7 CFR 3411.10 - Establishment and operation of peer review groups.

Code of Federal Regulations, 2011 CFR

2011-01-01

... INSTITUTE OF FOOD AND AGRICULTURE NATIONAL RESEARCH INITIATIVE COMPETITIVE GRANTS PROGRAM Scientific Peer Review of Research Grant Applications § 3411.10 Establishment and operation of peer review groups. Subject to § 3411.5, the Administrator shall adopt procedures for the conduct of peer reviews and the...

The Joanna Briggs Institute Best Practice Information Sheet: music as an intervention in hospitals.

PubMed

2011-03-01

This Best Practice Information Sheet aims to synthesize the best-available evidence on music as a therapeutic intervention for the management of anxiety or pain related to procedural or operative interventions. The information that is contained in this sheet has been derived from studies that were included in a systematic review that was conducted by The Joanna Briggs Institute. The original references can be sourced from the systematic review. Music as a therapeutic intervention is a development largely of the mid-20th century; however, it has existed in various forms in most cultures for many centuries. The Best Practice Information Sheet includes music-listening before a procedure or operation, during a procedure or operation, and after a procedure or operation. It excludes other forms of music therapy. Several recommendations for practice are made. © 2011 Blackwell Publishing Asia Pty Ltd.

78 FR 72091 - Agency Information Collection Activities; Submission for Office of Management and Budget Review...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-02

... in Sec. 211.100(b); and standard operating procedures should be reviewed and revised or supplementary... manufacturers to include a procedure in their Plan for notifying the Center for Drug Evaluation and Research... drug products will be manufactured under altered procedures, which products will have manufacturing...

75 FR 63832 - Agency Information Collection Activities; Submission for Office of Management and Budget Review...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-18

... requirements described in Sec. 211.100(b); and standard operating procedures should be reviewed and revised or..., and update. The draft guidance also encourages manufacturers to include a procedure in their Plan for... as which drug products will be manufactured under altered procedures, which products will have...

76 FR 40378 - Agency Information Collection Activities; Submission for Office of Management and Budget Review...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-08

..., 11.50, and 11.300) require the following standard operating procedures to assure appropriate use of... this regulation is a one-time burden associated with the creation of standard operating procedures... procedures and controls for persons who use closed systems to create, modify, maintain, or transmit...

40 CFR 68.175 - Prevention program/Program 3.

Code of Federal Regulations, 2012 CFR

2012-07-01

... operating procedures. (g) The date of the most recent review or revision of training programs; (1) The type of training provided—classroom, classroom plus on the job, on the job; and (2) The type of competency... review or revision of management of change procedures. (j) The date of the most recent pre-startup review...

40 CFR 68.175 - Prevention program/Program 3.

Code of Federal Regulations, 2013 CFR

2013-07-01

... operating procedures. (g) The date of the most recent review or revision of training programs; (1) The type of training provided—classroom, classroom plus on the job, on the job; and (2) The type of competency... review or revision of management of change procedures. (j) The date of the most recent pre-startup review...

40 CFR 68.175 - Prevention program/Program 3.

Code of Federal Regulations, 2011 CFR

2011-07-01

... operating procedures. (g) The date of the most recent review or revision of training programs; (1) The type of training provided—classroom, classroom plus on the job, on the job; and (2) The type of competency... review or revision of management of change procedures. (j) The date of the most recent pre-startup review...

40 CFR 68.175 - Prevention program/Program 3.

Code of Federal Regulations, 2014 CFR

2014-07-01

... operating procedures. (g) The date of the most recent review or revision of training programs; (1) The type of training provided—classroom, classroom plus on the job, on the job; and (2) The type of competency... review or revision of management of change procedures. (j) The date of the most recent pre-startup review...

7 CFR 3411.10 - Establishment and operation of peer review groups.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) COOPERATIVE STATE RESEARCH, EDUCATION, AND EXTENSION SERVICE, DEPARTMENT OF AGRICULTURE NATIONAL RESEARCH INITIATIVE COMPETITIVE GRANTS PROGRAM Scientific Peer Review of Research Grant Applications § 3411.10 Establishment and operation of peer review groups. Subject to § 3411.5, the Administrator shall adopt procedures...

7 CFR 3400.10 - Establishment and operation of peer review groups.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) COOPERATIVE STATE RESEARCH, EDUCATION, AND EXTENSION SERVICE, DEPARTMENT OF AGRICULTURE SPECIAL RESEARCH GRANTS PROGRAM Scientific Peer Review of Research Grant Applications § 3400.10 Establishment and operation of peer review groups. Subject to § 3400.5, the Administrator will adopt procedures for the...

Surface Area Analysis Using the Brunauer-Emmett-Teller (BET) Method: Standard Operating Procedure Series: SOP-C

DTIC Science & Technology

2016-09-01

Method Scientific Operating Procedure Series : SOP-C En vi ro nm en ta l L ab or at or y Jonathon Brame and Chris Griggs September 2016...BET) Method Scientific Operating Procedure Series : SOP-C Jonathon Brame and Chris Griggs Environmental Laboratory U.S. Army Engineer Research and...response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing

Assessing the safety and efficacy of drugs used in preparing the nose for diagnostic and therapeutic procedures: a systematic review.

PubMed

Saif, A M; Farboud, A; Delfosse, E; Pope, L; Adke, M

2016-10-01

Local anaesthetics and vasoconstrictors are essential for pain control and to aid intra-operative haemostasis in nasal procedures. They also improve access, and reduce discomfort when performing nasal endoscopy. There are no clear guidelines on preparing the nose despite evermore diagnostic and therapeutic procedures utilising the nose as a point of access. This review aims to identify nasal preparations used in diagnostic and therapeutic nasal procedures and to examine their safety and efficacy. Systematic review. A search was carried out using PubMed, MEDLINE, Ovid EMBASE, the Cochrane library and references from the included articles. The inclusion criteria included: full-text English language articles with regard to nasal preparation for surgery. Case reports, systematic reviews, meta-analysis, double-blind placebo controlled randomised trials (RCTs) and case series were included. A total of 53 articles were retrieved: 13 articles on nasal preparation for operative procedures, six on functional endoscopic sinus surgery and 22 on nasendoscopy as well as six case reports. Cocaine was the most widely used topical preparation for operative procedures but was associated with more side-effects; thus, topical tetracaine and levobupivacaine infiltration are alternatives with equivalent efficacy but reduced adverse effects. All articles reviewed for functional endoscopic sinus surgery used a mixture containing lidocaine, adrenaline or both. Flexible nasendoscopy causes minimal patient discomfort and preparation is only recommended in selected patients, in contrast to rigid nasendoscopy which requires preparation. For operative procedures, such as septorhinoplasty, a single agent tetracaine or levobupivicaine provides an improved surgical field. In functional endoscopic sinus surgery, lidocaine-adrenaline preparations have resulted in significantly better surgical and patient outcomes. There is little evidence to support the routine use of pre-procedural nasal preparation for flexible nasendoscopy. Those undergoing rigid endoscopy conversely always require the use of a vasoconstrictor and local anaesthetic. Pre-procedure assessment of patients is recommended, with agents being reserved for those with low pain thresholds, high anxiety and small nasal apertures presenting resistance to the insertion of the endoscope. © 2015 John Wiley & Sons Ltd.

21 CFR 58.35 - Quality assurance unit.

Code of Federal Regulations, 2013 CFR

2013-04-01

... the corrective actions taken. (5) Determine that no deviations from approved protocols or standard operating procedures were made without proper authorization and documentation. (6) Review the final study report to assure that such report accurately describes the methods and standard operating procedures, and...

21 CFR 58.35 - Quality assurance unit.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the corrective actions taken. (5) Determine that no deviations from approved protocols or standard operating procedures were made without proper authorization and documentation. (6) Review the final study report to assure that such report accurately describes the methods and standard operating procedures, and...

21 CFR 58.35 - Quality assurance unit.

Code of Federal Regulations, 2012 CFR

2012-04-01

... the corrective actions taken. (5) Determine that no deviations from approved protocols or standard operating procedures were made without proper authorization and documentation. (6) Review the final study report to assure that such report accurately describes the methods and standard operating procedures, and...

21 CFR 58.35 - Quality assurance unit.

Code of Federal Regulations, 2011 CFR

2011-04-01

... the corrective actions taken. (5) Determine that no deviations from approved protocols or standard operating procedures were made without proper authorization and documentation. (6) Review the final study report to assure that such report accurately describes the methods and standard operating procedures, and...

21 CFR 58.35 - Quality assurance unit.

Code of Federal Regulations, 2014 CFR

2014-04-01

... the corrective actions taken. (5) Determine that no deviations from approved protocols or standard operating procedures were made without proper authorization and documentation. (6) Review the final study report to assure that such report accurately describes the methods and standard operating procedures, and...

40 CFR 61.14 - Monitoring requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... determination of whether acceptable operating and maintenance procedures are being used will be based on information which may include, but not be limited to, review of operating and maintenance procedures...) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS General Provisions § 61.14 Monitoring requirements...

40 CFR 61.14 - Monitoring requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... determination of whether acceptable operating and maintenance procedures are being used will be based on information which may include, but not be limited to, review of operating and maintenance procedures...) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS General Provisions § 61.14 Monitoring requirements...

40 CFR 61.14 - Monitoring requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... determination of whether acceptable operating and maintenance procedures are being used will be based on information which may include, but not be limited to, review of operating and maintenance procedures...) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS General Provisions § 61.14 Monitoring requirements...

40 CFR 61.14 - Monitoring requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... determination of whether acceptable operating and maintenance procedures are being used will be based on information which may include, but not be limited to, review of operating and maintenance procedures...) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS General Provisions § 61.14 Monitoring requirements...

40 CFR 61.14 - Monitoring requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... determination of whether acceptable operating and maintenance procedures are being used will be based on information which may include, but not be limited to, review of operating and maintenance procedures...) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS General Provisions § 61.14 Monitoring requirements...

33 CFR 155.1070 - Procedures for plan review, revision, amendment, and appeal.

Code of Federal Regulations, 2010 CFR

2010-07-01

... REGULATIONS FOR VESSELS Tank Vessel Response Plans for Oil § 155.1070 Procedures for plan review, revision, amendment, and appeal. (a) A vessel response plan must be reviewed annually by the owner or operator. (1... of this part must be submitted. (c) Revisions or amendments to an approved response plan must be...

33 CFR 155.1070 - Procedures for plan review, revision, amendment, and appeal.

Code of Federal Regulations, 2014 CFR

2014-07-01

... REGULATIONS FOR VESSELS Tank Vessel Response Plans for Oil § 155.1070 Procedures for plan review, revision, amendment, and appeal. (a) A vessel response plan must be reviewed annually by the owner or operator. (1... “Application for Approval/Revision of Vessel Pollution Response Plans” (CG-6083) located at: http://www.uscg...

33 CFR 155.1070 - Procedures for plan review, revision, amendment, and appeal.

Code of Federal Regulations, 2011 CFR

2011-07-01

... REGULATIONS FOR VESSELS Tank Vessel Response Plans for Oil § 155.1070 Procedures for plan review, revision, amendment, and appeal. (a) A vessel response plan must be reviewed annually by the owner or operator. (1... of this part must be submitted. (c) Revisions or amendments to an approved response plan must be...

33 CFR 155.1070 - Procedures for plan review, revision, amendment, and appeal.

Code of Federal Regulations, 2012 CFR

2012-07-01

... REGULATIONS FOR VESSELS Tank Vessel Response Plans for Oil § 155.1070 Procedures for plan review, revision, amendment, and appeal. (a) A vessel response plan must be reviewed annually by the owner or operator. (1... of this part must be submitted. (c) Revisions or amendments to an approved response plan must be...

33 CFR 155.1070 - Procedures for plan review, revision, amendment, and appeal.

Code of Federal Regulations, 2013 CFR

2013-07-01

... REGULATIONS FOR VESSELS Tank Vessel Response Plans for Oil § 155.1070 Procedures for plan review, revision, amendment, and appeal. (a) A vessel response plan must be reviewed annually by the owner or operator. (1... of this part must be submitted. (c) Revisions or amendments to an approved response plan must be...

Development of a standard operating procedure for analysis of ammonia concentrations in coal fly ash.

DOT National Transportation Integrated Search

2015-04-01

Research was performed to support the development and recommendation of a standard operating : procedure (SOP) for analyzing the ammonia content in fly ash intended for use in concrete. A review : of existing ash producers found that several differen...

Laparoscopic Whipple procedure: review of the literature.

PubMed

Gagner, Michel; Palermo, Mariano

2009-01-01

Laparoscopic pancreatic surgery represents one of the most advanced applications for laparoscopic surgery currently in use. In the past, minimally invasive techniques were only used for diagnostic laparoscopy, staging of pancreatic cancer, and palliative procedures for unresectable pancreatic cancer. With new advances in technology and instrumentation, some sophisticated procedures are currently available, such as the Whipple procedure, one of the most sophisticated applications of minimally invasive surgery. A review of the literature shows that 146 laparoscopic Whipple procedures have been published worldwide since 1994. The authors analyzed blood loss, mean operating time, hospital stay, conversion rate, mean age, mortality rate, lymph nodes in the pathologic findings, follow up, and complications. Mean age was 59.1 years; mean operating time was 439 min. The average blood loss for the reviewed literature was 143 mL; median hospital stay was 18 days; conversion rate was 46%; number of lymph nodes in the pathologic findings was 19; and mortalities related to the procedure was low, 2 patients (1.3%) and the complication rate was 16% (23/46 patients). Complications included 2 hemorrhages, 4 bowel obstructions, 1 stress ulcer, 1 delay of gastric emptying, 4 pneumonias, and 11 leaks. This review demonstrates that the laparoscopic Whipple procedure is not only feasible but also safe, with low mortality and acceptable rates of complications.

Ground operation of robotics on Space Station Freedom

NASA Technical Reports Server (NTRS)

Wojcik, Z. Alex; Hunter, David G.; Cantin, Marc R.

1993-01-01

This paper reflects work carried out on Ground Operated Telerobotics (GOT) in 1992 to refine further the ideas, procedures, and technologies needed to test the procedures in a high latency environment, and to integrate GOT into Space Station Freedom operations. Space Station Freedom (SSF) will be in operation for 30 years, and will depend on robots to carry out a significant part of the assembly, maintenance, and utilization workload. Current plans call for on-orbit robotics to be operated by on-board crew members. This approach implies that on-orbit robotics operations use up considerable crew time, and that these operations cannot be carried out when SSF is unmanned. GOT will allow robotic operations to be operated from the ground, with on-orbit crew interventions only when absolutely required. The paper reviews how GOT would be implemented, how GOT operations would be planned and supported, and reviews GOT issues, critical success factors, and benefits.

Ground operation of robotics on Space Station Freedom

NASA Astrophysics Data System (ADS)

Wojcik, Z. Alex; Hunter, David G.; Cantin, Marc R.

1993-03-01

This paper reflects work carried out on Ground Operated Telerobotics (GOT) in 1992 to refine further the ideas, procedures, and technologies needed to test the procedures in a high latency environment, and to integrate GOT into Space Station Freedom operations. Space Station Freedom (SSF) will be in operation for 30 years, and will depend on robots to carry out a significant part of the assembly, maintenance, and utilization workload. Current plans call for on-orbit robotics to be operated by on-board crew members. This approach implies that on-orbit robotics operations use up considerable crew time, and that these operations cannot be carried out when SSF is unmanned. GOT will allow robotic operations to be operated from the ground, with on-orbit crew interventions only when absolutely required. The paper reviews how GOT would be implemented, how GOT operations would be planned and supported, and reviews GOT issues, critical success factors, and benefits.

77 FR 25188 - Extension of Agency Information Collection Activity Under OMB Review: Enhanced Security...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-27

... general aviation (GA) aircraft operators who wish to fly into and/or out of Ronald Reagan Washington.... Information Collection Requirement Title: Enhanced Security Procedures at Ronald Reagan Washington National...] Extension of Agency Information Collection Activity Under OMB Review: Enhanced Security Procedures at Ronald...

40 CFR 63.7500 - What emission limitations, work practice standards, and operating limits must I meet?

Code of Federal Regulations, 2014 CFR

2014-07-01

... pounds per million Btu of steam output, in Tables 1 or 2 to this subpart are an alternative applicable only to boilers and process heaters that generate steam. The output-based emission limits, in units of..., monitoring results, review of operation and maintenance procedures, review of operation and maintenance...

40 CFR 63.7500 - What emission limitations, work practice standards, and operating limits must I meet?

Code of Federal Regulations, 2013 CFR

2013-07-01

... pounds per million Btu of steam output, in Tables 1 or 2 to this subpart are an alternative applicable only to boilers and process heaters that generate steam. The output-based emission limits, in units of..., monitoring results, review of operation and maintenance procedures, review of operation and maintenance...

10 CFR 1.34 - Office of Administration.

Code of Federal Regulations, 2010 CFR

2010-01-01

... contracting policies and procedures; (b) Develops policies and procedures and manages the operation and... Regulatory Flexibility Act and the Congressional Review Act, manages the NRC Management Directives Program...

10 CFR 1.34 - Office of Administration.

Code of Federal Regulations, 2014 CFR

2014-01-01

... contracting policies and procedures; (b) Develops policies and procedures and manages the operation and... Regulatory Flexibility Act and the Congressional Review Act, manages the NRC Management Directives Program...

10 CFR 1.34 - Office of Administration.

Code of Federal Regulations, 2013 CFR

2013-01-01

... contracting policies and procedures; (b) Develops policies and procedures and manages the operation and... Regulatory Flexibility Act and the Congressional Review Act, manages the NRC Management Directives Program...

10 CFR 1.34 - Office of Administration.

Code of Federal Regulations, 2012 CFR

2012-01-01

... contracting policies and procedures; (b) Develops policies and procedures and manages the operation and... Regulatory Flexibility Act and the Congressional Review Act, manages the NRC Management Directives Program...

10 CFR 1.34 - Office of Administration.

Code of Federal Regulations, 2011 CFR

2011-01-01

... contracting policies and procedures; (b) Develops policies and procedures and manages the operation and... Regulatory Flexibility Act and the Congressional Review Act, manages the NRC Management Directives Program...

Transit satellite system timing capabilities

NASA Technical Reports Server (NTRS)

Finsod, T. D.

1978-01-01

Current time transfer capabilities of the Transit Satellite System are reviewed. Potential improvements in the changes in equipment and operational procedures using operational satellites are discussed.

76 FR 48166 - Agency Information Collection Activities; Submission for Office of Management and Budget Review...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-08

... contract facility; and (4) standard operating procedures. (1) Notification of All Important Proposed... facility. (4) Standard Operating Procedures In the guidance, we remind the license manufacturer that the... standards (21 CFR 600.3(t)). Therefore, if the license manufacturer enters into an agreement with a contract...

Fundamental principles in periodontal plastic surgery and mucosal augmentation--a narrative review.

PubMed

Burkhardt, Rino; Lang, Niklaus P

2014-04-01

To provide a narrative review of the current literature elaborating on fundamental principles of periodontal plastic surgical procedures. Based on a presumptive outline of the narrative review, MESH terms have been used to search the relevant literature electronically in the PubMed and Cochrane Collaboration databases. If possible, systematic reviews were included. The review is divided into three phases associated with periodontal plastic surgery: a) pre-operative phase, b) surgical procedures and c) post-surgical care. The surgical procedures were discussed in the light of a) flap design and preparation, b) flap mobilization and c) flap adaptation and stabilization. Pre-operative paradigms include the optimal plaque control and smoking counselling. Fundamental principles in surgical procedures address basic knowledge in anatomy and vascularity, leading to novel appropriate flap designs with papilla preservation. Flap mobilization based on releasing incisions can be performed up to 5 mm. Flap adaptation and stabilization depend on appropriate wound bed characteristics, undisturbed blood clot formation, revascularization and wound stability through adequate suturing. Delicate tissue handling and tension free wound closure represent prerequisites for optimal healing outcomes. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

23 CFR 630.1008 - State-level processes and procedures.

Code of Federal Regulations, 2010 CFR

2010-04-01

... review are intended to lead to improvements in work zone processes and procedures, data and information... 23 Highways 1 2010-04-01 2010-04-01 false State-level processes and procedures. 630.1008 Section... OPERATIONS PRECONSTRUCTION PROCEDURES Work Zone Safety and Mobility § 630.1008 State-level processes and...

Changing trends in abdominal surgical complications following cardiac surgery in an era of advanced procedures. A retrospective cohort study.

PubMed

Ashfaq, Awais; Johnson, Daniel J; Chapital, Alyssa B; Lanza, Louis A; DeValeria, Patrick A; Arabia, Francisco A

2015-03-01

Abdominal complications following cardiopulmonary bypass (CPB) procedures may have mortality rates as high as 25%. Advanced procedures such as ventricular assist devices, artificial hearts and cardiac transplantation are being increasingly employed, changing the complexity of interventions. This study was undertaken to examine the changing trends in complications and the impact of cardiac surgery on emergency general surgery (EGS) coverage. A retrospective review was conducted of all CPB procedures admitted to our ICU between Jan. 2007 and Mar. 2010. The procedures included coronary bypass (CABG), valve, combination (including adult congenital) and advanced heart failure (AHF) procedures. The records were reviewed to obtain demographics, need for EGS consult/procedure and outcomes. Mean age of the patients was 66 ± 8.5 years, 71% were male. There were 945 CPB procedures performed on 914 patients during this study period. Over 39 months, 23 EGS consults were obtained, resulting in 10 operations and one hospital death (10% operative mortality). CABG and valve procedures had minimal impact on EGS workload while complex cardiac and AHF procedures accounted for significantly more EGS consultations (p < 0.005) and operations (p < 0.005). The majority of consultations were for small bowel obstruction/ileus (n = 4, 17%), cholecystitis (n = 3, 13%) and to rule out ischemia (n = 2, 9%) In the era of modern critical care and cardiac surgery, advanced technology has increased the volume of complex CPB procedures increasing the EGS workload. Emergency general surgeons working in institutions that perform advanced procedures should be aware of the potential for general surgical complications perioperatively and the resultant nuances that are associated with operative management in this patient population. Copyright © 2015 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Report of the Shuttle Processing Review Team

NASA Technical Reports Server (NTRS)

1993-01-01

The intent of this report is to summarize the assessment of the shuttle processing operations at the Kennedy Space Center (KSC) as requested by the NASA Administrator. He requested a team reaffirmation that safety is the number one priority and review operations to ensure confidence in the shuttle processing procedures at KSC.

Meta-analysis of operative experiences of general surgery trainees during training.

PubMed

Elsey, E J; Griffiths, G; Humes, D J; West, J

2017-01-01

General surgical training curricula around the world set defined operative numbers to be achieved before completion of training. However, there are few studies reporting total operative experience in training. This systematic review aimed to quantify the published global operative experience at completion of training in general surgery. Electronic databases were searched systematically for articles in any language relating to operative experience in trainees completing postgraduate general surgical training. Two reviewers independently assessed citations for inclusion using agreed criteria. Studies were assessed for quantitative data in addition to study design and purpose. A meta-analysis was performed using a random-effects model of studies with appropriate data. The search resulted in 1979 titles for review. Of these, 24 studies were eligible for inclusion in the review and data from five studies were used in the meta-analysis. Studies with published data of operative experience at completion of surgical training originated from the USA (19), UK (2), the Netherlands (1), Spain (1) and Thailand (1). Mean total operative experience in training varied from 783 procedures in Thailand to 1915 in the UK. Meta-analysis produced a mean pooled estimate of 1366 (95 per cent c.i. 1026 to 1707) procedures per trainee at completion of training. There was marked heterogeneity between studies (I 2  = 99·6 per cent). There is a lack of robust data describing the operative experiences of general surgical trainees outside the USA. The number of surgical procedures performed by general surgeons in training varies considerably across the world. © 2016 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

Operational Readiness Review Final Report for K Basin Fuel Transfer System

DOE Office of Scientific and Technical Information (OSTI.GOV)

DAVIES, T.H.

2002-10-01

An Operational Readiness Review (ORR) was conducted by the U.S. Department of Energy (DOE), Richland Operations Office (RL) to verify that an adequate state of readiness had been achieved for startup of the K Basin Fuel Transfer System (FTS). The DOE ORR was conducted during the period November 6-18, 2002. The DOE ORR team concluded that the K Basin Fuel Transfer System is ready to start operations, subject to completion and verification of identified pre-start findings. The ORR was conducted in accordance with the Spent Nuclear Fuel (SNF) K Basin Fuel Transfer System (FTS) Operational Readiness Review (ORR) Plan ofmore » Action and the Operational Readiness Review Implementation Plan for K Basin Fuel Transfer System. Review activities consisted of staff interviews, procedure and document reviews, and observations of normal facility operations, operational upset conditions, and an emergency drill. The DOE ORR Team also reviewed and assessed the adequacy of the contractor ORR3 and the RL line management review. The team concurred with the findings and observations identified in these two reports. The DOE ORR for the FTS evaluated the contractor under single-shift operations. Of concern to the ORR Team was that SNF Project management intended to change from a single-shift FTS operation to a two-shift operation shortly after the completion of the DOE ORR. The ORR team did not assess two-shift FTS operations and the ability of the contractor to conduct a smooth transition from shift to shift. However, the DOE ORR team did observe an operational upset drill that was conducted during day shift and carried over into swing shift; during this drill, swing shift was staffed with fewer personnel as would be expected for two-shift operations. The facility was able to adequately respond to the event with the reduced level of staff. The ORR Team was also able to observe a Shift Manager turnover meeting when one shift manager had to be relieved during the middle of the day. The ORR Team did not have the opportunity to observe a shift turnover from one crew to another. The ORR Team has evaluated the risk of not observing this activity and considers the risk to be minimal based on the fact that operating staff are very familiar with the FTS equipment and its procedures, and because existing Conduct of Operations processes and procedures are adequate and implemented. Because the ORR Team has not observed two-shift FTS operations, we recommend that additional RL oversight be provided at the start of two-shift FTS operations to evaluate the adequacy of crew turnovers.« less

12 CFR 907.12 - Finance Board procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Finance Board procedures. 907.12 Section 907.12 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOUSING FINANCE BOARD ORGANIZATION AND OPERATIONS PROCEDURES Case-by-Case Determinations; Review of Disputed Supervisory Determinations § 907.12 Finance Board procedures. (a) Notice of Receipt...

[Standard operating procedures in ethic committees].

PubMed

Czarkowski, Marek

2006-02-01

Polish ethic committees should have to work together in order to maintain and develop high quality standards in the protection of human subjects. Exchanging knowledge, know-how and information polish ethic committees should have to implement standard operating procedures. Procedures should improve quality and proficiency of all types of ethic committee's activities. Standard operating procedures should cover as important problems as conflict of interest, trial's insurance or elections of ethic committees. The opinions of experts who have been reviewing medical research projects for several years may prove to be especially valuable in this setting. Governmental initiatives and creation of forum for polish ethic committees are essential in the effective standardisation, coordination and implementation of procedures in regional ethic committees. These projects need support via public funding from our authorities.

Early Australian experience in robotic sleeve gastrectomy: a single site series.

PubMed

Silverman, Candice D; Ghusn, Michael A

2017-05-01

The use of robotic platforms in bariatric surgery has recently gained relevance. With an increased use of this technology come concerns regarding learning curve effects during the initial implementation phase. The sleeve gastrectomy though may represent an ideal training procedure for introducing the robot into bariatric surgical practice. The present review of the first 10 consecutive robotic sleeve gastrectomy procedures performed in an Australian bariatric programme by a single surgeon describes the evolution of the technique, learning curve and initial patient outcomes. Between 2014 and 2015, robotic sleeve gastrectomies were performed as primary and revisional procedures by a consistent surgeon-assistant team. Technique evolution and theatre set-up were documented. Patient demographics, operative time (robot docking and total operation time), additional operative procedures performed, operative and post-operative complications at 1, 3 and 6 months post-procedure and weight loss achieved at 6 months were retrospectively reviewed from a prospectively maintained database. Ten robotic sleeve gastrectomies were performed without significant operative complications. One patient was treated as an outpatient with oral antibiotics for a superficial wound infection. The median total operative time was 123 min (interquartile range (IQR) 108.8-142.5), with a median incision to docking time of 19 min (IQR 15.0-31.8). Length of stay in hospital was 2-3 days. Median excess weight loss achieved at 6 months was 50% (IQR 33.9-66.5). This study describes a method of safely introducing the da Vinci robot into bariatric surgical practice. © 2016 Royal Australasian College of Surgeons.

48 CFR 970.4401-2 - Review and approval.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Management and Operating Contractor Purchasing... contract; (2) The size, experience, ability, reliability, and organization of the management and operating contractor's purchasing function; (3) The internal controls, procedures, and organizational stature of the...

Function Allocation in Complex Socio-Technical Systems: Procedure usage in nuclear power and the Context Analysis Method for Identifying Design Solutions (CAMIDS) Model

NASA Astrophysics Data System (ADS)

Schmitt, Kara Anne

This research aims to prove that strict adherence to procedures and rigid compliance to process in the US Nuclear Industry may not prevent incidents or increase safety. According to the Institute of Nuclear Power Operations, the nuclear power industry has seen a recent rise in events, and this research claims that a contributing factor to this rise is organizational, cultural, and based on peoples overreliance on procedures and policy. Understanding the proper balance of function allocation, automation and human decision-making is imperative to creating a nuclear power plant that is safe, efficient, and reliable. This research claims that new generations of operators are less engaged and thinking because they have been instructed to follow procedures to a fault. According to operators, they were once to know the plant and its interrelations, but organizationally more importance is now put on following procedure and policy. Literature reviews were performed, experts were questioned, and a model for context analysis was developed. The Context Analysis Method for Identifying Design Solutions (CAMIDS) Model was created, verified and validated through both peer review and application in real world scenarios in active nuclear power plant simulators. These experiments supported the claim that strict adherence and rigid compliance to procedures may not increase safety by studying the industry's propensity for following incorrect procedures, and when it directly affects the outcome of safety or security of the plant. The findings of this research indicate that the younger generations of operators rely highly on procedures, and the organizational pressures of required compliance to procedures may lead to incidents within the plant because operators feel pressured into following the rules and policy above performing the correct actions in a timely manner. The findings support computer based procedures, efficient alarm systems, and skill of the craft matrices. The solution to the problems facing the industry include in-depth, multiple fault failure training which tests the operator's knowledge of the situation. This builds operator collaboration, competence and confidence to know what to do, and when to do it in response to an emergency situation. Strict adherence to procedures and rigid compliance to process may not prevent incidents or increase safety; building operators' fundamental skills of collaboration, competence and confidence will.

How to develop a Standard Operating Procedure for sorting unfixed cells

PubMed Central

Schmid, Ingrid

2012-01-01

Written Standard Operating Procedures (SOPs) are an important tool to assure that recurring tasks in a laboratory are performed in a consistent manner. When the procedure covered in the SOP involves a high-risk activity such as sorting unfixed cells using a jet-in-air sorter, safety elements are critical components of the document. The details on sort sample handling, sorter set-up, validation, operation, troubleshooting, and maintenance, personal protective equipment (PPE), and operator training, outlined in the SOP are to be based on careful risk assessment of the procedure. This review provides background information on the hazards associated with sorting of unfixed cells and the process used to arrive at the appropriate combination of facility design, instrument placement, safety equipment, and practices to be followed. PMID:22381383

Negative Coefficients in the GRE Validity Study Service. GRE Research. GRE Board Professional Report No. 89-05P.

ERIC Educational Resources Information Center

Longford, Nicholas T.

Operational procedures for the Graduate Record Examinations Validity Study Service are reviewed, with emphasis on the problem of frequent occurrence of negative coefficients in the fitted within-department regressions obtained by the empirical Bayes method of H. I. Braun and D. Jones (1985). Several alterations of the operational procedures are…

Primary carcinoma of the gallbladder--review of 143 cases.

PubMed

Arnaud, J P; Casa, C; Georgeac, C; Serra-Maudet, V; Jacob, J P; Ronceray, J; Bergamaschi, R

1995-01-01

We reviewed a consecutive series of patients with primary cancer of the gallbladder and looked for specific symptoms, signs, laboratory tests, radiological examinations, operative procedures, operative findings and survival. The records of 143 patients with gallbladder carcinoma operatively treated between 1975 and 1990 were retrospectively reviewed. Abdominal pain was the most common symptom and present in 72% of our patients. Jaundice was present in 83 patients (58%) and weight loss in 68 (47.5%). The pre-operative diagnosis was made in only 28.7 per cent of the cases. Surgical procedures included cholecystectomy alone (24 patients), cholecystectomy and resection of the hepatic bed (17 patients), and exploration with biopsy or bypass (20 patients). Only 21.5% of patients underwent curative surgery. Overall five year survival rate was 11%. For patients whose tumor was limited to the gallbladder wall (T1, T2, T3), the acturial 5-year survival rate was respectively 100%, 29% and 23%. For patients with T4 and T5 tumor, the 5 year survival rate was nil.

78 FR 37548 - Agency Information Collection Activities: Proposed Collection; Comment Request; Guidance for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-21

... in Sec. 211.100(b); and standard operating procedures should be reviewed and revised or supplementary... manufacturers to include a procedure in their Plan for notifying the Center for Drug Evaluation and Research... drug products will be manufactured under altered procedures, which products will have manufacturing...

43 CFR 34.10 - Compliance reviews.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Compliance reviews. 34.10 Section 34.10... CONSTRUCTION AND OPERATION OF THE ALASKA NATURAL GAS TRANSPORTATION SYSTEM § 34.10 Compliance reviews. (a) Periodic compliance procedures. (1) The Federal Inspector will review the practices of recipients...

Operative experience of residents in US general surgery programs: a gap between expectation and experience.

PubMed

Bell, Richard H; Biester, Thomas W; Tabuenca, Arnold; Rhodes, Robert S; Cofer, Joseph B; Britt, L D; Lewis, Frank R

2009-05-01

The purpose of the study was to identify a group of operations which general surgery residency program directors believed residents should be competent to perform by the end of 5 years of training and then ascertain actual resident experience with these procedures during their training. There is concern about the adequacy of training of general surgeons in the United States. The American Board of Surgery and the Association of Program Directors in Surgery undertook a study to determine what operative procedures residency program directors consider to be essential to the practice of general surgery and then we measured the actual operative experience of graduating residents in those procedures, as reported to the Residency Review Committee for Surgery (RRC). An electronic survey was sent to residency program directors at the 254 general surgery programs in the US accredited by the RRC as of spring 2006. The program directors were presented with a list of 300 types of operations. Program directors graded the 300 procedures "A," "B," or "C" using the following criteria: A--graduating general surgery residents should be competent to perform the procedure independently; B--graduating residents should be familiar with the procedure, but not necessarily competent to perform it; and C--graduating residents neither need to be familiar with nor competent to perform the procedure. After ballots were tallied, the actual resident operative experience reported to the RRC by all residents finishing general surgery training in June 2005 was reviewed. One hundred twenty-one of the 300 operations were considered A level procedures by a majority of program directors (PDs). Graduating 2005 US residents (n = 1022) performed only 18 of the 121 A procedures, an average of more than 10 times during residency; 83 of 121 procedures were performed on an average less than 5 times and 31 procedures less than once. For 63 of the 121 procedures, the mode (most commonly reported) experience was 0. In addition, there was significant variation between residents in operative experience for specific procedures. In virtually all cases, the mean reported experience exceeded the mode, suggesting that the mean is a poor measure of typical experience. These data pose important problems for surgical educators. Methods will have to be developed to allow surgeons to reach a basic level of competence in procedures which they are likely to experience only rarely during residency. Even for more commonly performed procedures, the numbers of repetitions are not very robust, stressing the need to determine objectively whether residents are actually achieving basic competency in these operations. Finally, the large variations in experience between individuals in our residency system need to be explored, understood, and remedied.

Verbal autopsy: current practices and challenges.

PubMed Central

Soleman, Nadia; Chandramohan, Daniel; Shibuya, Kenji

2006-01-01

Cause-of-death data derived from verbal autopsy (VA) are increasingly used for health planning, priority setting, monitoring and evaluation in countries with incomplete or no vital registration systems. In some regions of the world it is the only method available to obtain estimates on the distribution of causes of death. Currently, the VA method is routinely used at over 35 sites, mainly in Africa and Asia. In this paper, we present an overview of the VA process and the results of a review of VA tools and operating procedures used at demographic surveillance sites and sample vital registration systems. We asked for information from 36 field sites about field-operating procedures and reviewed 18 verbal autopsy questionnaires and 10 cause-of-death lists used in 13 countries. The format and content of VA questionnaires, field-operating procedures, cause-of-death lists and the procedures to derive causes of death from VA process varied substantially among sites. We discuss the consequences of using varied methods and conclude that the VA tools and procedures must be standardized and reliable in order to make accurate national and international comparisons of VA data. We also highlight further steps needed in the development of a standard VA process. PMID:16583084

Financial Responsibilities for Underground Injection Well Owners or Operators

EPA Pesticide Factsheets

This page provides information on UIC financial responsibility requirements, qualifying financial instrumentsRoles and responsibilities for operators and UIC Directors UIC Director’s and review procedures for financial responsibility instruments.

Plastic surgeons’ self-reported operative infection rates at a Canadian academic hospital

PubMed Central

Ng, Wendy KY; Kaur, Manraj Nirmal; Thoma, Achilleas

2014-01-01

BACKGROUND: Surgical site infection rates are of great interest to patients, surgeons, hospitals and third-party payers. While previous studies have reported hospital-acquired infection rates that are nonspecific to all surgical services, there remain no overall reported infection rates focusing specifically on plastic surgery in the literature. OBJECTIVE: To estimate the reported surgical site infection rate in plastic surgery procedures over a 10-year period at an academic hospital in Canada. METHODS: A review was conducted on reported plastic surgery surgical site infection rates from 2003 to 2013, based on procedures performed in the main operating room. For comparison, prospective infection surveillance data over an eight-year period (2005 to 2013) for nonplastic surgery procedures were reviewed to estimate the overall operative surgical site infection rates. RESULTS: A total of 12,183 plastic surgery operations were performed from 2003 to 2013, with 96 surgical site infections reported, corresponding to a net operative infection rate of 0.79%. There was a 0.49% surgeon-reported infection rate for implant-based procedures. For non-plastic surgery procedures, surgical site infection rates ranged from 0.04% for cataract surgery to 13.36% for high-risk abdominal hysterectomies. DISCUSSION: The plastic surgery infection rate at the study institution was found to be <1%. This rate was equal to, or somewhat less than, surgical site infection rates. However, these results do not report patterns of infection rates germane to procedures, season, age groups or sex. To provide more in-depth knowledge of this topic, multicentre studies should be conducted. PMID:25535460

How to develop a standard operating procedure for sorting unfixed cells.

PubMed

Schmid, Ingrid

2012-07-01

Written standard operating procedures (SOPs) are an important tool to assure that recurring tasks in a laboratory are performed in a consistent manner. When the procedure covered in the SOP involves a high-risk activity such as sorting unfixed cells using a jet-in-air sorter, safety elements are critical components of the document. The details on sort sample handling, sorter set-up, validation, operation, troubleshooting, and maintenance, personal protective equipment (PPE), and operator training, outlined in the SOP are to be based on careful risk assessment of the procedure. This review provides background information on the hazards associated with sorting of unfixed cells and the process used to arrive at the appropriate combination of facility design, instrument placement, safety equipment, and practices to be followed. Copyright © 2012 Elsevier Inc. All rights reserved.

Arthroscopic procedures for the treatment of anterior shoulder instability: local experiences.

PubMed

Choi, S T; Tse, P Y T

2005-04-01

To review the outcomes of arthroscopic stabilisation procedures for the treatment of recurrent anterior shoulder dislocation. Retrospective study. Regional hospital, Hong Kong. Patients receiving arthroscopic stabilisation procedures for recurrent anterior shoulder dislocation between 1999 and 2003. Functional outcomes including pain, range of motion, and activity level were assessed using the Constant score. Intra-operative findings were also discussed. A total of 18 arthroscopic stabilisation procedures were performed for the treatment of recurrent shoulder instability. Two cases converted to open procedures were excluded from this review. The overall outcomes were good and seven patients reported a full recovery. Fourteen out of 16 patients reported minimal or no pain, and the mean Constant score was 80. There were no cases of re-dislocation and no major complication was noted. All the reviewed patients had a satisfactory functional recovery. Therefore, we believe that the use of arthroscopic stabilisation procedure can produce a favourable outcome for appropriate shoulder pathologies.

Sternotomy for substernal goiter: retrospective study of 52 operations.

PubMed

Rolighed, Lars; Rønning, Hanne; Christiansen, Peer

2015-04-01

Surgical treatment of substernal goiter occasionally involves sternotomy. Classification and handling of these operations are widely discussed. We aimed to review surgical results after thyroid operations including median sternotomy. A retrospective review of all thyroid operations performed in the department from 01.01.95 to 31.12.12. In 55 of 2065 thyroid operations (2.7 %), median sternotomy was performed. All hospital journals of the patients were collected and carefully reviewed. We included 52 of 55 identified patients. Pathologic examinations discovered malignant disease in 4 patients (8 %) and multinodular goiter in 48 patients (92 %). Mean operation time was 4 h and 5 min (n = 48). Mean estimated blood loss was 464 ml (n = 48). Blood transfusion was given in nine operations (17 %). Median duration of postoperative hospitalization was 7 days (range 4-27 days). Pulmonary complications occurred in 11 patients (21 %): six with pneumonia or atelectasis, three with pneumothorax, and two with pleural effusion. Three patients (6 %) had postoperative hypocalcaemia (permanent in two patients (4 %)). Three patients (6 %) had transient voice changes. Permanent vocal cord paresis was not observed in this series of patients. Thyroid operations with sternotomy are complicated procedures accompanied with considerable pulmonary complications. In spite of a large invasive procedure, the risk of hypoparathyroidism or recurrent laryngeal nerve injury was not increased.

Ethical review of human experimentation in the consumer products industry.

PubMed

Steadman, J H

1998-04-01

Ethical review of human experimentation in the consumer products industry is important and provides instructive parallels and contrasts with clinical medical research. The procedures used in Unilever NV/plc are described. A central body sets standards for and monitors compliance with ethical review of human studies throughout Unilever. Guidance has been produced on many topics including issues applying generally to human experimentation and more specifically to the consumer products sector. Deficiencies and inconsistencies in the procedures for ethical review and the care of subjects during the conduct of studies have been identified and corrected. Appropriate uniform standards have been achieved across all Unilever operations. All human experimentation in the industry needs adequate ethical review. Although the methods used by individual companies may differ, procedures must ensure uniform high standards across a global industry.

School Business. A Manual for School Officials. Revised Edition.

ERIC Educational Resources Information Center

Smith, Richard N.

An outline is presented of business procedures related to the many facets of educational program operations. Statutes, regulations, practices, attorney general's opinions and reports, and court decisions relative to school business in Iowa are cited. While the report is a review of the procedures for the state of Iowa, a number of procedures are…

75 FR 458 - Notice; Applications and Amendments to Facility Operating Licenses Involving Proposed No...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-05

... Unclassified Non-Safeguards Information and Order Imposing Procedures for Access to Sensitive Unclassified Non... procedures described below. To comply with the procedural requirements of E-Filing, at least ten (10) days... equipment lineup, accident scenario, or interaction mode not reviewed and approved as part of the design and...

77 FR 58998 - Agency Information Collection Activities; Submission for Office of Management and Budget Review...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-25

... reference existing standard operating procedures (SOPs) or other documents. The draft guidance specifies that a monitoring plan may reference existing policies and procedures in order to minimize the burden... risk device studies are already required under Sec. 812.25(e) to submit and maintain written procedures...

Operant ethanol self-administration in ethanol dependent mice.

PubMed

Lopez, Marcelo F; Becker, Howard C

2014-05-01

While rats have been predominantly used to study operant ethanol self-administration behavior in the context of dependence, several studies have employed operant conditioning procedures to examine changes in ethanol self-administration behavior as a function of chronic ethanol exposure and withdrawal experience in mice. This review highlights some of the advantages of using operant conditioning procedures for examining the motivational effects of ethanol in animals with a history of dependence. As reported in rats, studies using various operant conditioning procedures in mice have demonstrated significant escalation of ethanol self-administration behavior in mice rendered dependent via forced chronic ethanol exposure in comparison to nondependent mice. This paper also presents a summary of these findings, as well as suggestions for future studies. Copyright © 2014 Elsevier Inc. All rights reserved.

Simulation of flashing signal operations.

DOT National Transportation Integrated Search

1982-01-01

Various guidelines that have been proposed for the operation of traffic signals in the flashing mode were reviewed. The use of existing traffic simulation procedures to evaluate flashing signals was examined and a study methodology for simulating and...

Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review

PubMed Central

Chen, Brian Po-Han; Soleas, Ireena M.; Ferko, Nicole C.; Cameron, Chris G.; Hinoul, Piet

2017-01-01

Abstract Background: The incidence of surgical site infection (SSI) across surgical procedures, specialties, and conditions is reported to vary from 0.1% to 50%. Operative duration is often cited as an independent and potentially modifiable risk factor for SSI. The objective of this systematic review was to provide an in-depth understanding of the relation between operating time and SSI. Patients and Methods: This review included 81 prospective and retrospective studies. Along with study design, likelihood of SSI, mean operative times, time thresholds, effect measures, confidence intervals, and p values were extracted. Three meta-analyses were conducted, whereby odds ratios were pooled by hourly operative time thresholds, increments of increasing operative time, and surgical specialty. Results: Pooled analyses demonstrated that the association between extended operative time and SSI typically remained statistically significant, with close to twice the likelihood of SSI observed across various time thresholds. The likelihood of SSI increased with increasing time increments; for example, a 13%, 17%, and 37% increased likelihood for every 15 min, 30 min, and 60 min of surgery, respectively. On average, across various procedures, the mean operative time was approximately 30 min longer in patients with SSIs compared with those patients without. Conclusions: Prolonged operative time can increase the risk of SSI. Given the importance of SSIs on patient outcomes and health care economics, hospitals should focus efforts to reduce operative time. PMID:28832271

Post-operative ventricular flow dynamics following atrioventricular valve surgical and device therapies: A review.

PubMed

Nguyen, Yen Ngoc; Ismail, Munirah; Kabinejadian, Foad; Tay, Edgar Lik Wui; Leo, Hwa Liang

2018-04-01

Intra-ventricular flow dynamics has recently emerged as an important evaluation and diagnosis tool in different cardiovascular conditions. The formation of vortex pattern during the cardiac cycle has been suggested to play important epigenetic and energy-modulation roles in cardiac remodelling, adaptations and mal-adaptations. In this new perspective, flow alterations due to different cardiovascular procedures can affect the long-term outcome of those procedures. Especially, repairs and replacements performed on atrioventricular valves are likely to exert direct impact on intra-ventricular flow pattern. In this review, current consensus around the roles of vortex dynamics in cardiac function is discussed. An overview of physiological vortex patterns found in healthy left and right ventricles as well as post-operative ventricular flow phenomenon owing to different atrioventricular valvular procedures are reviewed, followed by the summary of different vortex identification schemes used to characterise intraventricular flow. This paper also emphasises on future research directions towards a comprehensive understanding of intra-cardiac flow and its clinical relevance. The knowledge could encourage more effective pre-operative planning and better outcomes for current clinical practices. Copyright © 2018. Published by Elsevier Ltd.

Using GoPro to Give Video-Assisted Operative Feedback for Surgery Residents: A Feasibility and Utility Assessment.

PubMed

Moore, Maureen D; Abelson, Jonathan S; O'Mahoney, Paul; Bagautdinov, Iskander; Yeo, Heather; Watkins, Anthony C

As an adjunct to simulation-based teaching, laparoscopic video-based surgical coaching has been an effective tool to augment surgical education. However, the wide use of video review in open surgery has been limited primarily due to technological and logistical challenges. The aims of our study were to (1) evaluate perceptions of general surgery (GS) residents on video-assisted operative instruction and (2) conduct a pilot study using a head-mounted GoPro in conjunction with the operative performance rating system to assess feasibility of providing video review to enhance operative feedback during open procedures. GS residents were anonymously surveyed to evaluate their perceptions of oral and written operative feedback and use of video-based operative resources. We then conducted a pilot study of 10 GS residents to assess the utility and feasibility of using a GoPro to record resident performance of an arteriovenous fistula creation with an attending surgeon. Categorical variables were analyzed using the chi-square test. Academic, tertiary medical center. GS residents and faculty. A total of 59 GS residents were anonymously surveyed (response rate = 65.5%). A total of 40% (n = 24) of residents reported that structured evaluations rarely or never provided meaningful feedback. When feedback was received, 55% (n = 32) residents reported that it was only rarely or sometimes in regard to their operative skills. There was no significant difference in surveyed responses among junior postgraduate year (PGY 1-2), senior (PGY 3-4), or chief residents (PGY-5). A total of 80% (n = 8) of residents found the use of GoPro video review very or extremely useful for education; they also deemed video review more useful for operative feedback than written or communicative feedback. An overwhelming majority (90%, n = 9) felt that video review would lead to improved technical skills, wanted to review the video with the attending surgeon for further feedback, and desired expansion of this tool to include additional procedures. Although there has been progress toward improving operative feedback, room for further improvement remains. The use of a head-mounted GoPro is a dynamic tool that provides high-quality video for operative review and has the potential to augment the training experience of GS residents. Future studies exploring a wide array of open procedures involving a greater number of trainees will be needed to further define the use of this resource. Copyright © 2017. Published by Elsevier Inc.

