC tumour thrombus below the hepatic vein concomitant to RCC. After precisely controlling the IVC and hepatic vessels, we then removed the thrombus en bloc with the renal vein. Blood loss volume, IVC clamping time, hypotension time, resuscitation, cardiocerebrovascular complications, and postoperative organ dysfunction were observed. Results: Surgery was successfully performed without perioperative death. Blood loss volume was 900 to 1500 mL, operation time was 165 to 250 minutes, vascular clamping time was 8 to 12 minutes, and intraoperative hypotension time was 9 to 12 minutes. Serious perioperative complications were not observed. Local recurrence was not observed during the 9 to 24 months of follow-up. One patient exhibited disease-free survival, 3 developed lung or liver metastasis, and 1 died 11 months after surgery. Conclusion: Precise control of IVC and hepatic pedicle vessels, without vascular bypass, is a safe and effective surgical treatment for level III tumor thrombus below the hepatic vein concomitant to RCC. The procedure was conducted without increased risks of intraoperative hypotensive shock, difficult resuscitation, pulmonary embolism, and multiple organ dysfunctions. PMID:26600890

  10. [Surgical aspects of acute aortic dissection].

    PubMed

    Laas, J; Heinemann, M; Jurmann, M; Borst, H G

    1992-12-01

    This paper highlights some of the surgical aspects of acute aortic dissections such as: emergency diagnosis, indications for surgery, reconstructive operative techniques, malperfusion phenomena and necessity for follow-up. Aortic dissection is caused by an intimal tear, called the "entry", and subsequent splitting of the media by the stream of blood. Two lumina are thus created, which may communicate through "re-entries". As this creates severe weakness of the aortic wall, rupture and/or dilatation are the imminent dangers of acute aortic dissection. Acute aortic dissection type A, by definition involving the ascending aorta (Figures 1 and 2), is an absolute indication for emergency surgical treatment, because its natural history shows an extremely poor outcome (Figure 3). Due to impending (intrapericardial) aortic rupture, it may be necessary to limit diagnostic procedures to a minimum. Transesophageal echocardiography is the method of choice for establishing a quick, precise and reliable diagnosis (Figure 4). In stable patients, computed tomography gives additional information about aortic diameters or sites of extrapericardial perforation. Digital subtraction angiography (DSA) shows perfusion of the lumina and dependent organs. The surgical strategy in acute aortic dissection type A aims at replacement of the ascending aorta. Reconstructive techniques have to be considered, especially in aortic valve regurgitation without annuloectasia (Figures 5 and 6). In recent times, the use of GRF tissue glue has reduced the need for teflon felt. Involvement of the aortic arch should be treated aggressively up to the point of total arch replacement in deep hypothermic circulatory arrest as part of the primary procedure (Figure 7). Malperfusion phenomena of aortic branches remain risk-factors.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1483624

  11. Surgical Treatment of Gastric Gastrointestinal Stromal Tumor

    PubMed Central

    Kong, Seong-Ho

    2013-01-01

    Gastrointestinal stromal tumor is the most common mesenchymal tumor in the gastrointestinal tract and is most frequently developed in the stomach in the form of submucosal tumor. The incidence of gastric gastrointestinal stromal tumor is estimated to be as high as 25% of the population when all small and asymptomatic tumors are included. Because gastric gastrointestinal stromal tumor is not completely distinguished from other submucosal tumors, a surgical excisional biopsy is recommended for tumors >2 cm. The surgical principles of gastrointestinal stromal tumor are composed of an R0 resection with a normal mucosa margin, no systemic lymph node dissection, and avoidance of perforation, which results in peritoneal seeding even in cases with otherwise low risk profiles. Laparoscopic surgery has been indicated for gastrointestinal stromal tumors <5 cm, and the indication for laparoscopic surgery is expanded to larger tumors if the above mentioned surgical principles can be maintained. A simple exogastric resection and various transgastric resection techniques are used for gastrointestinal stromal tumors in favorable locations (the fundus, body, greater curvature side). For a lesion at the gastroesophageal junction in the posterior wall of the stomach, enucleation techniques have been tried preserve the organ's function. Those methods have a theoretical risk of seeding a ruptured tumor, but this risk has not been evaluated by well-designed clinical trials. While some clinical trials are still on-going, neoadjuvant imatinib is suggested when marginally unresectable or multiorgan resection is anticipated to reduce the extent of surgery and the chance of incomplete resection, rupture or bleeding. PMID:23610714

  12. Microsoft Kinect based head tracking for Life Size Collaborative Surgical Simulation Environments (LS-CollaSSLE).

    PubMed

    Dargar, Saurabh; Nunno, Austin; Sankaranarayanan, Ganesh; De, Suvranu

    2013-01-01

    Virtual surgical skills trainers are proving to be very useful for the medical training community. With efforts to increase patient safety and surgeon expertise, the need for surgical skills trainers that provide training in an operating room (OR) like condition is now more pressing. To allow for virtual surgery simulators to be instructed in an OR-like setting we have created a large display based immersive surgical simulation environment. Using the Microsoft Kinect we have created a real-time simulation environment that tracks the test user and appropriately adjust the perspective of the virtual OR for an immersive virtual experience. PMID:23400140

  13. Multi-imager compatible actuation principles in surgical robotics

    PubMed Central

    Stoianovici, D

    2011-01-01

    Today’s most successful surgical robots are perhaps surgeon-driven systems, such as the daVinci (Intuitive Surgical Inc., USA, www.intuitivesurgical.com). These have already enabled surgery that was unattainable with classic instrumentation; however, at their present level of development, they have limited utility. The drawback of these systems is that they are independent self-contained units, and as such, they do not directly take advantage of patient data. The potential of these new surgical tools lies much further ahead. Integration with medical imaging and information are needed for these devices to achieve their true potential. Surgical robots and especially their subclass of image-guided systems require special design, construction and control compared to industrial types, due to the special requirements of the medical and imaging environments. Imager compatibility raises significant engineering challenges for the development of robotic manipulators with respect to imager access, safety, ergonomics, and above all the non-interference with the functionality of the imager. These apply to all known medical imaging types, but are especially challenging for achieving compatibility with the class of MRI systems. Even though a large majority of robotic components may be redesigned to be constructed of MRI compatible materials, for other components such as the motors used in actuation, prescribing MRI compatible materials alone is not sufficient. The electromagnetic motors most commonly used in robotic actuation, for example, are incompatible by principle. As such, alternate actuation principles using “intervention friendly” energy should be adopted and/or devised for these special surgical and radiological interventions. This paper defines the new concept of Multi-imager Compatibility of surgical manipulators and describes its requirements. Subsequently, the paper gives several recommendations and proposes new actuation principles for this concept. Several

  14. An overview of software safety standards

    SciTech Connect

    Lawrence, J.D.