48 CFR 24.103 - Procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... work statement specifically identifies the system of records on individuals and the design, development, or operation work to be performed; and (2) Make available, in accordance with agency procedures... contracting officer shall review requirements to determine whether the contract will involve the design...

Surgical manual of the Korean Gynecologic Oncology Group: ovarian, tubal, and peritoneal cancers.

PubMed

Jeon, Seob; Lee, Sung Jong; Lim, Myong Cheol; Song, Taejong; Bae, Jaeman; Kim, Kidong; Lee, Jung Yun; Kim, Sang Wun; Chang, Suk Joon; Lee, Jong Min

2017-01-01

The Surgery Treatment Modality Committee of the Korean Gynecologic Oncology Group has determined to develop a surgical manual to facilitate clinical trials and to improve communication between investigators by standardizing and precisely describing operating procedures. The literature on anatomic terminology, identification of surgical components, and surgical techniques were reviewed and discussed in depth to develop a surgical manual for gynecologic oncology. The surgical procedures provided here represent the minimum requirements for participating in a clinical trial. These procedures should be described in the operation record form, and the pathologic findings obtained from the procedures should be recorded in the pathologic report form. Here, we describe surgical procedure for ovarian, fallopian tubal, and peritoneal cancers.

The effect of video review of resident laparoscopic surgical skills measured by self- and external assessment.

PubMed

Herrera-Almario, Gabriel E; Kirk, Katherine; Guerrero, Veronica T; Jeong, Kwonho; Kim, Sara; Hamad, Giselle G

2016-02-01

Video review of surgical skills is an educational modality that allows trainees to reflect on self-performance. The purpose of this study was to determine whether resident and attending assessments of a resident's laparoscopic performance differ and whether video review changes assessments. Third-year surgery residents were invited to participate. Elective laparoscopic procedures were video recorded. The Global Operative Assessment of Laparoscopic Skills evaluation was completed immediately after the procedure and again 7 to 10 days later by both resident and attending. Scores were compared using t tests. Nine residents participated and 76 video reviews were completed. Residents scored themselves significantly lower than the faculty scores both before and after video review. Resident scores did not change significantly after video review. Attending and resident self-assessment of laparoscopic skills differs and subsequent video review does not significantly affect Global Operative Assessment of Laparoscopic Skills scores. Further studies should evaluate the impact of video review combined with verbal feedback on skill acquisition and assessment. Copyright © 2016 Elsevier Inc. All rights reserved.

Aircraft Mishap Exercise at SLF

NASA Image and Video Library

2018-02-14

NASA Kennedy Space Center's Flight Operations team reviews procedures before beginning a rehearsal of a helicopter crash-landing to test new and updated emergency procedures. Called the Aircraft Mishap Preparedness and Contingency Plan, the operation was designed to validate several updated techniques the center's first responders would follow, should they ever need to rescue a crew in case of a real accident. The mishap exercise took place at the center's Shuttle Landing Facility.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Barr, J.H.; Silha, R.E.; Richards, A.G.

A report of the Radiation Protection Committee of the American Academy of Oral Roentgenology on recommendation for reducing exposure to patient and dentist during oral radiographic procedures is reviewed. The following aspects of the problem of exposure reduction are considered: max permissible exposures to operators and patients, sources of radiation in dental offices, recommended building materials to be used for wall construction (with their lead equivalents), and detailed statements of procedures for protecting operators and patients. (TCO)

20 CFR 702.434 - Judicial review.

Code of Federal Regulations, 2010 CFR

2010-04-01

... WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Medical Care and Supervision... § 702.434 Judicial review. (a) Any physician, health care provider or claims representative, after any... such review shall not operate as a stay upon the effect of such decision. Such action shall be brought...

75 FR 2872 - Agency Information Collection Activities; Submission for Office of Management and Budget Review...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-19

... hours (10 x 20 = 200). FDA estimates that cost of developing standard operating procedures for each data... operating and maintenance costs associated with this collection of information. [[Page 2874

13 CFR 134.217 - Settlement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... has express authority, under statute, SBA regulation or SBA standard operating procedures, to review... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Settlement. 134.217 Section 134.217 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION RULES OF PROCEDURE GOVERNING CASES...

Wisconsin Fire Service Certification Program Procedures.

ERIC Educational Resources Information Center

Pribyl, Paul F.

These procedures for the Wisconsin Fire Service Certification Program provide professional qualification standards for three levels of fire fighter and four levels of fire service instructor. A section on program authority/operations covers program development, the credential review system, and revocation of certification. Requirements for…

Transanal surgery for obstructed defecation syndrome: Literature review and a single-center experience

PubMed Central

Liu, Wei-Cheng; Wan, Song-Lin; Yaseen, SM; Ren, Xiang-Hai; Tian, Cui-Ping; Ding, Zhao; Zheng, Ken-Yan; Wu, Yun-Hua; Jiang, Cong-Qing; Qian, Qun

2016-01-01

Obstructed defecation syndrome (ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS. However, no procedure has been proved to be superior to others at present. Each operation has its own merits and defects. Thus, choosing appropriate transanal surgical procedures for the treatment of ODS remains a challenge for all surgeons. This review provides an introduction of the current problems and options for treatment of ODS and a detailed summary of the essential assessments needed for patient evaluation before carrying out transanal surgery. Besides, an overview of the benefits and problems of current transanal surgical procedures for treatment of ODS is summarized in this review. A report of clinical experience of some transanal surgical techniques used in the authors’ center is also presented. PMID:27672293

Transanal surgery for obstructed defecation syndrome: Literature review and a single-center experience.

PubMed

Liu, Wei-Cheng; Wan, Song-Lin; Yaseen, S M; Ren, Xiang-Hai; Tian, Cui-Ping; Ding, Zhao; Zheng, Ken-Yan; Wu, Yun-Hua; Jiang, Cong-Qing; Qian, Qun

2016-09-21

Obstructed defecation syndrome (ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS. However, no procedure has been proved to be superior to others at present. Each operation has its own merits and defects. Thus, choosing appropriate transanal surgical procedures for the treatment of ODS remains a challenge for all surgeons. This review provides an introduction of the current problems and options for treatment of ODS and a detailed summary of the essential assessments needed for patient evaluation before carrying out transanal surgery. Besides, an overview of the benefits and problems of current transanal surgical procedures for treatment of ODS is summarized in this review. A report of clinical experience of some transanal surgical techniques used in the authors' center is also presented.

Sleeve gastrectomy and anti-reflux procedures.

PubMed

Crawford, Christopher; Gibbens, Kyle; Lomelin, Daniel; Krause, Crystal; Simorov, Anton; Oleynikov, Dmitry

2017-03-01

Obesity is an epidemic in the USA that continues to grow, becoming a leading cause of premature avoidable death. Bariatric surgery has become an effective solution for obesity and its comorbidities, and one of the most commonly utilized procedures, the sleeve gastrectomy, can lead to an increase in gastroesophageal reflux following the operation. While these data are controversial, sometimes operative intervention can be necessary to provide durable relief for this problem. We performed an extensive literature review examining the different methods of anti-reflux procedures that are available both before and after a sleeve gastrectomy. We reviewed several different types of anti-reflux procedures, including those that supplement the lower esophageal sphincter anatomy, such as magnetic sphincter augmentation and radiofrequency ablation procedures. Re-operation was also discussed as a possible treatment of reflux in sleeve gastrectomy, especially if the original sleeve becomes dilated or if a conversion to a Roux-en-Y gastric bypass or biliopancreatic diversion is deemed necessary. Sleeve gastrectomy with concomitant anti-reflux procedure was also reviewed, including the anti-reflux gastroplasty, hiatal hernia repair, and limited fundoplication. A number of techniques can be used to mitigate the severity of reflux, either by maintaining the normal anatomic structures that limit reflux or by supplementing these structures with a plication or gastroplasty. Individuals with existing severe reflux should not be considered for a sleeve gastrectomy. New techniques that incorporate plication at the time of the index sleeve gastrectomy show some improvement, but these are in small series that will need to be further evaluated. The only proven method of treating intractable reflux after sleeve gastrectomy is conversion to a Roux-en-Y gastric bypass.

Improved Quick Disconnect (QD) Interface Through Fail Safe Parts Identification

NASA Technical Reports Server (NTRS)

Blanch-Payne, Evelyn

2001-01-01

An extensive review of existing Quick Disconnects (QDs) mating and demating operations was performed to determine which shuttle part interface identifications and procedures contribute to human factor errors. The research methods used consisted of interviews with engineers and technicians, examination of incident reports, critiques of video and audio tapes of QD operations, and attendance of a Hyper QD operational course. The data strongly suggests that there are inherit human factor errors involved in QD operations. To promote fail-safe operations, QD interface problem areas and recommendations were outlined and reviewed. It is suggested that dialogue, investigations and recommendations continue.

Meteorological support for space operations: Review and recommendations

NASA Technical Reports Server (NTRS)

1988-01-01

The current meteorological support provided to NASA by NOAA, Air Weather Service, and other contractors is reviewed and suggestions are offered for its improvement. These recommendations include improvement in NASA's internal management organizational structure that would accommodate continued improvement in operational weather support, installation of new observing systems, improvement in analysis and forecasting procedures, and the establishment of an Applied Research and Forecasting Facility.

Surgical skills needed for humanitarian missions in resource-limited settings: common operative procedures performed at Médecins Sans Frontières facilities.

PubMed

Wong, Evan G; Trelles, Miguel; Dominguez, Lynette; Gupta, Shailvi; Burnham, Gilbert; Kushner, Adam L

2014-09-01

Surgeons in high-income countries increasingly are expressing interest in global surgery and participating in humanitarian missions. Knowledge of the surgical skills required to adequately respond to humanitarian emergencies is essential to prepare such surgeons and plan for interventions. A retrospective review of all surgical procedures performed at Médecins Sans Frontières Brussels facilities from June 2008 to December 2012 was performed. Individual data points included country of project; patient age and sex; and surgical indication and surgical procedure. Between June 2008 and December 2012, a total of 93,385 procedures were performed on 83,911 patients in 21 different countries. The most common surgical indication was for fetal-maternal pathologies, accounting for 25,548 of 65,373 (39.1%) of all cases. The most common procedure was a Cesarean delivery, accounting for a total of 24,182 or 25.9% of all procedures. Herniorrhaphies (9,873/93,385, 10.6%) and minor surgeries (11,332/93,385, 12.1%), including wound debridement, abscess drainage and circumcision, were also common. A basic skill set that includes the ability to provide surgical care for a wide variety of surgical morbidities is urgently needed to cope with the surgical need of humanitarian emergencies. This review of Médecins Sans Frontières's operative procedures provides valuable insight into the types of operations with which an aspiring volunteer surgeon should be familiar. Copyright © 2014 Mosby, Inc. All rights reserved.

Commander Brand and Pilot Overmyer operate controls on forward flight deck

NASA Technical Reports Server (NTRS)

1982-01-01

On forward flight deck, Commander Brand and Pilot Overmyer operate controls from commanders and pilots seats. Overall view taken from the aft flight deck looking forward shows both astronauts reviewing procedures and checking CRT screen data.

User's operating procedures. Volume 1: Scout project information programs

NASA Technical Reports Server (NTRS)

Harris, C. G.; Harris, D. K.

1985-01-01

A review of the user's operating procedures for the Scout Project Automatic Data System, called SPADS is given. SPADS is the result of the past seven years of software development on a Prime minicomputer located at the Scout Project Office. SPADS was developed as a single entry, multiple cross reference data management and information retrieval system for the automation of Project office tasks, including engineering, financial, managerial, and clerical support. The instructions to operate the Scout Project Information programs in data retrieval and file maintenance via the user friendly menu drivers is presented.

User's operating procedures. Volume 3: Projects directorate information programs

NASA Technical Reports Server (NTRS)

Haris, C. G.; Harris, D. K.

1985-01-01

A review of the user's operating procedures for the scout project automatic data system, called SPADS is presented. SPADS is the results of the past seven years of software development on a prime mini-computer. SPADS was developed as a single entry, multiple cross-reference data management and information retrieval system for the automation of Project office tasks, including engineering, financial, managerial, and clerical support. This volume, three of three, provides the instructions to operate the projects directorate information programs in data retrieval and file maintenance via the user friendly menu drivers.

Are friends electric?: A review of the electric handpiece in clinical dental practice.

PubMed

Campbell, Stuart C

2013-04-01

Contemporary restorative procedures demand precise detail in tooth preparation to achieve optimal results. Inadequate tooth preparation is a frequent cause of failure. This review considers the electric high-speed, high-torque handpiece and how it may assist clinicians in achieving greater accuracy in tooth preparation. The electric handpiece provides a satisfactory alternative to the air-turbine and may be considered by clinicians who wish greater control with operative procedures.

13 CFR 134.217 - Settlement.

Code of Federal Regulations, 2013 CFR

2013-01-01

... authority, under statute, SBA regulation or SBA standard operating procedures, to review the contents of a... 13 Business Credit and Assistance 1 2013-01-01 2013-01-01 false Settlement. 134.217 Section 134.217 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION RULES OF PROCEDURE GOVERNING CASES...

13 CFR 134.217 - Settlement.

Code of Federal Regulations, 2011 CFR

2011-01-01

... authority, under statute, SBA regulation or SBA standard operating procedures, to review the contents of a... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false Settlement. 134.217 Section 134.217 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION RULES OF PROCEDURE GOVERNING CASES...

13 CFR 134.217 - Settlement.

Code of Federal Regulations, 2014 CFR

2014-01-01

... authority, under statute, SBA regulation or SBA standard operating procedures, to review the contents of a... 13 Business Credit and Assistance 1 2014-01-01 2014-01-01 false Settlement. 134.217 Section 134.217 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION RULES OF PROCEDURE GOVERNING CASES...

13 CFR 134.217 - Settlement.

Code of Federal Regulations, 2012 CFR

2012-01-01

... authority, under statute, SBA regulation or SBA standard operating procedures, to review the contents of a... 13 Business Credit and Assistance 1 2012-01-01 2012-01-01 false Settlement. 134.217 Section 134.217 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION RULES OF PROCEDURE GOVERNING CASES...

Implementing an Integrated Commitment Management System at the Savannah River Site Tank Farms

DOE Office of Scientific and Technical Information (OSTI.GOV)

Blanchard, A.

1999-06-16

Recently, the Savannah River Site Tank Farms have been transitioning from pre-1990 Authorization Basis requirements to new 5480.22/.23 requirements. Implementation of the new Authorization Basis has resulted in more detailed requirements, a completely new set of implementing procedures, and the expectation of even more disciplined operations. Key to the success of this implementation has been the development of an Integrated Commitment Management System (ICMS) by Westinghouse Safety Management Solutions. The ICMS has two elements: the Authorization Commitment Matrix (ACM), and a Procedure Consistency Review methodology. The Authorization Commitment Matrix is a linking database, which ties requirements and implementing documents together.more » The associated Procedure Consistency Review process ensures that the procedures to be credited in the ACM do in fact correctly and completely meet all intended commitments. This Integrated Commitment Management System helps Westinghouse Safety Management Solutions and the facility operations and engineering organizations take ownership in the implementation of the requirements that have been developed.« less

Standard operating procedure: implementation, critical analysis, and validation in the Audiology Department at CESTEH/Fiocruz.

PubMed

Freitas, Anelisse Vasco Mascarenhas de; Quixabeiro, Elinaldo Leite; Luz, Geórgia Rosangela Soares; Franco, Viviane Moreira; Santos, Viviane Fontes Dos

2016-01-01

Evaluate three standard operational procedures (SOPs), regarding the application of the brainstem auditory evoked potential (BAEP) test, implemented by the Audiology Department of the Center for Studies in Occupational Health and Human Ecology (CESTEH) through the application of a questionnaire and to verify whether the SOPs are effective and assess the necessity for improvement. The study was conducted in three phases: in the first phase, eight speech-language pathologists and seven physicians, with no experience in BAEP, were instructed to read and perform each SOP, eventually all individuals evaluated the SOPs by responding to a questionnaire; in the second phase, the questionnaires were analyzed and the three SOP texts were reviewed; in the third phase, nine speech-language pathologists and six physicians, also with no experience in BAEP, read and re-evaluated the reviewed SOPs through a questionnaire. In the first phase, difficulties in understanding the texts were found, raising doubts about the procedures; however, every participant was able to perform the procedure as a whole. In the third phase, after the review, all individuals were able to perform the procedures appropriately and continuously without any doubts. The assessment of the SOPs by questionnaires showed the need for adaptation in the texts. After the texts were reviewed according to the suggestions of the health professionals, it was possible to observe that the SOPs assisted in the execution of the task, which was conducted without any difficulties or doubts, being regarded effective and ensuring quality to the service offered.

Surgical manual of the Korean Gynecologic Oncology Group: ovarian, tubal, and peritoneal cancers

PubMed Central

2017-01-01

The Surgery Treatment Modality Committee of the Korean Gynecologic Oncology Group has determined to develop a surgical manual to facilitate clinical trials and to improve communication between investigators by standardizing and precisely describing operating procedures. The literature on anatomic terminology, identification of surgical components, and surgical techniques were reviewed and discussed in depth to develop a surgical manual for gynecologic oncology. The surgical procedures provided here represent the minimum requirements for participating in a clinical trial. These procedures should be described in the operation record form, and the pathologic findings obtained from the procedures should be recorded in the pathologic report form. Here, we describe surgical procedure for ovarian, fallopian tubal, and peritoneal cancers. PMID:27670260

Psychological and Environmental Treatment of Asthma: A Review.

ERIC Educational Resources Information Center

Gray, Steven G.; And Others

Seventy citations (1886-1980) on psychological and environmental treatment of asthma are reviewed. Information is analyzed for the following topics (sample subtopics in parentheses): assessment of asthma (self report, activity restriction, medical examination); behavior therapy (relaxation procedures, biofeedback, operant techniques); dynamic…

40 CFR 307.23 - EPA's review of preauthorization applications.

Code of Federal Regulations, 2010 CFR

2010-07-01

... management, project management, financial management and documentation procedures; (12) Whether the applicant... procedures for oversight and the reporting of project issues and progress; (16) Cooperation of the applicant...(s) is based upon the completion of the project, an operable unit, or a discrete phase of the...

45 CFR 156.715 - Compliance reviews of QHP issuers in Federally-facilitated Exchanges.

Code of Federal Regulations, 2014 CFR

2014-10-01

...'s enrollees; (2) The QHP issuer's policies and procedures, protocols, standard operating procedures... REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Oversight and Financial Integrity Standards for Issuers of...

Reliable assessment of laparoscopic performance in the operating room using videotape analysis.

PubMed

Chang, Lily; Hogle, Nancy J; Moore, Brianna B; Graham, Mark J; Sinanan, Mika N; Bailey, Robert; Fowler, Dennis L

2007-06-01

The Global Operative Assessment of Laparoscopic Skills (GOALS) is a valid assessment tool for objectively evaluating the technical performance of laparoscopic skills in surgery residents. We hypothesized that GOALS would reliably differentiate between an experienced (expert) and an inexperienced (novice) laparoscopic surgeon (construct validity) based on a blinded videotape review of a laparoscopic cholecystectomy procedure. Ten board-certified surgeons actively engaged in the practice and teaching of laparoscopy reviewed and evaluated the videotaped operative performance of one novice and one expert laparoscopic surgeon using GOALS. Each reviewer recorded a score for both the expert and the novice videotape reviews in each of the 5 domains in GOALS (depth perception, bimanual dexterity, efficiency, tissue handling, and overall competence). The scores for the expert and the novice were compared and statistically analyzed using single-factor analysis of variance (ANOVA). The expert scored significantly higher than the novice did in the domains of depth perception (p = .005), bimanual dexterity (p = .001), efficiency (p = .001), and overall competence ( p = .001). Interrater reliability for the reviewers of the novice tape was Cronbach alpha = .93 and the expert tape was Cronbach alpha = .87. There was no difference between the two for tissue handling. The Global Operative Assessment of Laparoscopic Skills is a valid, objective assessment tool for evaluating technical surgical performance when used to blindly evaluate an intraoperative videotape recording of a laparoscopic procedure.

Academic Program Review: Guidelines and Procedures.

ERIC Educational Resources Information Center

State Univ. of New York, Delhi. Agricultural and Technical Coll.

The Academic Program Review system at the State University Agricultural and Technical College at Delhi consists of two phases: preparation of a self-study report by specialized faculty providing instruction in the particular program, and review of the report and program operation by a visiting panel of experts in the field or academic discipline.…

Towards developing standard operating procedures for pre-clinical testing in the mdx mouse model of Duchenne muscular dystrophy

PubMed Central

Grounds, Miranda D.; Radley, Hannah G.; Lynch, Gordon S.; Nagaraju, Kanneboyina; De Luca, Annamaria

2008-01-01

This review discusses various issues to consider when developing standard operating procedures for pre-clinical studies in the mdx mouse model of Duchenne muscular dystrophy (DMD). The review describes and evaluates a wide range of techniques used to measure parameters of muscle pathology in mdx mice and identifies some basic techniques that might comprise standardised approaches for evaluation. While the central aim is to provide a basis for the development of standardised procedures to evaluate efficacy of a drug or a therapeutic strategy, a further aim is to gain insight into pathophysiological mechanisms in order to identify other therapeutic targets. The desired outcome is to enable easier and more rigorous comparison of pre-clinical data from different laboratories around the world, in order to accelerate identification of the best pre-clinical therapies in the mdx mouse that will fast-track translation into effective clinical treatments for DMD. PMID:18499465

Blood loss in the space of Retzius and pelvis with tension-free vaginal tape and trans-obturator tape procedures.

PubMed

Huffaker, R Keith; Copas, Pleas

2006-11-01

The purpose of this study was to evaluate the space of Retzius and pelvis for hematoma formation and blood loss following placement of tension-free vaginal tapes (TVT) and transobturator tapes (TOT). 25 women were examined with ultrasonography on post-operative days one, two, three, four or five. One patient underwent TVT while the other 24 underwent TOT. Additional procedures were performed on most patients. No hematomas or collections of free fluid were identified post-operatively. TVT and TOT procedures are relatively safe procedures. We encountered no vascular complications in this small series of patients. Review of literature has yielded reports of infrequent complications.

40 CFR 63.783 - Standards.

Code of Federal Regulations, 2012 CFR

2012-07-01

... pollution control equipment and monitoring equipment, in a manner consistent with safety and good air... include, but is not limited to, monitoring results, review of operation and maintenance procedures, review... VOHAP-containing materials to and from containers, tanks, vats, drums, and piping systems is conducted...

40 CFR 63.783 - Standards.

Code of Federal Regulations, 2014 CFR

2014-07-01

... pollution control equipment and monitoring equipment, in a manner consistent with safety and good air... include, but is not limited to, monitoring results, review of operation and maintenance procedures, review... VOHAP-containing materials to and from containers, tanks, vats, drums, and piping systems is conducted...

40 CFR 63.783 - Standards.

Code of Federal Regulations, 2013 CFR

2013-07-01

... pollution control equipment and monitoring equipment, in a manner consistent with safety and good air... include, but is not limited to, monitoring results, review of operation and maintenance procedures, review... VOHAP-containing materials to and from containers, tanks, vats, drums, and piping systems is conducted...

24 CFR 572.410 - Environmental procedures and standards.

Code of Federal Regulations, 2012 CFR

2012-04-01

... categorically excluded from environmental review and compliance requirements of the National Environmental... information necessary for it to perform any necessary environmental review of the property (or neighborhood...; (iii) Located near hazardous operations handling fuels or chemicals of an explosive or flammable nature...

24 CFR 572.410 - Environmental procedures and standards.

Code of Federal Regulations, 2014 CFR

2014-04-01

... categorically excluded from environmental review and compliance requirements of the National Environmental... information necessary for it to perform any necessary environmental review of the property (or neighborhood...; (iii) Located near hazardous operations handling fuels or chemicals of an explosive or flammable nature...

24 CFR 572.410 - Environmental procedures and standards.

Code of Federal Regulations, 2011 CFR

2011-04-01

... categorically excluded from environmental review and compliance requirements of the National Environmental... information necessary for it to perform any necessary environmental review of the property (or neighborhood...; (iii) Located near hazardous operations handling fuels or chemicals of an explosive or flammable nature...

24 CFR 572.410 - Environmental procedures and standards.

Code of Federal Regulations, 2010 CFR

2010-04-01

... categorically excluded from environmental review and compliance requirements of the National Environmental... information necessary for it to perform any necessary environmental review of the property (or neighborhood...; (iii) Located near hazardous operations handling fuels or chemicals of an explosive or flammable nature...

24 CFR 572.410 - Environmental procedures and standards.

Code of Federal Regulations, 2013 CFR

2013-04-01

... categorically excluded from environmental review and compliance requirements of the National Environmental... information necessary for it to perform any necessary environmental review of the property (or neighborhood...; (iii) Located near hazardous operations handling fuels or chemicals of an explosive or flammable nature...

MSUSTAT.

ERIC Educational Resources Information Center

Mauriello, David

1984-01-01

Reviews an interactive statistical analysis package (designed to run on 8- and 16-bit machines that utilize CP/M 80 and MS-DOS operating systems), considering its features and uses, documentation, operation, and performance. The package consists of 40 general purpose statistical procedures derived from the classic textbook "Statistical…

40 CFR 160.35 - Quality assurance unit.

Code of Federal Regulations, 2012 CFR

2012-07-01

... standard operating procedures were made without proper authorization and documentation. (6) Review the final study report to assure that such report accurately describes the methods and standard operating... LABORATORY PRACTICE STANDARDS Organization and Personnel § 160.35 Quality assurance unit. (a) A testing...

40 CFR 160.35 - Quality assurance unit.

Code of Federal Regulations, 2010 CFR

2010-07-01

... standard operating procedures were made without proper authorization and documentation. (6) Review the final study report to assure that such report accurately describes the methods and standard operating... LABORATORY PRACTICE STANDARDS Organization and Personnel § 160.35 Quality assurance unit. (a) A testing...

40 CFR 160.35 - Quality assurance unit.

Code of Federal Regulations, 2014 CFR

2014-07-01

... standard operating procedures were made without proper authorization and documentation. (6) Review the final study report to assure that such report accurately describes the methods and standard operating... LABORATORY PRACTICE STANDARDS Organization and Personnel § 160.35 Quality assurance unit. (a) A testing...

40 CFR 160.35 - Quality assurance unit.

Code of Federal Regulations, 2013 CFR

2013-07-01

... standard operating procedures were made without proper authorization and documentation. (6) Review the final study report to assure that such report accurately describes the methods and standard operating... LABORATORY PRACTICE STANDARDS Organization and Personnel § 160.35 Quality assurance unit. (a) A testing...

40 CFR 160.35 - Quality assurance unit.

Code of Federal Regulations, 2011 CFR

2011-07-01

... standard operating procedures were made without proper authorization and documentation. (6) Review the final study report to assure that such report accurately describes the methods and standard operating... LABORATORY PRACTICE STANDARDS Organization and Personnel § 160.35 Quality assurance unit. (a) A testing...

41 CFR 109-1.5303 - Procedures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... a larger assembly, a complex operating system, or an older facility. The review of this property will be completed, prior to disposition, when replacing components or when operating systems and... Section 109-1.5303 Public Contracts and Property Management Federal Property Management Regulations System...

41 CFR 109-1.5303 - Procedures.

Code of Federal Regulations, 2012 CFR

2012-01-01

... a larger assembly, a complex operating system, or an older facility. The review of this property will be completed, prior to disposition, when replacing components or when operating systems and... Section 109-1.5303 Public Contracts and Property Management Federal Property Management Regulations System...

41 CFR 109-1.5303 - Procedures.

Code of Federal Regulations, 2013 CFR

2013-07-01

... a larger assembly, a complex operating system, or an older facility. The review of this property will be completed, prior to disposition, when replacing components or when operating systems and... Section 109-1.5303 Public Contracts and Property Management Federal Property Management Regulations System...

41 CFR 109-1.5303 - Procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... a larger assembly, a complex operating system, or an older facility. The review of this property will be completed, prior to disposition, when replacing components or when operating systems and... Section 109-1.5303 Public Contracts and Property Management Federal Property Management Regulations System...

41 CFR 109-1.5303 - Procedures.

Code of Federal Regulations, 2014 CFR

2014-01-01

... a larger assembly, a complex operating system, or an older facility. The review of this property will be completed, prior to disposition, when replacing components or when operating systems and... Section 109-1.5303 Public Contracts and Property Management Federal Property Management Regulations System...

45 CFR 164.316 - Policies and procedures and documentation requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) of this section for 6 years from the date of its creation or the date when it last was in effect... for implementing the procedures to which the documentation pertains. (iii) Updates (Required). Review documentation periodically, and update as needed, in response to environmental or operational changes affecting...

75 FR 10949 - Energy Conservation Program for Certain Commercial and Industrial Equipment: Test Procedure for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-09

... definitions for key terms. DATES: These test procedures are effective on April 8, 2010. The incorporation by... as of April 8, 2010. ADDRESSES: You may review copies of all materials related to this rulemaking at... supply characteristics, operational test temperatures, instrumentation requirements, setup connections...

Operational health physics.

PubMed

Miller, Kenneth L

2005-06-01

A review of the operational health physics papers published in Health Physics and Operational Radiation Safety over the past fifteen years indicated seventeen general categories or areas into which the topics could be readily separated. These areas include academic research programs, use of computers in operational health physics, decontamination and decommissioning, dosimetry, emergency response, environmental health physics, industrial operations, medical health physics, new procedure development, non-ionizing radiation, radiation measurements, radioactive waste disposal, radon measurement and control, risk communication, shielding evaluation and specification, staffing levels for health physics programs, and unwanted or orphan sources. That is not to say that there are no operational papers dealing with specific areas of health physics, such as power reactor health physics, accelerator health physics, or governmental health physics. On the contrary, there have been a number of excellent operational papers from individuals in these specialty areas and they are included in the broader topics listed above. A listing and review of all the operational papers that have been published is beyond the scope of this discussion. However, a sampling of the excellent operational papers that have appeared in Health Physics and Operational Radiation Safety is presented to give the reader the flavor of the wide variety of concerns to the operational health physicist and the current areas of interest where procedures are being refined and solutions to problems are being developed.

Operational health physics.

PubMed

Miller, Kenneth L

2005-01-01

A review of the operational health physics papers published in Health Physics and Operational Radiation Safety over the past fifteen years indicated seventeen general categories or areas into which the topics could be readily separated. These areas include academic research programs, use of computers in operational health physics, decontamination and decommissioning, dosimetry, emergency response, environmental health physics, industrial operations, medical health physics, new procedure development, non-ionizing radiation, radiation measurements, radioactive waste disposal, radon measurement and control, risk communication, shielding evaluation and specification, staffing levels for health physics programs, and unwanted or orphan sources. That is not to say that there are no operational papers dealing with specific areas of health physics, such as power reactor health physics, accelerator health physics, or governmental health physics. On the contrary, there have been a number of excellent operational papers from individuals in these specialty areas and they are included in the broader topics listed above. A listing and review of all the operational papers that have been published is beyond the scope of this discussion. However, a sampling of the excellent operational papers that have appeared in Health Physics and Operational Radiation Safety is presented to give the reader the flavor of the wide variety of concerns to the operational health physicist and the current areas of interest where procedures are being refined and solutions to problems are being developed.

Human Factors Considerations for Area Navigation Departure and Arrival Procedures

NASA Technical Reports Server (NTRS)

Barhydt, Richard; Adams, Catherine A.

2006-01-01

Area navigation (RNAV) procedures are being implemented in the United States and around the world as part of a transition to a performance-based navigation system. These procedures are providing significant benefits and have also caused some human factors issues to emerge. Under sponsorship from the Federal Aviation Administration (FAA), the National Aeronautics and Space Administration (NASA) has undertaken a project to document RNAV-related human factors issues and propose areas for further consideration. The component focusing on RNAV Departure and Arrival Procedures involved discussions with expert users, a literature review, and a focused review of the NASA Aviation Safety Reporting System (ASRS) database. Issues were found to include aspects of air traffic control and airline procedures, aircraft systems, and procedure design. Major findings suggest the need for specific instrument procedure design guidelines that consider the effects of human performance. Ongoing industry and government activities to address air-ground communication terminology, design improvements, and chart-database commonality are strongly encouraged. A review of factors contributing to RNAV in-service errors would likely lead to improved system design and operational performance.

Structured sedation programs in the emergency department, hospital and other acute settings: protocol for systematic review of effects and events.

PubMed

McCoy, Siobhán; Wakai, Abel; Blackburn, Carol; Barrett, Michael; Murphy, Adrian; Brenner, Maria; Larkin, Philip; Crispino-O'Connell, Gloria; Ratnapalan, Savithiri; O'Sullivan, Ronan

2013-10-01

The use of procedural sedation outside the operating theatre has increased in hospital settings and has gained popularity among non-anesthesiologists. Sedative agents used for procedural pain, although effective, also pose significant risks to the patient if used incorrectly. There is currently no universally accepted program of education for practitioners using or introducing procedural sedation into their practice. There is emerging literature identifying structured procedural sedation programs (PSPs) as a method of ensuring a standardized level of competency among staff and reducing risks to the patient. We hypothesize that programs of education for healthcare professionals using procedural sedation outside the operating theatre are beneficial in improving patient care, safety, practitioner competence and reducing adverse event rates. Electronic databases will be systematically searched for studies (randomized and non-randomized) examining the effectiveness of structured PSPs from 1966 to present. Database searches will be supplemented by contact with experts, reference and citation checking, and a grey literature search. No language restriction will be imposed. Screening of titles and abstracts, and data extraction will be performed by two independent reviewers. All disagreements will be resolved by discussion with an independent third party. Data analysis will be completed adhering to procedures outlined in the Cochrane Handbook of Systematic Reviews of Interventions. If the data allows, a meta-analysis will be performed. This review will cohere evidence on the effectiveness of structured PSPs on sedation events and patient outcomes within the hospital and other acute care settings. In addition, it will examine key components identified within a PSP associated with patient safety and improved patient outcomes. PROSPERO registration number: CRD42013003851.

Retroperitoneal laparoscopic nephrectomy: the effect of the learning curve, and concentrating expertise, on operating times.

PubMed

Skinner, Adrian; Maoate, Kiki; Beasley, Spencer

2010-05-01

Laparoscopic nephrectomy is an accepted alternative to open nephrectomy. We analyzed our first 80 procedures of laparoscopic nephrectomy to evaluate the effect of experience and configuration of service on operative times. A retrospective review of 80 consecutive children who underwent retroperitoneal laparoscopic nephrectomy or heminephrectomy during an 11-year period from 1997 at Christchurch Hospital (Christchurch, New Zealand) was conducted. Operative times, in relation to the experience of the surgeon for this procedure, were analyzed. Four surgeons, assisted by an annually rotating trainee registrar, performed the procedure in 26 girls and 54 boys (range, 8 months to 15 years). Operating times ranged from 38 to 225 minutes (mean, 104). The average operative time fell from 105 to 90 minutes. One surgeon performed 40% of the procedures and assisted with a further 55%. The operative times for all surgeons showed a tendency to reduce, but this was not marked. Most procedures were performed by two surgeons working together, although one surgeon was involved in the majority of cases. The lead surgeon is often assisted by a fellow consultant colleague. Operative times were influenced by experience, but not markedly so. The shorter operative times and minimal "learning curve," compared with other reported series, may, in part, be due to the involvement of two surgeons experienced in laparoscopy for the majority of cases.

Benchmarking surgical incident reports using a database and a triage system to reduce adverse outcomes.

PubMed

Antonacci, Anthony C; Lam, Steven; Lavarias, Valentina; Homel, Peter; Eavey, Roland D

2008-12-01

To study the profile of incidents affecting quality outcomes after surgery by developing a usable operating room and perioperative clinical incident report database and a functional electronic classification, triage, and reporting system. Previously, incident reports after surgery were handled on an individual, episodic basis, which limited the ability to perceive actuarial patterns and meaningfully improve outcomes. Clinical incident reports were experientially generated in the second largest health care system in New York City. Data were entered into a functional classification system organized into 16 categories, and weekly triage meetings were held to electronically review and report summaries on 40 to 60 incident reports per week. System development and deployment reviewed 1041 reports after 19,693 operative procedures. During the next 4 years, 3819 additional reports were generated from 83,988 operative procedures and were reported electronically to the appropriate departments. Number of incident reports generated annually. A significant decrease in volume-adjusted clinical incident reports occurred (from 53 to 39 reports per 1000 procedures) from 2001 to 2005 (P < .001). Reductions in incident reports were observed for ambulatory conversions (74% reduction), wasted implants (65%), skin breakdown (64%), complications in the operating room (42%), laparoscopic conversions (32%), and cancellations (23%) as a result of data-focused process and clinical interventions. Six of 16 categories of incident reports accounted for more than 88% of all incident reports. These data suggest that effective review, communication, and summary feedback of clinical incident reports can produce a statistically significant decrease in adverse outcomes.

Concurrent orthopedic and neurosurgical procedures in pediatric patients with spinal deformity.

PubMed

Mooney, James F; Glazier, Stephen S; Barfield, William R

2012-11-01

The management of pediatric patients with complex spinal deformity often requires both an orthopedic and a neurosurgical intervention. The reasons for multiple subspecialty involvement include, but are not limited to, the presence of a tethered cord requiring release or a syrinx requiring decompression. It has been common practice to perform these procedures in a staged manner, although there is little evidence in the literature to support separate interventions. We reviewed a series of consecutive patients who underwent spinal deformity correction and a neurosurgical intervention concurrently in an attempt to assess the safety, efficacy, and possible complications associated with such an approach. Eleven patients were reviewed who underwent concurrent orthopedic and neurosurgical procedures. Data were collected for patient demographics, preoperative diagnosis, procedures performed, intraoperative and perioperative complications, as well as any unexpected return to the operating room for any reason. Operative notes and anesthesia records were reviewed to determine estimated blood loss, surgical time, and the use of intraoperative neurological monitoring. Patient diagnoses included myelodysplasia (N=6), congenital scoliosis and/or kyphosis (N=4), and scoliosis associated with Noonan syndrome (N=1). Age at the time of surgery averaged 9 years 2 months (range=14 months to 17 years 2 months). Estimated blood loss averaged 605 ml (range=50-3000 ml). The operative time averaged 313 min (range=157-477 min). There were no intraoperative complications, including incidental dural tears or deterioration in preoperative neurological status. One patient developed a sore associated with postoperative cast immobilization that led to a deep wound infection. It appears that concurrent orthopedic and neurosurgical procedures in pediatric patients with significant spinal deformities can be performed safely and with minimal intraoperative and postoperative complications when utilizing modern surgical and neuromonitoring techniques. Level of evidence=Level IV. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Robotic inspection for vehicle-borne contraband

NASA Astrophysics Data System (ADS)

Witus, Gary; Gerhart, Grant; Smuda, W.; Andrusz, H.

2006-05-01

Vehicle-borne smuggling is widespread because of the availability, flexibility and capacity of the cars and trucks. Inspecting vehicles at border crossings and checkpoints are key security elements. At the present time, most vehicle security inspections at home and abroad are conducted manually. Remotely operated vehicle inspection robots could be integrated into the operating procedures to improve throughput while reducing the workload burden on security personnel. The robotic inspection must be effective at detecting contraband and efficient at clearing the "clean" vehicles that make up the bulk of the traffic stream, while limiting the workload burden on the operators. In this paper, we present a systems engineering approach to robotic vehicle inspection. We review the tactics, techniques and procedures to interdict contraband. We present an operational concept for robotic vehicle inspection within this framework, and identify needed capabilities. We review the technologies currently available to meet these needs. Finally, we summarize the immediate potential and R&D challenges for effective contraband detection robots.

Medical Operations Support for ISS Operations - The Role of the BME Operations Team Leads

NASA Technical Reports Server (NTRS)

Janney, Rob; Sabatier, Veronica

2010-01-01

This slide presentation reviews the role of the biomedical flight controllers (BMEs), and BME Operations Team Leads (OTLs) in providing medical support for personnel on the International Space Station. This presentation will concentrate on role of the BME OTLs, who provide the integration function across the integration function across all Crew Health Care System (CHeCS) disciplines for operational products and medical procedures.

Patients with single ventricle physiology undergoing noncardiac surgery are at high risk for adverse events.

PubMed

Brown, Morgan L; DiNardo, James A; Odegard, Kirsten C

2015-08-01

Patients with single ventricle physiology are at increased anesthetic risk when undergoing noncardiac surgery. To review the outcomes of anesthetics for patients with single ventricle physiology undergoing noncardiac surgery. This study is a retrospective chart review of all patients who underwent a palliative procedure for single ventricle physiology between January 1, 2007 and January 31, 2014. Anesthetic and surgical records were reviewed for noncardiac operations that required sedation or general anesthesia. Any noncardiac operation occurring prior to completion of a bidirectional Glenn procedure was included. Diagnostic procedures, including cardiac catheterization, insertion of permanent pacemaker, and procedures performed in the ICU, were excluded. During the review period, 417 patients with single ventricle physiology had initial palliation. Of these, 70 patients (16.7%) underwent 102 anesthetics for 121 noncardiac procedures. The noncardiac procedures included line insertion (n = 23); minor surgical procedures such as percutaneous endoscopic gastrostomy or airway surgery (n = 38); or major surgical procedures including intra-abdominal and thoracic operations (n = 41). These interventions occurred on median day 60 of life (1-233 days). The procedures occurred most commonly in the operating room (n = 79, 77.5%). Patients' median weight was 3.4 kg (2.4-15 kg) at time of noncardiac intervention. In 102 anesthetics, 26 patients had an endotracheal tube or tracheostomy in situ, 57 patients underwent endotracheal intubation, and 19 patients had a natural or mask airway. An intravenous induction was performed in 77 anesthetics, an inhalational induction in 17, and a combination technique in 8. The median total anesthetic time was 126 min (14-594 min). In 22 anesthetics (21.6%), patients were on inotropic support upon arrival; an additional 24 patients required inotropic support (23.5%), of which dopamine was the most common medication. There were 10 intraoperative adverse events (9.8%) including: arrhythmias requiring treatment (n = 4), conversion from sedation to a general anesthetic (n = 2), difficult airway (n = 1), inadvertent extubation with desaturation and bradycardia (n = 1), hypotension and desaturation (n = 1), and cardiac arrest (n = 1). Postoperative events (<48 h) included ST segment changes requiring cardiac catheterization (n = 1), and cardiorespiratory arrest (n = 1). Age, size, gender, type of cardiac palliation, patient location, procedure location, and type of procedure were not associated with adverse outcome. After 62 anesthetics (60.8%), patients went postoperatively to the cardiac ICU. There were no deaths at 48 h. We observed no mortality during or after noncardiac surgery in a high-risk subgroup of palliated cardiac patients with single ventricle physiology. However, 11.8% of patients had an adverse event associated with their anesthetic. © 2015 John Wiley & Sons Ltd.

A Study to Determine the Cost of Quality Assurance to the Department of Surgery at US Army Medical Department Activity. Fort Benning, Georgia

DTIC Science & Technology

1984-07-01

to make maximum use of available time. General Surgery averaged ninety-six operative procedures per month during 1983, ophthalmology averaged fifteen...health care providers 2. Document evaluation of: a) Surgical care review (tissue review) b) Blood utilization c) Antibiotics utilization d) Pharmacy and...21. Number Surgical Procedures Performed 470 470 on Patients Undergoing all Types of Surgery APPENDIX L EXAMPLES OF AUDIT CRITERIA 103 SERVICE MONTH

Risks and Complications of Coronary Angiography: A Comprehensive Review

PubMed Central

Tavakol, Morteza; Ashraf, Salman; Brener, Sorin J.

2012-01-01

Coronary angiography and heart catheterization are invaluable tests for the detection and quantification of coronary artery disease, identification of valvular and other structural abnormalities, and measurement of hemodynamic parameters. The risks and complications associated with these procedures relate to the patient’s concomitant conditions and to the skill and judgment of the operator. In this review, we examine in detail the major complications associated with invasive cardiac procedures and provide the reader with a comprehensive bibliography for advanced reading. PMID:22980117

The environmental analysis of helicopter operations by Federal agencies: Current procedures and research needs

NASA Technical Reports Server (NTRS)

Smith, C. C.; Warner, D. B.; Dajani, J. S.

1977-01-01

The technical, economic, and environmental problems restricting commercial helicopter passenger operations are reviewed. The key considerations for effective assessment procedures are outlined and a preliminary model for the environmental analysis of helicopters is developed. It is recommended that this model, or some similar approach, be used as a common base for the development of comprehensive environmental assessment methods for each of the federal agencies concerned with helicopters. A description of the critical environmental research issues applicable to helicopters is also presented.

The feasibility, safety and outcomes of laparoscopic re-operation for achalasia.

PubMed

James, David R C; Purkayastha, Sanjay; Aziz, Omer; Amygdalos, Iakovos; Darzi, Ara W; Hanna, George B; Zacharakis, Emmanouil

2012-05-01

Heller myotomy for achalasia is associated with a recurrence rate of around 10%, thus reoperative surgery is often necessitated. This paper aims to review the available literature on laparoscopic reoperation for achalasia in order to assess its feasibility and effectiveness. A Medline, Embase, Ovid, Cochrane database and Google(TM) Scholar search was performed with the following Mesh terms: "laparoscopic", "redo", "reoperative", "Heller's", "esophagomyotomy" and "achalasia". Outcomes of interest included patient demographics and details of primary procedure, operative details, intra- and post operative complications and symptom scores. Seven studies reported outcomes from 54 cases. Conversion occurred in 7% (4/54) of cases. Thirteen percent (7/54) of patients sustained intra-operative gastric or oesophageal perforation; however these were all noted and repaired intra-operatively leading to no subsequent morbidity. No deaths were reported. Pre- and post operative symptom scores were heterogeneous, however did appear to improve after the procedure. This review demonstrates that laparoscopic reoperation for achalasia is feasible and safe with complication rates comparable to the primary laparoscopic operation. It is recommended that laparoscopic reoperative Heller's myotomy should only be performed by surgeons with special interest in oesophagogastric surgery and adequate experience in laparoscopic surgery for achalasia.

A national review of the frequency of minimally invasive surgery among general surgery residents: assessment of ACGME case logs during 2 decades of general surgery resident training.

PubMed

Richards, Morgan K; McAteer, Jarod P; Drake, F Thurston; Goldin, Adam B; Khandelwal, Saurabh; Gow, Kenneth W

2015-02-01

Minimally invasive surgery (MIS) has created a shift in how many surgical diseases are treated. Examining the effect on resident operative experience provides valuable insight into trends that may be useful for restructuring the requirements of resident training. To evaluate changes in general surgery resident operative experience regarding MIS. Retrospective review of the frequency of MIS relative to open operations among general surgery residents using the Accreditation Council for Graduate Medical Education case logs for academic years 1993-1994 through 2011-2012. General surgery residency training among accredited programs in the United States. We analyzed the difference in the mean number of MIS techniques and corresponding open procedures across training periods using 2-tailed t tests with statistical significance set at P < .05. Of 6,467,708 operations with the option of MIS, 2,393,030 (37.0%) were performed with the MIS approach. Of all MIS operations performed, the 5 most common were cholecystectomy (48.5%), appendectomy (16.2%), groin hernia repair (10.0%), abdominal exploration (nontrauma) (4.4%), and antireflux procedures (3.6%). During the study period, there was a transition from a predominantly open to MIS approach for appendectomy, antireflux procedures, thoracic wedge resection, and partial gastric resection. Cholecystectomy is the only procedure for which MIS was more common than the open technique throughout the study period (P < .001). The open approach is more common for all other procedures, including splenectomy (0.7% MIS), common bile duct exploration (24.9% MIS), gastrostomy (25.9% MIS), abdominal exploration (33.1% MIS), hernia (20.3% MIS), lung resection (22.3% MIS), partial or total colectomy (39.1%), enterolysis (19.0% MIS), ileostomy (9.0% MIS), enterectomy (5.2% MIS), vagotomy (1.8% MIS), and pediatric antireflux procedures (35.9% MIS); P < .001. Minimally invasive surgery has an increasingly prominent role in contemporary surgical therapy for many common diseases. The open approach, however, still predominates in all but 5 procedures. Residents today must become efficient at performing multiple techniques for a single procedure, which demands a broader skill set than in the past.