    1995-10-01

    The writing of standards for software safety is an increasingly important activity. This essay briefly describes the two primary standards-writing organizations, IEEE and IEC, and provides a discussion of some of the more interesting software safety standards.

  15. Surgical Lasers In Veterinary Medicine

    NASA Astrophysics Data System (ADS)

    Newman, H. C.

    1987-03-01

    Veterinary medicine is a latecomer in benefiting from the advent of surgical lasers. It is ironic that although most of the basic work in lasers is carried out in animal species with which we are most conversant, veterinary medicine as a profession has not been very extensively involved.

  16. NASA Smart Surgical Probe Project

    NASA Technical Reports Server (NTRS)

    Mah, Robert W.; Andrews, Russell J.; Jeffrey, Stefanie S.; Guerrero, Michael; Papasin, Richard; Koga, Dennis (Technical Monitor)

    2002-01-01

    Information Technologies being developed by NASA to assist astronaut-physician in responding to medical emergencies during long space flights are being employed for the improvement of women's health in the form of "smart surgical probe". This technology, initially developed for neurosurgery applications, not only has enormous potential for the diagnosis and treatment of breast cancer, but broad applicability to a wide range of medical challenges. For the breast cancer application, the smart surgical probe is being designed to "see" a suspicious lump, determine by its features if it is cancerous, and ultimately predict how the disease may progress. A revolutionary early breast cancer detection tool based on this technology has been developed by a commercial company and is being tested in human clinical trials at the University of California at Davis, School of Medicine. The smart surgical probe technology makes use of adaptive intelligent software (hybrid neural networks/fuzzy logic algorithms) with the most advanced physiologic sensors to provide real-time in vivo tissue characterization for the detection, diagnosis and treatment of tumors, including determination of tumor microenvironment and evaluation of tumor margins. The software solutions and tools from these medical applications will lead to the development of better real-time minimally-invasive smart surgical probes for emergency medical care and treatment of astronauts on long space flights.

  17. Developing Expert Teams with a Strong Safety Culture

    NASA Technical Reports Server (NTRS)

    Rogers, David G.

    2010-01-01

    Would you like to lead a world renowned team that draws out all the talents and expertise of its members and consistently out performs all others in the industry? Ever wonder why so many organizations fail to truly learn from past mistakes only to repeat the same ones at a later date? Are you a program/project manager or team member in a high-risk organization where the decisions made often carry the highest of consequences? Leadership, communication, team building, critical decision-making and continuous team improvement skills and behaviors are mere talking points without the attitudes, commitment and strategies necessary to make them the very fabric of a team. Developing Expert Teams with a Strong Safety Culture, will provide you with proven knowledge and strategies to take your team soaring to heights you may have not thought possible. A myriad of teams have applied these strategies and techniques within their organization team environments: military and commercial aviation, astronaut flight crews, Shuttle flight controllers, members of the Space Shuttle Program Mission Management Team, air traffic controllers, nuclear power control teams, surgical teams, and the fire service report having spectacular success. Many industry leaders are beginning to realize that although the circumstances and environments of these teams may differ greatly to their own, the core elements, governing principles and dynamics involved in managing and building a stellar safety conscious team remain identical.

  18. Widespread surgical emphysema following trivial injury to the hand

    PubMed Central

    Gietzmann, William Kristian Miles; Mousinho, Joana; Tandon, Karuna; Turner, Samuel

    2014-01-01

    A 23-year-old glazer presented to the A&E department with pain in his left arm following a 2 mm puncture injury to his left thenar eminence. Examination showed crepitus throughout the arm and over the chest wall. Plain X-rays confirmed extensive surgical emphysema but no evidence of pneumothorax. Clinical observations and laboratory markers for infection were normal. The patient was prescribed broad spectrum antibiotics for presumed gas-producing organism infection. After 24 h cultures returned negative and no other signs of infection were detected. Treatment was discontinued and the patient was allowed home. Several days later he experienced severe diarrhoea and as a result required time off work. No cause was found on investigation. We postulate a benign aetiology for the surgical emphysema in this case. In future it may be possible to recognise benign surgical emphysema at presentation and avoid prescribing unnecessary antibiotics. PMID:24943140

  19. Surgical and Non-Surgical Interventions for Obesity in Service of Preserving Cognitive Function

    PubMed Central

    Haley, Andreana P.; Alosco, Michael L.; Gunstad, John

    2015-01-01

    Objective The purpose of this article is to highlight what is currently known about the mechanisms of obesity-related cognitive impairment and weight-loss-related cognitive improvement, and discuss the benefits and drawbacks of available treatments. Methods The manuscript is based on a live debate, presenting the main advantages and disadvantages of exercise interventions and bariatric surgery as related to cognitive functioning. The live debate took place during a one-day conference on Diabetes, Obesity and the Brain, organized by the American Psychosomatic Society in October of 2013. Results While it is well established that bariatric surgery tends to lead to greater weight loss, better glycemic control, and cognitive improvement (effect sizes ranging between 0.61 to 0.78) during the first one to two years post intervention than non-surgical treatments, medical complications are possible, and follow-up data beyond five years is limited. In contrast, non-surgical therapies have been extensively studied in a variety of clinical settings and have proved that they can sustain positive health outcomes up to 10 years later, but their cognitive benefits tend to be more modest (effect sizes ranging from 0.18 to 0.69) and long-term regiment compliance, especially in obese individuals is uncertain. Conclusions Rather than focusing on debating whether surgical or no-surgical interventions for obesity are better, additional research is needed to identify the most efficient and practical combination of approaches to ensure sustained positive health outcomes for the largest number of patients possible. PMID:26163819

  20. U.S. Coast Guard, Office of Boating Safety

    MedlinePlus

    ... Report Recalls Product Assurance Branch Boating Safety Circulars Beacon Alerts Marine Safety Alerts Multimedia PSA's Image Library ... Grants Nonprofit Organization Grants Grant Archives Grant Links Beacon Alerts MARINE SAFETY ALERT ISSUED FOR FOAM LIFE ...

  1. Recent advances in the surgical treatment of benign prostatic hyperplasia

    PubMed Central

    Rocco, Bernardo; Ferreira, Rafael Coelho; Spinelli, Matteo; Cozzi, Gabriele; Dell’Orto, Paolo; Patel, Vipul; Rocco, Francesco

    2011-01-01

    TURP for many years has been considered the gold standard for surgical treatment of BPH. Symptoms relief, improvement in Maximum flow rate and reduction of post void residual urine have been reported in several experiences. Notwithstanding a satisfactory efficacy, concerns have been reported in terms of safety outcomes:intracapsular perforation, TUR syndrome, bleeding with a higher risk of transfusion particularly in larger prostates have been extensivelyreported in the literature. In the recent years the use of new forms of energy and devices suchas bipolar resector, Ho: YAG and potassium-titanyl-phosphate laserare challenging the role of traditional TURP for BPH surgical treatment. In 1999 TURP represented the 81% of surgical treatment for BPHversus 39% of 2005. Is this a marketing driven change or is there areal advantage in new technologies? We analyzed guidelines and higher evidence studies to evaluate therole of the most relevant new surgical approaches compared to TURPfor the treatment of BPH. In case of prostates of very large size the challenge is ongoing, withminimally invasive laparoscopic approach and most recently roboticapproach. We will evaluate the most recent literature on thisemerging field. PMID:22164196

  2. Characterization of aerosols produced by surgical procedures: A summary

    SciTech Connect

    Yeh, Hsu-Chi; Muggenburg, B.A.; Lundgren, D.L.; Turner, R.S.; Guilmette, R.A.; Snipes, M.B.; Jones, R.K.

    1994-11-01

    In many types of surgery, especially orthopedic procedures, power tools such as saws and drills are used. These tools can impart considerable energy in disrupting tissue and may produce aerosolized blood and material from bone and other tissues. Surgical lasers and electrocautery tools can also produce aerosols due to vaporization of blood and tissues. A number of studies have been reported concerning production of aerosols during surgery, and some of the aerosols produced may contain infectious materials. Health care workers have expressed concern and questions pertaining to the occupational transmission of blood-borne pathogens including the human immunodeficiency virus (HIV) and hepatitis B virus (HBV) via blood aerosols during surgery. Little or no data existed characterizing the aerosols produced performing surgical procedures. Because of this lack of data, the National Institute for Occupational Safety and Health funded a project at ITRI to assess the extent of aerosolization of blood and other tissues during surgical procedures in the laboratory and in a hospital surgical suite.

  3. Laparoscopic Supracervical Hysterectomy With Transcervical Morcellation and Sacrocervicopexy: Initial Experience With a Novel Surgical Approach to Uterovaginal Prolapse

    PubMed Central

    Rosenblatt, Peter L.; Apostolis, Costas A.; Hacker, Michele R.; DiSciullo, Anthony

    2013-01-01

    The objective of this retrospective study was to evaluate the feasibility, safety, and efficacy of a new laparoscopic technique for the treatment of uterovaginal prolapse using a transcervical access port to minimize the laparoscopic incision. From February 2008 through August 2010, symptomatic pelvic organ prolapse in 43 patients was evaluated and surgically treated using this novel procedure. Preoperative assessment included pelvic examination, the pelvic organ prolapse quantification scoring system (POP-Q), and complex urodynamic testing with prolapse reduction to evaluate for symptomatic or occult stress urinary incontinence. The surgical procedure consisted of laparoscopic supracervical hysterectomy with transcervical morcellation and laparoscopic sacrocervicopexy with anterior and posterior mesh extension. Concomitant procedures were performed as indicated. All procedures were completed laparoscopically using only 5-mm abdominal port sites, with no intraoperative complications. Patients were followed up postoperatively for pelvic examination and POP-Q at 6 weeks, 6 months, and 12 months. The median (interquartile range) preoperative POP-Q values for point Aa was 0 (−1.0 to 1.0), and for point C was −1.0 (−3.0 to 2.0). Postoperatively, median points Aa and C were significantly improved at 6 weeks, 6 months, and 12 months (all p < .001). One patient was found to have a mesh/suture exposure from the sacrocervicopexy, which was managed conservatively without surgery. We conclude that laparoscopic supracervical hysterectomy with transcervical morcellation and laparoscopic sacrocervicopexy is a safe and feasible surgical approach to treatment of uterovaginal prolapse, with excellent anatomic results at 6 weeks, 6 months, and 12 months. Potential advantages of the procedure include minimizing laparoscopic port site size, decreasing the rate of mesh exposure compared with other published data, and reducing the rate of postoperative cyclic bleeding in

  4. National Safety Council

    MedlinePlus

    ... Introduction Safety Management Systems Workplace Safety Consulting Employee Perception Surveys Research Journey to Safety Excellence Join the ... Safety Safety Management Systems Workplace Safety Consulting Employee Perception Surveys Research Journey to Safety Excellence Join the ...

  5. Use of surgical videos for realistic simulation of surgical procedures.

    PubMed

    Jin, Wei; Lim, Yi-Je; Singh, Tejinder P; De, Suvranu

    2006-01-01

    One of the major challenges in the development of virtual environments for medical simulations is photorealistic rendering, permitting high fidelity visual effects and user interaction. Digitized videos recorded from the laparoscopic camera are a rich source of information about surgical scenarios. How to fully utilize the information is important for improving the realism of the simulated scenarios. In reality, the camera viewpoint changes frequently and even for the same viewpoint, the scene is dynamic due to rhythmic heartbeat. Hence, the results of classical texture mapping are usually visually unappealing as they fail to capture the pulsatile effect, as well as other global illumination properties of the scene. In this paper we present a hybrid technique to improve the photorealistic rendering of the virtual surgery scenarios by spatio-temporally utilizing videos recorded during actual surgical procedures. PMID:16404051

  6. Defining new directions for more effective management of surgical pain in the United States: highlights of the inaugural Surgical Pain Congress™.