Advanced laparoscopic bariatric surgery Is safe in general surgery training.

PubMed

Kuckelman, John; Bingham, Jason; Barron, Morgan; Lallemand, Michael; Martin, Matthew; Sohn, Vance

2017-05-01

Bariatric surgery makes up an increasing percentage of general surgery training. The safety of resident involvement in these complex cases has been questioned. We evaluated patient outcomes in resident performed laparoscopic bariatric procedures. Retrospective review of patients undergoing a laparoscopic bariatric procedure over seven years at a tertiary care single center. Procedures were primarily performed by a general surgery resident and proctored by an attending surgeon. Primary outcomes included operative volume, operative time and leak rate with perioperative outcomes evaluated as secondary outcomes. A total of 1649 bariatric procedures were evaluated. Operations included laparoscopic bypass (690) and laparoscopic sleeve gastrectomy (959). Average operating time was 136 min. Eighteen leaks (0.67%) were identified. Graduating residents performed an average of 89 laparoscopic bariatric cases during their training. There were no significant differences between resident levels with concern to operative time or leak rate (p 0.97 and p = 0.54). General surgery residents can safely perform laparoscopic bariatric surgery. When proctored by a staff surgeon, a resident's level of training does not significantly impact leak rate. Published by Elsevier Inc.

Reversal of Hartmann's procedure: a high-risk operation?

PubMed

Schmelzer, Thomas M; Mostafa, Gamal; Norton, H James; Newcomb, William L; Hope, William W; Lincourt, Amy E; Kercher, Kent W; Kuwada, Timothy S; Gersin, Keith S; Heniford, B Todd

2007-10-01

Patients who undergo Hartmann's procedure often do not have their colostomy closed based on the perceived risk of the operation. This study evaluated the outcome of reversal of Hartmann's procedure based on preoperative risk factors. We retrospectively reviewed adult patients who underwent reversal of Hartmann's procedure at our tertiary referral institution. Patient outcomes were compared based on identified risk factors (age >60 years, American Society of Anesthesiologists [ASA] score >2, and >2 preoperative comorbidities). One-hundred thirteen patients were included. Forty-four patients (39%) had an ASA score of >or=3. The mean hospital duration of stay was 6.8 days. There were 28 (25%) postoperative complications and no mortality. Patients >60 years old had significantly longer LOS compared with the rest of the group (P = .02). There were no differences in outcomes between groups based on ASA score or the presence of multiple preoperative comorbidities. An albumin level of <3.5 was the only significant predictor of postoperative complications (P = .04). The reversal of Hartmann's operation appears to be a safe operation with acceptable morbidity rates and can be considered in patients, including those with significant operative risk factors.

Perioperative Management of Sickle Cell Disease

PubMed Central

Adjepong, Kwame Ofori; Otegbeye, Folashade

2018-01-01

Over 30 million people worldwide have sickle cell disease (SCD). Emergent and non-emergent surgical procedures in SCD have been associated with relatively increased risks of peri-operative mortality, vaso-occlusive (painful) crisis, acute chest syndrome, post-operative infections, congestive heart failure, cerebrovascular accident and acute kidney injury. Pre-operative assessment must include a careful review of the patient’s known crisis triggers, baseline hematologic profile, usual transfusion requirements, pre-existing organ dysfunction and opioid use. Use of preoperative blood transfusions should be selective and decisions individualized based on the baseline hemoglobin, surgical procedure and anticipated volume of blood loss. Intra- and post-operative management should focus on minimizing hypoxia, hypothermia, acidosis, and intravascular volume depletion. Pre- and post-operative incentive spirometry use should be encouraged. PMID:29755709

Perioperative Management of Sickle Cell Disease.

PubMed

Adjepong, Kwame Ofori; Otegbeye, Folashade; Adjepong, Yaw Amoateng

2018-01-01

Over 30 million people worldwide have sickle cell disease (SCD). Emergent and non-emergent surgical procedures in SCD have been associated with relatively increased risks of peri-operative mortality, vaso-occlusive (painful) crisis, acute chest syndrome, post-operative infections, congestive heart failure, cerebrovascular accident and acute kidney injury. Pre-operative assessment must include a careful review of the patient's known crisis triggers, baseline hematologic profile, usual transfusion requirements, pre-existing organ dysfunction and opioid use. Use of preoperative blood transfusions should be selective and decisions individualized based on the baseline hemoglobin, surgical procedure and anticipated volume of blood loss. Intra- and post-operative management should focus on minimizing hypoxia, hypothermia, acidosis, and intravascular volume depletion. Pre- and post-operative incentive spirometry use should be encouraged.

Surgical manual of the Korean Gynecologic Oncology Group: classification of hysterectomy and lymphadenectomy

PubMed Central

Choi, Chel Hun; Chun, Yi Kyeong

2017-01-01

The Surgery Treatment Modality Committee of the Korean Gynecologic Oncologic Group (KGOG) has determined to develop a surgical manual to facilitate clinical trials and to improve communication between investigators by standardizing and precisely describing operating procedures. The literature on anatomic terminology, identification of surgical components, and surgical techniques were reviewed and discussed in depth to develop a surgical manual for gynecologic oncology. The surgical procedures provided here represent the minimum requirements for participating in a clinical trial. These procedures should be described in the operation record form, and the pathologic findings obtained from the procedures should be recorded in the pathologic report form. Here, we focused on radical hysterectomy and lymphadenectomy, and we developed a KGOG classification for those conditions. PMID:27670259

Surgical manual of the Korean Gynecologic Oncology Group: classification of hysterectomy and lymphadenectomy.

PubMed

Lee, Maria; Choi, Chel Hun; Chun, Yi Kyeong; Kim, Yun Hwan; Lee, Kwang Beom; Lee, Shin Wha; Shim, Seung Hyuk; Song, Yong Jung; Roh, Ju Won; Chang, Suk Joon; Lee, Jong Min

2017-01-01

The Surgery Treatment Modality Committee of the Korean Gynecologic Oncologic Group (KGOG) has determined to develop a surgical manual to facilitate clinical trials and to improve communication between investigators by standardizing and precisely describing operating procedures. The literature on anatomic terminology, identification of surgical components, and surgical techniques were reviewed and discussed in depth to develop a surgical manual for gynecologic oncology. The surgical procedures provided here represent the minimum requirements for participating in a clinical trial. These procedures should be described in the operation record form, and the pathologic findings obtained from the procedures should be recorded in the pathologic report form. Here, we focused on radical hysterectomy and lymphadenectomy, and we developed a KGOG classification for those conditions.

Laparoscopic versus robotic-assisted Roux-en-Y gastric bypass: a retrospective, single-center study of early perioperative outcomes at a community hospital.

PubMed

Ahmad, Arif; Carleton, Jared D; Ahmad, Zoha F; Agarwala, Ashish

2016-09-01

The purpose of this study was to compare the operative and early perioperative outcomes of laparoscopic versus robotic-assisted Roux-en-Y gastric bypass procedures performed in a community hospital setting. The study was a chart review and analysis of the early perioperative outcomes of a total of 345 Roux-en-Y gastric bypass procedures performed by a single surgeon in a community hospital setting from January 2011 to October 2014. Of these, 173 procedures were performed laparoscopically and 172 were performed with robotic assistance utilizing the daVinci(®) surgical platform. Factors such as baseline patient characteristics, operative time, estimated blood loss (EBL), conversions to open procedure, complication rates, adverse events, length of stay (LOS), and return to the operating room for the two groups were retrospectively analyzed from a prospectively maintained database. Student's t test with unequal variances was used for statistical analysis, and a p value <0.05 was used for significance. There were no statistically significant differences in complication rates, EBL, or LOS between the two groups. There was a significant difference between the total operative times (135.30 ± 37.60 min for the laparoscopic procedure versus 154.84 ± 38.44 min for the robotic procedure, p < 0.05). There were no adverse intraoperative events, conversions to open procedures, leaks, strictures, returns to the operating room within 30 days, or mortalities in either group. Our study, which is the first of its kind to analyze the operative and early perioperative outcomes between laparoscopic and robotic-assisted Roux-en-Y gastric bypass procedures in the US community hospital setting, indicates that both are comparable in terms of safety, efficacy, and operative and early perioperative outcomes.

Audit of Clinical Coding of Major Head and Neck Operations

PubMed Central

Mitra, Indu; Malik, Tass; Homer, Jarrod J; Loughran, Sean

2009-01-01

INTRODUCTION Within the NHS, operations are coded using the Office of Population Censuses and Surveys (OPCS) classification system. These codes, together with diagnostic codes, are used to generate Healthcare Resource Group (HRG) codes, which correlate to a payment bracket. The aim of this study was to determine whether allocated procedure codes for major head and neck operations were correct and reflective of the work undertaken. HRG codes generated were assessed to determine accuracy of remuneration. PATIENTS AND METHODS The coding of consecutive major head and neck operations undertaken in a tertiary referral centre over a retrospective 3-month period were assessed. Procedure codes were initially ascribed by professional hospital coders. Operations were then recoded by the surgical trainee in liaison with the head of clinical coding. The initial and revised procedure codes were compared and used to generate HRG codes, to determine whether the payment banding had altered. RESULTS A total of 34 cases were reviewed. The number of procedure codes generated initially by the clinical coders was 99, whereas the revised codes generated 146. Of the original codes, 47 of 99 (47.4%) were incorrect. In 19 of the 34 cases reviewed (55.9%), the HRG code remained unchanged, thus resulting in the correct payment. Six cases were never coded, equating to £15,300 loss of payment. CONCLUSIONS These results highlight the inadequacy of this system to reward hospitals for the work carried out within the NHS in a fair and consistent manner. The current coding system was found to be complicated, ambiguous and inaccurate, resulting in loss of remuneration. PMID:19220944

Ghrelin and Metabolic Surgery

PubMed Central

Pournaras, Dimitrios J.; le Roux, Carel W.

2010-01-01

Metabolic surgery is the most effective treatment for morbid obesity. Ghrelin has been implicated to play a role in the success of these procedures. Furthermore, these operations have been used to study the gut-brain axis. This article explores this interaction, reviewing the available data on changes in ghrelin levels after different surgical procedures. PMID:20700402

An introduction to testing techniques in the Intelsat TDMA/DSI system. II - Satellite system operations guide (SSOG) tests

NASA Astrophysics Data System (ADS)

Colby, R. J.; Parthasarathy, R.; Stimson, A. L.

1983-12-01

The test methods and procedures of the Intelsat TDMA/DSI SSOG are summarized. The overall structure of the SSOG is outlined, and the operational procedures to be followed for joining a new terminal to the system and for normal operations are reviewed, with an emphasis on the roles of the IOC and the TDMA reference and monitoring stations. The testing philosophy (based on minimal interruptions) and the star-test method are explained and illustrated with diagrams, and the test procedures are examined, including modem tests, electrical-path-length equalization, RF/IF downchain tests, protocol tests, nontransmitting protocol tests, IF/RF upchain tests, transmitting protocol tests, baseband tests, and orderwire lineups. The fundamental access discipline of the TDMA system is presented in an appendix.

Improving the Level and Quality of Ethics Review in Chinese Medicine and Integrative Medicine.

PubMed

Zhang, Cheng-Bin; Li, En-Chang

2018-04-01

Three features of ethics review in Chinese medicine (CM) and integrative medicine (IM) were put forward in this paper. It is consistent with the principles of ethical review in Western medicine; it has to be compliant with the laws of CM and IM; emphasis should be laid on the review of clinical practice facts and experience. Three problems were pointed out. The characteristics of CM and IM are not distinctive enough, operation procedures need to be refined and effectiveness remains to be improved. Based on the mentioned above, seven measures were proposed to improve the level and quality of ethics review in CM and IM, including better brand awareness, considerable tolerance, treatment based on disease differentiation and syndrome differentiation, scientific review and toxicity and side effects of CM, perfection of the ethics review system, reasonable procedures of ethics review and more specialized ethics review workers.

Systematic review of operative outcomes of robotic surgical procedures performed with endoscopic linear staplers or robotic staplers.

PubMed

Gutierrez, Mario; Ditto, Richard; Roy, Sanjoy

2018-05-09

A comprehensive review of operative outcomes of robotic surgical procedures performed with the da Vinci robotic system using either endoscopic linear staplers (ELS) or robotic staplers is not available in the published literature. We conducted a literature search to identify publications of robotic surgical procedures in all specialties performed with either ELS or robotic staplers. Twenty-nine manuscripts and six abstracts with relevant information on operative outcomes published from January 2011 to September 2017 were identified. Given the relatively recent market release of robotic staplers in 2014, comparative perioperative clinical outcomes data on the performance of ELS vs. robotic staplers in robotic surgery is very sparse in the published literature. Only three comparative studies of surgeries with the da Vinci robotic system plus ELS vs. da Vinci plus robotic staplers were identified; two in robotic colorectal surgery and the other in robotic gastric bypass surgery. These comparative studies illustrate some nuances in device design and usability, which may impact outcomes and cost, and therefore may be important to consider when selecting the appropriate stapling technologies/technique for different robotic surgeries. Comparative perioperative data on the use of ELS vs. robotic staplers in robotic surgery is scarce (three studies), and current literature identifies both types of devices as safe and effective. Given the longer clinical history of ELS and its relatively more robust evidence base, there may be trade-offs to consider before switching to robotic staplers in certain robotic procedures. However, this literature review may serve as an initial reference for future research.

25 CFR 700.823 - Permit reviews and disputes.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES... decision of the Federal Land Manager with respect to the issuance or denial of a permit, the inclusion of... request the Federal Land Manager to review the disputed decision and may request a conference to discuss...

25 CFR 700.823 - Permit reviews and disputes.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES... decision of the Federal Land Manager with respect to the issuance or denial of a permit, the inclusion of... request the Federal Land Manager to review the disputed decision and may request a conference to discuss...

25 CFR 700.823 - Permit reviews and disputes.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES... decision of the Federal Land Manager with respect to the issuance or denial of a permit, the inclusion of... request the Federal Land Manager to review the disputed decision and may request a conference to discuss...

25 CFR 700.823 - Permit reviews and disputes.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES... decision of the Federal Land Manager with respect to the issuance or denial of a permit, the inclusion of... request the Federal Land Manager to review the disputed decision and may request a conference to discuss...

The management of vertebral artery injury in anterior cervical spine operation: a systematic review of published cases.

PubMed

Park, Hyung-Ki; Jho, Hae-Dong

2012-12-01

Anterior cervical spine operations (ACSO) are generally considered to be safe and effective, but the vertebral artery (VA) is at risk during the procedure. Because the consequences of VA injury can be catastrophic, properly managing a VA injury is very important. However, due to the rarity of these injuries, there is no agreed upon treatment strategy. Studies were identified for inclusion in the review via sensitive searches of electronic databases through 31 December 2011. All cases included in the review were qualitatively analyzed to explore the relationship between type of VA injury management and neurological complications. Seventeen articles describing 39 cases of VA injury during ACSO were included in this study. Seven patients (17.9 %) had neurological complications followed by VA insufficiency. Two patients (5.1 %) had root damage due to ligation. One case (2.6 %) resulted in intraoperative death due to fatal bleeding. Delayed vascular complications were identified in nine (45.0 %) of the 20 patients that underwent only tamponade or hemostatic agent during the operation. Four patients underwent intraoperative endovascular treatment, and three of these patients had a cerebral infarction. All three patients who underwent clipping also had neurological complications. The five patients treated by direct repair did not have any complications. Our review suggests the management of VA injury should be considered in order listed: (1) performing tamponade with a hemostatic agent, (2) direct repair, (3) postoperative endovascular procedures to prevent delayed complications. If tamponade fails to achieve proper hemostasis, additional procedures as endovascular embolization, clipping and ligation should be considered but carry the risk of neurological complications. Because of the limitations of this review, further studies are recommended with larger sample sizes.

Short and long-term post-operative outcomes of duodenum preserving pancreatic head resection for chronic pancreatitis affecting the head of pancreas: a systematic review and meta-analysis.

PubMed

Jawad, Zaynab A R; Tsim, Nicole; Pai, Madhava; Bansi, Dev; Westaby, David; Vlavianos, Panagiotis; Jiao, Long R

2016-02-01

To evaluate the short and long term outcomes of duodenum preserving pancreatic head resection (DPPHR) procedures in the treatment of painful chronic pancreatitis. A systematic literature search was performed to identify all comparative studies evaluating long and short term postoperative outcomes (pain relief, morbidity and mortality, pancreatic exocrine and endocrine function). Five published studies fulfilled the inclusion criteria including 1 randomized controlled trial comparing the Beger and Frey procedure. In total, 323 patients underwent surgical procedures for chronic pancreatitis, including Beger (n = 138) and Frey (n = 99), minimal Frey (n = 32), modified Frey (n = 25) and Berne's modification (n = 29). Two studies comparing the Beger and Frey procedure were entered into a meta-analysis and showed no difference in post-operative pain (RD = -0.06; CI -0.21 to 0.09), mortality (RD = 0.01; CI -0.03 to 0.05), morbidity (RD = 0.12; CI -0.00 to 0.24), exocrine insufficiency (RD = 0.04; CI -0.10 to 0.18) and endocrine insufficiency (RD = -0.14 CI -0.28 to 0.01). All procedures are equally effective for the management of pain for chronic pancreatitis. The choice of procedure should be determined by other factors including the presence of secondary complications of pancreatitis and intra-operative findings. Registration number CRD42015019275. Centre for Reviews and Dissemination, University of York, 2009. Copyright © 2015 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Routine use of chest radiographs in the post-operative management of pectus bar removal: necessity or futility.

PubMed

Poola, Ashwini Suresh; Rentea, Rebecca M; Weaver, Katrina L; St Peter, Shawn David

2017-05-01

While there is literature on techniques for pectus bar removal, there are limited reports on post-operative management. This can include obtaining a postoperative chest radiograph (CXR) despite the minimal risk of associated intra-thoracic complications. This is a review of our experience with bar removal and lack of routine post-operative CXR. A single institution retrospective chart review was performed from 2000 to 2015. Patients who underwent a pectus bar removal procedure were included. We assessed operative timing of bar placement and removal, procedure length, intra-operative and post-operative complications and post-operative CXR findings, specifically the rate of pneumothoraces. 450 patients were identified in this study. Median duration of bar placement prior to removal was 35 months (interquartile range 30 and 36 months). Sixtey-four patients obtained a post-operative CXR. Of these, only one (58%) film revealed a pneumothorax; this was not drained. A CXR was not obtained in 386 (86%) patients with no immediate or delayed complications from this practice. Median follow-up time for all patients was 11 months (interquartile range 7.5-17 months). The risk for a clinically relevant pneumothorax is minimal following bar removal. This suggests that not obtaining routine imaging following bar removal may be a safe practice.

User's operating procedures. Volume 2: Scout project financial analysis program

NASA Technical Reports Server (NTRS)

Harris, C. G.; Haris, D. K.

1985-01-01

A review is presented of the user's operating procedures for the Scout Project Automatic Data system, called SPADS. SPADS is the result of the past seven years of software development on a Prime mini-computer located at the Scout Project Office, NASA Langley Research Center, Hampton, Virginia. SPADS was developed as a single entry, multiple cross-reference data management and information retrieval system for the automation of Project office tasks, including engineering, financial, managerial, and clerical support. This volume, two (2) of three (3), provides the instructions to operate the Scout Project Financial Analysis program in data retrieval and file maintenance via the user friendly menu drivers.

Prospective Comparison of Live Evaluation and Video Review in the Evaluation of Operator Performance in a Pediatric Emergency Airway Simulation

PubMed Central

House, Joseph B.; Dooley-Hash, Suzanne; Kowalenko, Terry; Sikavitsas, Athina; Seeyave, Desiree M.; Younger, John G.; Hamstra, Stanley J.; Nypaver, Michele M.

2012-01-01

Introduction Real-time assessment of operator performance during procedural simulation is a common practice that requires undivided attention by 1 or more reviewers, potentially over many repetitions of the same case. Objective To determine whether reviewers display better interrater agreement of procedural competency when observing recorded, rather than live, performance; and to develop an assessment tool for pediatric rapid sequence intubation (pRSI). Methods A framework of a previously established Objective Structured Assessment of Technical Skills (OSATS) tool was modified for pRSI. Emergency medicine residents (postgraduate year 1–4) were prospectively enrolled in a pRSI simulation scenario and evaluated by 2 live raters using the modified tool. Sessions were videotaped and reviewed by the same raters at least 4 months later. Raters were blinded to their initial rating. Interrater agreement was determined by using the Krippendorff generalized concordance method. Results Overall interrater agreement for live review was 0.75 (95% confidence interval [CI], 0.72–0.78) and for video was 0.79 (95% CI, 0.73–0.82). Live review was significantly superior to video review in only 1 of the OSATS domains (Preparation) and was equivalent in the other domains. Intrarater agreement between the live and video evaluation was very good, greater than 0.75 for all raters, with a mean of 0.81 (95% CI, 0.76–0.85). Conclusion The modified OSATS assessment tool demonstrated some evidence of validity in discriminating among levels of resident experience and high interreviewer reliability. With this tool, intrareviewer reliability was high between live and 4-months' delayed video review of the simulated procedure, which supports feasibility of delayed video review in resident assessment. PMID:23997874

Reversal of the Hartmann's procedure: A comparative study of laparoscopic versus open surgery.

PubMed

Melkonian, Ernesto; Heine, Claudio; Contreras, David; Rodriguez, Marcelo; Opazo, Patricio; Silva, Andres; Robles, Ignacio; Rebolledo, Rolando

2017-01-01

The Hartmann's operation, although less frequently performed today, is still used when initial colonic anastomosis is too risky in the short term. However, the subsequent procedure to restore gastrointestinal continuity is associated with significant morbidity and mortality. The review of an institutional review board (IRB)-approved prospectively maintained database provided data on the Hartmann's reversal procedure performed by either laparoscopic or open technique at our institution. The data collected included: demographic data, operative approach, conversion for laparoscopic cases and perioperative morbidity and mortality. Over a 14-year period from January 1997 to August 2011, 74 Hartmann's reversal procedures were performed (laparoscopic surgery-49, open surgery-25). The average age was 55 years for the laparoscopic and 57 years for the open surgery group, respectively. Male patients represent 61% of both groups. There was no significant difference in operative time between the two groups (149 min vs 151 min; P = 0.95), and there was a tendency to lower morbidity (3/49-7.3% vs 4/25-16%; P = 0.24) in the laparoscopic surgery group. In the laparoscopic group, eight patients (16.3%) were converted to open surgery, mostly due to severe adhesions. The length of hospital stay was significantly shorter for the laparoscopic group (5 days vs 7 days; P = 0.44). The Hartmann's reversal procedure can be safely performed in the majority of the cases using a laparoscopic approach with a low morbidity rate and achieving a shorter hospital stay.

Biospecimen Core Resource - TCGA

Cancer.gov

The Cancer Genome Atlas (TCGA) Biospecimen Core Resource centralized laboratory reviews and processes blood and tissue samples and their associated data using optimized standard operating procedures for the entire TCGA Research Network.

A Review Over the Past 15 Years of the Management of the Internal Piriform Apex Sinus Tract of a Branchial Pouch Anomaly and Case Description.

PubMed

Josephson, Gary D; Black, Kaelan

2015-12-01

Literature review of treating the piriform apex sinus tract through microlaryngoscopy and a case description. Fourteen papers were identified in PubMed using the search criteria of piriform sinus fistula, microlaryngoscopic repair, and endoscopy. Institutional Review Board approval was obtained. One hundred forty-five cases including ours were available for review, with 182 procedures. Sixty-two cases were male, 73 female, and 10 genders were not reported. Multiple treatment options were used, including electrocautery, chemocautery, mass excision, fibrin glue, lasers, suture closure, or combination of stated modalities. Of the 182 procedures, 147 procedures were performed endoscopically. There were 37 recurrences (25%). These patients either underwent a repeat endoscopic procedure or an open excision. One hundred and ten (75%) endoscopic procedures were successful. Piriform sinus tract anomalies often present as a mass and recurrent neck infections. This review reveals that treating the internal piriform sinus opening alone can be successful. This procedure has low morbidity, short operative time, and high success. We advocate this approach first with a combined open/laryngoscopic approach for failed cases. To our knowledge, our technique of CO₂laser ablation of the tract followed by suture closure has not been previously described. We believe this to be the first comprehensive review of this topic and the largest series of cases included in a single report. © The Author(s) 2015.

Formalising multidisciplinary peer review: developing a haematological malignancy-specific electronic proforma and standard operating procedure to facilitate procedural efficiency and evidence-based clinical practice.

PubMed

Trotman, Judith; Trinh, Jimmy; Kwan, Yiu Lam; Estell, Jane A; Fletcher, Julie; Archer, Kate; Lee, Kenneth; Foo, Kerwin; Curnow, Jennifer; Bianchi, Alessandra; Wignall, Lynda; Verner, Emma; Gasiorowski, Robin; Siedlecka, Elizabeth; Cunningham, Ilona

2017-05-01

Multidisciplinary team (MDT) meetings aimed at facilitating peer review have become standard practice in oncology. However, there is scant literature on the optimal structure and conduct of such meetings. To develop a process for formal peer review of patients with haematological malignancies and to audit any resulting changes made to the management recommendations of the treating physician. A standard operating procedure (SOP) for MDT meetings was developed essentially to integrate clinical peer review with weekly pathology and radiology meetings. The centrepiece is the electronic submission of a patient-specific proforma (Microsoft InfoPath) prior to the meeting. It serves as the template for presentation, discussion and recording of recommendations and conclusions. The final verified document is stored in the electronic patient record, and a copy is sent to the general practitioner. The proposed management plans were compared to the consensus recommendations of the meeting for the first 4 years since inception. Both SOP and proforma underwent continual improvements. These provided the framework for the conduct of a robust weekly MDT meeting for peer review of the management of patients with haematological malignancies. On 20% of occasions, patient management plans were altered to optimise patient care as a direct consequence on peer review at the MDT. Our streamlined process, in its ultimate format, has provided a mature and efficient forum for formal peer review in a genuine multidisciplinary environment. Both initial data and informal feedback support its ongoing activity as an integral component of delivering quality patient care. © 2016 Royal Australasian College of Physicians.

Effects and Effectiveness of Cavity Disinfectants in Operative Dentistry: A Literature Review.

PubMed

Bin-Shuwaish, Mohammed S

2016-10-01

The degree of success in the elimination of bacteria during cavity preparation and prior to the insertion of a restoration may increase the longevity of the restoration and therefore the success of the restorative procedure. The complete eradication of bacteria in a caries-affected tooth, during cavity preparation, is considered a difficult clinical task. In addition to weakening the tooth structure, attempts to excavate extensive carious tissue completely, by only mechanical procedures, may affect the vitality of the pulp. Therefore, disinfection of the cavity preparation after caries excavation can aid in the elimination of bacterial remnants that can be responsible for recurrent caries, postoperative sensitivity, and failure of the restoration. However, the effects of disinfectants on the restorative treatment have been a major concern for dental clinicians and researchers. This review aims to explore existing literature and provide information about different materials and techniques that have been used for disinfecting cavity preparations and their effects and effectiveness in operative dentistry and, therefore, helps dental practitioners with clinical decision to use cavity disinfectants during restorative procedures. Antimicrobial effectiveness and effects on the pulp and dental restorations, in addition to possible side effects, were all reviewed in this paper.

Adult and pediatric anesthesia/sedation for gastrointestinal procedures outside of the operating room.

PubMed

Michel Foehn, Esther R

2015-08-01

This review presents current trends of safe and efficient anesthesia and sedation for adults and children for gastrointestinal procedures outside of the operating room with a special focus on total intravenous anesthesia (TIVA), target-controlled infusion (TCI), intravenous or topical lidocaine, and the use of the video laryngoscope. The concepts of a well tolerated and adequate anesthesia or sedation for gastrointestinal procedures outside of the operating room have to meet the needs of the adult and pediatric patients and the special requests of the gastroenterologists. Anesthesia and sedation of adults for gastrointestinal procedures with TIVA or TCI and spontaneous breathing is well established. Many institutions perform anesthesia for pediatric patients undergoing gastrointestinal procedures with an inhalational agent, especially in young children and for short procedures. Unlike adults, in young children the airways frequently must be secured with a tracheal tube or laryngeal mask. Respiration may be spontaneous, assisted, or controlled. TIVA and TCI are increasingly chosen for older children and longer procedures. A local anesthetic administered intravenously or topically to the upper airways and the use of the video laryngoscope can facilitate the insertion of the endoscope. Both anesthesiologists and nonanesthesiologists have to achieve a consensus and develop quality-improvement strategies to provide safe and efficient anesthesia and sedation for gastrointestinal procedures outside of the operating room for pediatric and adult patients. Techniques using TIVA, TCI, intravenous or topical application of lidocaine, and the video laryngoscope may improve and facilitate gastrointestinal procedures for the patients, the anesthesiologists, and the gastroenterologists.

In-Office Endoscopic Laryngeal Laser Procedures: A Patient Safety Initiative.

PubMed

Anderson, Jennifer; Bensoussan, Yael; Townsley, Richard; Kell, Erika

2018-05-01

Objective To review complications of in-office endoscopic laryngeal laser procedures after implementation of standardized safety protocol. Methods A retrospective review was conducted of the first 2 years of in-office laser procedures at St Michaels Hospital after the introduction of a standardized safety protocol. The protocol included patient screening, procedure checklist with standardized reporting of processes, medications, and complications. Primary outcomes measured were complication rates of in-office laryngeal laser procedures. Secondary outcomes included hemodynamic changes, local anesthetic dose, laser settings, total laser/procedure time, and incidence of sedation. Results A total of 145 in-office KTP procedures performed on 65 patients were reviewed. In 98% of cases, the safety protocol was fully implemented. The overall complication rate was 4.8%. No major complications were encountered. Minor complications included vasovagal episodes and patient intolerance. The rate of patient intolerance resulting early termination of anticipated procedure was 13.1%. Total local anesthetic dose averaged 172.9 mg lidocaine per procedure. The mean amount of laser energy dispersed was 261.2 J, with mean total procedure time of 48.3 minutes. Sixteen percent of patients had preprocedure sedation. Vital signs were found to vary modestly. Systolic blood pressure was lower postprocedure in 13.8% and symptomatic in 4.1%. Discussion The review of our standardized safety protocol has revealed that in-office laser treatment for laryngeal pathology has extremely low complication rates with safe patient outcomes. Implications for Practice The trend of shifting procedures out of the operating room into the office/clinic setting requires new processes designed to promote patient safety.

Using a 3D CAD plant model to simplify process hazard reviews

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tolpa, G.

A Hazard and Operability (HAZOP) review is a formal predictive procedure used to identify potential hazard and operability problems associated with certain processes and facilities. The HAZOP procedure takes place several times during the life cycle of the facility. Replacing plastic models, layout and detail drawings with a 3D CAD electronic model, provides access to process safety information and a detailed level of plant topology that approaches the visualization capability of the imagination. This paper describes the process that is used for adding the use of a 3D CAD model to flowsheets and proven computer programs for the conduct ofmore » hazard and operability reviews. Using flowsheets and study nodes as a road map for the review the need for layout and other detail drawings is all but eliminated. Using the 3D CAD model again for a post-P and ID HAZOP supports conformance to layout and safety requirements, provides superior visualization of the plant configuration and preserves the owners equity in the design. The response from the review teams are overwhelmingly in favor of this type of review over a review that uses only drawings. Over the long term the plant model serves more than just process hazards analysis. Ongoing use of the model can satisfy the required access to process safety information, OHSA documentation and other legal requirements. In this paper extensive instructions address the logic for the process hazards analysis and the preparation required to assist anyone who wishes to add the use of a 3D model to their review.« less

Roadmap and standard operating procedures for biobanking and discovery of neurochemical markers in ALS.

PubMed

Otto, Markus; Bowser, Robert; Turner, Martin; Berry, James; Brettschneider, Johannes; Connor, James; Costa, Júlia; Cudkowicz, Merit; Glass, Jonathan; Jahn, Olaf; Lehnert, Stefan; Malaspina, Andrea; Parnetti, Lucilla; Petzold, Axel; Shaw, Pamela; Sherman, Alexander; Steinacker, Petra; Süssmuth, Sigurd; Teunissen, Charlotte; Tumani, Hayrettin; Wuolikainen, Anna; Ludolph, Albert

2012-01-01

Despite major advances in deciphering the neuropathological hallmarks of amyotrophic lateral sclerosis (ALS), validated neurochemical biomarkers for monitoring disease activity, earlier diagnosis, defining prognosis and unlocking key pathophysiological pathways are lacking. Although several candidate biomarkers exist, translation into clinical application is hindered by small sample numbers, especially longitudinal, for independent verification. This review considers the potential routes to the discovery of neurochemical markers in ALS, and provides a consensus statement on standard operating procedures that will facilitate multicenter collaboration, validation and ultimately clinical translation.

Review of performance, medical, and operational data on pilot aging issues

NASA Technical Reports Server (NTRS)

Stoklosa, J. H.

1992-01-01

An extensive review of the literature and studies relating to performance, medical, operational, and legal data regarding pilot aging issues was performed in order to determine what evidence there is, if any, to support mandatory pilot retirement. Popular misconceptions about aging, including the failure to distinguish between the normal aging process and disease processes that occur more frequently in older individuals, continue to contribute to much of the misunderstanding and controversy that surround this issue. Results: Review of medical data related to the pilot aging issue indicate that recent improvement in medical diagnostics and treatment technology have made it possible to identify to a high degree individuals who are at risk for developing sudden incapacitating illness and for treating those with disqualifying medical conditions. Performance studies revealed that after controlling for the presence of disease states, older pilots are able to perform as well as younger pilots on many performance tasks. Review of accident data showed that older, healthy pilots do not have higher accident rates than younger pilots, and indeeed, evidence suggests that older pilots have an advantage in the cockpit due to higher experience levels. The Man-Machine-Mission-Environment interface of factors can be managed through structured, supervised, and enhanced operations, maintenance, flight reviews, and safety procedures in order to ensure safe and productive operations by reducing the margin of error and by increasing the margin of safety. Conclusions: There is no evidence indicating any specific age as an arbitrary cut-off point for pilots to perform their fight duties. A combination of regular medical screening, performance evaluation, enhanced operational maintenance, and safety procedures can most effectively ensure a safe pilot population than can a mandatory retirement policy based on arbitrary age restrictions.

Review of CERN Data Centre Infrastructure

NASA Astrophysics Data System (ADS)

Andrade, P.; Bell, T.; van Eldik, J.; McCance, G.; Panzer-Steindel, B.; Coelho dos Santos, M.; Traylen and, S.; Schwickerath, U.

2012-12-01

The CERN Data Centre is reviewing strategies for optimizing the use of the existing infrastructure and expanding to a new data centre by studying how other large sites are being operated. Over the past six months, CERN has been investigating modern and widely-used tools and procedures used for virtualisation, clouds and fabric management in order to reduce operational effort, increase agility and support unattended remote data centres. This paper gives the details on the project's motivations, current status and areas for future investigation.

The double-eyelid operation in Japan: its evolution as related to cultural changes.

PubMed

Shirakabe, Y; Kinugasa, T; Kawata, M; Kishimoto, T; Shirakabe, T

1985-09-01

Of the many aspects of aesthetic surgery, the double-eyelid operation generates the most interest for Japanese surgeons, as there has been an enormous demand for it by patients who are fashion-conscious. It has been possible to locate 32 operative procedures that have been published in the Japanese literature over the past ninety years. Some of these procedures have been reviewed here in relation to the cultural and social changes which are important factors determining the extent of the demand for the operation and which correlate with various changes in surgical technique. This study chronologically describes each of the principal methods related to these social changes and also considers the influence of cultural fads and fashions.

The Utility of Recurrent Laryngeal Nerve Monitoring During Open Pharyngeal Diverticula Procedures.

PubMed

Coughlan, Carolyn A; Verma, Sunil P

2016-08-01

The recurrent laryngeal nerve is at risk of injury during open pharyngeal diverticula operations. The utility of recurrent laryngeal nerve (RLN) monitoring during these procedures was investigated. A retrospective chart review was performed of 8 open pharyngeal diverticulectomies completed between 2009 and 2014. Intraoperative RLN monitoring took place during all operations. Open pharyngectomy and myotomy was successfully performed in all cases. In two cases the RLN was encountered outside of its normal course. The identity of the nerve was confirmed with electrical stimulation and normal EMG response. Vocal fold motion was preserved in all cases. Use of intraoperative nerve monitoring in pharyngeal diverticula procedures may be beneficial, especially during open operations for Killian-Jamieson diverticulum (KJD) and large Zenker diverticulum (ZD), where the RLN is typically encountered outside of its normal course. © The Author(s) 2016.

Chapter 8. Medical procedures. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

PubMed

Zimmerman, Janice L; Sprung, Charles L

2010-04-01

To provide recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza pandemic or mass disaster with a specific focus on ensuring that adequate resources are available and appropriate protocols are developed to safely perform procedures in patients with and without influenza illness. Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including performing medical procedures. Key recommendations include: (1) specify high-risk procedures (aerosol generating-procedures); (2) determine if certain procedures will not be performed during a pandemic; (3) develop protocols for safe performance of high-risk procedures that include appropriateness, qualifications of personnel, site, personal protection equipment, safe technique and equipment needs; (4) ensure adequate training of personnel in high-risk procedures; (5) procedures should be performed at the bedside whenever possible; (6) ensure safe respiratory therapy practices to avoid aerosols; (7) provide safe respiratory equipment; and (8) determine criteria for cancelling and/or altering elective procedures. Judicious planning and adoption of protocols for safe performance of medical procedures are necessary to optimize outcomes during a pandemic.

Highway project cost estimating and management.

DOT National Transportation Integrated Search

2009-02-01

"This report provides detailed information about the project objectives, deliverables, and findings. The project team : thoroughly reviewed the Montana Department of Transportation (MDT) structure, operations, and current procedures as : related to M...

OECHC Program Review Guide. A Manual of Standard Operating Procedures. Revised.

ERIC Educational Resources Information Center

New York State Education Dept. Albany. Office for the Education of Children with Handicapping Conditions.

The program review guide provides a framework and a source of reference for the monitoring staff of the New York State Education Department's Office for Education of Children with Handicapping Conditions. The manual simultaneously provides a means for school districts, the Boards of Cooperative Educational Services, and other agencies to monitor…

47 CFR 76.945 - Procedures for Commission review of basic service rates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... schedule with the Commission within 30 days, with a copy to the local franchising authority. (b) Basic... cable operator and the local franchising authority. The cable operator may file an opposition within... franchising authority. (d) Filings proposing a rate not within the rate regulation standards of §§ 76.922 and...

Ground Operations Aerospace Language (GOAL)

NASA Technical Reports Server (NTRS)

1973-01-01

GOAL, is a test engineer oriented language designed to be used to standardize procedure terminology and as the test programming language to be used for ground checkout operations in a space vehicle launch environment. The material presented concerning GOAL includes: (1) a historical review, (2) development objectives and requirements, (3) language scope and format, and (4) language capabilities.

Use of National Burden to Define Operative Emergency General Surgery.

PubMed

Scott, John W; Olufajo, Olubode A; Brat, Gabriel A; Rose, John A; Zogg, Cheryl K; Haider, Adil H; Salim, Ali; Havens, Joaquim M

2016-06-15

Emergency general surgery (EGS) represents 11% of surgical admissions and 50% of surgical mortality in the United States. However, there is currently no established definition of the EGS procedures. To define a set of procedures accounting for at least 80% of the national burden of operative EGS. A retrospective review was conducted using data from the 2008-2011 National Inpatient Sample. Adults (age, ≥18 years) with primary EGS diagnoses consistent with the American Association for the Surgery of Trauma definition, admitted urgently or emergently, who underwent an operative procedure within 2 days of admission were included in the analyses. Procedures were ranked to account for national mortality and complication burden. Among ranked procedures, contributions to total EGS frequency, mortality, and hospital costs were assessed. The data query and analysis were performed between November 15, 2015, and February 16, 2016. Overall procedure frequency, in-hospital mortality, major complications, and inpatient costs calculated per 3-digit International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. The study identified 421 476 patient encounters associated with operative EGS, weighted to represent 2.1 million nationally over the 4-year study period. The overall mortality rate was 1.23% (95% CI, 1.18%-1.28%), the complication rate was 15.0% (95% CI, 14.6%-15.3%), and mean cost per admission was $13 241 (95% CI, $12 957-$13 525). After ranking the 35 procedure groups by contribution to EGS mortality and morbidity burden, a final set of 7 operative EGS procedures were identified, which collectively accounted for 80.0% of procedures, 80.3% of deaths, 78.9% of complications, and 80.2% of inpatient costs nationwide. These 7 procedures included partial colectomy, small-bowel resection, cholecystectomy, operative management of peptic ulcer disease, lysis of peritoneal adhesions, appendectomy, and laparotomy. Only 7 procedures account for most admissions, deaths, complications, and inpatient costs attributable to the 512 079 EGS procedures performed in the United States each year. National quality benchmarks and cost reduction efforts should focus on these common, complicated, and costly EGS procedures.

Generalized peritonitis due to perforated diverticulitis: Hartmann's procedure or primary anastomosis?

PubMed

Trenti, Loris; Biondo, Sebastiano; Golda, Thomas; Monica, Millan; Kreisler, Esther; Fraccalvieri, Domenico; Frago, Ricardo; Jaurrieta, Eduardo

2011-03-01

Hartmann's procedure (HP) still remains the most frequently performed procedure for diffuse peritonitis due to perforated diverticulitis. The aims of this study were to assess the feasibility and safety of resection with primary anastomosis (RPA) in patients with purulent or fecal diverticular peritonitis and review morbidity and mortality after single stage procedure and Hartmann in our experience. From January 1995 through December 2008, patients operated for generalized diverticular peritonitis were studied. Patients were classified into two main groups: RPA and HP. A total of 87 patients underwent emergency surgery for diverticulitis complicated with purulent or diffuse fecal peritonitis. Sixty (69%) had undergone HP while RPA was performed in 27 patients (31%). At the multivariate analysis, RPA was associated with less post-operative complications (P < 0.05). Three out of the 27 patients with RPA (11.1%) developed a clinical anastomotic leakage and needed re-operation. RPA can be safely performed without adding morbidity and mortality in cases of diffuse diverticular peritonitis. HP should be reserved only for hemodynamically unstable or high-risk patients. Specialization in colorectal surgery improves mortality and raises the percentage of one-stage procedures.

Digital I and C system upgrade integration technique

DOE Office of Scientific and Technical Information (OSTI.GOV)

Huang, H. W.; Shih, C.; Wang, J. R.

2012-07-01

This work developed an integration technique for digital I and C system upgrade, the utility can replace the I and C systems step by step systematically by this method. Inst. of Nuclear Energy Research (INER) developed a digital Instrumentation and Control (I and C) replacement integration technique on the basis of requirement of the three existing nuclear power plants (NPPs), which are Chin-Shan (CS) NPP, Kuo-Sheng (KS) NPP, and Maanshan (MS) NPP, in Taiwan, and also developed the related Critical Digital Review (CDR) Procedure. The digital I and C replacement integration technique includes: (I) Establishment of Nuclear Power Plant Digitalmore » Replacement Integration Guideline, (2) Preliminary Investigation on I and C System Digitalization, (3) Evaluation on I and C System Digitalization, and (4) Establishment of I and C System Digitalization Architectures. These works can be a reference for performing I and C system digital replacement integration of the three existing NPPs of Taiwan Power Company (TPC). A CDR is the review for a critical system digital I and C replacement. The major reference of this procedure is EPRI TR- 1011710 (2005) 'Handbook for Evaluating Critical Digital Equipment and Systems' which was published by the Electric Power Research Inst. (EPRI). With this document, INER developed a TPC-specific CDR procedure. Currently, CDR becomes one of the policies for digital I and C replacement in TPC. The contents of this CDR procedure include: Scope, Responsibility, Operation Procedure, Operation Flow Chart, CDR review items. The CDR review items include the comparison of the design change, Software Verification and Validation (SVandV), Failure Mode and Effects Analysis (FMEA), Evaluation of Diversity and Defense-in-depth (D3), Evaluation of Watchdog Timer, Evaluation of Electromagnetic Compatibility (EMC), Evaluation of Grounding for System/Component, Seismic Evaluation, Witness and Inspection, Lessons Learnt from the Digital I and C Failure Events. A solid review can assure the quality of the digital I and C system replacement. (authors)« less

Operative management of chronic pancreatitis: A review.

PubMed

Tillou, John D; Tatum, Jacob A; Jolissaint, Joshua S; Strand, Daniel S; Wang, Andrew Y; Zaydfudim, Victor; Adams, Reid B; Brayman, Kenneth L

2017-08-01

Pain secondary to chronic pancreatitis is a difficult clinical problem to manage. Many patients are treated medically or undergo endoscopic therapy and surgical intervention is often reserved for those who have failed to gain adequate pain relief from a more conservative approach. There have been a number of advances in the operative management of chronic pancreatitis over the last few decades and current therapies include drainage procedures (pancreaticojejunostomy, etc.), resection (pancreticoduodenectomy, etc.) and combined drainage/resection procedures (Frey procedure, etc.). Additionally, many centers currently perform total pancreatectomy with islet autotransplantation, in addition to minimally invasive options that are intended to tailor therapy to individual patients. Operative management of chronic pancreatitis often improves quality of life, and is associated with low rates of morbidity and mortality. The decision as to which procedure is optimal for each patient should be based on a combination of pathologic changes, prior interventions, and individual surgeon and center experience. Copyright © 2017 Elsevier Inc. All rights reserved.

General RMP Guidance - Chapter 6: Prevention Program (Program 2)

EPA Pesticide Factsheets

Sound prevention practices are founded on safety information, hazard review, operating procedures, training, maintenance, compliance audits, and accident investigation. These must be integrated into a risk management system that you implement consistently.

A cost and time analysis of laryngology procedures in the endoscopy suite versus the operating room.

PubMed

Hillel, Alexander T; Ochsner, Matthew C; Johns, Michael M; Klein, Adam M

2016-06-01

To assess the costs, charges, reimbursement, and efficiency of performing awake laryngology procedures in an endoscopy suite (ES) compared with like procedures performed in the operating room (OR). Retrospective review of billing records. Cost, charges, and reimbursements for the hospital, surgeon, and anesthesiologist were compared between ES injection laryngoplasty and laser excision procedures and matched case controls in the OR. Time spent in 1) the preoperative unit, 2) the operating or endoscopy suite, and 3) recovery unit were compared between OR and ES procedures. Hospital expenses were significantly less for ES procedures when compared to OR procedures. Reimbursement was similar for ES and OR injection laryngoplasty, though greater for OR laser excisions. Net balance (reimbursement-expenses) was greater for ES procedures. A predictive model of payer costs over a 3-year period showed similar costs for ES and OR laser procedures and reduced costs for ES compared to OR injection laryngoplasty. Times spent preoperatively and the procedure were significantly less for ES procedures. For individual laryngology procedures, the ES reduces time and costs compared to the OR, increasing otolaryngologist and hospital efficiency. This reveals cost and time savings of ES injection laryngoplasty, which occurs at a similar frequency as OR injection laryngoplasty. Given the increased frequency for ES laser procedures, total costs are similar for ES and OR laser excision of papilloma, which usually require repeated procedures. When regulated office space is unavailable, endoscopy rooms represent an alternative setting for unsedated laryngology procedures. NA Laryngoscope, 126:1385-1389, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Development of an activity-based costing model to evaluate physician office practice profitability.

PubMed

Dugel, Pravin U; Tong, Kuo Bianchini

2011-01-01

Newer treatment regimens for age-related macular degeneration have significantly affected traditional and non-traditional retinal services across all types of practice settings around the country as they seek to find a balance among delivering best patient care, keeping operating costs under control, and maintaining profitability. A systematic retrospective review of a multi-city, multi-physician retinal practice's accounting system to obtain data on revenues, expenses, and profit. Data reviewed were from practice management systems to obtain claims level data on clinical procedures across 7 primary activity centers: non-laser surgery, laser surgery, office visits, optical coherence tomography (OCT), non-OCT diagnostics, drugs and drug injections, and research. All treated patients from a retina practice from January 1, 2005, to December 31, 2007. Retrospective claims data review from a multi-physician retina practice detailing Current Procedural Terminology and Healthcare Common Procedure Coding System procedures performed and billed, submitted charges, allowed charges, and net collections. Analyses were performed by an outside firm and verified by a risk advisory firm. Identifying practice efficiencies/inefficiencies as they relate to patient care. An elaborate analysis using activity-based costing (ABC) showed that increased office visits and OCT and non-OCT diagnostics had a significant negative impact on the practice's profit margins, whereas surgical procedures contributed to the majority of the practice's profit margins because of the lower operating costs associated with surgery. The practice was able to accommodate the demand in patient volume, medical retina services, and medical imaging with the advent of anti-vascular endothelial growth factor therapy and realized a seismic shift in operating costs. The practice attempted to deliver state-of-the-art patient care in a cost-effective manner, yet underwent a significant decline in its financial health. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Data bank has operational impact. Proper peer review can protect hospitals from antitrust and defamation suits.

PubMed

Purtell, D L

1990-11-01

The Health Care Quality Improvement Act of 1986 can help protect medical professionals and healthcare facilities from antitrust and defamation claims and other forms of litigation arising from the peer review process. Some hospitals may need to make major changes in their peer review activity as a result of the act. The healthcare entity, not the physicians involved in peer review, has the burden of complying with the provisions of the act. Failure to comply with the act can lead to loss of immunity from damages, fines, and potential exclusion from the Medicare program. The potential for liability has sparked a need for hospitals to reexamine and possibly reorganize medical staff and update procedures and related governing documents. Healthcare entities may consider changes such as implementing a director of medical affairs function, choosing medical staff for multiple-year terms, and centralizing physician review files. In the 1980s many hospitals created quality assurance and risk management programs. Risk managers need to share data with quality assurance personnel, who must in turn share the information with medical staff involved with credentialing, peer review, and medical affairs management. Legal counsel will need to be familiar with the legalities of the act, as well as the hospital's peer review procedures and operations. General legal counsel should oversee coordination of hospital proceedings and assist in educating staff on the legalities of peer review.

Robotic Whipple Procedure for Pancreatic Cancer: The Moffitt Cancer Center Pathway.

PubMed

Rashid, Omar M; Mullinax, John E; Pimiento, Jose M; Meredith, Kenneth L; Malafa, Mokenge P

2015-07-01

Resection of malignancies in the head and uncinate process of the pancreas (Whipple procedure) using a robotic approach is emerging as a surgical option. Although several case series of the robotic Whipple procedure have been reported, detailed descriptions of operative techniques and a clear pathway for adopting this technology are lacking. We present a focused review of the procedure as it applies to pancreatic cancer and describe our clinical pathway for the robotic Whipple procedure used in pancreatic cancer and review the outcomes of our early experience. A systematic review of the literature is provided, focusing on the indications, variations in surgical techniques, complications, and oncological results of the robotic Whipple procedure. A clinical pathway has been defined for preoperative training of surgeons, the requirements for hospital privileges, patient selection, and surgical techniques for the robotic Whipple procedure. The robotic technique for managing malignant lesions of the pancreas head is safe when following well-established guidelines for adopting the technology. Preliminary data demonstrate that perioperative convalescence may exceed end points when compared with the open technique. The robotic Whipple procedure is a minimally invasive approach for select patients as part of multidisciplinary management of periampullary lesions in tertiary centers where clinicians have developed robotic surgical programs. Prospective trials are needed to define the short- and long-term benefits of the robotic Whipple procedure.

Implicit Memory in Korsakoff’s Syndrome: A Review of Procedural Learning and Priming Studies

PubMed Central

Hayes, Scott M.; Fortier, Catherine B.; Levine, Andrea; Milberg, William P.; McGlinchey, Regina

2013-01-01

Korsakoff’s syndrome (KS) is characterized by dense anterograde amnesia resulting from damage to the diencephalon region, typically resulting from chronic alcohol abuse and thiamine deficiency. This review assesses the integrity of the implicit memory system in KS, focusing on studies of procedural learning and priming. KS patients are impaired on several measures of procedural memory, most likely due to impairment in cognitive functions associated with alcohol-related neural damage outside of the diencephalon. The pattern of performance on tasks of implicit priming suggests reliance on a residual, non-flexible memory operating more or less in an automatic fashion. Our review concludes that whether measures of implicit memory reveal intact or impaired performance in individuals with KS depends heavily on specific task parameters and demands, including timing between stimuli, the specific nature of the stimuli used in a task, and the integrity of supportive cognitive functions necessary for performance. PMID:22592661

Traffic in the operating room: a review of factors influencing air flow and surgical wound contamination.

PubMed

Pokrywka, Marian; Byers, Karin

2013-06-01

Surgical wound contamination leading to surgical site infection can result from disruption of the intended airflow in the operating room (OR). When personnel enter and exit the OR, or create unnecessary movement and traffic during the procedure, the intended airflow in the vicinity of the open wound becomes disrupted and does not adequately remove airborne contaminants from the sterile field. An increase in the bacterial counts of airborne microorganisms is noted during increased activity levels within the OR. Researchers have studied OR traffic and door openings as a determinant of air contamination. During a surgical procedure the door to the operating room may be open as long as 20 minutes out of each surgical hour during critical procedures involving implants. Interventions into limiting excessive movement and traffic in the OR may lead to reductions in surgical site infections in select populations.

Lunar impact: A history of Project Ranger

NASA Technical Reports Server (NTRS)

Hall, R. C.

1977-01-01

Complete history of the Ranger project is provided as a tool for understanding the evolution and operational form of NASA's continuing progress of unmanned space exploration. Basic management techniques, flight operating procedures and technology for NASA's later unmanned lunar and planetary missions were reviewed. Methods for selecting experiments and integrating them with the spacecraft were also investigated.

The Arrival of Robotics in Spine Surgery: A Review of the Literature.

PubMed

Ghasem, Alexander; Sharma, Akhil; Greif, Dylan N; Alam, Milad; Maaieh, Motasem Al

2018-04-18

Systematic Review. The authors aim to review comparative outcome measures between robotic and free-hand spine surgical procedures including: accuracy of spinal instrumentation, radiation exposure, operative time, hospital stay, and complication rates. Misplacement of pedicle screws in conventional open as well as minimally invasive surgical procedures has prompted the need for innovation and allowed the emergence of robotics in spine surgery. Prior to incorporation of robotic surgery in routine practice, demonstration of improved instrumentation accuracy, operative efficiency, and patient safety is required. A systematic search of the PubMed, OVID-MEDLINE, and Cochrane databases was performed for papers relevant to robotic assistance of pedicle screw placement. Inclusion criteria were constituted by English written randomized control trials, prospective and retrospective cohort studies involving robotic instrumentation in the spine. Following abstract, title, and full-text review, 32 articles were selected for study inclusion. Intrapedicular accuracy in screw placement and subsequent complications were at least comparable if not superior in the robotic surgery cohort. There is evidence supporting that total operative time is prolonged in robot assisted surgery compared to conventional free-hand. Radiation exposure appeared to be variable between studies; radiation time did decrease in the robot arm as the total number of robotic cases ascended, suggesting a learning curve effect. Multi-level procedures appeared to tend toward earlier discharge in patients undergoing robotic spine surgery. The implementation of robotic technology for pedicle screw placement yields an acceptable level of accuracy on a highly consistent basis. Surgeons should remain vigilant about confirmation of robotic assisted screw trajectory, as drilling pathways have been shown to be altered by soft tissue pressures, forceful surgical application, and bony surface skiving. However, the effective consequence of robot-assistance on radiation exposure, length of stay, and operative time remains unclear and requires meticulous examination in future studies. 4.

A Case Review Series of Christiana Care Health System's Experience with Negative Pressure Wound Therapy Instillation.

PubMed

Felte, Robert; Gallagher, Kathy E; Tinkoff, Glen H; Cipolle, Mark

2016-11-07

Acute and chronic wounds afflict a multitude of patients to varying degrees. Wound care treatment modalities span the spectrum of technological advancement and with that differ greatly in cost. Negative pressure wound therapy (NPWT) can now be combined with instillation and dwell time (NPWTi-d). This case review series of 11 patients in a community hospital setting provides support for the utilization of NPWTi-d. Additionally, current literature on the use of NPWTi-d in comparison to NPWT will be reviewed.  We highlight three specific cases. The first case is a 16-year-old male who was shot in the left leg. He suffered a pseudoaneurysm and resultant compartment syndrome. This required a fasciotomy and delayed primary closure. To facilitate this, NPWTi-d was employed and resulted in a total of four operative procedures before closure 13 days after admission. Next, a 61-year-old uncontrolled diabetic female presented with necrotizing fasciitis of the lower abdomen and pelvis. She underwent extensive debridement and placement of NPWTi-d with Dakin's solution. A total of four operative procedures were performed including delayed primary closure six days after admission. Finally, a 48-year-old female suffered a crush injury with internal degloving. NPWTi-d with saline was utilized until discharge home on postoperative day 12. NPWTi-d, when compared to NPWT, has been reported to lead to a decrease in time to operative closure, hospital length of stay, as well as operative procedures required. The cost-benefit analysis in one retrospective review noted a $1,400 savings when these factors were taken into account. This mode of wound care therapy has significant benefits that warrant the development of a prospective randomized controlled trial to further define the improvement in quality-of-life provided to the patient and the reduction of potential overall healthcare costs.

The Impact of Maintenance Free Operating Period Approach to Acquisition Approaches, System Sustainment, and Costs

DTIC Science & Technology

2013-01-07

of MFOP principles on processes, procedures , and costs in acquisition planning. It investigates MFOP and reviews the results of a 2005 submarine pilot...approach be a game changer? This paper evaluates the potential impact of MFOP principles on processes, procedures , and costs in acquisition planning. It...elli=lc=_rpfkbpp=C=mr_if`=mlif`v= = - 2 - k^s^i=mlpqdo^ar^qb=p`elli= procedures , and costs in acquisition planning. The scope of the research was to

Evaluating the heat pump alternative for heating enclosed wastewater treatment facilities in cold regions

NASA Astrophysics Data System (ADS)

Martel, C. J.; Phetteplace, G. E.

1982-05-01

This report presents a five-step procedure for evaluating the technical and economic feasibility of using heat pumps to recover heat from treatment plant effluent. The procedure is meant to be used at the facility planning level by engineers who are unfamiliar with this technology. An example of the use of the procedure and general design information are provided. Also, the report reviews the operational experience with heat pumps at wastewater plants located in Fairbanks, Alaska, Madison, Wisconsin, and Wilton, Maine.

A brief history of punctoplasty: the 3-snip revisited.

PubMed

Caesar, R H; McNab, A A

2005-01-01

To determine when and how to perform punctoplasty, review the history, and determine the efficacy of posterior ampullectomy. Retrospective analysis of 53 cases of punctal stenosis, operated by a single surgeon by means of posterior ampullectomy via 3-snips. A review of the history of the procedure from papers found with a Medline search for 1-snip, 2-snip, 3-snip, and punctoplasty. In all, 102 sets of notes were reviewed. The age range was from 9 to 89 years with a mean age of 56 years. A total of 74% of patients were female. We excluded 22 patients who had additional surgery and 16 patients who elected not to have surgery. There was no comment as to success or failure in four sets of notes and seven notes could not be found; these cases were also excluded. Of the remaining 53 patients, success was documented in 49 cases, or 92%. The historical review helps explain the debate about the procedure. The retrospective review confirms that posterior ampullectomy via 3-snips is an effective procedure.

Psychological screening program overview.

PubMed

Wright, Kathleen M; Huffman, Ann H; Adler, Amy B; Castro, Carl A

2002-10-01

This article reviews the literature on health surveillance conducted during military deployments, focusing on models for assessing the impact of operational deployments on peacekeepers. A discussion of the stressors and potential mental health consequences of peacekeeping operations follows with relevant examples of findings from U.S. and international military forces. Psychological screening in different peacekeeping operations conducted in U.S. Army-Europe is reviewed. The review begins with the redeployment screening of military personnel deployed to Bosnia mandated under the Joint Medical Surveillance Program, and continues through the present screening of units deployed to Kosovo. The detailed description of the screening program includes a discussion of procedures and measures and demonstrates the evolution of the program. A summary of key findings from the screening program and a discussion of future research directions are provided.

78 FR 74217 - Reporting and Recordkeeping Requirements Under OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-10

... forms to recent updates in the Lender and Development Company Loan Programs standard operating procedures, designated as SOP 50 10 5 (F). The changes include revisions to the exhibits required to be...

76 FR 59190 - Voluntary Service National Advisory Committee; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-23

...). On October 14, agenda topics will include: Subcommittee reports; review of standard operating procedure revisions; 2013 NAC annual meeting plans; and any new business. No time will be allocated at this...

20 CFR 416.1226 - What is a plan to achieve self-support (PASS)?

Code of Federal Regulations, 2010 CFR

2010-04-01

... include a business plan that defines the business, provides a marketing strategy, details financial data, outlines the operational procedures, and describes the management plan. (d) Your progress will be reviewed...

42 CFR 424.58 - Accreditation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... crosswalk. (iii) A detailed description of the organization's operational processes, including procedures... survey forms, guidelines and instructions to surveyors, quality review processes for deficiencies identified with accreditation requirements, and dispute resolution processes and policies when there is a...

42 CFR 424.58 - Accreditation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... crosswalk. (iii) A detailed description of the organization's operational processes, including procedures... survey forms, guidelines and instructions to surveyors, quality review processes for deficiencies identified with accreditation requirements, and dispute resolution processes and policies when there is a...

42 CFR 424.58 - Accreditation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... crosswalk. (iii) A detailed description of the organization's operational processes, including procedures... survey forms, guidelines and instructions to surveyors, quality review processes for deficiencies identified with accreditation requirements, and dispute resolution processes and policies when there is a...

Retrospective Review of the Anaesthetic Management of Maxillectomies and Mandibulectomies for Benign Tumours in Sub-Saharan Africa.

PubMed

White, Michelle C; Horner, Katherine C; Lai, Peggy S

2016-01-01

Safe anaesthesia is a crucial component of safe surgical care, yet anaesthetic complications are common in resource-limited settings. We describe differences in anaesthetic needs for Mandibulectomy vs. Maxillectomy in three sub-Saharan African countries. Retrospective review of patients undergoing minor Mandibulectomy, major Mandibulectomy, or Maxillectomy in Togo, Guinea and Republic of the Congo. Surgeries were performed on the Africa Mercy, an international non-governmental hospital ship. Primary outcomes were need for advanced airway management and intra-operative blood loss. Secondary outcomes were time under general anaesthesia and hospital length of stay. Multivariate regression determined the association between operation type and each outcome measure. 105 patients were included (25 minor Mandibulectomy, 58 major Mandibulectomy, 22 Maxillectomy procedures). In-hospital mortality was 0%. 44/105 (41.9%) required an advanced airway management technique to achieve intubation, although in all cases this was anticipated prior to the procedure; no differences were noted between surgical procedure (p = 0.72). Operative procedure was a significant risk factor for intra-operative blood loss. Patients undergoing Maxillectomy lost on average 851.5 (413.3, 1289.8, p = 0.0003) mL more blood than patients undergoing minor Mandibulectomy, and 507.3 (150.3, 864.3, p = 0.007) mL more blood than patients undergoing major Mandibulectomy. Patients undergoing Maxillectomy had a significantly higher time under general anaesthesia than those undergoing minor Mandibulectomy. There was no significant difference in hospital length of stay between operation type. Anaesthetic considerations for minor Mandibulectomy, major Mandibulectomy, and Maxillectomy differ with respect to intra-operative blood loss and time under general anaesthesia, but not need for advanced airway management or length of stay. Although advanced airway management was required in 41.9% of patients, there were no unanticipated difficult airways. With appropriate training and resources, safe anaesthesia can be delivered to patients from low-income countries requiring major head and neck surgery.

Retrospective Review of the Anaesthetic Management of Maxillectomies and Mandibulectomies for Benign Tumours in Sub-Saharan Africa

PubMed Central

White, Michelle C.; Horner, Katherine C.; Lai, Peggy S.

2016-01-01

Background Safe anaesthesia is a crucial component of safe surgical care, yet anaesthetic complications are common in resource-limited settings. We describe differences in anaesthetic needs for Mandibulectomy vs. Maxillectomy in three sub-Saharan African countries. Materials and Methods Retrospective review of patients undergoing minor Mandibulectomy, major Mandibulectomy, or Maxillectomy in Togo, Guinea and Republic of the Congo. Surgeries were performed on the Africa Mercy, an international non-governmental hospital ship. Primary outcomes were need for advanced airway management and intra-operative blood loss. Secondary outcomes were time under general anaesthesia and hospital length of stay. Multivariate regression determined the association between operation type and each outcome measure. Results 105 patients were included (25 minor Mandibulectomy, 58 major Mandibulectomy, 22 Maxillectomy procedures). In-hospital mortality was 0%. 44/105 (41.9%) required an advanced airway management technique to achieve intubation, although in all cases this was anticipated prior to the procedure; no differences were noted between surgical procedure (p = 0.72). Operative procedure was a significant risk factor for intra-operative blood loss. Patients undergoing Maxillectomy lost on average 851.5 (413.3, 1289.8, p = 0.0003) mL more blood than patients undergoing minor Mandibulectomy, and 507.3 (150.3, 864.3, p = 0.007) mL more blood than patients undergoing major Mandibulectomy. Patients undergoing Maxillectomy had a significantly higher time under general anaesthesia than those undergoing minor Mandibulectomy. There was no significant difference in hospital length of stay between operation type. Conclusion Anaesthetic considerations for minor Mandibulectomy, major Mandibulectomy, and Maxillectomy differ with respect to intra-operative blood loss and time under general anaesthesia, but not need for advanced airway management or length of stay. Although advanced airway management was required in 41.9% of patients, there were no unanticipated difficult airways. With appropriate training and resources, safe anaesthesia can be delivered to patients from low-income countries requiring major head and neck surgery. PMID:27788172

Real Time Maintenance Approval and Required IMMT Coordination

NASA Technical Reports Server (NTRS)

Burchell, S.

2016-01-01

Payloads are assessed for nominal operations. Payload Developers have the option of performing a maintenance hazard assessment (MHA) for potential maintenance activities. When POIC (Payload Operations and Integration Center) Safety reviews an OCR calling for a maintenance procedure, we cannot approve it without a MHA. If no MHA exists, we contact MER (Mission Evaluation Room) Safety. Depending on the nature of the problem, MER Safety has the option to: Analyze and grant approval themselves; Direct the payload back to the ISRP (Integrated Safety Review Panel); Direct the payload to the IMMT (Increment Mission Management Team).

The effect of video review of resident laparoscopic surgical skills measured by self- and external assessment

PubMed Central

Herrera-Almario, Gabriel E.; Kirk, Katherine; Guerrero, Veronica T.; Jeong, Kwonho; Kim, Sara; Hamad, Giselle G.

2015-01-01

Background Video review of surgical skills is an educational modality that allows trainees to reflect on self-performance. The purpose of this study was to determine whether resident and attending assessments of a resident’s laparoscopic performance differ and whether video review changes assessments. Methods Third-year surgery residents were invited to participate. Elective laparoscopic procedures were video-recorded. The Global Operative Assessment of Laparoscopic Skills evaluation was completed immediately after the procedure and again 7–10 days later by both resident and attending. Scores were compared using t- tests. Results Nine residents participated and 76 video reviews were completed. Residents scored themselves significantly lower than the faculty scores both prior to and after video review. Resident scores did not change significantly after video review. Conclusions Attending and resident self-assessment of laparoscopic skills differ and subsequent video review doesn’t significantly affect GOALS scores. Further studies should evaluate the impact of video review combined with verbal feedback on skill acquisition and assessment. PMID:26590043

A tiered quality assurance review process for clinical data management standard operating procedures in an academic health center.

PubMed

Ittenbach, Richard F; Baker, Cynthia L; Corsmo, Jeremy J

2014-05-01

Standard operating procedures (SOPs) were once considered the province of the pharmaceutical industry but are now viewed as a key component of quality assurance programs. To address variability and increase the rigor of clinical data management (CDM) operations, the Cincinnati Children's Hospital Medical Center (CCHMC) decided to create CDM SOPs. In response to this challenge, and as part of a broader institutional initiative, the CCHMC leadership established an executive steering committee to oversee the development and implementation of CDM SOPs. This resulted in the creation of a quality assurance review process with three review panels: an SOP development team (16 clinical data managers and technical staff members), a faculty review panel (8 senior faculty and administrators), and an expert advisory panel (3 national CDM experts). This innovative, tiered review process helped ensure that the new SOPs would be created and implemented in accord with good CDM practices and standards. Twelve fully vetted, institutionally endorsed SOPs and one CDM template resulted from the intensive, iterative 10-month process (December 2011 to early October 2012). Phased implementation, which incoporated the CDM SOPs into the existing audit process for certain types of clinical research studies, was on schedule at the time of this writing. Once CCHMC researchers have had the opportunity to use the SOPs over time and across a broad range of research settings and conditions, the SOPs will be revisited and revalidated.

Report on the oversight assessment of the operational readiness review of the Replacement Tritium Facility at Savannah River Site

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, B.T.

1993-03-01

This report presents the results of an oversight assessment (OA) conducted by the US Department of Energy's (DOE) Office of Environment, Safety and Health (EH) of operational readiness review (ORR) activities for the Replacement Tritium Facility (RTF) located at Savannah River Site (SRS). The EH OA of this facility took place concurrently with an ORR conducted by the DOE Office of Defense Programs (DP). The DP ORR was conducted from January 19 through February 5, 1993. The EH OA was performed in accordance with the protocol and procedures specified in EH Program for Oversight Assessment of Operational Readiness Evaluations formore » Startups and Restarts,'' dated September 15, 1992. The EH OA Team evaluated the DP ORR to determine whether it was thorough and demonstrated sufficient inquisitiveness to verify that the implementation of programs and procedures adequately ensures the protection of worker safety and health. The EH OA Team performed its evaluation of the DP ORR in the following technical areas: occupational safety, industrial hygiene, and respiratory protection; fire protection; and chemical safety. In the areas of fire protection and chemical safety, the EH OA Team conducted independent vertical-slice reviews to confirm DP ORR results. Within each technical area, the EH OA Team reviewed the DP ORR Plan, including the Criteria Review and Approach Documents (CRADs); the qualifications of individual DP ORR team members; the performance of planned DP ORR activities; and the results of the DP ORR.« less

Report on the oversight assessment of the operational readiness review of the Replacement Tritium Facility at Savannah River Site

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, B.T.

1993-03-01

This report presents the results of an oversight assessment (OA) conducted by the US Department of Energy`s (DOE) Office of Environment, Safety and Health (EH) of operational readiness review (ORR) activities for the Replacement Tritium Facility (RTF) located at Savannah River Site (SRS). The EH OA of this facility took place concurrently with an ORR conducted by the DOE Office of Defense Programs (DP). The DP ORR was conducted from January 19 through February 5, 1993. The EH OA was performed in accordance with the protocol and procedures specified in ``EH Program for Oversight Assessment of Operational Readiness Evaluations formore » Startups and Restarts,`` dated September 15, 1992. The EH OA Team evaluated the DP ORR to determine whether it was thorough and demonstrated sufficient inquisitiveness to verify that the implementation of programs and procedures adequately ensures the protection of worker safety and health. The EH OA Team performed its evaluation of the DP ORR in the following technical areas: occupational safety, industrial hygiene, and respiratory protection; fire protection; and chemical safety. In the areas of fire protection and chemical safety, the EH OA Team conducted independent vertical-slice reviews to confirm DP ORR results. Within each technical area, the EH OA Team reviewed the DP ORR Plan, including the Criteria Review and Approach Documents (CRADs); the qualifications of individual DP ORR team members; the performance of planned DP ORR activities; and the results of the DP ORR.« less

Gastric transposition in infants and children.

PubMed

Cowles, Robert A; Coran, Arnold G

2010-12-01

The loss of esophageal length in long-gap esophageal atresia or obliteration of the esophageal lumen due to stricture may require major operative reconstruction. A number of procedures have been developed to allow anatomic replacement of the esophagus. The gastric transposition requires a single cervical anastomosis and uses a gastric conduit with excellent blood supply. This review illustrates the procedure and discusses its indications, planning, and outcome.

Australian Defence Force surgical support to peacekeeping operations in East Timor.

PubMed

Chambers, Anthony J; Crozier, John A

2004-07-01

The Australian Defence Force (ADF) has provided surgical support to peacekeeping operations in East Timor since September 1999. The aim of the present paper is to document the wide range of surgical procedures performed by the ADF in East Timor from September 1999 to December 2002 on peacekeeping force personnel and the civilian population. Records of all surgical procedures performed by the ADF in East Timor from their arrival in September 1999 to December 2002 were retrospectively reviewed. Details of the type of procedures performed and anaesthetic administered, the age and sex of the patients and whether they were a member of peacekeeping forces or East Timorese civilian were recorded. There were 702 surgical procedures performed by the ADF in East Timor during this period, of which 401 (57%) were for peacekeeping force personnel and 301 (43%) were for East Timorese or other civilians. The most commonly performed procedures were for the management of non-battle wounds, accounting for 181 cases (26%). Battle-type wounds accounted for only 36 procedures (5%). Obstetric and gynaecology cases accounted for 30 procedures (4%). Fifty-six procedures (8%) were on children 12 years or younger. The wide range of surgical procedures performed by the ADF during peacekeeping operations in East Timor highlights the requirement for deployed surgeons to possess a broad range of clinical skills and has implications for their preparation and training. Battle-type wounds accounted for only a small proportion of procedures.

Medical malpractice in endourology: analysis of closed cases from the State of New York.

PubMed

Duty, Brian; Okhunov, Zhamshid; Okeke, Zeph; Smith, Arthur

2012-02-01

Medical malpractice indemnity payments continue to rise, resulting in increased insurance premiums. We reviewed closed malpractice claims pertaining to endourological procedures with the goal of helping urologists mitigate their risk of lawsuit. All closed malpractice claims from 2005 to 2010 pertaining to endourological procedures filed against urologists insured by the Medical Liability Mutual Insurance Company of New York were examined. Claims were reviewed for plaintiff demographics, medical history, operative details, alleged complication, clinical outcome and lawsuit disposition. A total of 25 closed claims involved endourological operations and of these cases 10 were closed with an indemnity payment. The average payout was $346,722 (range $25,000 to $995,000). Of the plaintiffs 16 were women and mean plaintiff age was 51.4 years. Cystoscopy with ureteral stent placement/exchange resulted in 13 lawsuits, ureteroscopic lithotripsy 8, percutaneous stone extraction 2 and shock wave lithotripsy 2. There were 17 malpractice suits brought for alleged operative complications. Failure to arrange adequate followup was implicated in 4 cases. Error in diagnosis and delay in treatment was alleged in 3 claims. Urologists are not immune to the current medical malpractice crisis. Endourology and urological oncology generate the greatest number of lawsuits against urologists. Most malpractice claims involving endourological procedures result from urolithiasis and alleged technical errors. Therefore, careful attention to surgical technique is essential during stone procedures to reduce the risk of malpractice litigation. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Anaesthesia for bronchoscopy

PubMed Central

Chadha, Meenu; Kulshrestha, Mayank; Biyani, Alok

2015-01-01

Bronchoscopy as an investigation or therapeutic procedure demands anaesthesiologist to act accordingly. The present review will take the reader from rigid to fibreoptic flexible bronchoscopy. These procedures are now done as day care procedures in the operation theatre or in critical care units. Advantages and limitations of both rigid and flexible bronchoscopy are analysed. Recently, conscious sedation has come up as the commonly used anaesthetic technique for simple bronchoscopic procedures. However, general anaesthesia still remains a standard technique for more complex procedures. New advances in the field of anaesthesiology such as use of short acting opioids, use of newer drugs such as dexmedetomidine, supraglottic airways and mechanical jet ventilators have facilitated and eased the conduct of the procedure. PMID:26556915

Review of a single surgeon's stapedotomy cases performed with a nickel titanium prosthesis over a 14-year period.

PubMed

Justicz, Natalie; Strickland, Kaitlyn F; Motamedi, Kevin K; Mattox, Douglas E

2017-04-01

Stapes surgery with a nickel titanium prosthesis is a safe and well-tolerated procedure that leads to a significant improvement in hearing outcomes. To identify the efficacy and safety of stapedotomy procedures performed with a nickel titanium prosthesis for patients with otosclerosis. A review of 431 unique stapedotomies performed over 14 years by a single surgeon at an academic tertiary care center yielded 312 cases with nickel titanium prosthesis that met inclusion criteria of otosclerosis diagnosis, initial surgery in operative ear, and presence of pre-operative and post-operative audiograms. Pure-tone averages (PTA) at baseline and 8 weeks after surgery were calculated over four frequencies; 0.5, 1, 2, and 4 kHz. Average air-bone gaps (ABG) were calculated from pre-operative and post-operative audiograms. Average pre-operative baseline PTA was 56.7 dB in the affected ear. Post-operative PTA was 30.1 dB, a 26.6 dB improvement. Initial average ABG was 29.7 dB, while post-operative ABG averaged 5.4 dB, a 24.2 dB improvement. Surgical success (closure of ABG within 10 dB) was achieved in 263 (84%) patients. Rate of surgical success was not correlated with age, gender, race, or affected ear. Complications included recurrent conductive hearing loss (14), progressive SNHL (4), and post-operative BPPV (3).

[Post-operative infections after cosmetic tourism].

PubMed

Holst-Albrechtsen, Sine; Sørensen, Lene Birk; Juel, Jacob

2018-06-11

Cosmetic tourism is defined as patient mobility across borders, typically constituted by patients seeking cosmetic surgery at lower costs abroad. The most common procedures are abdominoplasty, fat grafting and breast augmentation. Very little is known about the complication rates after cosmetic tourism, and there is a paucity of evidence in all aspects of cosmetic tourism. In this review, we focus on post-operative complications i.e. post-operative infections, in particular with rare microorganisms such as mycobacteria.

Liquid and gaseous oxygen safety review, volume 2

NASA Technical Reports Server (NTRS)

Lapin, A.

1972-01-01

Guidelines, codes, regulations and special procedures used in the design, installation, fabrication, testing and operations for protection against hazards involved with production, transportation, storage and system handling of oxygen are presented with a list of related references.

Comprehensive review on endonasal endoscopic sinus surgery

PubMed Central

Weber, Rainer K.; Hosemann, Werner

2015-01-01

Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3–4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment. PMID:26770282

The impact of electrocautery method on post-operative bleeding complications after non-newborn circumcision and revision circumcision.

PubMed

Harty, Niall J; Nelson, Caleb P; Cendron, Marc; Turner, Shaunna; Borer, Joseph G

2013-10-01

We evaluated post-operative bleeding complications in non-newborns following use of monopolar versus bipolar electrocautery for circumcision or revision circumcision. We retrospectively reviewed sequentially performed cases of circumcision and revision circumcision performed by nine pediatric urologists at our institution from 2005 to 2010. In order to incorporate both the monopolar and bipolar electrocautery experience for a single surgeon employing bipolar technique, sequential cases from 2002 to 2010 were reviewed. Variables assessed included age, procedure, method of electrocautery, skin approximation and dressing, and bleeding complications. 1810 patients that underwent either circumcision or revision circumcision were reviewed. Complete data was available for 1617 patients. Age at operation was a mean 3.7 ± 4.9 yrs and median 1.5 yrs. Return for bleeding complication for all surgeons, was 2/336 (0.6%) for bipolar and 28/1281 (2.2%) for monopolar (p = 0.0545). For the single surgeon using bipolar technique, returns were 2/336 (0.6%) for bipolar and 5/309 (1.6%) for monopolar (p = 0.2133). Returns per procedure type were 1/200 (0.5%) bipolar and 24/844 (2.8%) monopolar for primary circumcision (p = 0.0513), and 1/136 (0.7%) bipolar and 4/437 (0.9%) monopolar (p = 0.84) for revision. Four of 1617 (0.2%) patients returned to the operating room [4/1281 (0.3%) monopolar (p = 0.31)]. There was no difference in return to the operating room for circumcision versus revision. Return for bleeding complications after circumcision and revision circumcision occurred more frequently after monopolar electrocautery compared to bipolar. However, there was no significant difference between the two electrocautery methods. Either form of electrocautery appears to be effective for this common pediatric urologic procedure. Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

The Difficult Gallbladder: A Safe Approach to a Dangerous Problem.

PubMed

Santos, B Fernando; Brunt, L Michael; Pucci, Michael J

2017-06-01

Laparoscopic cholecystectomy is a common surgical procedure, and remains the gold standard for the management of benign gallbladder and biliary disease. While this procedure can be technically straightforward, it can also represent one of the most challenging operations facing surgeons. This dichotomy of a routine operation performed so commonly that poses such a hidden risk of severe complications, such as bile duct injury, must keep surgeons steadfast in the pursuit of safety. The "difficult gallbladder" requires strict adherence to the Culture of Safety in Cholecystectomy, which promotes safety first and assists surgeons in managing or avoiding difficult operative situations. This review will discuss the management of the difficult gallbladder and propose the use of subtotal fenestrating cholecystectomy as a definitive option during this dangerous situation.

Toolbox of assessment tools of technical skills in otolaryngology-head and neck surgery: A systematic review.

PubMed

Labbé, Mathilde; Young, Meredith; Nguyen, Lily H P

2017-10-08

To support the development of programs of assessment of technical skills in the operating room (OR), we systematically reviewed the literature to identify assessment tools specific to otolaryngology-head and neck surgery (OTL-HNS) core procedures and summarized their characteristics. We systematically searched Embase, MEDLINE, PubMed, and Cochrane to identify and report on assessment tools that can be used to assess residents' technical surgical skills in the operating room for OTL-HNS core procedures. Of the 736 unique titles retrieved, 16 articles met inclusion criteria, covering 11 different procedures (in otology, rhinology, laryngology, head and neck, and general otolaryngology). The tools were composed of a task-specific checklist and/or global rating scale and were developed in the OR, on human cadavers, or in a simulation setting. Our study reports on published tools for assessing technical skills for OTL-HNS residents during core procedures conducted in the OR. These assessment tools could facilitate the provision of timely feedback to trainees including specific goals for improvement. However, the paucity of publications suggests little agreement on how to best perform work-based direct-observation assessment for core surgical procedures in OTL-HNS. The sparsity of tools specific to OTL-HNS may become a barrier to a fluid transition to competency-based medical education. Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Advanced Training in Laparoscopic Abdominal Surgery (Atlas): A Systematic Review

PubMed Central

Beyer-Berjot, Laura; Palter, Vanessa; Grantcharov, Teodor; Aggarwal, Rajesh

2014-01-01

Background Simulation has widely spread this last decade, especially in laparoscopic surgery, and training out of the operating room (OR) has proven its positive impact on basic skills during real laparoscopic procedures. However, few articles dealing with advanced training in laparoscopic abdominal surgery (ATLAS) have been published so far. Such training may reduce learning curves in the OR for junior surgeons with limited access to complex laparoscopic procedures as a primary operator. Methods Two reviewers, using MEDLINE, EMBASE, and The Cochrane Library, conducted a systematic research with combinations of the following keywords: (teaching OR education OR computer simulation) AND laparoscopy AND (gastric OR stomach OR colorectal OR colon OR rectum OR small bowel OR liver OR spleen OR pancreas OR advanced surgery OR advanced procedure OR complex procedure). Additional studies were searched in the reference lists of all included articles. Results Fifty-four original studies were retrieved. Their level of evidence was low: most of the studies were case series, one fifth purely descriptive, and there were 8 randomized trials. Porcine models and video trainers, as well as gastric and colorectal procedures were mainly assessed. The retrieved studies showed some encouraging trends in terms of trainees' satisfaction, improvement after training (but mainly on the training tool itself). Some tools have been proven to be construct-valid. Conclusions Higher quality studies are required to appraise ATLAS educational value. PMID:24947643

General surgery workloads and practice patterns in the United States, 2007 to 2009: a 10-year update from the American Board of Surgery.

PubMed

Valentine, R James; Jones, Andrew; Biester, Thomas W; Cogbill, Thomas H; Borman, Karen R; Rhodes, Robert S

2011-09-01

To assess changes in general surgery workloads and practice patterns in the past decade. Nearly 80% of graduating general surgery residents pursue additional training in a surgical subspecialty. This has resulted in a shortage of general surgeons, especially in rural areas. The purpose of this study is to characterize the workloads and practice patterns of general surgeons versus certified surgical subspecialists and to compare these data with those from a previous decade. The surgical operative logs of 4968 individuals recertifying in surgery 2007 to 2009 were reviewed. Data from 3362 (68%) certified only in Surgery (GS) were compared with 1606 (32%) with additional American Board of Medical Specialties certificates (GS+). Data from GS surgeons were also compared with data from GS surgeons recertifying 1995 to 1997. Independent variables were compared using factorial ANOVA. GS surgeons performed a mean of 533 ± 365 procedures annually. Women GS performed far more breast operations and fewer abdomen, alimentary tract and laparoscopic procedures compared to men GS (P < 0.001). GS surgeons recertifying at 10 years performed more abdominal, alimentary tract and laparoscopic procedures compared to those recertifying at 20 or 30 years (P < 0.001). Rural GS surgeons performed far more endoscopic procedures and fewer abdominal, alimentary tract, and laparoscopic procedures than urban counterparts (P < 0.001). The United States medical school graduates had similar workloads and distribution of operations to international medical graduates. Compared to 1995 to 1997, GS surgeons from 2007 to 2009 performed more procedures, especially endoscopic and laparoscopic. GS+ surgeons performed 15% to 33% of all general surgery procedures. GS practice patterns are heterogeneous; gender, age, and practice setting significantly affect operative caseloads. A substantial portion of general surgery procedures currently are performed by GS+ surgeons, whereas GS surgeons continue to perform considerable numbers of specialty operations. Reduced general surgery operative experience in GS+ residencies may negatively impact access to general surgical care. Similarly, narrowing GS residency operative experience may impair specialty operation access.

A guide to safe field operations

USGS Publications Warehouse

Yobbi, D.K.; Yorke, T.H.; Mycyk, R.T.

1996-01-01

Most functions of the U.S. Geological Survey (USGS), Water Resources Division (WRD) require employees to participate in numerous field activities ranging from routine meetings with cooperators, other federal and public officials, and private citizens to potentially hazardous assignments, such as making flood measurements and scuba diving to service underwater instruments. It is paramount that each employee be aware of safety procedures and operational policies of the WRD to ensure that (1) their activities avoid or minimize personal injury to the employee, coworkers, or anyone in the vicinity of the field activity, and (2) their conduct does not infringe on the personal or property rights of any individual or organization. The purpose of the guide is to familiarize employees with the operational and safety procedures expected to be followed by each employee as a representative of the WRD. It is also intended as a training tool for all new employees and a document to be reviewed by each employee before undertaking a field assignment. It includes general procedures that are standard and applicable to all field operations, such as communication, vehicle operation, and adequate preparation for anticipated weather conditions. It also includes a discussion of specific procedures and safety considerations for most of the routine field assignments undertaken by hydrologists and hydrologic technicians of the WRD. The guide is not intended to be a technical handbook outlining step-by-step procedures for performing specific tasks or a comprehensive discussion of every possible activity that may be undertaken by a USGS employee. Employees are referred to the Techniques for Water-Resources Investigations (TWRI) series for specific technical procedures and to the U.S. Geological Survey Safety and Environmental Health Handbook 445-1-H (USGS, August 1989), USGS Occupational Hazards and Safety Procedures Handbook 445-2-H (December 1993), the WRD notebook on Safety Policy and Guidance Memoranda, and other references for procedures and safety issues related to nonroutine activities, such as operations on large vessels and aircraft.

CNC Turning Center Operations and Prove Out. Computer Numerical Control Operator/Programmer. 444-334.

ERIC Educational Resources Information Center

Skowronski, Steven D.

This student guide provides materials for a course designed to instruct the student in the recommended procedures used when setting up tooling and verifying part programs for a two-axis computer numerical control (CNC) turning center. The course consists of seven units. Unit 1 discusses course content and reviews and demonstrates set-up procedures…

Complications of wrist arthroscopy.

PubMed

Ahsan, Zahab S; Yao, Jeffrey

2012-06-01

The purpose of this systematic review was to address the incidence of complications associated with wrist arthroscopy. Given the paucity of information published on this topic, an all-inclusive review of published wrist arthroscopy complications was sought. Two independent reviewers performed a literature search using PubMed, Google Scholar, EBSCO, and Academic Megasearch using the terms "wrist arthroscopy complications," "complications of wrist arthroscopy," "wrist arthroscopy injury," and "wrist arthroscopy." Inclusion criteria were (1) Levels I to V evidence, (2) "complication" defined as an adverse outcome directly related to the operative procedure, and (3) explicit description of operative complications in the study. Eleven multiple-patient studies addressing complications of wrist arthroscopy from 1994 to 2010 were identified, with 42 complications reported from 895 wrist arthroscopy procedures, a 4.7% complication rate. Four case reports were also found, identifying injury to the dorsal sensory branch of the ulnar nerve, injury to the posterior interosseous nerve, and extensor tendon sheath fistula formation. This systematic review suggests that the previously documented rate of wrist arthroscopy complications may be underestimating the true incidence. The report of various complications provides insight to surgeons for improving future surgical techniques. Level IV, systematic review of Levels I-V studies. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Spectral fitting, shock layer modeling, and production of nitrogen oxides and excited nitrogen

NASA Technical Reports Server (NTRS)

Blackwell, H. E.

1991-01-01

An analysis was made of N2 emission from 8.72 MJ/kg shock layer at 2.54, 1.91, and 1.27 cm positions and vibrational state distributions, temperatures, and relative electronic state populations was obtained from data sets. Other recorded arc jet N2 and air spectral data were reviewed and NO emission characteristics were studied. A review of operational procedures of the DSMC code was made. Information on other appropriate codes and modifications, including ionization, were made as well as a determination of the applicability of codes reviewed to task requirement. A review was also made of computational procedures used in CFD codes of Li and other codes on JSC computers. An analysis was made of problems associated with integration of specific chemical kinetics applicable to task into CFD codes.

Plastic freezer bags: a cost-effective method to protect extraction sites in laparoscopic colorectal procedures?

PubMed

Huynh, Hai P; Musselman, Reilly P; Trottier, Daniel C; Soto, Claudia M; Poulin, Eric C; Mamazza, Joseph; Boushey, Robin P; Auer, Rebecca C; Moloo, Husein

2013-10-01

To review surgical-site infection (SSI) and retrieval-site tumor recurrence rates in laparoscopic colorectal procedures when using a plastic freezer bag as a wound protector. Laparoscopic colorectal procedures where a plastic freezer bag used as a wound protector at the extraction site were reviewed between 1991 and 2008 from a prospectively collected database. χ test was used to compare SSI and tumor recurrence rates between groups. Costing data were obtained from the operating room supplies department. A total of 936 cases with 51 (5.45%) surgical-site infections were identified. SSI rates did not differ when comparing groups based on demographic factors, diagnosis, or location of procedure. Retrieval-site tumor recurrence rate was 0.21% (1/474). Cost of plastic freezer bags including sterilization ranged from $0.25 to $3. Plastic freezer bags as wound protectors in laparoscopic colorectal procedures are cost effective and have SSI and retrieval-site tumor recurrence rates that compare favorably to published data.

Does the Timing of Pre-Operative Medical Evaluation Influence Perioperative Total Hip Arthroplasty Outcomes?

PubMed

Lan, Roy H; Kamath, Atul F

2017-01-01

Medical evaluation pre-operatively is an important component of risk stratification and potential risk optimization. However, the effect of timing prior to surgical intervention is not well-understood. We hypothesized that total hip arthroplasty (THA) patients seen in pre-operative evaluation closer to the date of surgery would experience better perioperative outcomes. We retrospectively reviewed 167 elective THA patients to study the relationship between the number of days between pre-operative evaluation (range, 0-80 days) and surgical intervention. Patients' demographics, length of stay (LOS), ICU admission frequency, and rate of major complications were recorded. When pre-operative evaluation carried out 4 days or less before the procedure date, there was a significant reduction in LOS (3.91 vs. 4.49; p=0.03). When pre-operative evaluation carried out 11 days or less prior to the procedure date, there was a four-fold decrease in rate of intensive care admission (p=0.04). Furthermore, the major complication rate also significantly reduced (p<0.05). However, when pre-operative evaluation took place 30 days or less before the procedure date compared to more than 30 days prior, there were no significant changes in the outcomes. From this study, pre-operative medical evaluation closer to the procedure date was correlated with improved selected peri-operative outcomes. However, further study on larger patient groups must be done to confirm this finding. More study is needed to define the effect on rare events like infection, and to analyze the subsets of THA patients with modifiable risk factors that may be time-dependent and need further time to optimization.

Rocket propulsion hazard summary: Safety classification, handling experience and application to space shuttle payload

NASA Technical Reports Server (NTRS)

Pennington, D. F.; Man, T.; Persons, B.

1977-01-01

The DOT classification for transportation, the military classification for quantity distance, and hazard compatibility grouping used to regulate the transportation and storage of explosives are presented along with a discussion of tests used in determining sensitivity of propellants to an impact/shock environment in the absence of a large explosive donor. The safety procedures and requirements of a Scout launch vehicle, Western and Eastern Test Range, and the Minuteman, Delta, and Poseidon programs are reviewed and summarized. Requirements of the space transportation system safety program include safety reviews from the subsystem level to the completed payload. The Scout safety procedures will satisfy a portion of these requirements but additional procedures need to be implemented to comply with the safety requirements for Shuttle operation from the Eastern Test Range.

A cadaveric procedural anatomy course enhances operative competence.

PubMed

Sharma, Gaurav; Aycart, Mario A; Najjar, Peter A; van Houten, Trudy; Smink, Douglas S; Askari, Reza; Gates, Jonathan D

2016-03-01

Inadequate anatomy training has been cited as a major contributor to declines in surgical resident operative competence and confidence. We report the impact of a procedurally oriented general surgery cadaveric dissection course on trainee-operative confidence and competence. After obtaining institutional review board approval, postgraduate year 2 and 3 general surgery residents were prospectively enrolled into two cohorts: (1) an intervention group (n = 7) participating in an 8-wk procedurally oriented cadaver course and (2) controls (n = 7) given access to course materials without participation in cadaver dissection. At both the beginning and end of the study, we used two evaluation instruments: (1) an oral examination using standardized templates and (2) a questionnaire assessing operative confidence. There were no intergroup differences in baseline characteristics, including number of operative procedures performed to date. Residents who took the anatomy course had significantly higher improvements in examination scores on common bile duct exploration (mean ± standard error, 33 ± 8% versus 10 ± 7%, P = 0.04), femoral endarterectomy (43 ± 5% versus 11 ± 7%, P = 0.003), fasciotomies (55 ± 10% versus 22 ± 9%, P = 0.04), inguinal hernia repair (20 ± 9% versus -14 ± 5%, P = 0.005), superior mesenteric artery embolectomy (38 ± 10% versus 2 ± 11%, P = 0.04), and in overall examination scores (31 ± 4% versus 8% ± 3%, P = 0.0006). In addition, they reported higher operative confidence on common bile duct exploration (P = 0.008) and superior mesenteric artery embolectomy (P = 0.02), and a trend toward higher overall operative confidence (P = 0.06). In this study, we demonstrate that a procedurally oriented cadaver course covering a wide range of essential general surgery procedures resulted in significant improvements in self-reported operative confidence and competence as assessed by oral examination. Copyright © 2016 Elsevier Inc. All rights reserved.

48 CFR 1201.301 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

...—(i) Departmentwide acquisition regulations. The Department of Transportation's (DOT's) Senior..., shall be reviewed and approved by the Senior Procurement Executive (SPE) for insertion into the (TAR) 48... internal agency guidance at any organizational level. DOT internal operating procedures are contained in...

Student Receivables Management: Opportunities for Improved Practices.

ERIC Educational Resources Information Center

Jacquin, Jules C.; Goyal, Anil K.

1995-01-01

The college or university's business office can help reduce problems with student receivables through procedural review of the tuition revenue process, application of analytical methods, and improved operating practices. Admissions, financial aid, and billing offices must all be involved. (MSE)

TREATMENT PLANT EVALUATION FOR PARTICULATE CONTAMINANT REMOVAL

EPA Science Inventory

A general procedure is suggested for evaluating performance of water filtration plants. Plant operating records should be reviewed. Plant hydraulics should be evaluated. Chemical feed pumps, measuring, and additional points, plus control of chemical doses, are discussed. Rapid mi...

Duties and functions of veterinary public health for the management of food safety: present needs and evaluation of efficiency.

PubMed

Trevisani, M; Rosmini, R

2008-09-01

Functions of veterinarians in the context of food safety assurance have changed very much in the last ten years as a consequence of new legislation. The aim of this review is to evaluate the management tools in veterinary public health that shall be used in response to the actual need and consider some possible key performance indicators. This review involved an examination of the legislation, guidelines and literature, which was then discussed to analyse the actual need, the strategies and the procedures with which the public veterinary service shall comply. The management of information gathered at different stages of the food chain, from both food production operators and veterinary inspectors operating in primary production, food processing and feed production should be exchanged and integrated in a database, not only to produce annual reports and plan national sampling plans, but also to verify and validate the effectiveness of procedures and strategies implemented by food safety operators to control risks. Further, the surveillance data from environmental agencies and human epidemiological units should be used for assessing risks and addressing management options.