    PubMed

    Joshi, Girish P; Beck, David E; Emerson, Roger Hill; Halaszynski, Thomas M; Jahr, Jonathan S; Lipman, Arthur G; Nihira, Mikio A; Sheth, Ketan R; Simpson, Melanie H; Sinatra, Raymond S

    2014-03-01

    Despite advances in pharmacologic options for the management of surgical pain, there appears to have been little or no overall improvement over the last two decades in the level of pain experienced by patients. The importance of adequate and effective surgical pain management, however, is clear, because inadequate pain control 1) has a wide range of undesirable physiologic and immunologic effects; 2) is associated with poor surgical outcomes; 3) has increased probability of readmission; and 4) adversely affects the overall cost of care as well as patient satisfaction. There is a clear unmet need for a national surgical pain management consensus task force to raise awareness and develop best practice guidelines for improving surgical pain management, patient safety, patient satisfaction, rapid postsurgical recovery, and health economic outcomes. To comprehensively address this need, the multidisciplinary Surgical Pain Congress™ has been established. The inaugural meeting of this Congress (March 8 to 10, 2013, Celebration, Florida) evaluated the current surgical pain management paradigm and identified key components of best practices. PMID:24666860

  7. Surgical operation using lighting goggle composed of white LED arrays

    NASA Astrophysics Data System (ADS)

    Shimada, Junichi; Kawakami, Yoichi; Fujita, Shigeo

    2001-12-01

    Everywhere in the world, the highest quality and quantity of lighting is required during the surgical operations. However, the surgical approach has had many types and various angles, common ceiling surgical halogen lighting system cannot provide an adequate amount of beams because the surgeons' heads hinder the illuminations from reaching the operation field. Here, we newly design surgical lighting system composed of white LEDs equipped on both sides of goggles, which controls the lighting beams to the gazing point. With this system, it is just needed for surgeons to wear light plastic goggles with high quality LEDs made by Nichia. In fact, we have succeeded in the first internal shunt operation in the left forearm using the surgical LED lighting system on 11th Sept 2000. The electrical power for the system was supplied from lithium-ion battery for 2 hours. Since the white LEDs used were composed of InGaN-blue-emitters and YAG-yellow-phosphors, the color rendering property was not sufficient in the reddish colors. Therefore, in the next approach, it is very important to develop the spectral distribution of white LED to render inherent color of raw flesh such as skin, blood, fat tissue and internal organs. To improve the color rendering in red colors, some adjustments should be given in the fluorescents layers. Design of goggle is also very important for cutting into the real practical market of white LEDs.

  8. Medical lighting composed of LED arrays for surgical operation

    NASA Astrophysics Data System (ADS)

    Shimada, Junichi; Kawakami, Yoichi; Fujita, Shigeo

    2001-05-01

    Everywhere in the world, the highest quality and quantity of lighting is required during the surgical operations. However, the surgical approach has had many types and various angles, common ceiling surgical halogen lighting system cannot provide an adequate amount of beams because the surgeons' heads hinder the illuminations from reaching the operation field. Here, we newly design surgical lighting system composed of white LEDs equipped on both sides of goggles, which controls the lighting beams to the gazing point. With this system, it is just needed for surgeons to wear light plastic goggles with high quality LEDs made by Nichia. In fact, we have succeeded in the first internal shunt operation in the left forearm using the surgical LED lighting system on 11th Sept 2000. The electrical power for the system was supplied from lithium-ion battery for 2 hours. Since the white LEDs used were composed of InGaN- blue-emitters and YAG-yellow-phosphors, the color rendering property was not sufficient in the reddish colors. Therefore, in the next approach, it is very important to develop the spectral distribution of white LED to render inherent color of raw flesh such as skin, blood, fat tissue and internal organs.

  9. Organizational Culture and Safety

    NASA Technical Reports Server (NTRS)

    Adams, Catherine A.

    2003-01-01

    '..only a fool perseveres in error.' Cicero. Humans will break the most advanced technological devices and override safety and security systems if they are given the latitude. Within the workplace, the operator may be just one of several factors in causing accidents or making risky decisions. Other variables considered for their involvement in the negative and often catastrophic outcomes include the organizational context and culture. Many organizations have constructed and implemented safety programs to be assimilated into their culture to assure employee commitment and understanding of the importance of everyday safety. The purpose of this paper is to examine literature on organizational safety cultures and programs that attempt to combat vulnerability, risk taking behavior and decisions and identify the role of training in attempting to mitigate unsafe acts.

  10. Aerospace Safety Advisory Panel

    NASA Technical Reports Server (NTRS)

    1993-01-01

    The Aerospace Safety Advisory Panel (ASAP) provided oversight on the safety aspects of many NASA programs. In addition, ASAP undertook three special studies. At the request of the Administrator, the panel assessed the requirements for an assured crew return vehicle (ACRV) for the space station and reviewed the organization of the safety and mission quality function within NASA. At the behest of Congress, the panel formed an independent, ad hoc working group to examine the safety and reliability of the space shuttle main engine. Section 2 presents findings and recommendations. Section 3 consists of information in support of these findings and recommendations. Appendices A, B, C, and D, respectively, cover the panel membership, the NASA response to the findings and recommendations in the March 1992 report, a chronology of the panel's activities during the reporting period, and the entire ACRV study report.

  11. School Safety Review Checklist

    ERIC Educational Resources Information Center

    Vermont Department of Education, 2005

    2005-01-01

    The School Safety Review Checklist is an important component of the broader school crisis resources that have been developed by the Vermont School Crisis Planning Team. The Team is comprised of members from the law enforcement, emergency management, health, and education organizations who have worked throughout the year to update school and…

  12. Evaluating the optimal timing of surgical antimicrobial prophylaxis: study protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Surgical site infections are the most common hospital-acquired infections among surgical patients. The administration of surgical antimicrobial prophylaxis reduces the risk of surgical site infections . The optimal timing of this procedure is still a matter of debate. While most studies suggest that it should be given as close to the incision time as possible, others conclude that this may be too late for optimal prevention of surgical site infections. A large observational study suggests that surgical antimicrobial prophylaxis should be administered 74 to 30 minutes before surgery. The aim of this article is to report the design and protocol of a randomized controlled trial investigating the optimal timing of surgical antimicrobial prophylaxis. Methods/Design In this bi-center randomized controlled trial conducted at two tertiary referral centers in Switzerland, we plan to include 5,000 patients undergoing general, oncologic, vascular and orthopedic trauma procedures. Patients are randomized in a 1:1 ratio into two groups: one receiving surgical antimicrobial prophylaxis in the anesthesia room (75 to 30 minutes before incision) and the other receiving surgical antimicrobial prophylaxis in the operating room (less than 30 minutes before incision). We expect a significantly lower rate of surgical site infections with surgical antimicrobial prophylaxis administered more than 30 minutes before the scheduled incision. The primary outcome is the occurrence of surgical site infections during a 30-day follow-up period (one year with an implant in place). When assuming a 5% surgical site infection risk with administration of surgical antimicrobial prophylaxis in the operating room, the planned sample size has an 80% power to detect a relative risk reduction for surgical site infections of 33% when administering surgical antimicrobial prophylaxis in the anesthesia room (with a two-sided type I error of 5%). We expect the study to be completed within three

  13. The effect of intraoral suction on oxygen-enriched surgical environments: a mechanism for reducing the risk of surgical fires.

    PubMed

    VanCleave, Andrea M; Jones, James E; McGlothlin, James D; Saxen, Mark A; Sanders, Brian J; Vinson, LaQuia A

    2014-01-01

    In this study, a mechanical model was applied in order to replicate potential surgical fire conditions in an oxygen-enriched environment with and without high-volume suction typical for dental surgical applications. During 41 trials, 3 combustion events were measured: an audible pop, a visible flash of light, and full ignition. In at least 11 of 21 trials without suction, all 3 conditions were observed, sometimes with an extent of fire that required early termination of the experimental trial. By contrast, in 18 of 20 with-suction trials, ignition did not occur at all, and in the 2 cases where ignition did occur, the fire was qualitatively a much smaller, candle-like flame. Statistically comparing these 3 combustion events in the no-suction versus with-suction trials, ignition (P = .0005), audible pop (P = .0211), and flash (P = .0092) were all significantly more likely in the no-suction condition. These results suggest a possible significant and new element to be added to existing surgical fire safety protocols toward making surgical fires the "never-events" they should be. PMID:25517551

  14. Surgical services for children in developing countries.

    PubMed Central

    Bickler, S. W.; Rode, H.

    2002-01-01

    There is growing evidence that childhood surgical conditions, especially injuries, are common in developing countries and that poor care results in significant numbers of deaths and cases of disability. Unfortunately, however, surgical care is not considered an essential component of most child health programmes. Strategies for improving paediatric surgical care should be evidence-based and cost-effective and should aim to benefit the largest possible number of children. The most likely way of achieving policy change is to demonstrate that childhood surgical conditions are a significant public health problem. For paediatric purposes, special attention should also be given to defining a cost-effective package of surgical services, improving surgical care at the community level, and strengthening surgical education. Surgical care should be an essential component of child health programmes in developing countries. PMID:12471405

  15. Percentage of Surgical Patients Receiving Recommended Care

    MedlinePlus

    ... Recommended Care Percentage of Surgical Patients Receiving Recommended Care This is a composite measure based on individual ... Age Group Percentage of Surgical Patients Receiving Recommended Care by Age Group uzrc-9bvr Download these data » ...

  16. Safety Action; Traffic and Pedestrian Safety. A Guide for Teachers in the Elementary Schools.

    ERIC Educational Resources Information Center

    Department of Transportation, Washington, DC.

    GRADES OR AGES: Elementary, grades 1-6. SUBJECT MATTER: Safety action, traffic and pedestrian safety. ORGANIZATION AND PHYSICAL APPEARANCE: After introductory material explaining the philosophy of the guide, the elementary school child, characteristics of children as related to safety, and the responsibility of the safety team, the guide has…

  17. Safety Education Handbook. Volume 2.

    ERIC Educational Resources Information Center

    Kansas State Dept. of Education, Topeka.

    This is the second of three volumes of a safety guide developed to assist Kansas administrators and teachers in organizing, evaluating, and maintaining safety programs. It provides information to help them identify, assess, and correct unsafe conditions relating to equipment and facilities and ensure a safe and healthy environment for themselves…

  18. Practical Child Safety Education in England: A National Survey of the Child Safety Education Coalition

    ERIC Educational Resources Information Center

    Mulvaney, Caroline A.; Watson, Michael C.; Walsh, Patrick

    2013-01-01

    Objective: To examine the provision of practical safety education by Child Safety Education Coalition (CSEC) organizations in England. Design: A postal survey. Setting: Providers of child practical safety education who were also part of CSEC. Methods: In February 2010 all CSEC organizations were sent a self-completion postal questionnaire which…

  19. Surgical techniques and radiological findings of meniscus allograft transplantation.

    PubMed

    Lee, Hoseok; Lee, Sang Yub; Na, Young Gon; Kim, Sung Kwan; Yi, Jae Hyuck; Lim, Jae Kwang; Lee, So Mi

    2016-08-01

    Meniscus allograft transplantation has been performed over the past 25 years to relieve knee pain and improve knee function in patients with an irreparable meniscus injury. The efficacy and safety of meniscus allograft transplantation have been established in numerous experimental and clinical researches. However, there is a lack of reviews to aid radiologists who are routinely interpreting images and evaluating the outcome of the procedures, and also meniscus allograft transplantation is not widely performed in most hospitals. This review focuses on the indications of the procedure, the different surgical techniques used for meniscus allograft transplantation according to the involvement of the lateral and medial meniscus, and the associated procedures. The postoperative radiological findings and surgical complications of the meniscus allograft transplantation are also described in detail. PMID:27423673

  20. Integrating surgical robots into the next medical toolkit.

    PubMed

    Lai, Fuji; Entin, Eileen

    2006-01-01

    Surgical robots hold much promise for revolutionizing the field of surgery and improving surgical care. However, despite the potential advantages they offer, there are multiple barriers to adoption and integration into practice that may prevent these systems from realizing their full potential benefit. This study elucidated some of the most salient considerations that need to be addressed for integration of new technologies such as robotic systems into the operating room of the future as it evolves into a complex system of systems. We conducted in-depth interviews with operating room team members and other stakeholders to identify potential barriers in areas of workflow, teamwork, training, clinical acceptance, and human-system interaction. The findings of this study will inform an approach for the design and integration of robotics and related computer-assisted technologies into the next medical toolkit for "computer-enhanced surgery" to improve patient safety and healthcare quality. PMID:16404063

  1. Surgical Intervention for Instability of the Craniovertebral Junction.

    PubMed

    Takayasu, Masakazu; Aoyama, Masahiro; Joko, Masahiro; Takeuchi, Mikinobu

    2016-08-15

    Surgical approaches for stabilizing the craniovertebral junction (CVJ) are classified as either anterior or posterior approaches. Among the anterior approaches, the established method is anterior odontoid screw fixation. Posterior approaches are classified as either atlanto-axial fixation or occipito-cervical (O-C) fixation. Spinal instrumentation using anchor screws and rods has become a popular method for posterior cervical fixation. Because this method achieves greater stability and higher success rates for fusion without the risk of sublaminar wiring, it has become a substitute for previous methods that used bone grafting and wiring. Several types of anchor screws are available, including C1/2 transarticular, C1 lateral mass, C2 pedicle, and translaminar screws. Appropriate anchor screws should be selected according to characteristics such as technical feasibility, safety, and strength. With these stronger anchor screws, shorter fixation has become possible. The present review discusses the current status of surgical interventions for stabilizing the CVJ. PMID:27041630

  2. [Lobectomy for lung cancer using the Da Vinci surgical system].