Controversy of hand-assisted laparoscopic colorectal surgery

PubMed Central

Meshikhes, Abdul-Wahed Nasir

2010-01-01

Laparoscopically assisted colorectal procedures are time-consuming and technically demanding and hence have a long steep learning curve. In the technical demand, surgeons need to handle a long mobile organ, the colon, and have to operate on multiple abdominal quadrants, most of the time with the need to secure multiple mesenteric vessels. Therefore, a new surgical innovation called hand-assisted laparoscopic surgery (HALS) was introduced in the mid 1990s as a useful alternative to totally laparoscopic procedures. This hybrid operation allows the surgeon to introduce the non-dominant hand into the abdominal cavity through a special hand port while maintaining the pneumoperitoneum. A hand in the abdomen can restore the tactile sensation which is usually lacking in laparoscopic procedures. It also improves the eye-to-hand coordination, allows the hand to be used for blunt dissection or retraction and also permits rapid control of unexpected bleeding. All of those factors can contribute tremendously to reducing the operative time. Moreover, this procedure is also considered as a hybrid procedure that combines the advantages of both minimally invasive and conventional open surgery. Nevertheless, the exact role of HALS in colorectal surgery has not been well defined during the advanced totally laparoscopic procedures. This article reviews the current status of hand-assisted laparoscopic colorectal surgery as a minimally invasive procedure in the era of laparoscopic surgery. PMID:21128315

Safety of Running Two Rooms: A Systematic Review and Meta-Analysis of Overlapping Neurosurgical Procedures.

PubMed

Self, D Mitchell; Ilyas, Adeel; Stetler, William R

2018-04-27

Overlapping surgery, a long-standing practice within academic neurosurgery centers nationwide, has recently come under scrutiny from the government and media as potentially harmful to patients. Therefore, the objective of this systematic review and meta-analysis is to determine the safety of overlapping neurosurgical procedures. The authors performed a systematic review and meta-analysis in accordance with PRISMA guidelines. A review of PubMed and Medline databases was undertaken with the search phrase "overlapping surgery AND neurosurgery AND outcomes." Data regarding patient demographics, type of neurosurgical procedure, and outcomes and complications were extracted from each study. The principle summary measure was odds ratio (OR) of the association of overlapping versus non-overlapping surgery with outcomes. The literature search yielded a total of 36 studies, of which 5 studies met inclusion criteria and were included in this study. These studies included a total of 25,764 patients undergoing neurosurgical procedures. Overlapping surgery was associated with an increased likelihood of being discharged home (OR = 1.32; 95% CI 1.20 to 1.44; P < 0.001) and a reduced 30-day unexpected return to the operating room (OR = 0.79; 95% CI 0.72 to 0.87; P < 0.001). Overlapping surgery did not significantly affect OR of length of surgery, 30-day mortality, or 30-day readmission. Overlapping neurosurgical procedures were not associated with worse patient outcomes. Additional, prospective studies are needed to further assess the safety overlapping procedures. Copyright © 2018. Published by Elsevier Inc.

Intra-Operative Surgical Irrigation of the Surgical Incision: What Does the Future Hold-Saline, Antibiotic Agents, or Antiseptic Agents?

PubMed

Edmiston, Charles E; Leaper, David J

2016-12-01

Intra-operative surgical site irrigation (lavage) is common practice in surgical procedures in general, with all disciplines advocating some form of irrigation before incision closure. This practice, however, has been neither standardized nor is there compelling evidence that it effectively reduces the risk of surgical site infection (SSI). This narrative review addresses the laboratory and clinical evidence that is available to support the practice of irrigation of the abdominal cavity and superficial/deep incisional tissues, using specific irrigation solutions at the end of an operative procedure to reduce the microbial burden at wound closure. Review of PubMed and OVID for pertinent, scientific, and clinical publications in the English language was performed. Incision irrigation was found to afford a three-fold benefit: First, to hydrate the bed; second, to assist in allowing better examination of the area immediately before closure; and finally, by removing superficial and deep incisional contamination and lowering the bioburden, expedite the healing process. The clinical practice of intra-operative peritoneal lavage is highly variable and is dependent solely on surgeon preference. By contrast, intra-operative irrigation after device-related procedures has become a standard of care for the prophylaxis of acute peri-prosthetic infection. The clinical evidence that supports the use of antibiotic irrigation is limited and based on retrospective analysis and few acceptable randomized controlled trials. The results of laboratory and animal studies using aqueous 0.05% chlorhexidine gluconate are favorable, suggesting that further studies are justified to determine its clinical efficacy. The adoption of appropriate and standardized intra-operative irrigation practices into peri-operative care bundles, which include other evidence-based strategies (weight-based antimicrobial prophylaxis, antimicrobial sutures, maintenance of normothermia, and glycemic control), offers an inexpensive and effective method to reduce the risk of post-operative SSI and deserves further evaluation.

Surgical Burn Care by Médecins Sans Frontières-Operations Center Brussels: 2008 to 2014.

PubMed

Stewart, Barclay T; Trelles, Miguel; Dominguez, Lynette; Wong, Evan; Fiozounam, Hervé Tribunal; Hassani, Ghulam Hiadar; Akemani, Clemence; Naseer, Aemer; Ntawukiruwabo, Innocent Bagura; Kushner, Adam L

Humanitarian organizations care for burns during crisis and while supporting healthcare facilities in low-income and middle-income countries. This study aimed to define the epidemiology of burn-related procedures to aid humanitarian response. In addition, operational data collected from humanitarian organizations are useful for describing surgical need otherwise unmet by national health systems. Procedures performed in operating theatres run by Médecins Sans Frontières-Operations Centre Brussels (MSF-OCB) from July 2008 through June 2014 were reviewed. Surgical specialist missions were excluded. Burn procedures were quantified, related to demographics and reason for humanitarian response, and described. A total of 96,239 operations were performed at 27 MSF-OCB projects in 15 countries between 2008 and 2014. Of the 33,947 general surgical operations, 4,280 (11%) were for burns. This proportion steadily increased from 3% in 2008 to 24% in 2014. People receiving surgical care from conflict relief missions had nearly twice the odds of having a burn operation compared with people requiring surgery in communities affected by natural disaster (adjusted odds ratio, 1.94; 95% confidence interval, 1.46-2.58). Nearly 70% of burn procedures were planned serial visits to the theatre. A diverse skill set was required. Unmet humanitarian assistance needs increased US$400 million dollars in 2013 in the face of an increasing number of individuals affected by crisis and a growing surgical burden. Given the high volume of burn procedures performed at MSF-OCB projects and the resource intensive nature of burn management, requisite planning and reliable funding are necessary to ensure quality for burn care in humanitarian settings.

The effects of predictor method factors on selection outcomes: A modular approach to personnel selection procedures.

PubMed

Lievens, Filip; Sackett, Paul R

2017-01-01

Past reviews and meta-analyses typically conceptualized and examined selection procedures as holistic entities. We draw on the product design literature to propose a modular approach as a complementary perspective to conceptualizing selection procedures. A modular approach means that a product is broken down into its key underlying components. Therefore, we start by presenting a modular framework that identifies the important measurement components of selection procedures. Next, we adopt this modular lens for reviewing the available evidence regarding each of these components in terms of affecting validity, subgroup differences, and applicant perceptions, as well as for identifying new research directions. As a complement to the historical focus on holistic selection procedures, we posit that the theoretical contributions of a modular approach include improved insight into the isolated workings of the different components underlying selection procedures and greater theoretical connectivity among different selection procedures and their literatures. We also outline how organizations can put a modular approach into operation to increase the variety in selection procedures and to enhance the flexibility in designing them. Overall, we believe that a modular perspective on selection procedures will provide the impetus for programmatic and theory-driven research on the different measurement components of selection procedures. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Comparison Between Minimally Invasive and Open Pancreaticoduodenectomy: A Systematic Review.

PubMed

Doula, Chrysoula; Kostakis, Ioannis D; Damaskos, Christos; Machairas, Nikolaos; Vardakostas, Dimitrios V; Feretis, Themistoklis; Felekouras, Evangelos

2016-02-01

Minimally invasive approaches (laparoscopic or robotic) are used in various operations. Our aim was to compare them with the open approach in pancreaticoduodenectomy. We conducted a search for articles published in MEDLINE database comparing minimally invasive (laparoscopic or robotic) with open pancreaticoduodenectomy on June 15, 2014. Our search yielded 136 articles. We excluded 122 articles and we took into consideration 14 (10 for laparoscopic and 4 for robotic pancreaticoduodenectomies). Most cases were related to malignant diseases and tumors treated with minimally invasive operations tended to be smaller. There were relatively high conversion rates in both laparoscopic (0% to 15%) and robotic procedures (4.5% to 10%). There were no significant differences regarding resection margins, rates of pancreatic fistula formation, bile leak, and delayed gastric emptying, reoperation rates, and intraoperative and postoperative mortality. On the contrary, blood loss was less in minimally invasive than open operations, although this difference was not always significant. Moreover, totally laparoscopic and robotic procedures lasted longer than the open ones, whereas hand-assisted laparoscopic procedures did not. However, the findings regarding the number of the retrieved lymph nodes, the length of hospital stay, and costs were inconclusive and controversial. Laparoscopic and robotic pancreaticoduodenectomy are feasible, safe, and oncologically equivalent alternatives to open pancreaticoduodenectomy. Minimally invasive operations have the advantage of the less blood loss, but totally laparoscopic and robotic procedures last longer than open procedures.

Office-based deep sedation for pediatric ophthalmologic procedures using a sedation service model.

PubMed

Lalwani, Kirk; Tomlinson, Matthew; Koh, Jeffrey; Wheeler, David

2012-01-01

Aims. (1) To assess the efficacy and safety of pediatric office-based sedation for ophthalmologic procedures using a pediatric sedation service model. (2) To assess the reduction in hospital charges of this model of care delivery compared to the operating room (OR) setting for similar procedures. Background. Sedation is used to facilitate pediatric procedures and to immobilize patients for imaging and examination. We believe that the pediatric sedation service model can be used to facilitate office-based deep sedation for brief ophthalmologic procedures and examinations. Methods. After IRB approval, all children who underwent office-based ophthalmologic procedures at our institution between January 1, 2000 and July 31, 2008 were identified using the sedation service database and the electronic health record. A comparison of hospital charges between similar procedures in the operating room was performed. Results. A total of 855 procedures were reviewed. Procedure completion rate was 100% (C.I. 99.62-100). There were no serious complications or unanticipated admissions. Our analysis showed a significant reduction in hospital charges (average of $1287 per patient) as a result of absent OR and recovery unit charges. Conclusions. Pediatric ophthalmologic minor procedures can be performed using a sedation service model with significant reductions in hospital charges.

A review of the peri-operative management of paediatric burns: Identifying adverse events.

PubMed

Rode, H; Brink, C; Bester, K; Coleman, M P; Baisey, T; Martinez, R

2016-11-02

Burn injuries are common in poverty-stricken countries. The majority of patients with large and complex burns are referred to burn centres. Of the children who qualify for admission, according to burn admission criteria, about half require some kind of surgical procedure to obtain skin cover. These range from massive full-thickness fire burns to skin grafts for small, residual unhealed wounds. Burn anaesthetic procedures are of the most difficult to perform and are known for high complication rates. Reasons include peri-operative sepsis, bleeding, issues around thermoregulation, the hypermetabolic state, nutritional and electrolyte issues, inhalation injuries and the amount of movement during procedures to wash patients, change drapes and access different anatomical sites. The appropriate execution of surgery is therefore of the utmost importance for both minor and major procedures. To review the peri-operative management and standard of surgical care of burnt children. This was a retrospective review and analysis of standard peri-operative care of burnt children at Red Cross War Memorial Children's Hospital, Cape Town, South Africa. A total of 558 children were operated on and supervised by the first author. Factors that could adversely affect surgical and anaesthetic outcomes were identified. There were 257 males and 301 females in this study, with an average age of 50.1 months and average weight of 19.5 kg. The total body surface area involved was 1 - 80%, with an average of 23.5%. Inhalational injury was present in 11.3%, pneumonia in 13.1%, wound sepsis in 20.8%, and septicaemia in 9.7%, and organ dysfunction in more than one organ was seen in 6.1%. The average theatre temperature during surgery was 30.0°C. Core temperatures recorded at the start, halfway through and at completion of surgery were 36.9°C, 36.8°C and 36.5°C, respectively. The average preoperative and postoperative haemoglobin levels were 11.28 g/dL and 9.64 g/dL, respectively. Blood loss was reduced by the use of clysis from 1.5 mL/kg/% burn to 1.4 mL/kg/% burn. Adverse intraoperative events were seen in 17.6% of children. Burn surgery is a high-risk procedure and comorbidities are common. Anaesthesia and surgery must be well planned and executed with special reference to temperature control, rapid blood loss, preceding respiratory illnesses and measures to reduce blood loss.

Chemical, Biological, and Radiological Contamination Survivability: Material Effects Testing

DTIC Science & Technology

2012-06-22

form that can be compared to pretest and posttest functional performance data. If Soldiers are desired, ensure a Test Schedule and Review Committee...test execution. f. The material’s performance specification should also be reviewed before planning test execution. For example , the...test data, and conformance with specified test and operating procedures cannot be overemphasized. 3.1 Test Planning. 3.1.1 Pretest Preparation

AUTOMOTIVE DIESEL MAINTENANCE 2. UNIT XVIII, ALTERNATOR AND REGULATOR SERVICING AND TESTING, AND AN INTRODUCTION TO TRANSISTOR REGULATORS.

ERIC Educational Resources Information Center

Minnesota State Dept. of Education, St. Paul. Div. of Vocational and Technical Education.

THIS MODULE OF A 25-MODULE COURSE IS DESIGNED AS A REVIEW OF THE OPERATING PRINCIPLES AND SERVICING PROCEDURES FOR GENERATORS AND AS AN INTRODUCTION TO TRANSISTOR CONTROLLED VOLTAGE REGULATION FOR GENERATORS USED ON DIESEL POWERED EQUIPMENT. TOPICS ARE (1) REVIEW OF GENERATOR PRINCIPLES, AC AND DC, (2) SERVICING AND TESTING ALTERNATORS, AND (3)…

Since Chernobyl: A World of Difference.

ERIC Educational Resources Information Center

Clamp, Alice

1991-01-01

This article chronicles the international collaboration behind the technological review and the subsequent upgrading of operational safety procedures at Soviet-designed nuclear power plants within the Soviet Union and various Eastern European countries in the aftermath of the tragedy at Chernobyl. (JJK)

77 FR 21723 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-11

... on actual operational planning, development of procedures, and implementation of programs to update... clearance. Geographic Support System Initiative (GSS-I)--The GSS-I is an integrated program designed to... of children's demographic characteristics currently available. Information is distributed through the...

Are paediatric operations evidence based? A prospective analysis of general surgery practice in a teaching paediatric hospital.

PubMed

Zani-Ruttenstock, Elke; Zani, Augusto; Bullman, Emma; Lapidus-Krol, Eveline; Pierro, Agostino

2015-01-01

Paediatric surgical practice should be based upon solid scientific evidence. A study in 1998 (Baraldini et al., Pediatr Surg Int) indicated that only a quarter of paediatric operations were supported by the then gold standard of evidence based medicine (EBM) which was defined by randomized controlled trials (RCTs). The aim of the current study was to re-evaluate paediatric surgical practice 16 years after the previous study in a larger cohort of patients. A prospective observational study was performed in a tertiary level teaching hospital for children. The study was approved by the local research ethics board. All diagnostic and therapeutic procedures requiring a general anaesthetic carried out over a 4-week period (24 Feb 2014-22 Mar 2014) under the general surgery service or involving a general paediatric surgeon were included in the study. Pubmed and EMBASE were used to search in the literature for the highest level of evidence supporting the recorded procedures. Evidence was classified according to the Oxford Centre for Evidence Based Medicine (OCEBM) 2009 system as well as according to the classification used by Baraldini et al. Results was compared using Χ (2) test. P < 0.05 was considered statistically significant. During the study period, 126 operations (36 different types) were performed on 118 patients. According to the OCEBM classification, 62 procedures (49 %) were supported by systematic reviews of multiple homogeneous RCTs (level 1a), 13 (10 %) by individual RCTs (level 1b), 5 (4 %) by systematic reviews of cohort studies (level 2a), 11 (9 %) by individual cohort studies, 1 (1 %) by systematic review of case-control studies (level 3a), 14 (11 %) by case-control studies (level 3b), 9 (7 %) by case series (type 4) and 11 procedures (9 %) were based on expert opinion or deemed self-evident interventions (type 5). High level of evidence (OCEBM level 1a or 1b or level I according to Baraldini et al. PSI 1998) supported 75 (60 %) operations in the current study compared to 18 (26 %) in the study of 1998 (P < 0.0001). The present study shows that nowadays a remarkable number of paediatric surgical procedures are supported by high level of evidence. Despite this improvement in evidence-based paediatric surgical practice, more than a third of the procedures still lack sufficient evidence-based literature support. More RCTs are warranted to support and direct paediatric surgery practice according to the principals of EBM.

Brief surgical procedure code lists for outcomes measurement and quality improvement in resource-limited settings.

PubMed

Liu, Charles; Kayima, Peter; Riesel, Johanna; Situma, Martin; Chang, David; Firth, Paul

2017-11-01

The lack of a classification system for surgical procedures in resource-limited settings hinders outcomes measurement and reporting. Existing procedure coding systems are prohibitively large and expensive to implement. We describe the creation and prospective validation of 3 brief procedure code lists applicable in low-resource settings, based on analysis of surgical procedures performed at Mbarara Regional Referral Hospital, Uganda's second largest public hospital. We reviewed operating room logbooks to identify all surgical operations performed at Mbarara Regional Referral Hospital during 2014. Based on the documented indication for surgery and procedure(s) performed, we assigned each operation up to 4 procedure codes from the International Classification of Diseases, 9th Revision, Clinical Modification. Coding of procedures was performed by 2 investigators, and a random 20% of procedures were coded by both investigators. These codes were aggregated to generate procedure code lists. During 2014, 6,464 surgical procedures were performed at Mbarara Regional Referral Hospital, to which we assigned 435 unique procedure codes. Substantial inter-rater reliability was achieved (κ = 0.7037). The 111 most common procedure codes accounted for 90% of all codes assigned, 180 accounted for 95%, and 278 accounted for 98%. We considered these sets of codes as 3 procedure code lists. In a prospective validation, we found that these lists described 83.2%, 89.2%, and 92.6% of surgical procedures performed at Mbarara Regional Referral Hospital during August to September of 2015, respectively. Empirically generated brief procedure code lists based on International Classification of Diseases, 9th Revision, Clinical Modification can be used to classify almost all surgical procedures performed at a Ugandan referral hospital. Such a standardized procedure coding system may enable better surgical data collection for administration, research, and quality improvement in resource-limited settings. Copyright © 2017 Elsevier Inc. All rights reserved.

Standard operating procedures for female orgasmic disorder: consensus of the International Society for Sexual Medicine.

PubMed

Laan, Ellen; Rellini, Alessandra H; Barnes, Tricia

2013-01-01

As the field of sexual medicine evolves, it is important to continually improve patient care by developing contemporary "standard operating procedures" (SOPs), reflecting the consensus view of experts in sexual medicine. Few, if any, consensus SOPs have been developed for the diagnosis and treatment of Female Orgasmic Disorder (FOD). The objective is to provide standard operating procedures for FOD. The SOP Committee was composed of a chair, selected by the International Society for the Study of Sexual Medicine, and two additional experts. To inform its key recommendations, the Committee used systematic reviews of available evidence and discussions during a group meeting, conference calls and e-mail communications. The Committee received no corporate funding or remuneration. A total of 12 recommendations for the assessment and treatment of FOD were generated, including suggestions for further research. Evidence-based, practice recommendations for the treatment of FOD are provided that will hopefully inform clinical decision making for those treating this common condition. © 2012 International Society for Sexual Medicine.

Standard operation procedures for conducting the on-the-road driving test, and measurement of the standard deviation of lateral position (SDLP)

PubMed Central

Verster, Joris C; Roth, Thomas

2011-01-01

This review discusses the methodology of the standardized on-the-road driving test and standard operation procedures to conduct the test and analyze the data. The on-the-road driving test has proven to be a sensitive and reliable method to examine driving ability after administration of central nervous system (CNS) drugs. The test is performed on a public highway in normal traffic. Subjects are instructed to drive with a steady lateral position and constant speed. Its primary parameter, the standard deviation of lateral position (SDLP), ie, an index of ‘weaving’, is a stable measure of driving performance with high test–retest reliability. SDLP differences from placebo are dose-dependent, and do not depend on the subject’s baseline driving skills (placebo SDLP). It is important that standard operation procedures are applied to conduct the test and analyze the data in order to allow comparisons between studies from different sites. PMID:21625472

Standard operation procedures for conducting the on-the-road driving test, and measurement of the standard deviation of lateral position (SDLP).

PubMed

Verster, Joris C; Roth, Thomas

2011-01-01

This review discusses the methodology of the standardized on-the-road driving test and standard operation procedures to conduct the test and analyze the data. The on-the-road driving test has proven to be a sensitive and reliable method to examine driving ability after administration of central nervous system (CNS) drugs. The test is performed on a public highway in normal traffic. Subjects are instructed to drive with a steady lateral position and constant speed. Its primary parameter, the standard deviation of lateral position (SDLP), ie, an index of 'weaving', is a stable measure of driving performance with high test-retest reliability. SDLP differences from placebo are dose-dependent, and do not depend on the subject's baseline driving skills (placebo SDLP). It is important that standard operation procedures are applied to conduct the test and analyze the data in order to allow comparisons between studies from different sites.

Office Operative Hysteroscopy: An Update.

PubMed

Salazar, Christina Alicia; Isaacson, Keith B

2018-02-01

Hysteroscopy is considered the gold standard for the evaluation of intracavitary pathology in both premenopausal and postmenopausal patients associated with abnormal uterine bleeding, as well as for the evaluation of infertile patients with suspected cavity abnormalities. Office-based operative hysteroscopy allows patients to resume activities immediately and successfully integrates clinical practice into a "see and treat" modality, avoiding the added risks of anesthesia and the inconvenience of the operating room. For 2017, the Centers for Medicare and Medicaid Services has provided a substantial increase in reimbursement for a select number of office-based hysteroscopic procedures. This review provides an update on the indications, equipment, and procedures for office hysteroscopy, as well as the management of complications that may arise within an office-based practice. Copyright © 2018. Published by Elsevier Inc.

Multi-institutional Experience in Laparoendoscopic Single-site Surgery (LESS): For Major Extirpative and Reconstructive Procedures in Pediatric Urology.

PubMed

Gor, Ronak A; Long, Christopher J; Shukla, Aseem R; Kirsch, Andrew J; Perez-Brayfield, Marcos; Srinivasan, Arun K

2016-02-01

To review peri-procedural outcomes from a large, multi-institutional series of pediatric urology patients treated with laparaendoscopic single-site surgery (LESS) for major extirpative and reconstructive procedures. Consecutive LESS cases between January 2011 and May 2014 from three free-standing pediatric referral centers were reviewed. Data include age, sex, operative time, blood loss, length of stay, and complications according to the modified Clavien-Dindo classification. Hasson technique was used for peritoneal entry, GelPOINT advanced access platform was inserted, and standard 5mm laparoscopic instruments were used. Fifty-nine patients (median age 5 years, 4 months-17 years) met inclusion criteria: 29 nephrectomies, 9 nephroureterectomies, 3 bilateral nephrectomies, 5 heminephrectomies, 5 renal cyst decortications, 3 bilateral gonadectomies, 2 Malone antegrade continence enema, 2 calyceal diverticulectomy, and 1 ovarian detorsion with cystectomy. Median operative times for each case type were comparable to published experiences with traditional laparoscopy. Overall mean and median length of stay was 36.2 hours and 1 day, respectively. There were two complications: port site hernia requiring surgical repair (Clavien IIIb) and a superficial port site infection that resolved with antibiotics (Clavien II). Cosmetic outcomes were subjectively well received by patients and their parents. Operative time was significantly shorter between the first half of the experience and the second half (102 vs 70 minutes, P  <  .05). LESS approach can be broadly applied across many major extirpative and reconstructive procedures within pediatric urology. Our series advances our field's utilization of this technique and its safety. Copyright © 2016 Elsevier Inc. All rights reserved.

Does prone repositioning before posterior fixation produce greater lordosis in lateral lumbar interbody fusion (LLIF)?

PubMed

Yson, Sharon C; Sembrano, Jonathan N; Santos, Edward R G; Luna, Jeffrey T P; Polly, David W

2014-10-01

Retrospective comparative radiographic review. To determine if lateral to prone repositioning before posterior fixation confers additional operative level lordosis in lateral lumbar interbody fusion (LLIF) procedures. In a review of 56 consecutive patients who underwent LLIF, there was no statistically significant change in segmental lordosis from lateral to prone once a cage is in place. The greatest lordosis increase was observed after cage insertion. We reviewed 56 consecutive patients who underwent LLIF in the lateral position followed by posterior fixation in the prone position. Eighty-eight levels were fused. Disk space angle was measured on intraoperative C-arm images, and change in operative level segmental lordosis brought about by each of the following was determined: (1) cage insertion, (2) prone repositioning, and (3) posterior instrumentation. Paired t test was used to determine significance (α=0.05). Mean lordosis improvement brought about by cage insertion was 2.6 degrees (P=0.00005). There was a 0.1 degree mean lordosis change brought about by lateral to prone positioning (P=0.47). Mean lordosis improvement brought about by posterior fixation, including rod compression, was 1.0 degree (P=0.03). In LLIF procedures, the largest increase in operative level segmental lordosis is brought about by cage insertion. Further lordosis may be gained by placing posterior fixation, including compressive maneuvers. Prone repositioning after cage placement does not produce any incremental lordosis change. Therefore, posterior fixation may be performed in the lateral position without compromising operative level sagittal alignment.

Safety concerns for first entry operations of orbiting spacecraft

NASA Technical Reports Server (NTRS)

Wilson, Steven H.; Limero, Thomas F.; James, John T.

1994-01-01

The Space Station Freedom crew will face operational problems unique to the spacecraft environment due to the absence of convection currents and the confined atmosphere within the habitable modules. Airborne contaminants from the materials offgassing or contingency incidents like thermodegradation may accumulate until they reach hazardous concentrations. Flow modeling and experiences from previous space flight missions confirm that caution must be exercised during first-entry operations. A review of the first-entry procedures performed during the Skylab Program will be presented to highlight the necessity for carefully planned operations. Many of the environmental conditions that can be expected on the Space Station are analogous to those which exist in confined storage or work spaces in the industrial setting. Experience with closed-loop environmental operations (e.g., atmospheric control of submarines) have also demonstrated that the buildup of trace contaminant gases could result in conditions that lead to mission termination or loss of crew. Consequently, some first-entry issues for the Station can be addressed by comparing them to familiar techniques developed on Earth. The instruments of the Environmental Health System (EHS) will provide the necessary monitoring capability to protect crew health and safety during the planned first-entry procedures of the MTC phase of the SSF Program. The authors of this paper will describe those procedures and will cite an example of the consequences when proper first-entry procedures are not followed.

Retrieval medicine: a review and guide for UK practitioners. Part 2: safety in patient retrieval systems

PubMed Central

Hearns, S; Shirley, P J

2006-01-01

Retrieval and transfer of critically ill and injured patients is a high risk activity. Risk can be minimised with robust safety and clinical governance systems in place. This article describes the various governance systems that can be employed to optimise safety and efficiency in retrieval services. These include operating procedure development, equipment management, communications procedures, crew resource management, significant event analysis, audit and training. PMID:17130608

Surgical strategies in the treatment of chronic pancreatitis: An updated systematic review and meta-analysis of randomized controlled trials.

PubMed

Zhao, Xin; Cui, Naiqiang; Wang, Ximo; Cui, Yunfeng

2017-03-01

Chronic pancreatitis (CP) is a common and frequently occurring disease. Pancreaticoduodenectomy (PD), pylorus-preserving pancreaticoduodenectomy (PPPD), and duodenum-preserving pancreatic head resection (DPPHR) are important treatment options for patients with chronic pancreatitis. The Beger and Frey procedures are 2 main duodenum-preserving techniques in duodenum-preserving pancreatic head resection (DPPHR) strategies. We conducted this systematic review and meta-analysis to compare the clinical efficacy of DPPHR versus PD, the Beger procedure versus PD, the Frey procedure versus PD, and the Beger procedure versus the Frey procedure in the treatment of pancreatitis. The optimal surgical option for chronic pancreatitis is still under debate. The aim of this systematic review and meta-analysis was to evaluate the clinical efficacy of different surgical strategies for chronic pancreatitis. Five databases (PubMed, Medline, SinoMed, Embase, and Cochrane Library) were searched with the limitations of human subjects and randomized controlled trials (RCTs) text. Data were extracted by 2 of the coauthors independently and analyzed using the RevMan statistical software, version 5.3. Weighted mean differences (WMDs), risk ratios (RRs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration's Risk of Bias Tool was used to assess the risk of bias. Seven studies involving a total of 385 patients who underwent the surgical treatments were assessed. The methodological quality of the trials ranged from low to moderate and included PD (n = 134) and DPPHR (n = 251 [Beger procedure = 100; Frey procedure = 109; Beger or Frey procedure = 42]). There were no significant differences between DPPHR and PD in post-operation mortality (RR = 2.89, 95% CI = 0.31-26.87, P = 0.36), pain relief (RR = 1.09, 95% CI = 0.94-1.25, P = 0.26), exocrine insufficiency (follow-up time > 60 months: RR = 0.91, 95% CI = 0.72-1.15, P = 0.41), and endocrine insufficiency (RR = 0.75, 95% CI = 0.52-1.08, P = 0.12). Concerning the follow-up time < 60 months, the DPPHR group had better results of exocrine insufficiency (RR = 0.22, 95% CI = 0.08-0.62, P = 0.04). However, operation time (P < 0.0001), blood transfusion (P = 0.02), hospital stay (P = 0.0002), postoperation morbidity (P = 0.0007), weight gain (P < 0.00001), quality of life (P = 0.01), and occupational rehabilitation (P = 0.007) were significantly better for patients who underwent the DPPHR procedure compared with the PD procedure. The comparison results of the Frey procedure and PD showed that both procedures had an equal effect in the pain relief, postoperation mortality, exocrine and endocrine function, and quality of life (QoL) (P > 0.05), whereas patients who underwent the Frey procedure had significantly reduced operative times (P < 0.05) and less blood transfusions (P < 0.05). Comparing the Beger procedure to the PD procedure, there were no significant differences in hospital stay, blood transfusion, postoperation morbidity or mortality, pain relief, weight gain, exocrine insufficiency, and occupational rehabilitation (P > 0.05). Two studies comparing the Beger and Frey procedures showed no differences in postoperative morbidity, pain relief, exocrine insufficiency, and quality of life (P > 0.05). In terms of operative time, blood transfusion, hospital stay, postoperation morbidity, weight gain, quality of life, and occupational rehabilitation, the results also favored duodenum-preserving pancreatic head resection (DPPHR) strategies. All procedures are equally effective for the management of pain, postoperation morbidity, exocrine insufficiency, and endocrine insufficiency for chronic pancreatitis. Improved short- and long-term outcomes, including operative time, blood transfusion, hospital stay, quality of life, weight gain, and occupational rehabilitation make DPPHR a more favorable surgical strategy for patients with chronic pancreatitis. Further, relevant trails are eager to prove these findings.

Surgical team turnover and operative time: An evaluation of operating room efficiency during pulmonary resection.

PubMed

Azzi, Alain Joe; Shah, Karan; Seely, Andrew; Villeneuve, James Patrick; Sundaresan, Sudhir R; Shamji, Farid M; Maziak, Donna E; Gilbert, Sebastien

2016-05-01

Health care resources are costly and should be used judiciously and efficiently. Predicting the duration of surgical procedures is key to optimizing operating room resources. Our objective was to identify factors influencing operative time, particularly surgical team turnover. We performed a single-institution, retrospective review of lobectomy operations. Univariate and multivariate analyses were performed to evaluate the impact of different factors on surgical time (skin-to-skin) and total procedure time. Staff turnover within the nursing component of the surgical team was defined as the number of instances any nurse had to leave the operating room over the total number of nurses involved in the operation. A total of 235 lobectomies were performed by 5 surgeons, most commonly for lung cancer (95%). On multivariate analysis, percent forced expiratory volume in 1 second, surgical approach, and lesion size had a significant effect on surgical time. Nursing turnover was associated with a significant increase in surgical time (53.7 minutes; 95% confidence interval, 6.4-101; P = .026) and total procedure time (83.2 minutes; 95% confidence interval, 30.1-136.2; P = .002). Active management of surgical team turnover may be an opportunity to improve operating room efficiency when the surgical team is engaged in a major pulmonary resection. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

General Anesthesia Time for Pediatric Dental Cases

PubMed Central

Forsyth, Anna R.; Seminario, Ana Lucia; Scott, JoAnna; Berg, Joel; Ivanova, Iskra; Lee, Helen

2012-01-01

Purpose The purpose of this study was to describe the use of operating room (OR) time for pediatric dental procedures performed under general anesthesia (GA) at a regional children’s hospital over a 2-year period. Methods A cross-sectional review of a pediatric dental GA records was performed at Seattle Children’s Hospital. Data were collected for 709 0- to 21-year-old patients from January 2008 to December 2009. Demographic data, dental and anesthesia operator types, and procedures were recorded. Utilization of OR time was analyzed. Results The mean age of patients was 7.1 years (±4.2 SD), and 58% were male. Distribution by American Society of Anesthesiology (ASA) classifications were: ASA I 226 (32%); ASA II 316 (45%); ASA III 167 (24%). Cases finished earlier than the scheduled time by an average of 14 minutes (±28). Overrun time was significantly associated with: patient age (P=.01); ASA classification (P=.006); treatment type (P<.001); number of teeth treated (P<.001); and dentist operator type (P=.005). Conclusions Overall, 73% of dental procedures under GA finished early or on time. Significant variables included patient age, medical status, treatment type and extent, and dentist operator type. Assessing factors that impact the time needed in GA may enhance efficiency for pediatric dental procedures. PMID:23211897

Evaluation of Bridges Subjected to Military Loading and Dynamic Hydraulic Effects: Review of Design Regulations, Selection Criteria, and Inspection Procedures for Bridge Railing Systems

DTIC Science & Technology

2011-08-01

Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any...may be required by the United States Customs and Immigration Services, in connection with the operation of an international bridge or tunnel. ERDC...significant effect on the operation , service quality, and safety of road networks by restricting the traffic volume and vehicle weight that can be

Surgery for failed cervical spine reconstruction.

PubMed

Helgeson, Melvin D; Albert, Todd J

2012-03-01

Review article. To review the indications, operative strategy, and complications of revision cervical spine reconstruction. With many surgeons expanding their indications for cervical spine surgery, the number of patients being treated operatively has increased. Unfortunately, the number of patients requiring revision procedures is also increasing, but very little literature exists reviewing changes in the indications or operative planning for revision reconstruction. Narrative and review of the literature. In addition to the well-accepted indications for primary cervical spine surgery (radiculopathy, myelopathy, instability, and tumor), we have used the following indications for revision surgery: pseudarthrosis, adjacent segment degeneration, inadequate decompression, iatrogenic instability, and deformity. Our surgical goal for pseudarthrosis is obviously to obtain a fusion, which can usually be performed with an approach not done previously. Our surgical goals for instability and deformity are more complex, with a focus on decompression of any neurologic compression, correction of deformity, and stability. Revision cervical spine reconstruction is safe and effective if performed for the appropriate indications and with proper planning.

Frequency and complications after operative fixation of clavicular fractures.

PubMed

Navarro, Ronald A; Gelber, Jonathan D; Harrast, John J; Seiler, John G; Jackson, Kent R; Garcia, Ivan A

2016-05-01

The purpose of this study was to analyze whether a recent trend in evidence supporting operative treatment of clavicular fractures is matched with an increase in operative fixation and complication rates in the United States. The American Board of Orthopaedic Surgery database was reviewed for cases with Current Procedural Terminology (American Medical Association, Chicago, IL, USA) code 23515 (clavicle open reduction internal fixation [ORIF]) from 1999 to 2010. The procedure rate for each year and the number of procedures for each candidate performing clavicle ORIF were calculated to determine if a change had occurred in the frequency of ORIF for clavicular fractures. Complication and outcome data were also reviewed. In 2010 vs, 1999, there were statistically significant increases in the mean number of clavicle ORIF performed among all candidates (0.89 vs. 0.13; P < .0001) and in the mean number of clavicle ORIF per candidate performing clavicle ORIF (2.47 vs. 1.20, P < .0473). The difference in the percentage of part II candidates performing clavicle ORIF from the start to the end of the study (11% vs. 36%) was significant (P < .0001). There was a significant increase in the clavicle ORIF percentage of total cases (0.11% vs. 0.74%, P < .0001). The most common complication was hardware failure (4%). The rate of ORIF of clavicular fractures has increased in candidates taking part II of the American Board of Orthopaedic Surgery, with a low complication rate. The increase in operative fixation during this interval may have been influenced by literature suggesting improved outcomes in patients treated with operative stabilization of their clavicular fracture. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Completeness of breast cancer operative reports in a community care setting.

PubMed

Eng, Jordan Lang; Baliski, Christopher Ronald; McGahan, Colleen; Cai, Eric

2017-10-01

The narrative operative report represents the traditional means by which breast cancer surgery has been documented. Previous work has established that omissions occur in narrative operative reports produced in an academic setting. The goal of this study was to determine the completeness of breast cancer narrative operative reports produced in a community care setting and to explore the effect of a surgeon's case volume and years in practice on the completeness of these reports. A standardized retrospective review of operative reports produced over a consecutive 2 year period was performed using a set of procedure-specific elements identified through a review of the relevant literature and work done locally. 772 operative reports were reviewed. 45% of all elements were completely documented. A small positive trend was observed between case volume and completeness while a small negative trend was observed between years in practice and completeness. The dictated narrative report inadequately documents breast cancer surgery irrespective of the recording surgeon's volume or experience. An intervention, such as the implementation of synoptic reporting, should be considered in an effort to maximize the utility of the breast cancer operative report. Copyright © 2017. Published by Elsevier Ltd.

AGR-5/6/7 LEUCO Kernel Fabrication Readiness Review

DOE Office of Scientific and Technical Information (OSTI.GOV)

Marshall, Douglas W.; Bailey, Kirk W.

2015-02-01

In preparation for forming low-enriched uranium carbide/oxide (LEUCO) fuel kernels for the Advanced Gas Reactor (AGR) fuel development and qualification program, Idaho National Laboratory conducted an operational readiness review of the Babcock & Wilcox Nuclear Operations Group – Lynchburg (B&W NOG-L) procedures, processes, and equipment from January 14 – January 16, 2015. The readiness review focused on requirements taken from the American Society Mechanical Engineers (ASME) Nuclear Quality Assurance Standard (NQA-1-2008, 1a-2009), a recent occurrence at the B&W NOG-L facility related to preparation of acid-deficient uranyl nitrate solution (ADUN), and a relook at concerns noted in a previous review. Topicmore » areas open for the review were communicated to B&W NOG-L in advance of the on-site visit to facilitate the collection of objective evidences attesting to the state of readiness.« less

The motivating operation and negatively reinforced problem behavior: a systematic review.

PubMed

Langthorne, Paul; McGill, Peter; Oliver, Chris

2014-01-01

The concept of motivational operations exerts an increasing influence on the understanding and assessment of problem behavior in people with intellectual and developmental disability. In this systematic review of 59 methodologically robust studies of the influence of motivational operations in negative reinforcement paradigms in this population, we identify themes related to situational and biological variables that have implications for assessment, intervention, and further research. There is now good evidence that motivational operations of differing origins influence negatively reinforced problem behavior, and that these might be subject to manipulation to facilitate favorable outcomes. There is also good evidence that some biological variables warrant consideration in assessment procedures as they predispose the person's behavior to be influenced by specific motivational operations. The implications for assessment and intervention are made explicit with reference to variables that are open to manipulation or that require further research and conceptualization within causal models.

48 CFR 7.104 - General procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., fiscal, legal, and technical personnel. If contract performance is to be in a designated operational area... shall review the plan and, if appropriate, revise it. (b) Requirements and logistics personnel should... planner should consult with requirements and logistics personnel who determine type, quality, quantity...

48 CFR 7.104 - General procedures.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., fiscal, legal, and technical personnel. If contract performance is to be in a designated operational area... shall review the plan and, if appropriate, revise it. (b) Requirements and logistics personnel should... planner should consult with requirements and logistics personnel who determine type, quality, quantity...

48 CFR 7.104 - General procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., fiscal, legal, and technical personnel. If contract performance is to be in a designated operational area... shall review the plan and, if appropriate, revise it. (b) Requirements and logistics personnel should... planner should consult with requirements and logistics personnel who determine type, quality, quantity...

48 CFR 7.104 - General procedures.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., fiscal, legal, and technical personnel. If contract performance is to be in a designated operational area... shall review the plan and, if appropriate, revise it. (b) Requirements and logistics personnel should... planner should consult with requirements and logistics personnel who determine type, quality, quantity...

48 CFR 7.104 - General procedures.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., fiscal, legal, and technical personnel. If contract performance is to be in a designated operational area... shall review the plan and, if appropriate, revise it. (b) Requirements and logistics personnel should... planner should consult with requirements and logistics personnel who determine type, quality, quantity...

77 FR 53841 - Amador County Resource Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-04

... Self-Determination Act (Pub. L. 112-141) (the Act) and operates in compliance with the Federal Advisory...'s processes and procedures, review applications, and make recommendations for projects to be.... Written comments may be submitted as described under SUPPLEMENTARY INFORMATION. All comments, including...

46 CFR 272.44 - Dates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Dates. 272.44 Section 272.44 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION REGULATIONS AFFECTING SUBSIDIZED VESSELS AND OPERATORS REQUIREMENTS... Examination, Audit, Review and Appeal Procedures § 272.44 Dates. The dates noted on the letters or...

46 CFR 272.44 - Dates.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 8 2011-10-01 2011-10-01 false Dates. 272.44 Section 272.44 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION REGULATIONS AFFECTING SUBSIDIZED VESSELS AND OPERATORS REQUIREMENTS... Examination, Audit, Review and Appeal Procedures § 272.44 Dates. The dates noted on the letters or...

28 CFR 550.57 - Inmate appeals.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.57 Inmate appeals. Inmates may seek formal review of complaints regarding the operation of the drug abuse treatment program by using administrative remedy procedures in 28...

28 CFR 550.57 - Inmate appeals.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.57 Inmate appeals. Inmates may seek formal review of complaints regarding the operation of the drug abuse treatment program by using administrative remedy procedures in 28...

28 CFR 550.57 - Inmate appeals.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.57 Inmate appeals. Inmates may seek formal review of complaints regarding the operation of the drug abuse treatment program by using administrative remedy procedures in 28...

28 CFR 550.57 - Inmate appeals.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.57 Inmate appeals. Inmates may seek formal review of complaints regarding the operation of the drug abuse treatment program by using administrative remedy procedures in 28...

28 CFR 550.57 - Inmate appeals.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.57 Inmate appeals. Inmates may seek formal review of complaints regarding the operation of the drug abuse treatment program by using administrative remedy procedures in 28...

Space construction system analysis. Part 2: Space construction experiments concepts

NASA Technical Reports Server (NTRS)

Boddy, J. A.; Wiley, L. F.; Gimlich, G. W.; Greenberg, H. S.; Hart, R. J.; Lefever, A. E.; Lillenas, A. N.; Totah, R. S.

1980-01-01

Technology areas in the orbital assembly of large space structures are addressed. The areas included structures, remotely operated assembly techniques, and control and stabilization. Various large space structure design concepts are reviewed and their construction procedures and requirements are identified.

75 FR 36390 - Notice of Public Information Collection(s) Being Submitted for Review and Approval to the Office...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-25

... the local franchising authority may file a complaint with the Commission, pursuant to our dispute resolution procedures set forth in Sec. 76.1514, if the open video system operator and the local franchising...

17 CFR 39.5 - Review of swaps for Commission determination on clearing requirement.

Code of Federal Regulations, 2013 CFR

2013-04-01

... publicly; (vi) Risk management procedures, including measurement and monitoring of credit exposures... derivative clearing organization's ability to manage the risks associated with clearing the swap, especially... of rule framework, capacity, operational expertise and resources, and credit support infrastructure...

17 CFR 39.5 - Review of swaps for Commission determination on clearing requirement.

Code of Federal Regulations, 2014 CFR

2014-04-01

... publicly; (vi) Risk management procedures, including measurement and monitoring of credit exposures... derivative clearing organization's ability to manage the risks associated with clearing the swap, especially... of rule framework, capacity, operational expertise and resources, and credit support infrastructure...

40 CFR 243.204-2 - Recommended procedures: Operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... collection system. These records should be used for scheduling maintenance and replacement, for budgeting, and for system evaluation and comparison. (b) The collection system should be reviewed on a regular...) SOLID WASTES GUIDELINES FOR THE STORAGE AND COLLECTION OF RESIDENTIAL, COMMERCIAL, AND INSTITUTIONAL...

Site-Based Budgeting in Fort Worth, Texas.

ERIC Educational Resources Information Center

Peternick, Lauri; Sherman, Joel

1998-01-01

Examines the Fort Worth Independent School District's decentralized decision-making system through three lenses: a review of site-based decision-making procedures at several schools; an examination of who participates; and stakeholders' perceptions. Some schools operated democratically, significantly including teachers, parents, and community…

Standard operating procedures (SOPs): reason for, types of, adequacy, approval, and deviations from and revisions to.

PubMed

Isaman, V; Thelin, R

1995-09-01

Standard Operating Procedures (SOPs) are required in order to comply with the Good Laboratory Practice Standards (GLPS) as promulgated in the Federal Insecticide, Fungicide and Rodenticide Act (FIFRA) 40 CFR Part 160. Paragraph 160.81 (a) states: "A testing facility shall have standard operating procedures in writing setting forth study methods that management is satisfied are adequate to insure the quality and integrity of the data generated in the course of a study." Types of SOPs include administrative and personnel, analyses, substances, quality assurance and records, test system, equipment, and field related. All SOPs must be adequate in scope to describe the function in sufficient detail such that the study data are reproducible. All SOPs must be approved by a management level as described in a corporate organization chart. Signatures for SOP responsibility, authorship, and Quality Assurance review adds strength and accountability to the SOP. In the event a procedure or method is performed differently from what is stated in the SOP, an SOP deviation is necessary. As methods and procedures are improved, SOP revisions are necessary to maintain SOP adequacy and applicability. The replaced SOP is put into a historical SOP file and all copies of the replaced SOPs are destroyed.

Transcutaneous laparoscopic hernia repair in children: a prospective review of 275 hernia repairs with minimum 2-year follow-up.

PubMed

Dutta, Sanjeev; Albanese, Craig

2009-01-01

Inguinal hernia in children is traditionally repaired through a groin incision by dissecting the hernia sac from the spermatic cord and suture ligating its base. A laparoscopic modification of this procedure involves placement of a transcutaneous suture around the neck of the sac through a 2-mm stab incision under visualization with an umbilically placed 2.7-mm 30 degrees lens. We reviewed the clinical outcome of this novel procedure at our institution. Prospective review of 275 hernias in 187 children (144 male, 43 female) performed laparoscopically by a single surgeon between September, 2002 and June, 2005. Data analyzed included side of hernia, incarceration, prematurity, recurrence rate, and complications. 30 left, 69 right, and 25 bilateral hernias were repaired. Sixty-three unilateral hernias had a contralateral patent processus vaginalis that was repaired. Mean operative time for a bilateral repair was 17 min. Two procedures were for recurrence after open repair. Forty-nine patients were ex-premature infants, accounting for 79 repairs. Fifteen cases followed reduction of incarcerated hernias, nine of whom were in preterm infants. Four out of 275 hernias (1.5%) recurred in four patients (mean age 4.5 years; 3 male, 1 female). There were four superficial wound infections, two umbilical granulomas, two hydroceles, and six self-resolving hematomas. There were no spermatic cord injuries, testicular atrophy, or symptoms of ilioinguinal nerve injuries. This novel laparoscopic inguinal hernia repair is an effective method in children, with recurrence rates comparable to the traditional approach. Advantages of the laparoscopic operation include a "no-touch" approach to the spermatic cord structures, a virtually virgin operative field in cases of recurrence, and excellent cosmesis. Disadvantages include peritoneal access and nonhermetic seal in males.