    PubMed

    Nakamura, Hiroshige

    2014-05-01

    Robot-assisted surgery using the da Vinci surgical system has attracted attention because of excellent operability without shaking by joint forceps under the clear vision of a three-dimensional high-definition camera in lung cancer surgery. Although this form of advanced medical care is not yet approved for insurance coverage, it is at the stage of clinical research and expected to be useful in hilar exposure, lymph node dissection, and suturing of the lung parenchyma or bronchus. Lung cancer surgery with the da Vinci system has the advantage of combining thoracotomy and minimally invasive surgery in video-assisted thoracic surgery. However, safety management, education, and significant cost are problems to be resolved. Several important issues such as sharing knowledge and technology of robotic surgery, education, training, development of new instruments, and acquisition of advanced medical insurance are discussed for the future development of robotic surgical systems. PMID:24946522

  3. Surgical Intervention for Instability of the Craniovertebral Junction

    PubMed Central

    TAKAYASU, Masakazu; AOYAMA, Masahiro; JOKO, Masahiro; TAKEUCHI, Mikinobu

    2016-01-01

    Surgical approaches for stabilizing the craniovertebral junction (CVJ) are classified as either anterior or posterior approaches. Among the anterior approaches, the established method is anterior odontoid screw fixation. Posterior approaches are classified as either atlanto-axial fixation or occipito-cervical (O-C) fixation. Spinal instrumentation using anchor screws and rods has become a popular method for posterior cervical fixation. Because this method achieves greater stability and higher success rates for fusion without the risk of sublaminar wiring, it has become a substitute for previous methods that used bone grafting and wiring. Several types of anchor screws are available, including C1/2 transarticular, C1 lateral mass, C2 pedicle, and translaminar screws. Appropriate anchor screws should be selected according to characteristics such as technical feasibility, safety, and strength. With these stronger anchor screws, shorter fixation has become possible. The present review discusses the current status of surgical interventions for stabilizing the CVJ. PMID:27041630

  4. Assessment of luteal function after surgical tubal sterilization.

    PubMed

    Garza-Flores, J; Vázquez-Estrada, L; Reyes, A; Valero, A; Morales del Olmo, A; Alba, V M; Bonilla, C

    1991-12-01

    To evaluate ovarian luteal function after tubal occlusion, a group of women who underwent Pomeroy sterilization were studied. A prospective group I (n = 16) were followed for one year and scheduled for blood sampling every other day during their luteal phase before surgical procedure and at 3 and 12 months thereafter. Group II (n = 15) included women who were studied during their luteal phase at 1 or 5 years post-surgery. Mid-luteal progesterone and estradiol serum levels were calculated by estimating the average of at least 3 values of serum samples obtained in days 20-25 of a menstrual cycle. The data suggest that no major changes occur in ovarian function after surgical tubal occlusion, as assessed by the mid-luteal hormone serum levels, and underscore the safety of this procedure. PMID:1776562

  5. [Surgical treatment of pulmonary echinococcosis].

    PubMed

    Shipulin, P P; Baĭdan, V I; Chetverikov, S G; Martyniuk, V A; Baĭdan, V V; Koziar, O N

    2008-07-01

    The experience of surgical treatment of the pulmonary echinococcosis (PE) at 515 patients is generalized. Character of operative intervention at PE depends on cyst's localization and presence of complications. The method of echinococcectomy with the cappitonnage of fibrous capsule, which is the most effective method of PE surgical treatment, is expounded. The methods of fibrous capsule anti-parasitogenic treatment are described: chemical (10% solution of sodium chloride, chlorhexidinum, betalin), physical (laser radiation, stream of hot air), being most effective, simple and accessible. The methods of videothoracoscopic (VTO) and video-assisted echinococcectomy (VAE), at which application permits the rehabilitation period of patients diminishes considerably, are expounded. The amount of postoperative complications at VTO and VAE made 16.7%, at open echinococcectomy--2.7%. Lethality was 0.2% (one patient died). PMID:19048820

  6. Surgical treatment of Graves' ophthalmopathy.

    PubMed

    Eckstein, Anja; Schittkowski, Michael; Esser, Joachim

    2012-06-01

    The aims of surgical treatment in Graves's orbitopathy (GO) are improvement of function and appearance. Since antiinflammatory treatment of GO rarely results in a complete resolution of symptoms, surgical treatment is very important for patients well being. Rehabilitative surgery includes orbital decompression, squint correction, lid lengthening and blepharoplasty and these procedures have to be performed in centres of expertise. Various techniques have been developed for orbital decompression which allow now a graded approach to proptosis reduction and optic nerve decompression in emergency situations. Extraocular muscle recessions can be successfully performed to treat most of the patients with diplopia. Only large or complex squint angles are difficult to treat and step by step procedures are recommended in these patients. Lid lengthening procedures are performed most often in GO patients and should be performed under local anaesthesia to get a good result. Serious complications are rare. PMID:22632370

  7. Surgical Management for Peyronie's Disease

    PubMed Central

    Segal, Robert L.

    2013-01-01

    Peyronie's disease is a common debilitating condition for both men and their partners that results in penile deformity and compromises sexual functioning. While there are a myriad of medical therapeutic options, these have not been demonstrated to correct the deformity and restore sexual function definitively. As such, surgery is the mainstay of treatment for this disease, and multiple surgical approaches may be considered depending on disease characteristics, patient co-morbidity, and findings on preoperative diagnostic testing. The purpose of this review is to highlight the different surgical approaches and different procedures within each approach, and to examine important issues for surgeons to consider for administering the best treatment that restores function while reconciling patient expectations. PMID:23658860

  8. Testicular torsion: A surgical emergency

    SciTech Connect

    Prater, J.M.; Overdorf, B.S. )

    1991-09-01

    Testicular torsion is caused by twisting of the spermatic cord, which results in compromised testicular blood flow. The degree of ischemic injury is determined by the severity of arterial compression and the interval between the onset of symptoms and surgical intervention. Torsion usually occurs at puberty, and an anatomic defect known as bell-clapper deformity is usually present. Typical symptoms include acute scrotal pain with associated nausea and vomiting. Up to one-half of patients report previous similar episodes. On examination, the testis is high-riding, tender, swollen and firm. Testicular scan or Doppler ultrasound examination can be helpful in distinguishing torsion from acute epididymitis. Prompt surgical treatment is indicated to reduce the torsion, and bilateral orchiopexy is performed to prevent recurrence. Exocrine function, as determined by semen analysis, is often abnormal after unilateral torsion. 25 references.