Dosing antibiotic prophylaxis during cardiopulmonary bypass-a higher level of complexity? A structured review.

PubMed

Paruk, Fathima; Sime, Fekade B; Lipman, Jeffrey; Roberts, Jason A

2017-04-01

In highly invasive procedures such as open heart surgery, the risk of post-operative infection is particularly high due to exposure of the surgical field to multiple foreign devices. Adequate antibiotic prophylaxis is an essential intervention to minimise post-operative morbidity and mortality. However, there is a lack of clear understanding on the adequacy of traditional prophylactic dosing regimens, which are rarely supported by data. The aim of this structured review is to describe the relevant pharmacokinetic/pharmacodynamic (PK/PD) considerations for optimal antibiotic prophylaxis for major cardiac surgery including cardiopulmonary bypass (CPB). A structured review of the relevant published literature was performed and 45 relevant studies describing antibiotic pharmacokinetics in patients receiving extracorporeal CPB as part of major cardiac surgery were identified. Some of the studies suggested marked PK alterations in the peri-operative period with increases in volume of distribution (V d ) by up to 58% and altered drug clearances of up to 20%. Mechanisms proposed as causing the PK changes included haemodilution, hypothermia, retention of the antibiotic within the extracorporeal circuit, altered physiology related to a systemic inflammatory response, and maldistribution of blood flow. Of note, some studies reported no or minimal impact of the CPB procedure on antibiotic pharmacokinetics. Given the inconsistent data, ongoing research should focus on clarifying the influence of CPB procedure and related clinical covariates on the pharmacokinetics of different antibiotics during cardiac surgery. Traditional prophylactic dosing regimens may need to be re-assessed to ensure sufficient drug exposures that will minimise the risk of surgical site infections. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

Vaginal hysterectomies in patients without uterine prolapse: ten-year experience.

PubMed

Cheung, K W; Pun, T C

2013-08-01

To review the results of vaginal hysterectomies in patients without uterine prolapse. Retrospective chart review. University affiliated hospital, Hong Kong. All patients who had vaginal hysterectomies in the absence of uterine prolapse from 1999 to 2005 inclusive (first period) and 2006 to 2009 inclusive (second period). The number of such hysterectomies, indications, operative procedures, complications, use of preoperative gonadotropin-releasing hormone agonist, and concomitant vaginal salpingo-oophorectomies performed. In all, 94 and 98 patients fulfilling the necessary inclusion criteria within the two respective periods underwent vaginal hysterectomy. The indications for hysterectomy in the respective groups were similar, and 89 (95%) and 90 (92%) of the patients were Chinese. The respective proportions having additional procedures were 11% versus 23% (P=0.018) and the respective vaginal bilateral salpingo-oophorectomy rates were 1% versus 15% (P<0.001). The vault haematoma rate decreased significantly in the second period (from 12% to 1%; P=0.002). There were no significant differences between the periods with respect to mean operative blood losses, uterine weights, and operating times. The use of gonadotropin-releasing hormone agonist resulted in reduced mean uterine sizes (12 weeks vs 10 weeks; P=0.041). A decreasing trend in mean operating times and blood losses was also observed after such use. Vaginal hysterectomy and bilateral salpingo-oophorectomies were successfully performed in 12 (80%) patients without laparoscopic assistance. For this procedure, a learning curve was also evident. Surgeons' experience can influence the complication rate and the chance of successful vaginal salpingo-oophorectomy. More liberal use of gonadotropin-releasing hormone agonist may further reduce the complication rate and allow more vaginal hysterectomies.

The impact of operative time on complications after plastic surgery: a multivariate regression analysis of 1753 cases.

PubMed

Hardy, Krista L; Davis, Kathryn E; Constantine, Ryan S; Chen, Mo; Hein, Rachel; Jewell, James L; Dirisala, Karunakar; Lysikowski, Jerzy; Reed, Gary; Kenkel, Jeffrey M

2014-05-01

Little evidence within plastic surgery literature supports the precept that longer operative times lead to greater morbidity. The authors investigate surgery duration as a determinant of morbidity, with the goal of defining a clinically relevant time for increased risk. A retrospective chart review was conducted of patients who underwent a broad range of complex plastic surgical procedures (n = 1801 procedures) at UT Southwestern Medical Center in Dallas, Texas, from January 1, 2008 to January 31, 2012. Adjusting for possible confounders, multivariate logistic regression assessed surgery duration as an independent predictor of morbidity. To define a cutoff for increased risk, incidence of complications was compared among quintiles of surgery duration. Stratification by type of surgery controlled for procedural complexity. A total of 1753 cases were included in multivariate analyses with an overall complication rate of 27.8%. Most operations were combined (75.8%), averaging 4.9 concurrent procedures. Each hour increase in surgery duration was associated with a 21% rise in odds of morbidity (P < .0001). Compared with the first quintile of operative time (<2.0 hours), there was no change in complications until after 3.1 hours of surgery (odds ratio, 1.6; P = .017), with progressively greater odds increases of 3.1 times after 4.5 hours (P < .0001) and 4.7 times after 6.8 hours (P < .0001). When stratified by type of surgery, longer operations continued to be associated with greater morbidity. Surgery duration is an independent predictor of complications, with a significantly increased risk above 3 hours. Although procedural complexity undoubtedly affects morbidity, operative time should factor into surgical decision making.

Office-Based Procedures for the Diagnosis and Treatment of Laryngeal Pathology.

PubMed

Wellenstein, David J; Schutte, Henrieke W; Takes, Robert P; Honings, Jimmie; Marres, Henri A M; Burns, James A; van den Broek, Guido B

2017-09-18

Since the development of distal chip endoscopes with a working channel, diagnostic and therapeutic possibilities in the outpatient clinic in the management of laryngeal pathology have increased. Which of these office-based procedures are currently available, and their clinical indications and possible advantages, remains unclear. Review of literature on office-based procedures in laryngology and head and neck oncology. Flexible endoscopic biopsy (FEB), vocal cord injection, and laser surgery are well-established office-based procedures that can be performed under topical anesthesia. These procedures demonstrate good patient tolerability and multiple advantages. Office-based procedures under topical anesthesia are currently an established method in the management of laryngeal pathology. These procedures offer medical and economic advantages compared with operating room-performed procedures. Furthermore, office-based procedures enhance the speed and timing of the diagnostic and therapeutic process. Copyright © 2017 The Voice Foundation. All rights reserved.

Use of an operating microscope during spine surgery is associated with minor increases in operating room times and no increased risk of infection.

PubMed

Basques, Bryce A; Golinvaux, Nicholas S; Bohl, Daniel D; Yacob, Alem; Toy, Jason O; Varthi, Arya G; Grauer, Jonathan N

2014-10-15

Retrospective database review. To evaluate whether microscope use during spine procedures is associated with increased operating room times or increased risk of infection. Operating microscopes are commonly used in spine procedures. It is debated whether the use of an operating microscope increases operating room time or confers increased risk of infection. The American College of Surgeons National Surgical Quality Improvement Program database, which includes data from more than 370 participating hospitals, was used to identify patients undergoing elective spinal procedures with and without the use of an operating microscope for the years 2011 and 2012. Bivariate and multivariate linear regressions were used to test the association between microscope use and operating room times. Bivariate and multivariate logistic regressions were similarly conducted to test the association between microscope use and infection occurrence within 30 days of surgery. A total of 23,670 elective spine procedures were identified, of which 2226 (9.4%) used an operating microscope. The average patient age was 55.1±14.4 years. The average operative time (incision to closure) was 125.7±82.0 minutes.Microscope use was associated with minor increases in preoperative room time (+2.9 min, P=0.013), operative time (+13.2 min, P<0.001), and total room time (+18.6 min, P<0.001) on multivariate analysis.A total of 328 (1.4%) patients had an infection within 30 days of surgery. Multivariate analysis revealed no significant difference between the microscope and nonmicroscope groups for occurrence of any infection, superficial surgical site infection, deep surgical site infection, organ space infection, or sepsis/septic shock, regardless of surgery type. We did not find operating room times or infection risk to be significant deterrents for use of an operating microscope during spine surgery. 3.

Use of an operating microscope during spine surgery is associated with minor increases in operating room times and no increased risk of infection

PubMed Central

Basques, Bryce A.; Golinvaux, Nicholas S.; Bohl, Daniel D.; Yacob, Alem; Toy, Jason O.; Varthi, Arya G.; Grauer, Jonathan N.

2014-01-01

Study Design Retrospective database review. Objective To evaluate whether microscope use during spine procedures is associated with increased operating room times or increased risk of infection. Summary of Background Data Operating microscopes are commonly used in spine procedures. It is debated whether the use of an operating microscope increases operating room time or confers increased risk of infection. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, which includes data from over 370 participating hospitals, was used to identify patients undergoing elective spinal procedures with and without an operating microscope for the years 2011 and 2012. Bivariate and multivariate linear regressions were used to test the association between microscope use and operating room times. Bivariate and multivariate logistic regressions were similarly conducted to test the association between microscope use and infection occurrence within 30 days of surgery. Results A total of 23,670 elective spine procedures were identified, of which 2,226 (9.4%) used an operating microscope. The average patient age was 55.1 ± 14.4 years. The average operative time (incision to closure) was 125.7 ± 82.0 minutes. Microscope use was associated with minor increases in preoperative room time (+2.9 minutes, p=0.013), operative time (+13.2 minutes, p<0.001), and total room time (+18.6 minutes, p<0.001) on multivariate analysis. A total of 328 (1.4%) patients had an infection within 30 days of surgery. Multivariate analysis revealed no significant difference between the microscope and non-microscope groups for occurrence of any infection, superficial surgical site infection (SSI), deep SSI, organ space infection, or sepsis/septic shock, regardless of surgery type. Conclusions We did not find operating room times or infection risk to be significant deterrents for use of an operating microscope during spine surgery. PMID:25188600

Recurrent instability after revision anterior shoulder stabilization surgery.

PubMed

Friedman, Lisa Genevra Mandeville; Griesser, Michael J; Miniaci, Anthony A; Jones, Morgan H

2014-03-01

The purpose of this study was to perform a systematic review of the literature to compare outcomes of revision anterior stabilization surgeries based on technique. This study also sought to compare the impact of bone defects on outcomes. A systematic review of the electronic databases PubMed, Cochrane Central Register of Controlled Trials, and Scopus was performed in July 2012 and March 2013. Of 345 articles identified in the search, 17 studies with Level I to IV Evidence satisfied the inclusion criteria and were analyzed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Recurrent instability was defined as redislocation, resubluxation, or a positive apprehensive test after revision surgery. Procedures were categorized as arthroscopic Bankart repair, open Bankart repair, Bristow-Latarjet procedure, and other open procedures. In total, 388 shoulders were studied. Male patients comprised 74.1% of patients, 66.7% of cases involved the dominant shoulder, the mean age was 28.2 years, and the mean follow-up period was 44.2 months. The surgical procedures classified as "other open procedures" had the highest rate of recurrent instability (42.7%), followed by arthroscopic Bankart repair (14.7%), the Bristow-Latarjet procedure (14.3%), and open Bankart repair (5.5%). Inconsistent reporting of bone defects precluded drawing significant conclusions. A number of different procedures are used to address recurrent instability after a primary operation for anterior shoulder instability has failed. There is significant variability in the rate of recurrent instability after revision anterior shoulder stabilization surgery. Level IV, systematic review of Level I to IV studies. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

A Review of the Ahmed Glaucoma Valve Implant and Comparison with Other Surgical Operations.

PubMed

Riva, Ivano; Roberti, Gloria; Katsanos, Andreas; Oddone, Francesco; Quaranta, Luciano

2017-04-01

The Ahmed glaucoma valve (AGV) is a popular glaucoma drainage implant used for the control of intraocular pressure in patients with glaucoma. While in the past AGV implantation was reserved for glaucoma patients poorly controlled after one or more filtration procedures, mounting evidence has recently encouraged its use as a primary surgery in selected cases. AGV has been demonstrated to be safe and effective in reducing intraocular pressure in patients with primary or secondary refractory glaucoma. Compared to other glaucoma surgeries, AGV implantation has shown favorable efficacy and safety. The aim of this article is to review the results of studies directly comparing AGV with other surgical procedures in patients with glaucoma.

Space Transportation System Cargo projects: inertial stage/spacecraft integration plan. Volume 1: Management plan

NASA Technical Reports Server (NTRS)

1981-01-01

The Kennedy Space Center (KSC) Management System for the Inertial Upper Stage (IUS) - spacecraft processing from KSC arrival through launch is described. The roles and responsibilities of the agencies and test team organizations involved in IUS-S/C processing at KSC for non-Department of Defense missions are described. Working relationships are defined with respect to documentation preparation, coordination and approval, schedule development and maintenance, test conduct and control, configuration management, quality control and safety. The policy regarding the use of spacecraft contractor test procedures, IUS contractor detailed operating procedures and KSC operations and maintenance instructions is defined. Review and approval requirements for each documentation system are described.

Takotsubo cardiomyopathy precipitated by maxillofacial surgery and general anesthesia: a case report and review of literature.

PubMed

Bruckman, Karl C; Taub, Daniel I; McNulty, Stephen E

2013-12-01

Takotsubo cardiomyopathy (TCM) is a syndrome characterized by a transient episode of heart failure. The specific etiology of this condition is widely speculated. The purpose of this case report and literature review was to investigate the incidence of TCM with regard to general anesthesia, especially those cases involving operative procedures within the realm of oral and maxillofacial surgery. It is intended that the present case serve as a guide for fellow surgeons to identify and manage this syndrome. The present case was explained and a review of the literature was performed. PubMed was used to search for articles involving surgical procedures under general anesthesia, including oral and maxillofacial surgery. It was determined that TCM rarely occurs in conjunction with surgical procedures under general anesthesia, especially those of the head and neck region. TCM is an uncommon medical condition with significant morbidity and mortality when managed incorrectly. The occurrence of this syndrome in relation to oral and maxillofacial procedures is also rare, although it is imperative that surgeons be able to recognize and treat this condition appropriately. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures.

PubMed

McClelland, Shearwood; Hall, Walter A

2007-07-01

Postoperative central nervous system infection (PCNSI) in patients undergoing neurosurgical procedures represents a serious problem that requires immediate attention. PCNSI most commonly manifests as meningitis, subdural empyema, and/or brain abscess. Recent studies (which have included a minimum of 1000 operations) have reported that the incidence of PCNSI after neurosurgical procedures is 5%-7%, and many physicians believe that the true incidence is even higher. To address this issue, we examined the incidence of PCNSI in a sizeable patient population. The medical records and postoperative courses for patients involved in 2111 neurosurgical procedures at our institution during 1991-2005 were reviewed retrospectively to determine the incidence of PCNSI, the identity of offending organisms, and the factors associated with infection. The median age of patients at the time of surgery was 45 years. Of the 1587 cranial operations, 14 (0.8%) were complicated by PCNSI, whereas none of the 32 peripheral nerve operations resulted in PCNSI. The remaining 492 operative cases involved spinal surgery, of which 2 (0.4%) were complicated by PCNSI. The overall incidence of PCNSI was 0.8% (occurring after 16 of 2111 operations); the incidence of bacterial meningitis was 0.3% (occurring after 4 of 1587 operations), and the incidence of brain abscess was 0.2% (occurring after 3 of 1587 operations). The most common offending organism was Staphylococcus aureus (8 cases; 50% of infections), followed by Propionibacterium acnes (4 cases; 25% of infections). Cerebrospinal fluid leakage, diabetes mellitus, and male sex were not associated with PCNSI (P>.05). In one of the largest neurosurgical studies to have investigated PCNSI, the incidence of infection after neurosurgical procedures was <1%--more than 6 times lower than that reported in recent series of comparable numerical size. Cerebrospinal fluid leak, diabetes mellitus, and male sex were not associated with an increased incidence of PCNSI. The results from this study indicate that the true incidence of PCNSI after neurosurgical procedures may be greatly overestimated in the literature and that, in surgical procedures associated with a high risk of infection, prophylaxis for S. aureus and/or P. acnes infection should be of primary concern.

Standardizing care and monitoring for anesthesia or procedural sedation delivered outside the operating room.

PubMed

Eichhorn, Volker; Henzler, Dietrich; Murphy, Michael F

2010-08-01

The purpose of this review is to summarize recommendations for the safe and efficient conductance of sedation and anesthesia at remote locations; and to define safety standards, monitoring techniques, quality of care and procedural eligibility. Anesthesia outside of the operating room is rapidly increasing in numbers, which has seen a growth of older and sicker patients. These circumstances have created a need for guidelines, for both specialist anesthesia providers and nonanesthesia-trained practitioners, that define patient selection, minimum monitoring (hemodynamics and respiration), facility design and equipment, policy framework, recovery facilities and policies. The patient's safety throughout all stages of sedation and/or anesthesia is the most pertinent goal. Recent data emphasize the importance of monitoring pulse oximetry and end-tidal carbon dioxide for any sedating or anesthetic procedure. Substandard monitoring combined with oversedation and subsequent respiratory depression are implicated as the main reasons for catastrophic sedation and anesthetic outcomes at remote locations. Patient selection, procedure appropriateness and location appropriateness are the key elements defining the provision of safe anesthesia care outside the operating room. Titratable, short-acting intravenous drugs are preferred such as propofol and remifentanil.

[Neurologist and emergency neuroendovascular revascularization -training programs for endovascular procedures-].

PubMed

Imai, Keisuke; Hamanaka, Masashi; Yamada, Takehiro; Yamazaki, Hidekazu; Yamamoto, Atsushi; Tsuto, Kazuma; Takegami, Tetsuro; Umezawa, Kunihiko; Ikeda, Eito; Mizuno, Toshiki

2014-01-01

Emergency neuroendovascular revascularization is a reperfusion therapy for acute stroke. The operator for this therapy has to obtain a license as a specialist in endovascular procedures. For neurologists wishing to acquire this license, there are two kinds of training programs: full-time training and concurrent training. Full-time training was chosen by the first author of this review, while concurrent training will be performed by staff in the author's department. The advantage of full-time training is the acquisition of a lot of experience of various diseases that are treated with endovascular procedures and managed in the periprocedural period. However, full-time training has the disadvantages of a requirement to discontinue medical care of neurological diseases except for stroke and employment at a remote institution. The advantages and disadvantages of concurrent training are the reverse of those of full-time training. Neither training system can succeed without cooperation from Departments of Neurology in neighboring universities and the institutional Department of Neurosurgery. It is particularly important for each neurologist to establish a goal of becoming an operator for recanalization therapy alone or for all fields of endovascular procedures because training will differ for attainment of each operator's goal.

Pre and post processing using the IBM 3277 display station graphics attachment (RPQ7H0284)

NASA Technical Reports Server (NTRS)

Burroughs, S. H.; Lawlor, M. B.; Miller, I. M.

1978-01-01

A graphical interactive procedure operating under TSO and utilizing two CRT display terminals is shown to be an effective means of accomplishing mesh generation, establishing boundary conditions, and reviewing graphic output for finite element analysis activity.

77 FR 47490 - Shipping Coordinating Committee; Notice of Committee Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-08

...): --Review and modernization of the GMDSS --Further development of the GMDSS master plan on shore-based facilities --Consideration of operational and technical coordination provisions of maritime safety... search and rescue procedures, including SAR training matters --Further development of the Global SAR Plan...

A Surgical Approach to Pediatric Glaucoma

PubMed Central

Khan, Arif O

2015-01-01

Glaucoma in children differs from adult-onset disease and typically requires surgical intervention. However, affected children exhibit a spectrum of disease severity and prospective data guiding the choice of operation are lacking. This article reviews common procedures and a surgical approach to pediatric glaucoma. PMID:26069523

Shark attack.

PubMed

Guidera, K J; Ogden, J A; Highhouse, K; Pugh, L; Beatty, E

1991-01-01

Shark attacks are rare but devastating. This case had major injuries that included an open femoral fracture, massive hemorrhage, sciatic nerve laceration, and significant skin and muscle damage. The patient required 15 operative procedures, extensive physical therapy, and orthotic assistance. A review of the literature pertaining to shark bites is included.

Defining Reinforcers--A Problem in Communication For Consultation in Behavior Modification

ERIC Educational Resources Information Center

Schmits, Donald W.

1973-01-01

This paper reviews the respondent (Hull-Spence) and operant (Skinnerian) conditioning definitions of reinforcers and reinforcement and demonstrates the need to keep the systems separate when consulting about behavior modification. The two systems are shown to lead to different modification procedures. (Author)

Study report recommendations for the next generation Range Safety System (RSS) Integrated Receiver/Decoder (IRD)

NASA Technical Reports Server (NTRS)

Crosby, Robert H.

1992-01-01

The Integrated Receiver/Decoder (IRD) currently used on the Space Shuttle was designed in the 1980 and prior time frame. Over the past 12 years, several parts have become obsolete or difficult to obtain. As directed by the Marshall Space Flight Center, a primary objective is to investigate updating the IRD design using the latest technology subsystems. To take advantage of experience with the current designs, an analysis of failures and a review of discrepancy reports, material review board actions, scrap, etc. are given. A recommended new design designated as the Advanced Receiver/Decoder (ARD) is presented. This design uses the latest technology components to simplify circuits, improve performance, reduce size and cost, and improve reliability. A self-test command is recommended that can improve and simplify operational procedures. Here, the new design is contrasted with the old. Possible simplification of the total Range Safety System is discussed, as is a single-step crypto technique that can improve and simplify operational procedures.

Systematic review of general thoracic surgery articles to identify predictors of operating room case durations.

PubMed

Dexter, Franklin; Dexter, Elisabeth U; Masursky, Danielle; Nussmeier, Nancy A

2008-04-01

Previous studies of operating room (OR) information systems data over the past two decades have shown how to predict case durations using the combination of scheduled procedure(s), individual surgeon and assistant(s), and type of anesthetic(s). We hypothesized that the accuracy of case duration prediction could be improved by the use of other electronic medical record data (e.g., patient weight or surgeon notes using standardized vocabularies). General thoracic surgery was used as a model specialty because much of its workload is elective (scheduled) and many of its cases are long. PubMed was searched for thoracic surgery papers reporting operative time, surgical time, etc. The systematic literature review identified 48 papers reporting statistically significant differences in perioperative times. There were multiple reports of differences in OR times based on the procedure(s), perioperative team including primary surgeon, and type of anesthetic, in that sequence of importance. All such detail may not be known when the case is originally scheduled and thus may require an updated duration the day before surgery. Although the use of these categorical data from OR systems can result in few historical data for estimating each case's duration, bias and imprecision of case duration estimates are unlikely to be affected. There was a report of a difference in case duration based on additional information. However, the incidence of the procedure for the diagnosis was so uncommon as to be unlikely to affect OR management. Matching findings of prior studies using OR information system data, multiple case series show that it is important to rely on the precise procedure(s), surgical team, and type of anesthetic when estimating case durations. OR information systems need to incorporate the statistical methods designed for small numbers of prior surgical cases. Future research should focus on the most effective methods to update the prediction of each case's duration as these data become available. The case series did not reveal additional data which could be cost-effectively integrated with OR information systems data to improve the accuracy of predicted durations for general thoracic surgery cases.

Utilization of a cognitive task analysis for laparoscopic appendectomy to identify differentiated intraoperative teaching objectives.

PubMed

Smink, Douglas S; Peyre, Sarah E; Soybel, David I; Tavakkolizadeh, Ali; Vernon, Ashley H; Anastakis, Dimitri J

2012-04-01

Experts become automated when performing surgery, making it difficult to teach complex procedures to trainees. Cognitive task analysis (CTA) enables experts to articulate operative steps and cognitive decisions in complex procedures such as laparoscopic appendectomy, which can then be used to identify central teaching points. Three local surgeon experts in laparoscopic appendectomy were interviewed using critical decision method-based CTA methodology. Interview transcripts were analyzed, and a cognitive demands table (CDT) was created for each expert. The individual CDTs were reviewed by each expert for completeness and then combined into a master CDT. Percentage agreement on operative steps and decision points was calculated for each expert. The experts then participated in a consensus meeting to review the master CDT. Each surgeon expert was asked to identify in the master CDT the most important teaching objectives for junior-level and senior-level residents. The experts' responses for junior-level and senior-level residents were compared using a χ(2) test. The surgeon experts identified 24 operative steps and 27 decision points. Eighteen of the 24 operative steps (75%) were identified by all 3 surgeon experts. The percentage of operative steps identified was high for each surgeon expert (96% for surgeon 1, 79% for surgeon 2, and 83% for surgeon 3). Of the 27 decision points, only 5 (19%) were identified by all 3 surgeon experts. The percentage of decision points identified varied by surgeon expert (78% for surgeon 1, 59% for surgeon 2, and 48% for surgeon 3). When asked to identify key teaching points, the surgeon experts were more likely to identify operative steps for junior residents (9 operative steps and 6 decision points) and decision points for senior residents (4 operative steps and 13 decision points) (P < .01). CTA can deconstruct the essential operative steps and decision points associated with performing a laparoscopic appendectomy. These results provide a framework to identify key teaching principles to guide intraoperative instruction. These learning objectives could be used to guide resident level-appropriate teaching of an essential general surgery procedure. Copyright © 2012 Elsevier Inc. All rights reserved.

Systematic review of cortical bone trajectory versus pedicle screw techniques for lumbosacral spine fusion.

PubMed

Phan, Kevin; Ramachandran, Vignesh; Tran, Tommy M; Shah, Kevin P; Fadhil, Matthew; Lackey, Alan; Chang, Nicholas; Wu, Ai-Min; Mobbs, Ralph J

2017-12-01

Fusion of the lumbosacral spine is a common surgical procedure to address a range of spinal pathologies. Fixation in lumbar fusion has traditionally been performed using pedicle screw (PS) augmentation. However, an alternative method of screw insertion via cortical bone trajectory (CBT) has been advocated as a less invasive approach which improves initial fixation and reduces neurovascular injury. There is a paucity of robust clinical evidence to support these claims, particularly in comparison to traditional pedicle screws. This study aims to review the available evidence to assess the merits of the CBT approach. Six electronic databases were searched for original published studies which compared CBT with traditional PS and their findings reviewed. Nine comparative studies were identified through a comprehensive literature search. Studies were classified as retrospective cohort, prospective cohort or case control studies with medium quality as assessed by the GRADE criteria. The available literature is not cohesive regarding outcomes and complications of CBT versus PT procedures. Most studies found no difference in operative time, but reported less blood loss during CBT. Radiological outcomes show no difference in slippage at one year although CBT is associated with greater bone-density compared to PT. Results for post-operative pain are inconclusive.

Surgical Resection and Inferior Vena Cava Reconstruction for Treatment of the Malignant Tumor: Technical Success and Outcomes

PubMed Central

2014-01-01

Objective: The purpose of this study was to review patients who underwent inferior vena cava (IVC) resection with concomitant malignant tumor resection and to consider the operative procedures and the outcomes. Materials and Methods: Between 2000 and 2012, 41 patients underwent resection of malignant tumors concomitant with surgical resection of the IVC at our institute. The records of these patients were retrospectively reviewed. Results: Primary tumor resections included nephrectomy, hepatectomy, retroperitoneal tumor extirpation, lymph node dissection, and pancreaticoduodenectomy. The IVC interventions were partial resection in 23 patients and total resection in 18 patients. Four patients underwent IVC replacement. Operation-related complications included pulmonary embolism, acute myocardial infarction, deep vein thrombosis, leg edema and temporary hemodialysis. There were no operative deaths. The mean follow-up period was 24.9 months (range: 2–98 months). The prognosis depended on the type and stage of the tumor. Conclusion: Resection and reconstruction of the IVC can be performed safely if the preoperative evaluations and surgical procedures are performed properly. The IVC resection without reconstruction was permissive if the IVC was completely obstructed preoperatively, but it may also be considered in cases where the IVC is not completely obstructed. PMID:24995055

Getting started with robotics in general surgery with cholecystectomy: the Canadian experience.

PubMed

Jayaraman, Shiva; Davies, Ward; Schlachta, Christopher M

2009-10-01

The value of robotics in general surgery may be for advanced minimally invasive procedures. Unlike other specialties, formal fellowship training opportunities for robotic general surgery are few. As a result, most surgeons currently develop robotic skills in practice. Our goal was to determine whether robotic cholecystectomy is a safe and effective bridge to advanced robotics in general surgery. Before performing advanced robotic procedures, 2 surgeons completed the Intuitive Surgical da Vinci training course and agreed to work together on all procedures. Clinical surgery began with da Vinci cholecystectomy with a plan to begin advanced procedures after at least 10 cholecystectomies. We performed a retrospective review of our pilot series of robotic cholecystectomies and compared them with contemporaneous laparoscopic controls. The primary outcome was safety, and the secondary outcome was learning curve. There were 16 procedures in the robotics arm and 20 in the laparoscopic arm. Two complications (da Vinci port-site hernia, transient elevation of liver enzymes) occurred in the robotic arm, whereas only 1 laparoscopic patient (slow to awaken from anesthetic) experienced a complication. None was significant. The mean time required to perform robotic cholecystectomy was significantly longer than laparoscopic surgery (91 v. 41 min, p < 0.001). The mean time to clear the operating room was significantly longer for robotic procedures (14 v. 11 min, p = 0.015). We observed a trend showing longer mean anesthesia time for robotic procedures (23 v. 15 min). Regarding learning curve, the mean operative time needed for the first 3 robotic procedures was longer than for the last 3 (101 v. 80 min); however, this difference was not significant. Since this experience, the team has confidently gone on to perform robotic biliary, pancreatic, gastresophageal, intestinal and colorectal operations. Robotic cholecystectomy can be performed reliably; however, owing to the significant increase in operating room resources, it cannot be justified for routine use. Our experience, however, demonstrates that robotic cholecystectomy is one means by which general surgeons may gain confidence in performing advanced robotic procedures.

Genitourinary Surgical Workload at Deployed U.S. Facilities in Iraq and Afghanistan, 2002-2016.

PubMed

Turner, Caryn A; Orman, Jean A; Stockinger, Zsolt T; Hudak, Steven J

2018-06-13

Genitourinary surgery constitutes approximately 1.15% of procedures performed for combat injuries. During forward deployment, surgeons usually deploy without urology support. To better understand the training and skills maintenance needs for genitourinary procedures by describing in detail the genitourinary surgical workload during 15 years of combat operations and compare our findings with those from previously published articles. A retrospective analysis of the Department of Defense Trauma Registry (DoDTR) was performed for all Roles 2 and 3 medical treatment facilities in Iraq and Afghanistan, from January 2002 to May 2016. The 177 ICD-9-CM procedure codes identified as genitourinary procedures were grouped into 15 anatomic categories by subject matter experts. Select groups were further subdivided by procedure types. Descriptive analyses were performed and stratified workload percentiles were calculated for the 10th, 50th, and 90th percentiles. Data analysis was performed using Stata Version 14 (College Station, TX, USA). This quality improvement project was deemed exempt from institutional review board review by the U.S. Army Institute of Surgical Research. A total of 3,963 genitourinary surgical procedures were identified, the majority occurring at Role 3 medical treatment facilities (3,512, 88.6%). The most common procedure groups were testis (20.6%), bladder (18.8%), scrotum (17.7%), and kidney (13.5%). The single most common individual procedures performed were unilateral orchiectomy (394, 9.9%), suture of laceration of scrotum and tunica vaginalis (373, 9.4%), nephroureterectomy (360, 9.1%), and other suprapubic cystostomy (268, 6.8%). Of the 77 gynecological procedures, 15 were C-sections. Genitourinary caseload per facility was low, never exceeding nine procedures per month. All deploying surgeons may be required to evaluate, stage, and surgically manage genitourinary, gynecologic, and obstetrical conditions. Surgery on the male genitalia, bladder, and kidney were the most commonly required genitourinary operative procedures in deployed facilities; therefore, non-urological surgeons should receive pre-deployment training in these techniques. The workload data from our study can be used to help guide the development of pre-deployment training to ensure military surgeons have the skills to perform the specialty procedures required while deployed.

Research ethics policies and practices in health research institutions in sub-Saharan African countries: results of a questionnaire-based survey.

PubMed

Zielinski, Chris; Kebede, Derege; Mbondji, Peter Ebongue; Sanou, Issa; Kouvividila, Wenceslas; Lusamba-Dikassa, Paul-Samson

2014-05-01

To describe the state of research ethics policies and practices in health research institutions in sub-Saharan African countries. A structured questionnaire was used to solicit information on research ethics from health research institutions. Forty-two sub-Saharan African countries. Key informants from the health research institutions. Existence of institutional ethics review policies and mechanisms. About half (51%) of respondent institutions reported having policies on research ethics and 58% had written policies requiring that researchers obtain informed consent of research participants. About one-third of respondent institutions (34%) had established ethics review committees, 42% required that studies went through ethics review committees and 46% had linkages with national or regional ethics organisations. Regarding operating procedures for ethics review committees, 53% had adopted standard operating procedures. Less than one-quarter of respondent institutions reported having policies in place to monitor ongoing research. Of the institutions that monitored ongoing research, 34% did an annual ethical review and 74% required a periodic written report. Only 36% provided any type of ethics training for staff, including those conducting health research and those who were not members of the ethics review committee. There are substantial gaps in the capacity of health research institutions in the WHO African Region to undertake ethical review of studies before, during and after studies conducted. There is a need to strengthen such capacity in order to ensure the wellbeing of individuals enrolled in studies and that of communities that host these studies. © The Royal Society of Medicine.

Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity.

PubMed

Bridwell, Keith H

2006-09-01

Author experience and literature review. To investigate and discuss decision-making on when to perform a Smith-Petersen osteotomy as opposed to a pedicle subtraction procedure and/or a vertebral column resection. Articles have been published regarding Smith-Petersen osteotomies, pedicle subtraction procedures, and vertebral column resections. Expectations and complications have been reviewed. However, decision-making regarding which of the 3 procedures is most useful for a particular spinal deformity case is not clearly investigated. Discussed in this manuscript is the author's experience and the literature regarding the operative options for a fixed coronal or sagittal deformity. There are roles for Smith-Petersen osteotomy, pedicle subtraction, and vertebral column resection. Each has specific applications and potential complications. As the magnitude of resection increases, the ability to correct deformity improves, but also the risk of complication increases. Therein, an understanding of potential applications and complications is helpful.

Perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted gastric sleeve resection.

PubMed

Joselyn, Anita; Bhalla, Tarun; McKee, Christopher; Pepper, Victoria; Diefenbach, Karen; Michalsky, Marc; Tobias, Joseph D

2015-01-01

One of the major advantages for patients undergoing minimally invasive surgery as compared to an open surgical procedure is the improved recovery profile and decreased opioid requirements in the perioperative period. There are no definitive studies comparing the analgesic requirements in patients undergoing two different types of minimally invasive procedure. This study retrospectively compares the perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted, laparoscopic gastric sleeve resection. With Institutional Review Board approval, the medication administration records of all severely obese patients who underwent gastric sleeve resection were retrospectively reviewed. Intra-operative analgesic and adjuvant medications administered, postoperative analgesic requirements, and visual analog pain scores were compared between those undergoing a laparoscopic procedure versus a robotic-assisted procedure. This study cohort included a total of 28 patients who underwent gastric sleeve resection surgery with 14 patients in the laparoscopic group and 14 patients in the robotic-assisted group. Intra-operative adjuvant administration of both intravenous acetaminophen and ketorolac was similar in both groups. Patients in the robotic-assisted group required significantly less opioid during the intra-operative period as compared to patients in the laparoscopic group (0.15 ± 0.08 mg/kg vs. 0.19 ± 0.06 mg/kg morphine, P = 0.024). Cumulative opioid requirements for the first 72 postoperative h were similar in both the groups (0.64 ± 0.25 vs. 0.68 ± 0.27 mg/kg morphine, P = NS). No difference was noted in the postoperative pain scores. Although intraoperative opioid administration was lower in the robotic-assisted group, the postoperative opioid requirements, and the postoperative pain scores were similar in both groups.

ACOG Technology Assessment No. 13: Hysteroscopy.

PubMed

2018-05-01

Hysteroscopy is performed to view and treat pathology within the uterine cavity and endocervix. Diagnostic hysteroscopy allows visualization of the endocervical canal, endometrial cavity, and fallopian tube ostia. Operative hysteroscopy incorporates the use of mechanical, electrosurgical, or laser instruments to treat intracavitary pathology and perform hysteroscopic sterilization procedures. Selection of a distending medium requires consideration of the advantages, disadvantages, and risks associated with various media as well as their compatibility with electrosurgical or laser energy. A preoperative consultation allows the patient and physician to discuss the hysteroscopic procedure, weigh its inherent risks and benefits, review the patient's medical history for any comorbid conditions, and exclude pregnancy. Known pregnancy, genital tract infections, and active herpetic infection are contraindications to hysteroscopy. The most common perioperative complications associated with operative hysteroscopy are hemorrhage, uterine perforation, and cervical laceration. The procedure is minimally invasive and can be used with a high degree of safety.

ACOG Technology Assessment No. 13 Summary: Hysteroscopy.

PubMed

2018-05-01

Hysteroscopy is performed to view and treat pathology within the uterine cavity and endocervix. Diagnostic hysteroscopy allows visualization of the endocervical canal, endometrial cavity, and fallopian tube ostia. Operative hysteroscopy incorporates the use of mechanical, electrosurgical, or laser instruments to treat intracavitary pathology and perform hysteroscopic sterilization procedures. Selection of a distending medium requires consideration of the advantages, disadvantages, and risks associated with various media as well as their compatibility with electrosurgical or laser energy. A preoperative consultation allows the patient and physician to discuss the hysteroscopic procedure, weigh its inherent risks and benefits, review the patient's medical history for any comorbid conditions, and exclude pregnancy. Known pregnancy, genital tract infections, and active herpetic infection are contraindications to hysteroscopy. The most common perioperative complications associated with operative hysteroscopy are hemorrhage, uterine perforation, and cervical laceration. The procedure is minimally invasive and can be used with a high degree of safety.

Pre-operative planning and intra-operative guidance in modern neurosurgery: a review of 300 cases.

PubMed Central

Wadley, J.; Dorward, N.; Kitchen, N.; Thomas, D.

1999-01-01

Operative neurosurgery has recently entered an exciting era of image guided surgery or neuronavigation and application of this novel technology is beginning to have a significant impact in many ways in a variety of intracranial procedures. In order to fully assess the advantages of image guided techniques over conventional planning and surgery in selected cases, detailed prospective evaluation has been carried out during the advanced development of an optically tracked neuronavigation system. Over a 2-year period, 300 operative neurosurgical procedures have been performed with the assistance of interactive image guidance, as well as the development of new software applications and hardware tools. A broad range of intracranial neurosurgical procedures were seen to benefit from image guidance, including 163 craniotomies, 53 interactive stereotactic biopsies, 7 tracked neuroendoscopies and 37 complex skull base procedures. The most common pathological diagnoses were cerebral glioma in 98 cases, meningioma in 64 and metastasis in 23. Detailed analysis of a battery of postoperative questions revealed benefits in operative planning, appreciation of anatomy, lesion location, safety of surgery and greatly enhanced surgical confidence. The authors believe that image guided surgical technology, with new developments such as those described, has a significant role to play in contemporary neurosurgery and its widespread adoption in practice will be realised in the near future. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 PMID:10615186

Safety in out-of-hours operating in trauma and orthopaedics at a district general hospital.

PubMed

Gulamhussein, M A; Chaudhry, S; Noor, S; Chaudhry, T; Guha, A; Knebel, R

2017-05-01

INTRODUCTION According to the National Confidential Enquiry into Perioperative Deaths (NCEPOD), out-of-hours operating in trauma and orthopaedics should be reserved for life or limb threatening cases only. The aim of our study was to determine the nature of non-emergency work carried out in our trust at night in 2015. The overall efficacy and clinical safety of the services provided was evaluated. METHODS Surgical activity undertaken after 9pm was reviewed along with patient ASA (American Society of Anesthesiologists) grade, grade of operating surgeon and any complications that occurred following the procedure. Furthermore, the clinical urgency and safety of cases was assessed based on whether there was any record of life or limb threatening indications at the time of admission. RESULTS Overall, 131 procedures were performed after 9pm, with 102 performed between 9pm and midnight, and 29 after midnight. Consultants performed 16 cases and the remaining 115 cases were operated on by middle grades or specialty trainees. A fifth (20%) of the cases were genuinely life or limb threatening. A total of 123 procedures were classed as having good outcomes. The complication rate was 8%. CONCLUSIONS In our study, 80% of the procedures performed after 9pm could not be categorised as life or limb threatening. Appropriate NCEPOD classification would ensure that only life or limb threatening cases were listed for theatre after 9pm. Alternative methods of operating within working hours should be considered.

Safety in out-of-hours operating in trauma and orthopaedics at a district general hospital

PubMed Central

Chaudhry, S; Noor, S; Chaudhry, T; Guha, A; Knebel, R

2017-01-01

INTRODUCTION According to the National Confidential Enquiry into Perioperative Deaths (NCEPOD), out-of-hours operating in trauma and orthopaedics should be reserved for life or limb threatening cases only. The aim of our study was to determine the nature of non-emergency work carried out in our trust at night in 2015. The overall efficacy and clinical safety of the services provided was evaluated. METHODS Surgical activity undertaken after 9pm was reviewed along with patient ASA (American Society of Anesthesiologists) grade, grade of operating surgeon and any complications that occurred following the procedure. Furthermore, the clinical urgency and safety of cases was assessed based on whether there was any record of life or limb threatening indications at the time of admission. RESULTS Overall, 131 procedures were performed after 9pm, with 102 performed between 9pm and midnight, and 29 after midnight. Consultants performed 16 cases and the remaining 115 cases were operated on by middle grades or specialty trainees. A fifth (20%) of the cases were genuinely life or limb threatening. A total of 123 procedures were classed as having good outcomes. The complication rate was 8%. CONCLUSIONS In our study, 80% of the procedures performed after 9pm could not be categorised as life or limb threatening. Appropriate CEPOD classification would ensure that only life or limb threatening cases were listed for theatre after 9pm. Alternative methods of operating within working hours should be considered. PMID:27917666

8 CFR 271.1 - Procedures for inspections.

Code of Federal Regulations, 2010 CFR

2010-01-01

... REASONABLE EFFORTS TO PREVENT THE UNAUTHORIZED ENTRY OF ALIENS BY THE OWNERS OF RAILROAD LINES, INTERNATIONAL... director determines that preventive measures are inadequate, he or she shall advise the owners or operators... results of his or her review. (c) Preventive measures and certification. Upon a determination by the...

78 FR 72139 - Reporting and Recordkeeping Requirements Under OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-02

...'s 7(a) loan program, are necessary to conform to recent updates to SBA's Standard Operating Procedures (SOP), Lender and Development Company Loan Programs, designated as SOP 50 10 5(F). The update resulted in changes related to franchise eligibility, character determinations, credit standards, and...

77 FR 49779 - Meeting of the Amador County Resource Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-17

... Community Self-Determination Act (Pub. L. 112-141) (the Act) and operates in compliance with the Federal... committee's processes and procedures, review applications, and make recommendations for projects to be.... Written comments may be submitted as described under Supplementary Information. All comments, including...

49 CFR 242.507 - Request for a hearing.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., DEPARTMENT OF TRANSPORTATION QUALIFICATION AND CERTIFICATION OF CONDUCTORS Dispute Resolution Procedures § 242.507 Request for a hearing. (a) If adversely affected by the Operating Crew Review Board's decision... 20 days of service of the Board's decision on that party, file a written request with the Docket...

49 CFR 242.507 - Request for a hearing.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., DEPARTMENT OF TRANSPORTATION QUALIFICATION AND CERTIFICATION OF CONDUCTORS Dispute Resolution Procedures § 242.507 Request for a hearing. (a) If adversely affected by the Operating Crew Review Board's decision... 20 days of service of the Board's decision on that party, file a written request with the Docket...

49 CFR 242.507 - Request for a hearing.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., DEPARTMENT OF TRANSPORTATION QUALIFICATION AND CERTIFICATION OF CONDUCTORS Dispute Resolution Procedures § 242.507 Request for a hearing. (a) If adversely affected by the Operating Crew Review Board's decision... 20 days of service of the Board's decision on that party, file a written request with the Docket...

75 FR 2488 - Mid-Atlantic Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-15

... Mid-Atlantic Fishery Management Council's (MAFMC) Scientific and Statistical Committee (SSC) will hold... include new member orientation (overview of Council process and role of the SSC), review and adoption of SSC Standard Operating Practices and Procedures, ABC Control Rule Framework and Council Risk Policy...

10 CFR Appendix A to Part 851 - Worker Safety and Health Functional Areas

Code of Federal Regulations, 2014 CFR

2014-01-01

... requirements to research and development laboratory type operations consistent with the DOE level of protection... safety policies and procedures to ensure that pressure systems are designed, fabricated, tested... must include the following: (1) Design drawings, sketches, and calculations must be reviewed and...

10 CFR Appendix A to Part 851 - Worker Safety and Health Functional Areas

Code of Federal Regulations, 2012 CFR

2012-01-01

... requirements to research and development laboratory type operations consistent with the DOE level of protection... safety policies and procedures to ensure that pressure systems are designed, fabricated, tested... must include the following: (1) Design drawings, sketches, and calculations must be reviewed and...

10 CFR Appendix A to Part 851 - Worker Safety and Health Functional Areas

Code of Federal Regulations, 2011 CFR

2011-01-01

... requirements to research and development laboratory type operations consistent with the DOE level of protection... safety policies and procedures to ensure that pressure systems are designed, fabricated, tested... must include the following: (1) Design drawings, sketches, and calculations must be reviewed and...

77 FR 34186 - Appeal Procedures

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-11

... Order 12866 and will not be reviewed by the Office of Management and Budget. Regulatory Flexibility Act... operations as well as expertise in farm and ranch management. After a decision rendered by NRCS becomes final... committee that affords a participant opportunity to present testimony and documentary evidence to show why...

Ultrasound image guidance of cardiac interventions

NASA Astrophysics Data System (ADS)

Peters, Terry M.; Pace, Danielle F.; Lang, Pencilla; Guiraudon, Gérard M.; Jones, Douglas L.; Linte, Cristian A.

2011-03-01

Surgical procedures often have the unfortunate side-effect of causing the patient significant trauma while accessing the target site. Indeed, in some cases the trauma inflicted on the patient during access to the target greatly exceeds that caused by performing the therapy. Heart disease has traditionally been treated surgically using open chest techniques with the patient being placed "on pump" - i.e. their circulation being maintained by a cardio-pulmonary bypass or "heart-lung" machine. Recently, techniques have been developed for performing minimally invasive interventions on the heart, obviating the formerly invasive procedures. These new approaches rely on pre-operative images, combined with real-time images acquired during the procedure. Our approach is to register intra-operative images to the patient, and use a navigation system that combines intra-operative ultrasound with virtual models of instrumentation that has been introduced into the chamber through the heart wall. This paper illustrates the problems associated with traditional ultrasound guidance, and reviews the state of the art in real-time 3D cardiac ultrasound technology. In addition, it discusses the implementation of an image-guided intervention platform that integrates real-time ultrasound with a virtual reality environment, bringing together the pre-operative anatomy derived from MRI or CT, representations of tracked instrumentation inside the heart chamber, and the intra-operatively acquired ultrasound images.

Management of antithrombotic therapy in patients with coronary artery disease or atrial fibrillation who underwent abdominal surgical operations.

PubMed

Schizas, Dimitrios; Kariori, Maria; Boudoulas, Konstantinos Dean; Siasos, Gerasimos; Patelis, Nikolaos; Kalantzis, Charalampos; Carmen-Maria, Moldovan; Vavuranakis, Manolis

2018-04-02

Patients treated with antithrombotic therapy that require abdominal surgical procedures has progressively increased overtime. The management of antithrombotics during both the peri- and post- operative period is of crucial importance. The goal of this review is to present current data concerning the management of antiplatelets in patients with coronary artery disease and of anticoagulants in patients with atrial fibrillation who had to undergo abdominal surgical operations. For this purpose, incidence of major adverse cardiovascular events (MACE) and risk of antithrombotic use during surgical procedures, as well as the recommendations based on recent guidelines were reported. A thorough search of PubMed, Scopus and the Cochrane Databases was conducted to identify randomized controlled trials, observational studies, novel current reviews, and ESC and ACC/AHA guidelines on the subject. Antithrombotic use in daily clinical practice results to two different pathways: reduction of thromboembolic risk, but a simultaneous increase of bleeding risk. This may cause a therapeutic dilemma during the perioperative period. Nevertheless, careless cessation of antithrombotics can increase MACE and thromboembolic events, however, maintenance of antithrombotic therapy may increase bleeding complications. Studies and current guidelines can assist clinicians in making decisions for the treatment of patients that undergo abdominal surgical operations while on antithrombotic therapy. Aspirin should not be stopped perioperatively in the majority of surgical operations. Determining whether to discontinue the use of anticoagulants before surgery depends on the surgical procedure. In surgical operations with a low risk for bleeding, oral anticoagulants should not be discontinued. Bridging therapy should only be considered in patients with a high risk of thromboembolism. Finally, patients with an intermediate risk for thromboembolism, management should be individualized according to patient's thrombotic and bleeding risk. Management of antithrombotics therapy during the perioperative period in patients undergoing abdominal surgery should follow a patient-centered approach according to a patient's medical history and thrombotic risk weighted for bleeding risk. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

High definition in minimally invasive surgery: a review of methods for recording, editing, and distributing video.