  9. SURGICAL TREATMENT OF PATELLOFEMORAL INSTABILITY

    PubMed Central

    de Andrade, Marco Antônio Percope; de Abreu e Silva, Guilherme Moreira; Freire, Marcelo Machado; Teixeira, Luiz Eduardo Moreira

    2015-01-01

    Objective: To describe functional outcomes following surgical treatment of patients with patellofemoral instability submitted to patellar realignment. Methods: This was a retrospective study evaluating 34 operated knees for patellofemoral instability between 1989 and 2004. The patients were evaluated in the late postoperative period when a functional questionnaire was applied. Results: After a mean follow-up time of 6 years and 5 months, the mean score was 82.94 in the surgical group (p=0.00037). The results of this investigation showed pain relief in 97.05% and low rate of recurrent dislocation (5.88%), although lower scores were seen in intense articular activities (squatting, running and jumping). No patient developed osteoarthritis while being followed up. Conclusion: The procedure for joint described in this paper was shown to be effective for treating patients with recurrent patellofemoral instability. PMID:27077065

  10. Surgical strategies for pediatric epilepsy

    PubMed Central

    Guan, Jian; Karsy, Michael; Ducis, Katrina

    2016-01-01

    Pediatric epilepsy is a debilitating condition that impacts millions of patients throughout the world. Approximately 20–30% of children with recurrent seizures have drug-resistant epilepsy (DRE). For these patients, surgery offers the possibility of not just seizure freedom but significantly improved neurocognitive and behavioral outcomes. The spectrum of surgical options is vast, ranging from outpatient procedures such as vagus nerve stimulation to radical interventions including hemispherectomy. The thread connecting all of these interventions is a common goal—seizure freedom, an outcome that can be achieved safely and durably in a large proportion of patients. In this review, we discuss many of the most commonly performed surgical interventions and describe the indications, complications, and outcomes specific to each. PMID:27186522

  11. Results of surgical therapy for lung carcinoma.

    PubMed

    Paris, F; Padilla, J; Tarazona, V; Blasco, E; Canto, A; Pastor, J; Zarza, A G

    1979-01-01

    A series of 300 pulmonary resections in patients with lung carcinoma is presented. Total survival rate of the series since the operation, including surgical mortality, was 33% at 3 years and 24% at 5 years. The survival rate and surgical criteria were correlated, having better results when standard surgery was performed. The authors emphasize that the surgical figures of the series are of great value as the surgical indications were large and nonselective, with 85% of resectability in the thoracotomies. PMID:229985

  12. An assessment of surgical education.

    PubMed

    Lang, Nicholas P

    2002-02-01

    A review of the dramatic changes in society, science and medicine that have affected the time we have available for education of students and residents. Reference is made to distance learning, educational efficiency and mental practice as concepts that may aid educators in the quest to provide the public with well trained surgeons. Surgical educators are urged to look outside of traditional models of teaching and evaluating for tools that have been successfully used by industry or business. PMID:11918871

  13. [Surgical anatomy of the nose].

    PubMed

    Nguyen, P S; Bardot, J; Duron, J B; Jallut, Y; Aiach, G

    2014-12-01

    Thorough knowledge of the anatomy of the nose is an essential prerequisite for preoperative analysis and the understanding of surgical techniques. Like a tent supported by its frame, the nose is an osteo-chondral structure covered by a peri-chondroperiosteal envelope, muscle and cutaneous covering tissues. For didactic reasons, we have chosen to treat this chapter in the form of comments from eight key configurations that the surgeon should acquire before performing rhinoplasty. PMID:25159815

  14. Surgical Anatomy of the Eyelids.

    PubMed

    Sand, Jordan P; Zhu, Bovey Z; Desai, Shaun C

    2016-05-01

    Slight alterations in the intricate anatomy of the upper and lower eyelid or their underlying structures can have pronounced consequences for ocular esthetics and function. The understanding of periorbital structures and their interrelationships continues to evolve and requires consideration when performing complex eyelid interventions. Maintaining a detailed appreciation of this region is critical to successful cosmetic or reconstructive surgery. This article presents a current review of the anatomy of the upper and lower eyelid with a focus on surgical implications. PMID:27105794

  15. A literature review of safety culture.

    SciTech Connect

    Cole, Kerstan Suzanne; Stevens-Adams, Susan Marie; Wenner, Caren A.

    2013-03-01

    Workplace safety has been historically neglected by organizations in order to enhance profitability. Over the past 30 years, safety concerns and attention to safety have increased due to a series of disastrous events occurring across many different industries (e.g., Chernobyl, Upper Big-Branch Mine, Davis-Besse etc.). Many organizations have focused on promoting a healthy safety culture as a way to understand past incidents, and to prevent future disasters. There is an extensive academic literature devoted to safety culture, and the Department of Energy has also published a significant number of documents related to safety culture. The purpose of the current endeavor was to conduct a review of the safety culture literature in order to understand definitions, methodologies, models, and successful interventions for improving safety culture. After reviewing the literature, we observed four emerging themes. First, it was apparent that although safety culture is a valuable construct, it has some inherent weaknesses. For example, there is no common definition of safety culture and no standard way for assessing the construct. Second, it is apparent that researchers know how to measure particular components of safety culture, with specific focus on individual and organizational factors. Such existing methodologies can be leveraged for future assessments. Third, based on the published literature, the relationship between safety culture and performance is tenuous at best. There are few empirical studies that examine the relationship between safety culture and safety performance metrics. Further, most of these studies do not include a description of the implementation of interventions to improve safety culture, or do not measure the effect of these interventions on safety culture or performance. Fourth, safety culture is best viewed as a dynamic, multi-faceted overall system composed of individual, engineered and organizational models. By addressing all three components of

  16. Surgical smoke and ultrafine particles

    PubMed Central

    Brüske-Hohlfeld, Irene; Preissler, Gerhard; Jauch, Karl-Walter; Pitz, Mike; Nowak, Dennis; Peters, Annette; Wichmann, H-Erich