PubMed

Kelly, Christopher R; Hogle, Nancy J; Landman, Jaime; Fowler, Dennis L

2008-09-01

The use of high-definition cameras and monitors during minimally invasive procedures can provide the surgeon and operating team with more than twice the resolution of standard definition systems. Although this dramatic improvement in visualization offers numerous advantages, the adoption of high definition cameras in the operating room can be challenging because new recording equipment must be purchased, and several new technologies are required to edit and distribute video. The purpose of this review article is to provide an overview of the popular methods for recording, editing, and distributing high-definition video. This article discusses the essential technical concepts of high-definition video, reviews the different kinds of equipment and methods most often used for recording, and describes several options for video distribution.

NASA Spinoff Article: Automated Procedures To Improve Safety on Oil Rigs

NASA Technical Reports Server (NTRS)

Garud, Sumedha

2013-01-01

On May 11th, 2013, two astronauts emerged from the interior of the International Space Station (ISS) and worked their way toward the far end of spacecraft. Over the next 51/2 hours, the two replaced an ammonia pump that had developed a significant leak a few days before. On the ISS, ammonia serves the vital role of cooling components-in this case, one of the station's eight solar arrays. Throughout the extravehicular activity (EVA), the astronauts stayed in constant contact with mission control: every movement, every action strictly followed a carefully planned set of procedures to maximize crew safety and the chances of success. Though the leak had come as a surprise, NASA was prepared to handle it swiftly thanks in part to the thousands of procedures that have been written to cover every aspect of the ISS's operations. The ISS is not unique in this regard: Every NASA mission requires well-written procedures-or detailed lists of step-by-step instructions-that cover how to operate equipment in any scenario, from normal operations to the challenges created by malfunctioning hardware or software. Astronauts and mission control train and drill extensively in procedures to ensure they know what the proper procedures are and when they should be used. These procedures used to be exclusively written on paper, but over the past decade, NASA has transitioned to digital formats. Electronic-based documentation simplifies storage and use, allowing astronauts and flight controllers to find instructions more quickly and display them through a variety of media. Electronic procedures are also a crucial step toward automation: once instructions are digital, procedure display software can be designed to assist in authoring, reviewing, and even executing them.

[Rectal carcinoma in a 24-year-old man with Hirschsprung's disease].

PubMed

Henriksen, Jeppe; Green, Charlotte; Ljungmann, Ken

2018-06-18

This case report presents an incident of rectal carcinoma in a 24-year-old man with Hirschsprung's disease, for which he was operated in his early childhood, with a Soave pull-through procedure. No direct association between Hirschsprung's disease and rectal cancer was found in our review of the literature. However, several case reports of rectal cancers following pull-through procedures exist. A low threshold for further clinical investigations is recommended, if these patients are presenting with gastrointestinal symptoms.

Transcervical Sterilization: A Comparison of Essure® Permanent Birth Control System and Adiana® Permanent Contraception System

PubMed Central

Palmer, Sophia N; Greenberg, James A

2009-01-01

Transcervical sterilization has moved female sterilization from a minimally invasive laparoscopic technique, which requires entry into the abdominal cavity, to a less invasive hysteroscopic procedure. Along with the decreased potential for complications, its ease of performance with minimal anesthesia has facilitated a move from the operating room to the office. This review compares the available data on transcervical sterilization procedures to better understand the strengths and weakness of each system. PMID:19609402

Feasibility study of modern airships, phase 1. Volume 3: Historical overview (task 1)

NASA Technical Reports Server (NTRS)

Faurote, G. L.

1975-01-01

The history of lighter-than-air vehicles is reviewed in terms of providing a background for the mission analysis and parametric analysis tasks. Data from past airships and airship operations are presented in the following areas: (1) parameterization of design characteristics; (2) markets, missions, costs, and operating procedures, (3) indices of efficiency for comparison; (4) identification of critical design and operational characteristics; and (5) definition of the 1930 state-of-the-art and the 1974 state-of-the-art from a technical and economic standpoint.

Management and presentation of grouped procedures: has the IHE integration profile cracked the toughest radiology workflow nut?

NASA Astrophysics Data System (ADS)

Parisot, Charles R.; Channin, David S.; Avrin, David E.; Lindop, Christopher

2001-08-01

In a simple, typical radiology workflow process, an order generates a single procedure, which in turn generates a single data set, from which, one radiology report is generated. There are, however, occasions when a single order consists of more than one procedure each with a separate report, yet the procedures are accomplished by one physical acquisition of data. The prototypical example of this is the request for computed tomographic evaluation of the chest, abdomen and pelvis. The study is accomplished, with modern day scanners, by a single helical acquisition, yet there are typically three codable and billable procedures involved, and these may be reported independently either for administrative or academic reasons. This grouping of procedures remained up to now a challenge to automate across integrated modalities, PACS and RIS. This paper discusses a number of other practical cases where this situation occurs and reviews the capabilities of the Presentation of Grouped Procedures IHE Integration Profile in solving this problem. The DICOM services used are evaluated as well as the strengths and weaknesses of this IHE Integration Profile. The implementation experience gained on both a CT and an MR for the IHE Demonstration at RSNA 2000 and HIMSS 2001 is also reviewed. In conclusion, the resulting clinical and operational benefits are discussed.

Potential impacts of advanced technologies on the ATC capacity of high-density terminal areas

NASA Technical Reports Server (NTRS)

Simpson, R. W.; Odoni, A. R.; Salas-Roche, F.

1986-01-01

Advanced technologies for airborne systems (automatic flight control, flight displays, navigation) and for ground ATC systems (digital communications, improved surveillance and tracking, automated decision-making) create the possibility of advanced ATC operations and procedures which can bring increased capacity for runway systems. A systematic analysis is carried out to identify certain such advanced ATC operations, and then to evaluate the potential benefits occurring over time at typical US high-density airports (Denver and Boston). The study is divided into three parts: (1) A Critical Examination of Factors Which Determine Operational Capacity of Runway Systems at Major Airports, is an intensive review of current US separation criteria and terminal area ATC operations. It identifies 11 new methods to increase the capacity of landings and takeoffs for runway systems; (2) Development of Risk Based Separation Criteria is the development of a rational structure for establishing reduced ATC separation criteria which meet a consistent Target Level of Safety using advanced technology and operational procedures; and (3) Estimation of Capacity Benefits from Advanced Terminal Area Operations - Denver and Boston, provides an estimate of the overall annual improvement in runway capacity which might be expected at Denver and Boston from using some of the advanced ATC procedures developed in Part 1. Whereas Boston achieved a substantial 37% increase, Denver only achieved a 4.7% increase in its overall annual capacity.

Profix cemented total knee replacement: a 5-year outcome review from Lagos, Nigeria.

PubMed

Ugbeye, M E; Odunubi, O O; Dim, E M; Ekundayo, O O

2012-01-01

Total knee replacement is a standard treatment for severe osteoarthritis of the knees. It is however, still a novel procedure in Nigeria. Literature on the procedure and outcome of management are sparse in Nigeria. This study aimed at describing Total Knee prosthetic Replacement as it is practiced in National Orthopaedic Hospital, Lagos. Data on patients treated with Total knee replacement between 2006 and 2010 were analyzed retrospectively. The standard anterior approach, with a medial parapatellar incision under pneumatic tourniquet was used in all cases. There were a total of 59 knees in 48 patients operated, with a female: male ratio of 5:1. Patients were in the sixth to ninth decades of life. There was a statistically significant relationship between duration of symptoms and severity of angular deformity. The average pre-operative Knee score (KS) was 27 and average function score (FS) was 43. Average duration of surgery was 126.38 minutes. Tourniquet removal after wound closure was associated with reduced intra-operative blood loss (p < 0.05). Post-operative complications included peri-prosthetic fracture (1.69%), post-operative anaemia (8.47%), superficial wound dehiscence (3.39%) and foot drop (3.39%). The mean post-operative KS and FS increased to 80 and 75 respectively. Total knee replacement, though a novel procedure in our institution is beneficial to patients with severe osteoarthritis. A long term outcome study is being planned.

Training potential in minimally invasive surgery in a tertiary care, paediatric urology centre.

PubMed

Schroeder, R P J; Chrzan, R J; Klijn, A J; Kuijper, C F; Dik, P; de Jong, T P V M

2015-10-01

Minimally invasive surgery (MIS) is being utilized more frequently as a surgical technique in general surgery and in paediatric urology. It is associated with a steep learning curve. Currently, the centre does not offer a MIS training programme. It is hypothesized that the number of MIS procedures performed in the low-volume specialty of paediatric urology will offer insufficient training potential for surgeons. To assess the MIS training potential of a highly specialized, tertiary care, paediatric urology training centre that has been accredited by the Joint Committee of Paediatric Urology (JCPU). The clinical activity of the department was retrospectively reviewed by extracting the annual number of admissions, outpatient consultations and operative procedures. The operations were divided into open procedures and MIS. Major ablative procedures (nephrectomy) and reconstructive procedures (pyeloplasty) were analysed with reference to the patients' ages. The centre policy is not to perform major MIS in children who are under 2 years old or who weigh less than 12 kg. Every year, this institution provides approximately 4300 out-patient consultations, 600 admissions, and 1300 procedures under general anaesthesia for children with urological problems. In 2012, 35 patients underwent major intricate MIS: 16 pyeloplasties, eight nephrectomies and 11 operations for incontinence (seven Burch, and four bladder neck procedures). In children ≥2 years of age, 16/21 of the pyeloplasties and 8/12 of the nephrectomies were performed laparoscopically. The remaining MIS procedures included 25 orchidopexies and one intravesical ureteral reimplantation. There is no consensus on how to assess laparoscopic training. It would be valuable to reach a consensus on a standardized laparoscopic training programme in paediatric urology. Often training potential is based on operation numbers only. In paediatric urology no minimum requirement has been specified. The number of procedures quoted for proficiency in MIS remains controversial. The MIS numbers for this centre correspond to, or exceed, numbers mentioned in other literature. To provide high-quality MIS training, exposure to laparoscopic procedures should be expanded. This may be achieved by centralizing patients into a common centre, collaborating with other specialities, modular training and training outside the operating theatre. Even in a high-volume, paediatric urology educational centre, the number of major MIS procedures performed remains relatively low, leading to limited training potential. Copyright © 2015. Published by Elsevier Ltd.

Computed-tomography modeled polyether ether ketone (PEEK) implants in revision cranioplasty.

PubMed

O'Reilly, Eamon B; Barnett, Sam; Madden, Christopher; Welch, Babu; Mickey, Bruce; Rozen, Shai

2015-03-01

Traditional cranioplasty methods focus on pre-operative or intraoperative hand molding. Recently, CT-guided polyether ether ketone (PEEK) plate reconstruction enables precise, time-saving reconstruction. This case series aims to show a single institution experience with use of PEEK cranioplasty as an effective, safe, precise, reusable, and time-saving cranioplasty technique in large, complex cranial defects. We performed a 6-year retrospective review of cranioplasty procedures performed at our affiliated hospitals using PEEK implants. A total of nineteen patients underwent twenty-two cranioplasty procedures. Pre-operative, intra-operative, and post-operative data was collected. Nineteen patients underwent twenty-two procedures. Time interval from injury to loss of primary cranioplasty averaged 57.7 months (0-336 mo); 4.0 months (n=10, range 0-19) in cases of trauma. Time interval from primary cranioplasty loss to PEEK cranioplasty was 11.8 months for infection (n=11, range 6-25 mo), 12.2 months for trauma (n=5, range 2-27 mo), and 0.3 months for cosmetic or functional reconstructions (n=3, range 0-1). Similar surgical techniques were used in all patients. Drains were placed in 11/22 procedures. Varying techniques were used in skin closure, including adjacent tissue transfer (4/22) and free tissue transfer (1/22). The PEEK plate required modification in four procedures. Three patients had reoperation following PEEK plate reconstruction. Cranioplasty utilizing CT-guided PEEK plate allows easy inset, anatomic accuracy, mirror image aesthetics, simplification of complex 3D defects, and potential time savings. Additionally, it's easily manipulated in the operating room, and can be easily re-utilized in cases of intraoperative course changes or infection. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

77 FR 28383 - Information Collection Being Reviewed by the Federal Communications Commission

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-14

..., Digital Selective Calling (DSC) Operating Procedures--Maritime Mobile Identity (MMSI). Form Number: N/A... Annual Cost: N/A. Privacy Impact Assessment: Yes. The Commission maintains a system of records notice (SORN), FCC/WTB-1, ``Wireless Services Licensing Records,'' that covers this collection, purpose(s...

78 FR 40745 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-08

.... Description: The Advance Planning Document (APD) process, established in the rules at 45 CFR part 95, subpart F, is the procedure by which States request and obtain approval for Federal financial participation... Advance Planning Document 34 1.2 120 4,896 Operational Advance Planning Document 20 1 30 600 Estimated...

Creating Alternative Methods for Educational Evaluation.

ERIC Educational Resources Information Center

Smith, Nick L.

1981-01-01

A project supported by the National Institute of Education is adapting evaluation procedures from such areas as philosophy, geography, operations research, journalism, film criticism, and other areas. The need for such methods is reviewed, as is the context in which they function, and their contributions to evaluation methodology. (Author/GK)

40 CFR 63.11115 - What are my general duties to minimize emissions?

Code of Federal Regulations, 2014 CFR

2014-07-01

... Dispensing Facilities Emission Limitations and Management Practices § 63.11115 What are my general duties to... consistent with safety and good air pollution control practices for minimizing emissions. Determination of... and maintenance procedures, review of operation and maintenance records, and inspection of the source...

40 CFR 63.11115 - What are my general duties to minimize emissions?

Code of Federal Regulations, 2012 CFR

2012-07-01

... Dispensing Facilities Emission Limitations and Management Practices § 63.11115 What are my general duties to... consistent with safety and good air pollution control practices for minimizing emissions. Determination of... and maintenance procedures, review of operation and maintenance records, and inspection of the source...

40 CFR 63.11115 - What are my general duties to minimize emissions?

Code of Federal Regulations, 2011 CFR

2011-07-01

... Dispensing Facilities Emission Limitations and Management Practices § 63.11115 What are my general duties to... consistent with safety and good air pollution control practices for minimizing emissions. Determination of... and maintenance procedures, review of operation and maintenance records, and inspection of the source...

Rx Articulation. A Guidebook to Successful Curriculum Articulation.

ERIC Educational Resources Information Center

Epps, Irvine

This procedural guide is designed for program operators and service providers who are cognizant of the potential advantages of articulation and are interested in beginning or expanding articulation efforts. The guide's first section explains the various forms of articulation and reviews briefly benefits and barriers. Other sections introduce the…

COSMOS (County of San Mateo Online System). A Searcher's Manual.

ERIC Educational Resources Information Center

San Mateo County Superintendent of Schools, Redwood City, CA. Educational Resources Center.

Operating procedures are explained for COSMOS (County of San Mateo Online System), a computerized information retrieval system designed for the San Mateo Educational Resources Center (SMERC), which provides interactive access to both ERIC and a local file of fugitive documents. COSMOS hardware and modem compatibility requirements are reviewed,…

15 CFR 290.8 - Reviews of centers.

Code of Federal Regulations, 2011 CFR

2011-01-01

... the purpose of evaluation and program shaping. Centers are encouraged to try new approaches, must... at least annually, and at the end of its third year of operation according to the procedures and... ability to obtain suitable match, as well as on the budgetary requirements of its proposed program...

15 CFR 290.8 - Reviews of centers.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the purpose of evaluation and program shaping. Centers are encouraged to try new approaches, must... at least annually, and at the end of its third year of operation according to the procedures and... ability to obtain suitable match, as well as on the budgetary requirements of its proposed program...

77 FR 45331 - Humboldt (NV) Resource Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-31

... Act. The purpose is to review Title II funding procedures and Humboldt (NV) RAC operating guidelines..., Winnemucca, Nevada. Written comments should be sent to USDA Forest Service, 1500 E Winnemucca Blvd... between 8:00 a.m. and 8:00 p.m., Eastern Standard Time, Monday through Friday. SUPPLEMENTARY INFORMATION...

75 FR 43898 - Hazardous Materials Transportation: Revisions of Special Permits Procedures

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-27

... information about its operations to enable the agency to evaluate the applicant's fitness and the safety... a special permit undergoes a safety fitness evaluation further assuring the safety of transportation... must review an applicant's safety fitness (i.e., previous incidents, citations) to assure that the...

78 FR 12136 - Fifty Eighth Meeting: RTCA Special Committee 186, Automatic Dependent Surveillance-Broadcast (ADS-B)

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-21

.... Issued in Washington, DC, on February 19, 2013. Paige Williams, Management Analyst, Business Operations... Trajectory Management Other? Other Business. None Identified Review Action Items/Work Programs. Adjourn...) [ssquf] Flight-deck Interval Management (FIM) [ssquf] CAVS and CDTI Assisted Pilot Procedures (CAPP...

20 CFR 416.1181 - What is a plan to achieve self-support (PASS)?

Code of Federal Regulations, 2010 CFR

2010-04-01

... earnings level reached. (c) If your employment goal is self-employment, you must include a business plan that defines the business, provides a marketing strategy, details financial data, outlines the operational procedures, and describes the management plan. (d) Your progress will be reviewed at least...

Space Station Human Factors Research Review. Volume 4: Inhouse Advanced Development and Research

NASA Technical Reports Server (NTRS)

Tanner, Trieve (Editor); Clearwater, Yvonne A. (Editor); Cohen, Marc M. (Editor)

1988-01-01

A variety of human factors studies related to space station design are presented. Subjects include proximity operations and window design, spatial perceptual issues regarding displays, image management, workload research, spatial cognition, virtual interface, fault diagnosis in orbital refueling, and error tolerance and procedure aids.

33 CFR 154.2010 - Qualifications for acceptance as a certifying entity.

Code of Federal Regulations, 2014 CFR

2014-07-01

... qualifications: (a) The ability to review and evaluate design drawings and failure analyses for compliance to... incorporated by reference; (c) The ability to monitor and evaluate test procedures and results for compliance with the operational requirements of this subpart; (d) The ability to perform inspections and observe...

77 FR 42498 - Information Collection(s) Being Submitted for Review and Approval to the Office of Management and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-19

...: Section 80.103, Digital Selective Calling (DSC) Operating Procedures--Maritime Mobile Identity (MMSI...: Individuals or households; business or other for- profit entities and Federal Government. Number of... Marine VHF radios with Digital Selective Calling (DSC) capability in this collection. The licensee...

Estimating the Cost of Neurosurgical Procedures in a Low-Income Setting: An Observational Economic Analysis.

PubMed

Abdelgadir, Jihad; Tran, Tu; Muhindo, Alex; Obiga, Doomwin; Mukasa, John; Ssenyonjo, Hussein; Muhumza, Michael; Kiryabwire, Joel; Haglund, Michael M; Sloan, Frank A

2017-05-01

There are no data on cost of neurosurgery in low-income and middle-income countries. The objective of this study was to estimate the cost of neurosurgical procedures in a low-resource setting to better inform resource allocation and health sector planning. In this observational economic analysis, microcosting was used to estimate the direct and indirect costs of neurosurgical procedures at Mulago National Referral Hospital (Kampala, Uganda). During the study period, October 2014 to September 2015, 1440 charts were reviewed. Of these patients, 434 had surgery, whereas the other 1006 were treated nonsurgically. Thirteen types of procedures were performed at the hospital. The estimated mean cost of a neurosurgical procedure was $542.14 (standard deviation [SD], $253.62). The mean cost of different procedures ranged from $291 (SD, $101) for burr hole evacuations to $1,221 (SD, $473) for excision of brain tumors. For most surgeries, overhead costs represented the largest proportion of the total cost (29%-41%). This is the first study using primary data to determine the cost of neurosurgery in a low-resource setting. Operating theater capacity is likely the binding constraint on operative volume, and thus, investing in operating theaters should achieve a higher level of efficiency. Findings from this study could be used by stakeholders and policy makers for resource allocation and to perform economic analyses to establish the value of neurosurgery in achieving global health goals. Copyright © 2017 Elsevier Inc. All rights reserved.

[Which invasive diagnostic procedure should we use for twin pregnancies: chorionic villous sampling or amniocentesis?].

PubMed

Gallot, D; Vélémir, L; Delabaere, A; Accoceberry, M; Niro, J; Vendittelli, F; Laurichesse-Delmas, H; Jacquetin, B; Lémery, D

2009-12-01

To describe invasive diagnostic procedures (amniocentesis/choriocentesis) and subsequent risks in twin pregnancies. PubMed and Cochrane database investigations were conducted using following key words: twin gestation, amniocentesis, chorionic villous sampling, karyotype. Guidelines for twin management edicted by different societies were reviewed. Risk of pregnancy loss after invasive diagnostic procedure in twin pregnancies seems to be slightly higher to singletons, i.e about 1.5-2% after mid-trimester amniocentesis and about 2% after first trimester choriocentesis. Dual sampling is not always mandatory but can be performed on parent's request. Specific risks are associated with twins: redundant sampling, permutation or misidentification of affected twin in case of discordant status. Procedures should be performed by highly-skilled operators under permanent ultrasound-guidance. A scheme describing placental locations and funicular insertions appears to be useful for correct identification. If foeticide can be anticipated, diagnostic procedure and foeticide should be performed by the same operators. For amniocentesis, one or two needles can be used except for cases with infectious disease (two needles and two separate insertions required). For choriocentesis, sampling should be performed close to funicular insertions. First-trimester choriocentesis makes earlier diagnosis and earlier foeticide possible compared with mid-trimester amniocentesis. Both techniques require highly-skilled operators to reduce subsequent risks in the context of twin pregnancies. Copyright © 2009 Elsevier Masson SAS. All rights reserved.

Cancer Treatment in Malawi: A Disease of Palliation.

PubMed

Kendig, Claire E; Samuel, Jonathan C; Tyson, Anna F; Khoury, Amal L; Boschini, Laura P; Mabedi, Charles; Cairns, Bruce A; Varela, Carlos; Shores, Carol G; Charles, Anthony G

2013-06-01

Worldwide, new cancer cases will nearly double in the next 20 years while disproportionately affecting low and middle income countries (LMICs). Cancer outcomes in LMICs also remain bleaker than other regions of the world. Despite this, little is known about cancer epidemiology and surgical treatment in LMICs. To address this we sought to describe the characteristics of cancer patients presenting to the Surgery Department at Kamuzu Central Hospital in Lilongwe, Malawi. We conducted a retrospective review of adult (18 years or older) surgical oncology services at Kamuzu Central Hospital in Lilongwe, Malawi from 2007 - 2010. Data obtained from the operating theatre logs included patient demographics, indication for operative procedure, procedure performed, and operative procedures (curative, palliative, or staging). Of all the general surgery procedures performed during this time period (7,076 in total), 16% (406 cases) involved cancer therapy. The mean age of male and female patients in this study population was 52 years and 47 years, respectively. Breast cancer, colorectal cancer, gastric cancer, and melanoma were the most common cancers among women, whereas prostate, colorectal, pancreatic, and, gastric were the most common cancers in men. Although more than 50% of breast cancer operations were performed with curative intent, most procedures were palliative including prostate cancer (98%), colorectal cancer (69%), gastric cancer (71%), and pancreatic cancer (94%). Patients with colorectal, gastric, esophageal, pancreatic, and breast cancer presented at surprisingly young ages. The paucity of procedures with curative intent and young age at presentation reveals that many Malawians miss opportunities for cure and many potential years of life are lost. Though KCH now has pathology services, a cancer registry and a surgical training program, the focus of surgical care remains palliative. Further research should address other methods of increasing early cancer detection and treatment in such populations.

Tissue welding forceps usage in superficial parotidectomy: a clinical assessment.

PubMed

Michel, Randall G; Tsau, Kang; Weinstock, Bernard I

2008-01-01

Tissue welding forceps (TWF) have been used effectively in a number of surgical procedures including blood vessel harvesting and tonsillectomy. Our objective was to assess the safety and efficacy of TWF usage in superficial parotidectomy. We performed a retrospective review of 25 patients between November 2002 and July 2006 who underwent superficial parotidectomy using TWF. The inpatient and outpatient records were reviewed for diagnosis, operative times, estimated blood loss, and postoperative facial paresis. Only one of the 25 patients (4%) who underwent superficial parotidectomy using TWF had transient postoperative facial weakness and no procedure had blood loss of greater than 150 cc. This initial evaluation suggests that use of TWF is safe in superficial parotidectomy and may help reduce the development of postoperative facial paresis.

Status of research into lightning effects on aircraft

NASA Technical Reports Server (NTRS)

Plumer, J. A.

1976-01-01

Developments in aircraft lightning protection since 1938 are reviewed. Potential lightning problems resulting from present trends toward the use of electronic controls and composite structures are discussed, along with presently available lightning test procedures for problem assessment. The validity of some procedures is being questioned because of pessimistic results and design implications. An in-flight measurement program is needed to provide statistics on lightning severity at flight altitudes and to enable more realistic tests, and operators are urged to supply researchers with more details on electronic components damaged by lightning strikes. A need for review of certain aspects of fuel system vulnerability is indicated by several recent accidents, and specific areas for examination are identified. New educational materials and standardization activities are also noted.

Epinephrine-induced pulmonary edema during hip arthroscopy: a report of two cases and a review of the literature.

PubMed

Belkin, Nicole S; Degen, Ryan M; Liguori, Gregory A; Kelly, Bryan T

2017-09-01

Hip arthroscopy utilization has significantly increased in recent years. While it is a relatively safe procedure, it is not without risk. Life-threatening complications, albeit rare, can potentially occur and must be appropriately recognized and treated. We describe 2 cases in which patients' undergoing hip arthroscopy developed pulmonary edema and their respective courses of treatment. Both patients were being treated for symptomatic femoroacetabular impingement (FAI), with labral tears, requiring operative management after a failed trial of conservative management. The complication occurred during a primary hip arthroscopy procedure and a retrospective review of their clinical records and intra-operative notes was performed. Hip arthroscopy was performed under spinal anesthetic in the supine position in both patients. In both procedures, patients developed severe hypertension and tachycardia, with subsequent oxygen desaturations with noted pulmonary edema. The postulated etiology was systemic effects from intra-articular epinephrine, causing acute pulmonary edema with corresponding cardiovascular changes. With supportive ventilation, selective alpha-adrenergic blocker and furosemide administration, and cessation of epinephrine exposure, vital signs normalized and both patients experienced symptom resolution. During arthroscopy, if acute hypertension, tachycardia and hypoxia develop, epinephrine-induced pulmonary edema should be considered as a cause by the treating orthopedic surgeon and anesthesiologist in order to initiate an appropriate treatment plan.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hagen, E.W.

This report reviews and evaluates the performance of the compressed-air and pressurized-nitrogen gas systems in commercial nuclear power units. The information was collected from readily available operating experiences, licensee event reports, system designs in safety analysis reports, and regulatory documents. The results are collated and analyzed for significance and impact on power plant safety performance. Under certain circumstances, the fail-safe philosophy for a piece of equipment or subsystem of the compressed-air systems initiated a series of actions culminating in reactor transient or unit scram. However, based on this study of prevailing operating experiences, reclassifying the compressed-gas systems to a highermore » safety level will neither prevent (nor mitigate) the reoccurrences of such happenings nor alleviate nuclear power plant problems caused by inadequate maintenance, operating procedures, and/or practices. Conversely, because most of the problems were derived from the sources listed previously, upgrading of both maintenance and operating procedures will not only result in substantial improvement in the performance and availability of the compressed-air (and backup nitrogen) systems but in improved overall plant performance.« less

A scoping review of assessment tools for laparoscopic suturing.

PubMed

Bilgic, Elif; Endo, Satoshi; Lebedeva, Ekaterina; Takao, Madoka; McKendy, Katherine M; Watanabe, Yusuke; Feldman, Liane S; Vassiliou, Melina C

2018-05-03

A needs assessment identified a gap in teaching and assessment of laparoscopic suturing (LS) skills. The purpose of this review is to identify assessment tools that were used to assess LS skills, to evaluate validity evidence available, and to provide guidance for selecting the right assessment tool for specific assessment conditions. Bibliographic databases were searched till April 2017. Full-text articles were included if they reported on assessment tools used in the operating room/simulation to (1) assess procedures that require LS or (2) specifically assess LS skills. Forty-two tools were identified, of which 26 were used for assessing LS skills specifically and 26 for procedures that require LS. Tools had the most evidence in internal structure and relationship to other variables, and least in consequences. Through identification and evaluation of assessment tools, the results of this review could be used as a guideline when implementing assessment tools into training programs.

Endoscopic submucosal dissection for removal of superficial gastrointestinal neoplasms: A technical review

PubMed Central

Matsui, Noriaki; Akahoshi, Kazuya; Nakamura, Kazuhiko; Ihara, Eikichi; Kita, Hiroto

2012-01-01

Endoscopic submucosal dissection (ESD) is now the most common endoscopic treatment in Japan for intramucosal gastrointestinal neoplasms (non-metastatic). ESD is an invasive endoscopic surgical procedure, requiring extensive knowledge, skill, and specialized equipment. ESD starts with evaluation of the lesion, as accurate assessment of the depth and margin of the lesion is essential. The devices and strategies used in ESD vary, depending on the nature of the lesion. Prior to the procedure, the operator must be knowledgeable about the treatment strategy(ies), the device(s) to use, the electrocautery machine settings, the substances to inject, and other aspects. In addition, the operator must be able to manage complications, should they arise, including immediate recognition of the complication(s) and its treatment. Finally, in case the ESD treatment is not successful, the operator should be prepared to apply alternative treatments. Thus, adequate knowledge and training are essential to successfully perform ESD. PMID:22523613

Space Shuttle Orbiter corrosion history, 1981-1993: A review and analysis of issues involving structures and subsystems

NASA Technical Reports Server (NTRS)

1995-01-01

This report summarizes past corrosion issues experienced by the NASA space shuttle orbiter fleet. Design considerations for corrosion prevention and inspection methods are reviewed. Significant corrosion issues involving structures and subsystems are analyzed, including corrective actions taken. Notable successes and failures of corrosion mitigation systems and procedures are discussed. The projected operating environment used for design is contrasted with current conditions in flight and conditions during ground processing.

Whipple procedure: a review of a 7-year clinical experience in a referral center for hepatobiliary and pancreas diseases.

PubMed

Saraee, Amir; Vahedian-Ardakani, Jalal; Saraee, Ehsan; Pakzad, Roshanak; Wadji, Massoud Baghai

2015-03-11

Pancreatic cancer is generally found in the older population Pancreaticoduodenectomy seems to be the only way in resolving these resectable tumors. Allen. O Whipple was the first to describe pancreaticoduodenectomy in 1935 as a modified procedure. This article is a case series with respect to the 7-year experience of the Whipple procedure in Firoozgar Teaching Hospital. Patient surgery details were gathered from the surgical records of the operating room and their clinical records from the hospital archives. Data was analyzed with SPSS software (version 16.0.1). Those patients, whose tumor had invaded the superior mesenteric artery, had extensive portal vein involvement or distant metastasis was considered as unresectable. The first Whipple procedure was recorded in our hospital in 2008. From 2008 till 20 March 2014, 70 cases were collected and analyzed. The mean age of cases was 58.4 years, the mean hospital stay length was 12.9 days (±6.23 days), mean operation time was 376 min (±37.3 min),. The most common presenting symptom was jaundice (78.6 %). Delayed gastric emptying was the most common post-operative complication. The most prevalent cause of reoperation was intra-abdominal abscess. Major morbidities of these patients consisted of cardiac arrhythmias (21.4%) and pneumonia (10%). Minor complications were wound infection (17.1%) and delayed gastric emptying (32.9%). The statistics revealed pancreatic anastomosis failure as 2.9% and a decrease in mortality rate from 50% during the first years of this study to 16% to 20% during the last years. In this case series, the time of operation decreased during the recent years .Analysis shows a correlation between operation time and pack cell transfused during the operation, but no correlation was found between operation time and post-operation hospitalization course. It is true that hospital setting, socioeconomic level of the patients including their compliance, and the expertise of the surgeons and surgical staff can have an influence on the result of this operation, but it seems that the magnitude of the surgical stress of this procedure and the (compromised) functional reserve of this patient population can be a notable factor influencing the outcome.

Postoperative Early Major and Minor Complications in Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) Procedures: A Meta-Analysis and Systematic Review.

PubMed

Osland, Emma; Yunus, Rossita Mohamad; Khan, Shahjahan; Alodat, Tareq; Memon, Breda; Memon, Muhammed Ashraf

2016-10-01

Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic vertical sleeve gastrectomy (LVSG) have been proposed as cost-effective strategies to manage obesity-related chronic disease. The aim of this meta-analysis and systematic review was to compare the "early postoperative complication rate i.e. within 30-days" reported from randomized control trials (RCTs) comparing these two procedures. RCTs comparing the early complication rates following LVSG and LRYGB between 2000 and 2015 were selected from PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane database. The outcome variables analyzed included 30-day mortality, major and minor complications and interventions required for their management, length of hospital stay, readmission rates, operating time, and conversions from laparoscopic to open procedures. Six RCTs involving a total of 695 patients (LVSG n = 347, LRYGB n = 348) reported on early major complications. A statistically significant reduction in relative odds of early major complications favoring the LVSG procedure was noted (p = 0.05). Five RCTs representing 633 patients (LVSG n = 317, LRYGB n = 316) reported early minor complications. A non-statically significant reduction in relative odds of 29 % favoring the LVSG procedure was observed for early minor complications (p = 0.4). However, other outcomes directly related to complications which included reoperation rates, readmission rate, and 30-day mortality rate showed comparable effect size for both surgical procedures. This meta-analysis and systematic review of RCTs suggests that fewer early major and minor complications are associated with LVSG compared with LRYGB procedure. However, this does not translate into higher readmission rate, reoperation rate, or 30-day mortality for either procedure.

[Osteosynthesis of distal radius fractures by doral plate: advantages and disadvantages].

PubMed

Obert, L; Vichard, P; Garbuio, P; Tropet, Y

2001-12-01

Distal radius fractures remain a challenge. No one osteosynthesis procedure can solve all the problems. A method of analysis is necessary in order to choose the best tools. Open treatment of the fracture is logical but rarely performed. A review of the literature and the experience of the authors are reported in order to analyse the correct place of dorsal plating in distal radius fracture with dorsal displacement. The learning curve of the operative procedure and the design of the implants can explain the occurrence of several complications. The dorsal plate is effective against secondary dorsal displacement. This demanding procedure must be compared with other reported procedures (pining and external fixator) to define the advantages and disadvantages.

Robotic surgery for colorectal cancer: systematic review of the literature.

PubMed

Papanikolaou, Ioannis G

2014-12-01

Surgical practice has been changed since the introduction of robotic techniques and robotic colorectal surgery is an emerging field. Innovative robotic technologies have helped surgeons overcome many technical difficulties of conventional laparoscopic surgery. Herein, we review the clinical studies regarding the application of surgical robots in resections for colorectal cancer. A systematic review of the literature was conducted for articles published up to September 9, 2012, using the MEDLINE database. The keywords that were used in various combinations were: "surgical robotics," "robotic surgery," "computer-assisted surgery," "colectomy," "sigmoid resection," "sigmoidectomy," and "rectal resection." Fifty-nine articles reporting on robot-assisted resections of colon and/or rectum were identified and 41 studies were finally included in the analysis. A total of 1635 colorectal procedures were performed: 254 right colectomies, 185 left colectomies/sigmoid resections, 969 anterior resections, 182 abdominoperineal or intersphincteric resections, 34 colectomies (without being specified as right or left), and 11 total/subtotal colectomies. In general, blood loss, conversion rates, and complications were low but the operative time was longer than the open procedures, whereas the duration of hospitalization was shorter. The number of harvested lymph nodes was also quite satisfactory. Robotic colorectal operations provide favorable results, with acceptable operative times and low conversion rates and morbidity. Surgical robots may provide additional benefits treating challenging pathologies, such as rectal cancer. Further clinical studies and long-term follow-up are required to better evaluate the outcomes of robotic colorectal surgery.

Using percutaneous transhepatic cholangioscopic lithotripsy for intrahepatic calculus in hostile abdomen.

PubMed

Kow, A W C; Wang, B; Wong, D; Sundeep, P J; Chan, C Y; Ho, C K; Liau, K H

2011-04-01

Hepatolithiasis is a challenging condition to treat especially in patients with previous hepatobiliary surgery. Percutaneous Transhepatic Cholangioscopic Lithotripsy (PTCSL) is an attractive salvage option for the treatment of recurrent hepatolithiasis. We reviewed our experience using PTCSL in treating 4 patients with previous complex abdominal surgery. We studied the 4 patients who underwent PTCSL from October 2007 to July 2009. We reviewed the operative procedures, workflow of performing PTCSL in our institution and the outcome of the procedure. PTCSL was performed in our institution using 3 mm cholangioscope (Dornier MedTech(®)) and Holmium laser with setting at 0.8 J, 20 Hz and 16 W. This was performed through a Percutaneous Transhepatic Cholangio-catheter inserted by interventional radiologists. There were 4 patients with a median age of 50 (43-69) years. The median duration of the condition prior to PTCSL was 102 (60-156) months. Three patients had recurrent pyogenic cholangitis (RPC) with recurrent intrahepatic stone. They all had prior complex hepatobiliary operations. The median duration of surgery was 130 (125-180) min. There was minimal intra-operative blood loss. The first procedure was performed under local anaesthesia and sedation, however, with experience the subsequent 3 patients had the procedure performed under general anaesthesia. The median size of bile duct was 18 (15-20) mm prior to the procedure. The number of stones ranged from one to three with the largest size of stone comparable to the size of bile duct. The median follow up was 18 (10-24) months. All patients were symptom free with neither stone recurrence or cholangitis at the last follow up. PTCSL is a feasible and an effective treatment method for patients with recurrent biliary stone following complex abdominal surgery as the success rates from open surgery and endoscopic procedures are limited. Excellent results can be expected with this minimally invasive technique. Copyright © 2010 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Standard operating procedures for vascular surgery in erectile dysfunction: revascularization and venous procedures.

PubMed

Sohn, Michael; Hatzinger, Martin; Goldstein, Irwin; Krishnamurti, Sudhakar

2013-01-01

The impact of penile blood supply on erectile function was recognized some 500 years ago. At the turn of the 20th century first results of penile venous ligation were published and in 1973 the first surgical attempts to restore penile arterial inflow were undertaken. Numerous techniques were published in the meantime, but inclusion criteria, patient selection, and success evaluation differed extremely between study groups. To develop evidence-based standard operating procedures (SOPs) for vascular surgery in erectile dysfunction, based on recent state of the art consensus reports and recently published articles in peer-reviewed journals. Based on the recent publication of the consensus process during the 2009 International Consultation on Sexual Medicine in Paris, recommendations are derived for diagnosis and surgical treatment of vascular erectile dysfunction. In addition several recent publications in this field not mentioned in the consensus statements are included in the discussion. The Oxford system of evidence-based review was systematically applied. Due to the generally low level of evidence in this field expert opinions were accepted, if published after a well-defined consensus process in peer-reviewed journals. Referring to penile revascularization it may be concluded, that in the face of missing randomized trials, only recommendations grade D may be given: this kind of surgery may be offered to men less than 55 years, who are nonsmokers, nondiabetic, and demonstrate isolated arterial stenoses in the absence of generalized vascular disease. The evidence level for recommendations concerning penile venous ligations may be even lower. Too many unsolved controversies exist and universal diagnostic criteria for patient selection as well as operative technique selection have not been unequivocally established. This kind of surgery is still considered investigational but may be offered in special situations on an individualized basis in an investigational or research setting after obtaining written consent, using both pre- and postoperatively validated measuring instruments of success evaluation. SOPs for penile revascularization procedures can be developed, concerning a highly selected patient group with isolated arterial stenoses. Based on the available data it is not yet possible to define SOPs for surgical treatment of corporal veno-occlusive dysfunction. © 2012 International Society for Sexual Medicine.

Use of Data Comm by Flight Crew to Conduct Interval Management Operations to Parallel Dependent Runways

NASA Technical Reports Server (NTRS)

Baxley, Brian T.; Hubbs, Clay; Shay, Rick; Karanian, James

2011-01-01

The Interval Management (IM) concept is being developed as a method to maintain or increase high traffic density airport arrival throughput while allowing aircraft to conduct near idle thrust descents. The Interval Management with Spacing to Parallel Dependent Runways (IMSPiDR1) experiment at NASA Langley Research Center used 24 commercial pilots to examine IM procedures to conduct parallel dependent runway arrival operations while maintaining safe but efficient intervals behind the preceding aircraft. The use of IM procedures during these operations requires a lengthy and complex clearance from Air Traffic Control (ATC) to the participating aircraft, thereby making the use of Controller Pilot Data Link Communications (CPDLC) highly desirable as the communication method. The use of CPDLC reduces the need for voice transmissions between controllers and flight crew, and enables automated transfer of IM clearance elements into flight management systems or other aircraft avionics. The result is reduced crew workload and an increase in the efficiency of crew procedures. This paper focuses on the subset of data collected related to the use of CPDLC for IM operations into a busy airport. Overall, the experiment and results were very successful, with the mean time under 43 seconds for the flight crew to load the clearance into the IM spacing tool, review the calculated speed, and respond to ATC. An overall mean rating of Moderately Agree was given when the crews were asked if the use of CPDLC was operationally acceptable as simulated in this experiment. Approximately half of the flight crew reported the use of CPDLC below 10,000 for IM operations was unacceptable, with 83% reporting below 5000 was unacceptable. Also described are proposed modifications to the IM operations that may reduce CPDLC Respond time to less than 30 seconds and should significantly reduce the complexity of crew procedures, as well as follow-on research issues for operational use of CPDLC during IM operations.

Short- and long-term outcomes of surgical management of peptic ulcer complications in the era of proton pump inhibitors.

PubMed

Hasadia, Rabea; Kopelman, Yael; Olsha, Oded; Alfici, Ricardo; Ashkenazi, Itamar

2018-01-22

We evaluated the short-term and long-term outcomes of emergency operations for peptic ulcer (PUD) complications in a period of time in which the need for surgery is infrequent. Retrospective review of operated patients (2007-2015) in one medical center. 81 patients were included (8.9 patients/year): 70 (86.4%) male; 11 (13.6%) female. Indications for operation were hemorrhage in 18 (22.2%), perforation in 62 (76.5%) and gastric-outlet obstruction in one (1.2%). Only 16 (19.8%) operations included a procedure to reduce gastric acid secretion. Six (7.4%) patients had a second operation for recurrent or persistent complication. Of these, two had a procedure to reduce gastric acid secretion in their first operation. 16 (19.8%) patients died during the index hospitalization. Three (3.7%) patients were rehospitalized for a PUD complication following 3-24 months. One patient, who had surgery for a second perforation 3 months following the first operation, was treated empirically for Helicobacter Pylori (HP) between the two operations. In comparison to perforation, patients with hemorrhage were older (69.9 ± 20.3 vs. 52.1 ± 19.9 years; p = 0.0015), more commonly had a history of PUD or treatment by nonsteroidal anti-inflammotry drugs (55.6 vs. 19.4%; p = 0.0054), more commonly had a procedure to reduce gastric acid secretion during their index operation (61.1 vs. 6.5%; p < 0.0001), and had a higher mortality (38.9 vs. 14.5%; p = 0.0406). Mortality is high following surgery for the complications of PUD, moreso in patients undergoing surgery for hemorrhage. Reoperations and repeated hospitalizations for complications are not uncommon, even in patients who have had procedures to reduce gastric acid secretion and HP eradication.

Economics in ground operations of the Space Shuttle

NASA Technical Reports Server (NTRS)

Gray, R. H.

1973-01-01

The physical configuration, task versatility, and typical mission profile of the Space Shuttle are illustrated and described, and a comparison of shuttle and expendable rocket costs is discussed, with special emphasis upon savings to be achieved in ground operations. A review of economies achieved by engineering design improvements covers the automated checkout by onboard shuttle systems, the automated launch processing system, the new maintenance concept, and the analogy of Space Shuttle and airline repetitive operations. The Space Shuttle is shown to represent a new level in space flight technology, particularly, the sophistication of the systems and procedures devised for its support and ground operations.

Satellite Ground Operations Automation: Lessons Learned and Future Approaches

NASA Technical Reports Server (NTRS)

Catena, John; Frank, Lou; Saylor, Rick; Weikel, Craig; Obenschain, Arthur F. (Technical Monitor)

2001-01-01

Reducing spacecraft ground system operations costs is a major goal in all missions. The Fast Auroral Snapshot (FAST) flight operations team at the NASA/Goddard Spacecraft Flight Center developed in-house scripts and procedures to automate monitoring of critical spacecraft functions. The initial staffing profile of 16x7 was reduced first to 8x5 and then to 'lights out'. Operations functions became an offline review of system performance and the generation of future science plans for subsequent upload to the spacecraft. Lessons learned will be applied to the challenging Triana mission, where 24x7 contact with the spacecraft will be necessary at all times.

Single-incision laparoscopic cholecystectomy: a systematic review of methodology and outcomes.

PubMed

Yamazaki, Masato; Yasuda, Hideki; Koda, Keiji

2015-05-01

(1) To survey the dissemination of SILC; (2) to determine which SILC method has become mainstream; (3) to determine whether the characteristic complications vary according to the type of procedure. An electronic search of PubMed, Databases@Ovid, and SciVerse Scopus between 2003/01/01 and 2012/12/31 was performed. The peak number of annually published articles was 70 in 2011. The most common procedures were single skin incision, the use of a SILS Port(®), suture suspension and a 5-mm oblique scope. The intraoperative complications rate was 1.69 %. Postoperative complications occurred in 213/5283 cases. According to the surgical procedure, five factors (approach; P = 0.0017, gallbladder anchorage; P < 0.001, size; P = 0.049 and type; P < 0.001 of the scope, and size of the clip applier; P = 0.074) significantly affected the incidence of wound infection. The incidence of wound seroma/bleeding was significantly influenced by gallbladder anchorage (P = 0.009), the use of curved/articulated instruments (P = 0.048), and the diameter of the clip applier (P < 0.001). To determine the best operative procedure for SILC, an analysis of uniform operative procedures is needed.

Guide to good practices for operations and administration updates through required reading

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1998-12-01

This Guide to Good Practices is written to enhance understanding of, and provide direction for, Required Reading, Chapter XIV of Department of Energy (DOE) Order 5480.19, Conduct of Operations Requirements for DOE Facilities. The practices in this guide should be considered when planning or reviewing programs for updating personnel with operations and administration information through required reading. Contractors are advised to adopt procedures that meet the intent of DOE Order 5480.19. Required Reading is an element of an effective Conduct of Operations program. The complexity and array of activities performed in DOE facilities dictate the necessity for a coordinated requiredmore » reading program to promote safe and efficient operations.« less

Image guided percutaneous spine procedures using an optical see-through head mounted display: proof of concept and rationale.

PubMed

Deib, Gerard; Johnson, Alex; Unberath, Mathias; Yu, Kevin; Andress, Sebastian; Qian, Long; Osgood, Gregory; Navab, Nassir; Hui, Ferdinand; Gailloud, Philippe

2018-05-30

Optical see-through head mounted displays (OST-HMDs) offer a mixed reality (MixR) experience with unhindered procedural site visualization during procedures using high resolution radiographic imaging. This technical note describes our preliminary experience with percutaneous spine procedures utilizing OST-HMD as an alternative to traditional angiography suite monitors. MixR visualization was achieved using the Microsoft HoloLens system. Various spine procedures (vertebroplasty, kyphoplasty, and percutaneous discectomy) were performed on a lumbar spine phantom with commercially available devices. The HMD created a real time MixR environment by superimposing virtual posteroanterior and lateral views onto the interventionalist's field of view. The procedures were filmed from the operator's perspective. Videos were reviewed to assess whether key anatomic landmarks and materials were reliably visualized. Dosimetry and procedural times were recorded. The operator completed a questionnaire following each procedure, detailing benefits, limitations, and visualization mode preferences. Percutaneous vertebroplasty, kyphoplasty, and discectomy procedures were successfully performed using OST-HMD image guidance on a lumbar spine phantom. Dosimetry and procedural time compared favorably with typical procedural times. Conventional and MixR visualization modes were equally effective in providing image guidance, with key anatomic landmarks and materials reliably visualized. This preliminary study demonstrates the feasibility of utilizing OST-HMDs for image guidance in interventional spine procedures. This novel visualization approach may serve as a valuable adjunct tool during minimally invasive percutaneous spine treatment. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Robotics in endoscopy.