    2008-01-01

    Background Electrocautery, laser tissue ablation, and ultrasonic scalpel tissue dissection all generate a 'surgical smoke' containing ultrafine (<100 nm) and accumulation mode particles (< 1 μm). Epidemiological and toxicological studies have shown that exposure to particulate air pollution is associated with adverse cardiovascular and respiratory health effects. Methods To measure the amount of generated particulates in 'surgical smoke' during different surgical procedures and to quantify the particle number concentration for operation room personnel a condensation particle counter (CPC, model 3007, TSI Inc.) was applied. Results Electro-cauterization and argon plasma tissue coagulation induced the production of very high number concentration (> 100000 cm-3) of particles in the diameter range of 10 nm to 1 μm. The peak concentration was confined to the immediate local surrounding of the production side. In the presence of a very efficient air conditioning system the increment and decrement of ultrafine particle occurrence was a matter of seconds, with accumulation of lower particle number concentrations in the operation room for only a few minutes. Conclusion Our investigation showed a short term very high exposure to ultrafine particles for surgeons and close assisting operating personnel – alternating with longer periods of low exposure. PMID:19055750

  17. Surgical Management of Chronic Pancreatitis.

    PubMed

    Parekh, Dilip; Natarajan, Sathima

    2015-10-01

    Advances over the past decade have indicated that a complex interplay between environmental factors, genetic predisposition, alcohol abuse, and smoking lead towards the development of chronic pancreatitis. Chronic pancreatitis is a complex disorder that causes significant and chronic incapacity in patients and a substantial burden on the society. Major advances have been made in the etiology and pathogenesis of this disease and the role of genetic predisposition is increasingly coming to the fore. Advances in noninvasive diagnostic modalities now allow for better diagnosis of chronic pancreatitis at an early stage of the disease. The impact of these advances on surgical treatment is beginning to emerge, for example, patients with certain genetic predispositions may be better treated with total pancreatectomy versus lesser procedures. Considerable controversy remains with respect to the surgical management of chronic pancreatitis. Modern understanding of the neurobiology of pain in chronic pancreatitis suggests that a window of opportunity exists for effective treatment of the intractable pain after which central sensitization can lead to an irreversible pain syndrome in patients with chronic pancreatitis. Effective surgical procedures exist for chronic pancreatitis; however, the timing of surgery is unclear. For optimal treatment of patients with chronic pancreatitis, close collaboration between a multidisciplinary team including gastroenterologists, surgeons, and pain management physicians is needed. PMID:26722211

  18. Virtual intraoperative surgical photoacoustic microscopy

    NASA Astrophysics Data System (ADS)

    Lee, Changho; Lee, Donghyun; Zhou, Qifa; Kim, Jeehyun; Kim, Chulhong

    2015-07-01

    A virtual intraoperative surgical photoacoustic microscopy at 1064 nm wavelength (VISPAM) system was designed and fabricated by integrating a commercial type surgical microscope and laser scanning photoacoustic microscopy (PAM) with a 1064 nm pulsed laser. Based on simple augmented reality device, VISPAM could simultaneously provide 2D depth-resolved photoacoustic and magnified microscope images of surgery regions on the same vision of surgeon via an eyepiece of the microscope. The invisible 1064 nm laser removed the interruption of surgical sight due to visible laser scanning of previous report, and decreased the danger of tissue damage caused by over irradiated laser. In addition, to approach the real practical surgery application, a needle-type transducer was utilized without a water bath for PA signal coupling. In order to verify our system's performance, we conducted needle guiding as ex vivo phantom study and needle guiding and injection of carbon particles mixtures into a melanoma tumor region as in vivo study. We expect that VISPAM can be essential tool of brain and ophthalmic microsurgery.

  19. Surgical treatment for pulmonary emphysema.

    PubMed

    Delarue, N C; Woolf, C R; Sanders, D E; Pearson, F G; Henderson, R D; Cooper, J D; Nelems, J M

    1977-05-01

    Three in-vivo observations stimulated interest in surgical treatment for emphysema: (a) the destructive changes are rarely generalized, (b) the central portions of the lungs are frequently less seriously affected, and (c) marginal folding produces obstructive change in the more normal lung tissue. If destroyed avascular space-occupying areas can be removed, the compressed lung tissue may be stretched to fill pleural space in a functionally effective fashion. Residual elastic tissue will them maintain patency of terminal bronchioles. Preoperatively the extent of the destructive change can be defined most accurately by pulmonary angiography, and zones of functioning capilary circulation can be identified. Forty-seven patients with multifocal space-occupying emphysematous change have been treated surgically. The postoperative mortality was 21% but worthwhile long-term improvement has been obtained in 45% of patients presenting with disabling dyspnea. In these patients, surgical treatment warrants consideration if significant space occupation accompanies the bullous disease, provided alveolar vascularization can be demonstrated in the compressed adjacent normal lung tissue. Limited resections that preserve all vascularized and potentially functioning lung tissue are preferable. It is essential that obliteration of the hemithorax be obtained promptly in view of the high incidence of postoperative complications requiring secondary operative procedures, if 'leaks' and residual spaces are allowed to persist. Postoperative care in a respiratory intensive care unit is mandatory. PMID:870155

  20. Decision making in surgical oncology.

    PubMed

    Lamb, B; Green, J S A; Vincent, C; Sevdalis, N

    2011-09-01

    Decisions in surgical oncology are increasingly being made by multi-disciplinary teams (MDTs). Although MDTs have been widely accepted as the preferred model for cancer service delivery, the process of decision making has not been well described and there is little evidence pointing to the ideal structure of an MDT. Performance in surgery has been shown to depend on non-technical skills, such as decision making, as well as patient factors and the technical skills of the healthcare team. Application of this systems approach to MDT working allows the identification of factors that affect the quality of decision making for cancer patients. In this article we review the literature on decision making in surgical oncology and by drawing from the systems approach to surgical performance we provide a framework for understanding the process of decision making in MDTs. Technical factors that affect decision making include the information about patients, robust ICT and video-conferencing equipment, a minimum dataset with expert review of radiological and pathological information, implementation and recording of the MDTs decision. Non-technical factors with an impact on decision making include attendance of team members at meetings, leadership, teamwork, open discussion, consensus on decisions and communication with patients and primary care. Optimising these factors will strengthen the decision making process and raise the quality of care for cancer patients. PMID:20719499