PubMed

Klibansky, David; Rothstein, Richard I

2012-09-01

The increasing complexity of intralumenal and emerging translumenal endoscopic procedures has created an opportunity to apply robotics in endoscopy. Computer-assisted or direct-drive robotic technology allows the triangulation of flexible tools through telemanipulation. The creation of new flexible operative platforms, along with other emerging technology such as nanobots and steerable capsules, can be transformational for endoscopic procedures. In this review, we cover some background information on the use of robotics in surgery and endoscopy, and review the emerging literature on platforms, capsules, and mini-robotic units. The development of techniques in advanced intralumenal endoscopy (endoscopic mucosal resection and endoscopic submucosal dissection) and translumenal endoscopic procedures (NOTES) has generated a number of novel platforms, flexible tools, and devices that can apply robotic principles to endoscopy. The development of a fully flexible endoscopic surgical toolkit will enable increasingly advanced procedures to be performed through natural orifices. The application of platforms and new flexible tools to the areas of advanced endoscopy and NOTES heralds the opportunity to employ useful robotic technology. Following the examples of the utility of robotics from the field of laparoscopic surgery, we can anticipate the emerging role of robotic technology in endoscopy.

Objective review of mediastinal lymph node examination in a lung cancer resection cohort.

PubMed

Osarogiagbon, Raymond U; Allen, Jeffrey W; Farooq, Aamer; Wu, James T

2012-02-01

Accurate staging of resected lung cancer requires mediastinal lymph node (MLN) examination. MLN dissection (MLND) and systematic sampling (SS) are acceptable procedures; random sampling (RS) and no sampling (NS) are not. Forty percent of US lung cancer resections have NS. We closely examined the pattern of MLN examination in a lung resection cohort. This is a retrospective review of all lung cancer resections in Memphis, TN, from 2004 to 2007. We compared operating surgeons' claims to the pathology report and an audit of the operation narrative by an independent surgeon. Forty-five percent of resections were reported by surgeons as MLND, 8% RS, and 48% NS. None met pathology criteria for MLND, 9% were SS, 50% were RS, and 42% were NS. The concordance rate between the operating surgeon and pathology report was 39%. The surgeon audit suggested 29% of resections had MLND, 26% RS, and 45% NS. Concordance between operating and auditing surgeons was 71%. Sublobar resection, T1 stage, and age were associated with NS. Most resections had suboptimal MLN examination. Concordance was poor between surgeon claims, objective review of pathology reports, and an independent surgeon audit. The higher concordance between operating and auditing surgeons may suggest incomplete pathology examination of MLN material. The terms used by operating surgeons to describe MLN retrieval were often inaccurate.

SOHO Mission Interruption Joint NASA/ESA Investigation Board

NASA Technical Reports Server (NTRS)

1998-01-01

Contact with the SOlar Heliospheric Observatory (SOHO) spacecraft was lost in the early morning hours of June 25, 1998, Eastern Daylight Time (EDT), during a planned period of calibrations, maneuvers, and spacecraft reconfigurations. Prior to this the SOHO operations team had concluded two years of extremely successful science operations. A joint European Space Agency (ESA)/National Aeronautics and Space Administration (NASA) engineering team has been planning and executing recovery efforts since loss of contact with some success to date. ESA and NASA management established the SOHO Mission Interruption Joint Investigation Board to determine the actual or probable cause(s) of the SOHO spacecraft mishap. The Board has concluded that there were no anomalies on-board the SOHO spacecraft but that a number of ground errors led to the major loss of attitude experienced by the spacecraft. The Board finds that the loss of the SOHO spacecraft was a direct result of operational errors, a failure to adequately monitor spacecraft status, and an erroneous decision which disabled part of the on-board autonomous failure detection. Further, following the occurrence of the emergency situation, the Board finds that insufficient time was taken by the operations team to fully assess the spacecraft status prior to initiating recovery operations. The Board discovered that a number of factors contributed to the circumstances that allowed the direct causes to occur. The Board strongly recommends that the two Agencies proceed immediately with a comprehensive review of SOHO operations addressing issues in the ground procedures, procedure implementation, management structure and process, and ground systems. This review process should be completed and process improvements initiated prior to the resumption of SOHO normal operations.

Basic research and 12 years of clinical experience in computer-assisted navigation technology: a review.

PubMed

Ewers, R; Schicho, K; Undt, G; Wanschitz, F; Truppe, M; Seemann, R; Wagner, A

2005-01-01

Computer-aided surgical navigation technology is commonly used in craniomaxillofacial surgery. It offers substantial improvement regarding esthetic and functional aspects in a range of surgical procedures. Based on augmented reality principles, where the real operative site is merged with computer generated graphic information, computer-aided navigation systems were employed, among other procedures, in dental implantology, arthroscopy of the temporomandibular joint, osteotomies, distraction osteogenesis, image guided biopsies and removals of foreign bodies. The decision to perform a procedure with or without computer-aided intraoperative navigation depends on the expected benefit to the procedure as well as on the technical expenditure necessary to achieve that goal. This paper comprises the experience gained in 12 years of research, development and routine clinical application. One hundred and fifty-eight operations with successful application of surgical navigation technology--divided into five groups--are evaluated regarding the criteria "medical benefit" and "technical expenditure" necessary to perform these procedures. Our results indicate that the medical benefit is likely to outweight the expenditure of technology with few exceptions (calvaria transplant, resection of the temporal bone, reconstruction of the orbital floor). Especially in dental implantology, specialized software reduces time and additional costs necessary to plan and perform procedures with computer-aided surgical navigation.

Holmium:YAG Laser Ablation for the Management of Lower Urinary Tract Foreign Bodies Following Incontinence Surgery: A Case Series and Systematic Review.

PubMed

Chan, Garson; Mamut, Adiel; Martin, Paul; Welk, Blayne

2016-11-01

The objective of this study was to determine the outcomes associated with the endoscopic removal of foreign bodies (such as mesh or permanent suture) in the lower urinary tract after female stress incontinence surgery with the Holmium:YAG (Ho:YAG) laser, and to systematically review the literature on this topic. A retrospective chart review of 18 consecutive women found to have mesh or suture exposure was performed. All patients underwent Ho:YAG laser ablation. A systematic review was performed to identify literature addressing the endoscopic management of mesh/suture exposure after stress incontinence surgery. Between November 2011 and February 2016, 18 women underwent Ho:YAG laser ablation of exposed mesh or suture. Presenting symptoms included lower urinary tract symptoms, pelvic pain, incontinence, or recurrent urinary tract infections. Thirteen women had a previous synthetic midurethral sling and five had a prior retropubic suspension. The median age was 58 years (interquartile range [IQR] 50-60) and median follow-up was 2 years (IQR 1-2). Four patients (22%) had residual mesh after the first procedure, requiring a repeat endoscopic procedure. Only one patient had a small amount of asymptomatic residual mesh on cystoscopy after the final procedure. Only minor postoperative complications were observed. Eight patients had stress incontinence and four underwent operative treatment for this. In our systematic review, we identified 16 case series, which described a total of 158 patients. Women most commonly presented with voiding symptoms or incontinence. Based on the synthesis of these data, repeat procedures were necessary in 16% and vesicovaginal fistula occurred in 2%. Recurrent/persistent stress incontinence was present in 20%, and of these patients, 3/4 underwent a new stress incontinence procedure. Both our case series and the systematic review of the literature demonstrated that endoscopic treatment of lower urinary tract foreign bodies after stress incontinence surgery has good success rates and minimal morbidity.

78 FR 51664 - Vessel Traffic Service Updates, Including Establishment of Vessel Traffic Service Requirements...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-21

... requirements. The changes made by this rule will align regulations with the current operating procedures of the... History V. Discussion of Comments and Changes VI. Regulatory Analyses A. Regulatory Planning and Review B... Waterways Safety System PWSA Ports and Waterways Safety Act SOLAS International Convention for the Safety of...

78 FR 37819 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-24

.... Description: The Advance Planning Document (APD) process, established in the rules at 45 CFR Part 95, Subpart F, is the procedure by which States request and obtain approval for Federal financial participation... Advance Planning Document 34 1.2 120 4,896 Operational Advance Planning Document 20 1 30 600 [[Page 37820...

77 FR 31027 - Submission for OMB Review; Comment Request; Web-Based Assessment of the Clinical Studies Support...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-24

...; Comment Request; Web-Based Assessment of the Clinical Studies Support Center (CSSC) Summary: Under the... current valid OMB control number. Proposed Collection: Title: Web-Based Assessment of the Clinical Studies... Operations and Procedures (MOP); coordinating meeting space and logistics for in-person meetings, Web...

Effluent-Monitoring Procedures: Basic Laboratory Skills. Student Reference Manual.

ERIC Educational Resources Information Center

Engel, William T.; And Others

This is one of several short-term courses developed to assist in the training of waste water treatment plant operational personnel in the tests, measurements, and report preparation required for compliance with their NPDES Permits. This Student Reference Manual provides a review of basic mathematics as it applies to the chemical laboratory. The…

75 FR 2868 - Agency Information Collection Activities; Submission for Office of Management and Budget Review...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-19

... operating procedures for each recordkeeper is $300 (6 hours of work at $50/hour (h)). This results in a... public health, safety, and with ethical standards. Investigators should have freedom to pursue the least... product development and the protection of public health, safety, and ethical standards, FDA has...

Review and Enhancement for Crash Analysis and Prediction: Phase 1 Evaluation of the Crash Studies and Analysis Standard Operating Procedures in Maryland

DOT National Transportation Integrated Search

2010-03-01

Traffic safety has become one of the most critical issues facing transportation agencies across the nation. In 2006, about 43,000 people were killed, and another 290,000 were seriously injured in crashes on public roadways in the United States. Accor...

49 CFR 385.308 - What may cause an expedited action?

Code of Federal Regulations, 2010 CFR

2010-10-01

... SAFETY FITNESS PROCEDURES New Entrant Safety Assurance Program § 385.308 What may cause an expedited... inspections or by any other means, may be subjected to an expedited safety audit or a compliance review or may..., or missing a required endorsement. (2) Operating a vehicle placed out of service for violations of...

AUTOMOTIVE DIESEL MAINTENANCE 2. UNIT XVII, LEARNING ABOUT AC GENERATOR (ALTERNATOR) PRINCIPLES (PART II).

ERIC Educational Resources Information Center

Minnesota State Dept. of Education, St. Paul. Div. of Vocational and Technical Education.

THIS MODULE OF A 25-MODULE COURSE IS DESIGNED TO DEVELOP AN UNDERSTANDING OF THE OPERATING PRINCIPLES AND THE SERVICING AND TESTING PROCEDURES FOR ALTERNATING CURRENT (AC) GENERATORS AND REGULATORS USED ON DIESEL POWERED EQUIPMENT. TOPICS ARE REVIEW OF ALTERNATOR PRINCIPLES, ALTERNATOR SERVICING AND TESTING, ALTERNATOR REGULATOR OPERATING…

21 CFR 111.140 - Under this subpart F, what records must you make and keep?

Code of Federal Regulations, 2010 CFR

2010-04-01

... and making a disposition decision and written procedures for approving or rejecting any reprocessing... perform the quality control operation, who conducted the material review and made the disposition decision... System: Requirements for Quality Control § 111.140 Under this subpart F, what records must you make and...

Overpayments of Education Benefits Could Be Reduced for Veterans Enrolled in Noncollege Degree Courses.

DTIC Science & Technology

1981-09-30

We conducted our review to determine the effectiveness of VA’s absence accounting procedures. our work was performed at the VA central office, the VA...malfunctions, was discontinued several years ago. Maintenance is performed only if requested by the machine operator after a problem is identified

School-Based Management/Shared-Decision Making--a Pilot Program: A Historical Perspective.

ERIC Educational Resources Information Center

Dade County Public Schools, Miami, FL.

The Dade County (Florida) Public School system has had various types of school-based management (SBM) procedures in operation since 1974. During the 1985-86 school year, a committee of principals and other administrators reviewed the concepts of SBM from a different viewpoint, using various materials that addressed the professionalization of…

Robotics and telesurgery in otolaryngology.

PubMed

Newman, Jason G; Kuppersmith, Ronald B; O'Malley, Bert W

2011-12-01

This article reviews the use of robotic technology for otolaryngologic surgery. The authors discuss the development of the technology and its current uses in the operating room. They address procedures such as oropharyngeal transoral robotic surgery (TORS), laryngeal TORS, and thyroidectomy, and also note the role of robotics in teaching. Copyright © 2011 Elsevier Inc. All rights reserved.

Incidence and management of colonoscopic perforations: 8 years’ experience

PubMed Central

Tulchinsky, Hagit; Madhala-Givon, Osnat; Wasserberg, Nir; Lelcuk, Shlomo; Niv, Yaron

2006-01-01

AIM: To review the experience of a major medical teaching center with diagnostic and therapeutic colonoscopies and to assess the incidence and management of related colonic perforations. METHODS: All colonoscopies performed between January 1994 and December 2001 were studied. Data on patients, colonoscopic reports and procedure-related complications were collected from the departmental computerized database. The medical records of the patients with post procedural colonic perforation were reviewed. RESULTS: A total of 12 067 colonoscopies were performed during the 8 years of the study. Seven colonoscopic perforations (4 females, 3 males) were diagnosed (0.058%). Five occurred during diagnostic and two during therapeutic colonoscopy. Six were suspected during or immediately after colonoscopy. All except one had signs of diffuse tenderness and underwent immediate operation with primary repair done in 4 patients. No deaths were reported. CONCLUSION: Perforation rate during colonoscopy is low. Nevertheless, it is a serious complication and its early recognition and treatment are essential to optimize outcome. In patients with diffuse peritonitis early operative intervention makes primary repair a safe option. PMID:16830377

The Operative Burden of General Surgical Disease and Non-Battle Injury in a Deployed Military Treatment Facility in Afghanistan.

PubMed

Hollingsworth, Andrew C; Bowley, Douglas M; Lundy, Jonathan B

2016-09-01

Contemporary medical operations support a mobile, nonconventional force involved in nation building, counterinsurgency, and humanitarian operations. Prior reports have described surgical care for disease and nonbattle injuries (DNBI). The purpose of this report is to describe the prevalence and scope of DNBI managed by general surgeons in a contemporary, deployed medical facility. A 2-year retrospective review of the operative logbook from the U.K. Role 3 Multinational Hospital, Camp Bastion, Afghanistan, was performed to determine the prevalence and makeup of procedures performed for DNBI by general surgeons. Nontrauma general surgical procedures accounted for 7.7% (n = 279 of 3,607 cases) of cases; appendectomy (n = 146) was the most common, followed by drainage of soft tissue (n = 55) and oral abscesses (n = 5), scrotal exploration (n = 12), and hernia repair (n = 7). A total of 7.2% (n = 20 of 279) of cases fell outside the standard scope of practice of an urban, civilian general surgeon. Although the prevalence of operative procedures for DNBI was low, the spectrum of cases included those not typically managed in the civilian setting of the United Kingdom. With an evolving decline in case volume performed in multiple anatomic locations due to subspecialization during surgical training, this gap in expertise is likely to increase. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Current Controversies in Diagnosis and Management of Cleft Palate and Velopharyngeal Insufficiency

PubMed Central

Ysunza, Pablo Antonio; Repetto, Gabriela M.; Pamplona, Maria Carmen; Calderon, Juan F.; Shaheen, Kenneth; Chaiyasate, Konkgrit; Rontal, Matthew

2015-01-01

Background. One of the most controversial topics concerning cleft palate is the diagnosis and treatment of velopharyngeal insufficiency (VPI). Objective. This paper reviews current genetic aspects of cleft palate, imaging diagnosis of VPI, the planning of operations for restoring velopharyngeal function during speech, and strategies for speech pathology treatment of articulation disorders in patients with cleft palate. Materials and Methods. An updated review of the scientific literature concerning genetic aspects of cleft palate was carried out. Current strategies for assessing and treating articulation disorders associated with cleft palate were analyzed. Imaging procedures for assessing velopharyngeal closure during speech were reviewed, including a recent method for performing intraoperative videonasopharyngoscopy. Results. Conclusions from the analysis of genetic aspects of syndromic and nonsyndromic cleft palate and their use in its diagnosis and management are presented. Strategies for classifying and treating articulation disorders in patients with cleft palate are presented. Preliminary results of the use of multiplanar videofluoroscopy as an outpatient procedure and intraoperative endoscopy for the planning of operations which aimed to correct VPI are presented. Conclusion. This paper presents current aspects of the diagnosis and management of patients with cleft palate and VPI including 3 main aspects: genetics and genomics, speech pathology and imaging diagnosis, and surgical management. PMID:26273595

Readiness Review of BWXT for Fabrication of AGR 5/6/7 Compacts

DOE Office of Scientific and Technical Information (OSTI.GOV)

Marshall, Douglas William; Sharp, Michelle Tracy

In support of preparations for fabricating compacts for the Advanced Gas Reactor (AGR) fuel qualification irradiation experiments (AGR-5/6/7), Idaho National Laboratory (INL) conducted a readiness review of the BWX Technology (BWXT) procedures, processes, and equipment associated with compact fabrication activities at the BWXT Nuclear Operations Group (BWXT-NOG) facility outside Lynchburg, VirginiaVA. The readiness review used quality assurance requirements taken from the American Society of Mechanical Engineers (ASME) Nuclear Quality Assurance Standard (NQA-1-2008/1a-2009) as a basis to assess readiness to start compact fabrication.

Analysis of the causes of surgery-related medical disputes in Taiwan: Need for acute care surgeons to improve quality of care.

PubMed

Hu, Yi-Hsuan; Wang, Chien-Ying; Huang, Mu-Shun; Lee, Chen-Hsen; Wen, Yi-Szu

2016-11-01

This study investigated surgery-related medical disputes and analyzed disease etiologies and the main causes of disputes in order to identify key points for the purpose of improving the quality of surgical patient care in Taiwan. Reports on all surgery-related cases appraised by the Taiwan Witness Examiner Committee of the Department of Health between 2004 and 2008 were reviewed retrospectively by three senior physicians from the emergency department who specialize in both trauma and emergency general surgery. The causes of the various medical disputes were categorized under the following descriptions: operation- or procedure-related complication, anesthesia complication, inappropriate management or decision, delayed diagnosis or misdiagnosis, and unsatisfactory result. A total of 154 cases were reviewed, of which 39 were trauma-related and 115 were disease-related. The two leading causes of disputes in this review were found to be operation- or procedure-related complications (35.7%) and unsatisfactory results (31.8%), followed by delayed diagnoses or misdiagnoses, inappropriate management, and anesthesia complications. Among these, 74 cases (48.1%) required the care of an acute care surgeon and 40 cases (26.0%) required emergency general surgery intervention. Surgery- or procedure-related complications and unsatisfactory treatment results constituted the major causes of medical disputes in Taiwan. The majority of these cases involved acute care surgery; thus, the establishment of an acute care surgery system should be considered to improve patient care. The management of hemorrhagic shock and incarcerated hernia should be reinforced in future medical training. Copyright © 2016. Published by Elsevier Taiwan LLC.

Regular tracheostomy tube changes to prevent formation of granulation tissue.

PubMed

Yaremchuk, Kathleen

2003-01-01

Tracheostomy is a commonly performed operative procedure that has been described since 2000 B.C. The early indications for tracheostomy were for upper airway obstruction, usually occurring in young people as a result of an infectious process. Recently, tracheostomies are more commonly performed in the critically ill patient to assist in long-term ventilatory support. Granulation tissue at the stoma and the trachea has been described as a late complication resulting in bleeding, drainage, and difficulty with maintaining mechanical ventilatory support. The present report is of an observational study of a newly implemented policy that required regular changing of tracheostomy tubes. Comparable groups of patients were compared before and after this procedural change to document complications. Data collection consisted of chart reviews of all admissions for 1 year before the policy change and the subsequent 2 years. Complication rates were compared using standard statistical techniques. A policy change was instituted that required all tracheostomy tubes to be changed every 2 weeks in conjunction with a detailed evaluation of the tracheostomy stoma. Charts were reviewed the year before the change in policy and in the subsequent 2 years to determine the incidence of granulation tissue requiring operative intervention. The number of patients requiring surgical intervention secondary to granulation tissue showed a statistically significant decrease (P =.02). A review of policies and procedures from the six largest hospitals in southeastern Michigan had no recommendations for routine tracheostomy tube changes. A policy requiring a routine change of tracheostomy tubes results in fewer complications from granulation tissue. Tracheostomy tube changes to prevent granulation tissue and its complications.

The efficacy of virtual reality simulation training in laparoscopy: a systematic review of randomized trials.

PubMed

Larsen, Christian Rifbjerg; Oestergaard, Jeanett; Ottesen, Bent S; Soerensen, Jette Led

2012-09-01

Virtual reality (VR) simulators for surgical training might possess the properties needed for basic training in laparoscopy. Evidence for training efficacy of VR has been investigated by research of varying quality over the past decade. To review randomized controlled trials regarding VR training efficacy compared with traditional or no training, with outcome measured as surgical performance in humans or animals. In June 2011 Medline, Embase, the Cochrane Central Register of Controlled Trials, Web of Science and Google Scholar were searched using the following medical subject headings (MeSh) terms: Laparoscopy/standards, Computing methodologies, Programmed instruction, Surgical procedures, Operative, and the following free text terms: Virtual real* OR simulat* AND Laparoscop* OR train* Controlled trials. All randomized controlled trials investigating the effect of VR training in laparoscopy, with outcome measured as surgical performance. A total of 98 studies were screened, 26 selected and 12 included, with a total of 241 participants. Operation time was reduced by 17-50% by VR training, depending on simulator type and training principles. Proficiency-based training appeared superior to training based on fixed time or fixed numbers of repetition. Simulators offering training for complete operative procedures came out as more efficient than simulators offering only basic skills training. Skills in laparoscopic surgery can be increased by proficiency-based procedural VR simulator training. There is substantial evidence (grade IA - IIB) to support the use of VR simulators in laparoscopic training. © 2012 The Authors  Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

Application of imaging to the atmospheric Cherenkov technique

NASA Technical Reports Server (NTRS)

Cawley, M. F.; Fegan, D. J.; Gibbs, K.; Gorham, P. W.; Hillas, A. M.; Lamb, R. C.; Liebing, D. F.; Mackeown, P. K.; Porter, N. A.; Stenger, V. J.

1985-01-01

Turver and Weekes proposed using a system of phototubes in the focal plane of a large reflector to give an air Cherenkov camera for gamma ray astronomy. Preliminary results with a 19 element camera have been reported previously. In 1983 the camera was increased to 37 pixels; it has now been routinely operated for two years. A brief physical description of the camera, its mode of operation, and the data reduction procedures are presented. The Monte Carlo simultations on which these are based on also reviewed.

WHIPPLE PROCEDURE: PANCREATICOGASTROSTOMY VERSUS PANCREATICOJEJUNOSTOMY: A LITERATURE REVIEW.

PubMed

Rehman, Sameer; Umer, Affan; Kuncewitch, Michael; Molmenti, Ernesto

2016-01-01

Pancreatic cancer is one of the leading causes of oncologic morbidity and mortality worldwide. The definitive surgical management for pancreatic cancer includes pancreaticoduodenectomy with either anastomosis to, or implantation of remnant pancreas to the stomach (pancreaticogastrostomy) or the jejunum (pancreaticojejunostomy). Operative morbidity and mortality following pancreaticoduodenectomy frequently results from complications associated with a pancreaticojejunal anastomotic leak. Pancreaticogastrostomy is an alternative method of restoring pancreatic continuity with the gut, which has been employed by a number of institutions showing some benefit in operative mortality.

Standard Procedures for Air Force Operational Test and Evaluation. Volume I.

DTIC Science & Technology

1974-10-01

of the foregoing, and assuming the successful advocacy of the prcposed OT&E a Test Directive is drafted by AFTEC, reviewed by HQ USAF, and upon...design purposes. A successful approach to this problem used by both Air Force and Army OT&E agencies is to conduct an analysis of the operational mission...conduct an analysis of the mission structure involved in the OT&E. This constitutes a top level structure of the scenario with identification of the players

Evidence-Based Management of Pain After Excisional Haemorrhoidectomy Surgery: A PROSPECT Review Update.

PubMed

Sammour, Tarik; Barazanchi, Ahmed W H; Hill, Andrew G

2017-02-01

The aim of this systematic review was to update previous PROSPECT ( http://www.postoppain.org ) review recommendations for the management of pain after excisional haemorrhoidectomy. Randomized studies and reviews published in the English language from July 2006 (end date of last review) to March 2016, assessing analgesic, anaesthetic, and operative interventions pertaining to excisional haemorrhoidectomy in adults, and reporting pain scores, were retrieved from the EMBASE and MEDLINE databases. An additional 464 studies were identified of which 74 met the inclusion criteria. There were 48 randomized controlled trials and 26 reviews. Quantitative analyses were not performed, as there were limited numbers of trials with a sufficiently homogeneous design. Pudendal nerve block, with or without general anaesthesia, is recommended for all patients undergoing haemorrhoidal surgery. Either closed haemorrhoidectomy, or open haemorrhoidectomy with electrocoagulation of the pedicle is recommended as the primary procedure. Combinations of analgesics (paracetamol, non-steroidal anti-inflammatory drugs, and opioids), topical lignocaine and glyceryl trinitrate, laxatives, and oral metronidazole are recommended post-operatively. The recommendations are largely based on single intervention, not multimodal intervention, studies.

Management of Post-Traumatic Phlegmasia Cerulea Dolens via Right-to-Left Femoral Vein to Femoral Vein Bypass (Palma Procedure).

PubMed

Dua, Anahita; Heller, Jennifer; Lee, Cheong

2017-11-01

Phlegmasia cerulea dolens (PCD) is a rare condition resulting from venous occlusion that impairs arterial flow. We report a rare case of post-traumatic PCD after ligation of the iliac vein with successful treatment by right-to-left femoral vein to femoral vein bypass using left great saphenous vein (Palma procedure). The clinical presentation, diagnostic process, and approach to management along with a literature review on the operative management of PCD are presented in this case report.

Report of Apollo 204 Review Board to the Administrator, National Aeronautics and Space Administration . Appendix F ; Schedule of Physical Evidence

NASA Technical Reports Server (NTRS)

1967-01-01

Immediately following the Apollo 204 accident of January 27, 1961. all associated equipment and material were impounded. Release of this equipment and material for normal use was under the close control of the Apollo 204 Review Board. Apollo Review Board Administrative Procedure No. 11, February 11, 1961, established the Apollo 204 Review Board Material Release Record (MRR). This MRR was the official form used to release material from full impoundment and was valid only after being approved by the Board and signed by a Member. The form was used as the authority to place any impounded item into one of the three Categories defined in Administrative Procedure No. 11. This appendix contains all of the authorized MRR's. Each item submitted on an MRR was given a control number; a description, including the part number and serial number; the relevance and location to the accident; any constraints before release; and the control category. The categories placed on the equipment were as follows: Category A - Items which may have a significant influence or bearing on the results or findings of the Apollo 204 Review Board; Category B - All material other than Category A which is considered relevant to the Apollo 204 Review Board investigation; Category C - Material released from Board jurisdiction. Several classes of equipment were released by special Board action prior to the establishment of the MRR system. The operating procedure for release of these classes is Enclosure F-l to this appendix.

Is Decellularized Porcine Small Intestine Sub-mucosa Patch Suitable for Aortic Arch Repair?

PubMed Central

Corno, Antonio F.; Smith, Paul; Bezuska, Laurynas; Mimic, Branko

2018-01-01

Introduction: We reviewed our experience with decellularized porcine small intestine sub-mucosa (DPSIS) patch, recently introduced for congenital heart defects. Materials and Methods: Between 10/2011 and 04/2016 a DPSIS patch was used in 51 patients, median age 1.1 months (5 days to 14.5 years), for aortic arch reconstruction (45/51 = 88.2%) or aortic coarctation repair (6/51 = 11.8%). All medical records were retrospectively reviewed, with primary endpoints interventional procedure (balloon dilatation) or surgery (DPSIS patch replacement) due to patch-related complications. Results: In a median follow-up time of 1.5 ± 1.1 years (0.6–2.3years) in 13/51 patients (25.5%) a re-intervention, percutaneous interventional procedure (5/51 = 9.8%) or re-operation (8/51 = 15.7%) was required because of obstruction in the correspondence of the DPSIS patch used to enlarge the aortic arch/isthmus, with median max velocity flow at Doppler interrogation of 4.0 ± 0.51 m/s. Two patients required surgery after failed interventional cardiology. The mean interval between DPSIS patch implantation and re-intervention (percutaneous procedure or re-operation) was 6 months (1–17 months). While there were 3 hospital deaths (3/51 = 5.9%) not related to the patch implantation, no early or late mortality occurred for the subsequent procedure required for DPSIS patch interventional cardiology or surgery. The median max velocity flow at Doppler interrogation through the aortic arch/isthmus for the patients who did not require interventional procedure or surgery was 1.7 ± 0.57 m/s. Conclusions: High incidence of re-interventions with DPSIS patch for aortic arch and/or coarctation forced us to use alternative materials (homografts and decellularized gluteraldehyde preserved bovine pericardial matrix). PMID:29900163

Evolution of treatment of fistula in ano.

PubMed

Blumetti, J; Abcarian, A; Quinteros, F; Chaudhry, V; Prasad, L; Abcarian, H

2012-05-01

Fistula-in-ano is a common medical problem affecting thousands of patients annually. In the past, the options for treatment of fistula-in-ano were limited to fistulotomy and/or seton placement. Current treatment options also include muscle-sparing techniques such as a dermal island flap, endorectal advancement flap, fibrin sealent injection, anal fistula plug, and most recently ligation of the intersphincteric fistula tract (procedure). This study seeks to evaluate types and time trends for treatment of fistula-in-ano. A retrospective review from 1975 to 2009 was performed. Data were collected and sorted into 5-year increments for type and time trends of treatment. Fistulotomy and partial fistulotomy were grouped as cutting procedures. Seton placement, fibrin sealant, dermal flap, endorectal flap, and fistula plug were grouped as noncutting procedures. Statistical analysis was performed for each time period to determine trends. With institutional review board approval, the records of 2,267 fistula operations available for analysis were included. Most of the patients were men (74 vs. 26%). Cutting procedures comprised 66.6% (n = 1510) of all procedures. Noncutting procedures were utilized in 33.4% (n = 757), including Seton placement alone 370 (16.3%), fibrin sealant 168 (7.4%), dermal or endorectal flap 147 (6.5%), and fistula plug 72 (3.2%). The distribution of operations grouped in 5-year intervals is as follows: 1975-1979, 78 cutting and one noncutting; 1980-1984, 170 cutting and 10 noncutting; 1985-1989, 54 cutting and five noncutting; 1990-1994, 37 cutting and six noncutting; 1995-1999, 367 cutting and 167 noncutting; 2000-2004, 514 cutting and 283 noncutting; 2005-2009, 290 cutting and 285 noncutting. The percentage of cutting and noncutting procedures significantly differed over time, with cutting procedures decreasing and noncutting procedures increasing proportionally (χ(2) linear-by-linear association, p < 0.05). Fistula-in-ano remains a common complex disease process. Its treatment has evolved to include a variety of noncutting techniques in addition to traditional fistulotomy. With the advent of more sphincter-sparing techniques, the number of patients undergoing fistulotomy should continue to decrease over time. Surgeons should become familiar with various surgical techniques so the treatment can be tailored to the patient.

Feasibility of same day discharge after robotic assisted pelvic floor reconstruction.

PubMed

Lloyd, Jessica C; Guzman-Negron, Juan; Goldman, Howard B

2018-06-01

Robotic surgical procedures have become more common in female pelvic reconstruction. Purported benefits of robotic assisted pelvic floor reconstruction (RAPFR) procedures include shorter hospital stay, faster recovery, lower blood loss, and decreased postoperative pain. Following RAPFR procedures, the current accepted practice is discharge after a one-night hospitalization. We assessed whether same day discharge (SDD) affects the short term safety of and patient satisfaction with robotic assisted pelvic floor reconstructive procedures, relative to those who remain hospitalized overnight. We retrospectively reviewed the charts of women who underwent RAPFR procedures between October 2015 and October 2016. A same day discharge protocol for RAPFR was initiated in July 2016. To date, 10 patients have undergone SDD. These patients were compared to the consecutive patients from the prior 9 months who stayed overnight. To evaluate short term safety, we reviewed the medical record for any unscheduled Cleveland Clinic emergency department (ED) and/or office visits within 30 days of the RAPFR procedure. We then sent a mailed survey to all patients, querying their pelvic organ prolapse-related PGI-I and also offering a postoperative satisfaction questionnaire. Demographic, perioperative, postoperative data and survey results were compared using Student's t test and Fisher's exact test. In our series, 38 patients (95%) underwent robotic assisted sacrocolpopexy (RASC). Only 2 (5%) had a different RAPFR procedure, a robotic assisted vaginal mesh excision. Concomitant robotic assisted supracervical hysterectomy (SCH) was performed in 9 patients (30%) in the overnight group, whereas 1 of the SDD patients underwent SCH (10%). Demographics and operative characteristics did not differ between groups. Ultimately, patients in the SDD group were no more likely than the overnight group to require an unscheduled ED or office visit in the early postoperative period. With respect to satisfaction, no significant differences were observed between groups, with both groups noting substantial improvement in POP symptoms following surgery. In this pilot study, same day discharge after RAPFR procedures appears to be safe and feasible. RAPFR procedures were well-tolerated, with no difference in ED or non-urology office visits occurring during the early post-operative period in our series, regardless of length of stay. Patient satisfaction was equivalent between groups and universally high.

Evaluating the use of preoperative antibiotics in pediatric orthopaedic surgery.

PubMed

Formaini, Nathan; Jacob, Paul; Willis, Leisel; Kean, John R

2012-01-01

To evaluate the rate of infection after minimally invasive procedures on a consecutive series of pediatric orthopaedic patients. We hypothesized that the use of preoperative antibiotics for minimally invasive pediatric orthopaedic procedures does not significantly reduce the incidence of surgical site infection requiring surgical debridement within 30 days of the primary procedure. We retrospectively reviewed 2330 patients having undergone minimally invasive orthopaedic procedures at our institution between March 2008 and November 2010. Knee arthroscopy, closed reduction with percutaneous fixation, soft tissue releases, excision of bony or soft-tissue masses, and removal of hardware constituted the vast majority of included procedures. Two groups, based on whether prophylactic antibiotics were administered before surgery, were created and the incidence of a repeat procedure required for deep infection was recorded. Statistical analysis was performed to determine significance, if any, between the 2 groups. Chart review of the 2330 patients identified 1087 as having received preoperative antibiotics, whereas the remaining 1243 patients did not receive antibiotics before surgery. Only 1 patient out of the 1243 cases in which antibiotics were not given required additional surgery within 30 days of the primary procedure due to a complicated surgical site infection (an incidence of 0.0008%). No patients in the antibiotic group developed a postoperative infection within 30 days requiring a return to the operating room for management. Our data revealed no significant increase in the incidence of complicated infection requiring additional procedures when antibiotics were not administered before surgery. Though prophylactic antibiotics have been shown to confer numerous benefits for patients undergoing relatively major operations, their use in cases of minimally invasive and/or percutaneous orthopaedic surgery is not well defined. Our data suggest that the use of prophylactic antibiotics may not be indicated for many less invasive procedures when performed in a low-risk pediatric population. Future studies are warranted to help establish evidence-based guidelines regarding the routine use of prophylactic antibiotics in this specific population, hopefully resulting in improved cost-effectiveness and safety while slowing the emergence of new drug-resistant organisms. Level III, retrospective comparative.

Operative time and cost of resident surgical experience: effect of instituting an otolaryngology residency program.

PubMed

Pollei, Taylor R; Barrs, David M; Hinni, Michael L; Bansberg, Stephen F; Walter, Logan C

2013-06-01

Describe the procedure length difference between surgeries performed by an attending surgeon alone compared with the resident surgeon supervised by the same attending surgeon. Case series with chart review. Tertiary care center and residency program. Six common otolaryngologic procedures performed between August 1994 and May 2012 were divided into 2 cohorts: attending surgeon alone or resident surgeon. This division coincided with our July 2006 initiation of an otolaryngology-head and neck surgery residency program. Operative duration was compared between cohorts with confounding factors controlled. In addition, the direct result of increased surgical length on operating room cost was calculated and applied to departmental and published resident case log report data. Five of the 6 procedures evaluated showed a statistically significant increase in surgery length with resident involvement. Operative time increased 6.8 minutes for a cricopharyngeal myotomy (P = .0097), 11.3 minutes for a tonsillectomy (P < .0001), 27.4 minutes for a parotidectomy (P = .028), 38.3 minutes for a septoplasty (P < .0001), and 51 minutes for tympanomastoidectomy (P < .0021). Thyroidectomy showed no operative time difference. Cost of increased surgical time was calculated per surgery and ranged from $286 (cricopharyngeal myotomy) to $2142 (mastoidectomy). When applied to reported national case log averages for graduating residents, this resulted in a significant increase of direct training-related costs. Resident participation in the operating room results in increased surgical length and additional system cost. Although residency is a necessary part of surgical training, associated costs need to be acknowledged.

Individual Differences in Human Reliability Analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jeffrey C. Joe; Ronald L. Boring

2014-06-01

While human reliability analysis (HRA) methods include uncertainty in quantification, the nominal model of human error in HRA typically assumes that operator performance does not vary significantly when they are given the same initiating event, indicators, procedures, and training, and that any differences in operator performance are simply aleatory (i.e., random). While this assumption generally holds true when performing routine actions, variability in operator response has been observed in multiple studies, especially in complex situations that go beyond training and procedures. As such, complexity can lead to differences in operator performance (e.g., operator understanding and decision-making). Furthermore, psychological research hasmore » shown that there are a number of known antecedents (i.e., attributable causes) that consistently contribute to observable and systematically measurable (i.e., not random) differences in behavior. This paper reviews examples of individual differences taken from operational experience and the psychological literature. The impact of these differences in human behavior and their implications for HRA are then discussed. We propose that individual differences should not be treated as aleatory, but rather as epistemic. Ultimately, by understanding the sources of individual differences, it is possible to remove some epistemic uncertainty from analyses.« less

Periodontal microsurgery: A case report

PubMed Central

Kapadia, Janak Anil; Bhedasgoankar, Surekha Y.; Bhandari, Saurabh Dilip

2013-01-01

The purpose of this article is to limelight the benefit of periodontal microsurgery in the surgical disciplines. It reviews the benefits and potential applications of magnification and microsurgery in the specialty of periodontics and a case report on microsurgical approach for free gingival graft surgery in the treatment of gingival recession. The increased demand for mucogingival esthetics has required the optimization of periodontal procedures. Microsurgery is a minimally invasive technique that is performed with the surgical microscope and adapted instruments and suture materials. Although this hardware and knowledge of various operations are necessary to achieve patient esthetic expectations, clinicians must be willing to undergo an extended period of systematic training to become familiar with novel operating procedures and instruments. This article describes the application of the surgical microscope to provide enhanced perioplastic treatment. PMID:24554892

Developing policies and procedures for a picture archiving and communication system.

PubMed

Gaytos, B

2001-06-01

Policies and procedures (P&P) constitute the mechanism for planning, standardizing, and documenting the provision of clinical services. Upon approval by hospital management, the P&P is an official statement of hospital rules and regulations. Each P&P establishes organizational responsibility for providing services. P&P are a mechanism for communicating standard operating procedures to hospital and medical staff. P&P serve as a reference document for unusual events, as well as routine procedures. P&P are often reviewed by inspection teams from the Joint Commission on Accreditation of Hospital Organizations (JCAHO) to determine whether the hospital has documented systematic practices. A picture archival and communications system (PACS) provides a new vehicle for providing radiology services. P&P that were designed for conventional film-based imaging are often not appropriate for electronic imaging. Because PACS is new and not yet widespread, good examples of PACS P&P are not yet available. JCAHO has no official requirements for PACS: PACS is viewed only as a means for the hospital to accomplish its work. Successful P&P development is a team effort, drafted by personnel responsible for executing the procedure, assisted by staff proficient in PACS technology, and tested in the field. The P&P should be reviewed and approved by management personnel knowledgeable about hospital and imaging operations. P&P should be written in clear and concise language. Successful P&P development is an ongoing effort. P&P must be periodically reviewed and updated to reflect changes in PACS technology and changes in clinical operations. New P&P must be developed when a deficit is noted. PACS security is a good example of a topic worthy of P&P development, especially in the face of the Health Insurance Portability and Accountability Act (HIPAA) legislation of 1996. What are the provisions for access control? Does the system include a feature for automatic shut-off of the software? Are there "generic" passwords and log-ins shared by a community of users? How are passwords assigned and how frequently are they changed? What security measures are in place to assure passwords are given to the appropriate user? Who grants and denies access? Service calls are another topic for P&P. Who initiates a service call? What is the process for escalating a service call from the operator level to the vendor? What immediate actions are expected by the operator in order to restore PACS services? How are service events documented? Who is responsible for determining when "downtime" procedures should be initiated or suspended? When our hospital's total electrical system had to be shut down for an extended period, we found that a P&P was lacking for a task as mundane as shutting down and restarting our PACS components. What is the sequence for the shutdown? Who is responsible for shutting down and restarting? How long can the devices operate on uninteruptible power supplies (UPS)? What components are on emergency power? Should we expect the components to survive the switchover to generator power? Developing this P&P was worth the effort: it made the PACS more fault-tolerant and served as a reference document 3 years later when expansion of our physical plant required two more power outages.

Getting started with robotics in general surgery with cholecystectomy: the Canadian experience

PubMed Central

Jayaraman, Shiva; Davies, Ward; Schlachta, Christopher M.

2009-01-01

Background The value of robotics in general surgery may be for advanced minimally invasive procedures. Unlike other specialties, formal fellowship training opportunities for robotic general surgery are few. As a result, most surgeons currently develop robotic skills in practice. Our goal was to determine whether robotic cholecystectomy is a safe and effective bridge to advanced robotics in general surgery. Methods Before performing advanced robotic procedures, 2 surgeons completed the Intuitive Surgical da Vinci training course and agreed to work together on all procedures. Clinical surgery began with da Vinci cholecystectomy with a plan to begin advanced procedures after at least 10 cholecystectomies. We performed a retrospective review of our pilot series of robotic cholecystectomies and compared them with contemporaneous laparoscopic controls. The primary outcome was safety, and the secondary outcome was learning curve. Results There were 16 procedures in the robotics arm and 20 in the laparoscopic arm. Two complications (da Vinci port-site hernia, transient elevation of liver enzymes) occurred in the robotic arm, whereas only 1 laparoscopic patient (slow to awaken from anesthetic) experienced a complication. None was significant. The mean time required to perform robotic cholecystectomy was significantly longer than laparoscopic surgery (91 v. 41 min, p < 0.001). The mean time to clear the operating room was significantly longer for robotic procedures (14 v. 11 min, p = 0.015). We observed a trend showing longer mean anesthesia time for robotic procedures (23 v. 15 min). Regarding learning curve, the mean operative time needed for the first 3 robotic procedures was longer than for the last 3 (101 v. 80 min); however, this difference was not significant. Since this experience, the team has confidently gone on to perform robotic biliary, pancreatic, gastresophageal, intestinal and colorectal operations. Conclusion Robotic cholecystectomy can be performed reliably; however, owing to the significant increase in operating room resources, it cannot be justified for routine use. Our experience, however, demonstrates that robotic cholecystectomy is one means by which general surgeons may gain confidence in performing advanced robotic procedures. PMID:19865571

Most scaphoid non-unions heal with bone chip grafting and Kirschner-wire fixation. Thirty-nine patients reviewed 10 years after operation.

PubMed

Finsen, Vilhjalmur; Hofstad, Morten; Haugan, Hans

2006-09-01

Many recommend to operate scaphoid pseudarthroses with wedge grafts and screw fixation. These are difficult operations. We have employed a simpler procedure and wished to review our results with regard to healing and long-term clinical results. We reviewed 39 unselected scaphoid pseudarthroses which had been operated with Kirschner-wire fixation and bone chip transplantation 10 (3.5-12) years previously. Postoperative cast treatment was 15 (11-30) weeks. Four pseudarthroses failed to unite, one of which was after a trans-scaphoid perilunar dislocation. In another the pins were dislocated by an injury while the arm was in plaster. There were no other complications. All 14 proximal pseudarthroses united. There was no loss of grip strength but some loss of key-pinch strength and wrist mobility. Most patients reported no or little pain and none used analgesics because of wrist pain. The disability of the arm, shoulder and hand (DASH) score was 2 (0-33). Very few cases of mild arthrosis had arisen after operation. Three patients would not have consented to operation if they had known the outcome in advance. Kirschner-wire fixation and bone chip grafting of scaphoid pseudarthroses is an undemanding operation with few complications that produces good long-term results. Results are excellent also for proximal pole pseudarthroses.

Pre-operative assessment and post-operative care in elective shoulder surgery.

PubMed

Akhtar, Ahsan; Macfarlane, Robert J; Waseem, Mohammad

2013-01-01

Pre-operative assessment is required prior to the majority of elective surgical procedures, primarily to ensure that the patient is fit to undergo surgery, whilst identifying issues that may need to be dealt with by the surgical or anaesthetic teams. The post-operative management of elective surgical patients begins during the peri-operative period and involves several health professionals. Appropriate monitoring and repeated clinical assessments are required in order for the signs of surgical complications to be recognised swiftly and adequately. This article examines the literature regarding pre-operative assessment in elective orthopaedic surgery and shoulder surgery, whilst also reviewing the essentials of peri- and post-operative care. The need to recognise common post-operative complications early and promptly is also evaluated, along with discussing thromboprophylaxis and post-operative analgesia following shoulder surgery.

A combined hands-on teaching programme and clinical pathway focused on pleural ultrasound and procedure supervision transforms pleural procedure outcomes.

PubMed

Edwards, Timothy; Cook, Alistair; Salamonsen, Matthew; Bashirzadeh, Farzad; Fielding, David

2017-11-01

Management of pleural effusions is a common diagnostic and management problem. We reviewed the outcomes from pleural procedures after the instigation of pleural effusion management guidelines, focusing on pleural ultrasound and a hands-on teaching programme followed by procedure supervision that enabled many operators to perform such procedures. This is a retrospective analysis of all procedures performed for pleural effusions on medical patients. Outcomes were assessed prior to the instigation of pleural effusion management guidelines (pleural pathway) and hands-on teaching (January 2010 to June 2011) and following these interventions (January 2012 to June 2013). A total of 171 procedures involving 129 patients (pre-pathway group) and 146 procedures involving 115 patients (post-pathway group) was analysed. The rate of complications prior to the pleural pathway was 22.2% (38 of 171 procedures). Following the pathway, the rate of complications declined to 7.5% (11 of 146 procedures, P < 0.003). The use of pleural ultrasound increased dramatically (72.5 vs 90.2%). The number of patients who underwent repeated procedures (defined as ≥3) reduced dramatically (21 vs 7, P < 0.01). This improvement occurred using many supervised operators who completed the hands-on teaching programme (n = 32) and followed the pleural pathway (127 of 146 procedures). The instigation of a clinical pathway focused on the use of bedside pleural ultrasound, and teaching of drainage techniques with procedure supervision vastly improved patient outcomes. This not only allowed better quality of care for patients, it also provided the acquisition of new skills to medical staff, not limiting these skills to specialised staff. © 2017 Royal Australasian College of Physicians.

Using GOMS models and hypertext to create representations of medical procedures for online display

NASA Technical Reports Server (NTRS)

Gugerty, Leo; Halgren, Shannon; Gosbee, John; Rudisill, Marianne

1991-01-01

This study investigated two methods to improve organization and presentation of computer-based medical procedures. A literature review suggested that the GOMS (goals, operators, methods, and selecton rules) model can assist in rigorous task analysis, which can then help generate initial design ideas for the human-computer interface. GOMS model are hierarchical in nature, so this study also investigated the effect of hierarchical, hypertext interfaces. We used a 2 x 2 between subjects design, including the following independent variables: procedure organization - GOMS model based vs. medical-textbook based; navigation type - hierarchical vs. linear (booklike). After naive subjects studies the online procedures, measures were taken of their memory for the content and the organization of the procedures. This design was repeated for two medical procedures. For one procedure, subjects who studied GOMS-based and hierarchical procedures remembered more about the procedures than other subjects. The results for the other procedure were less clear. However, data for both procedures showed a 'GOMSification effect'. That is, when asked to do a free recall of a procedure, subjects who had studies a textbook procedure often recalled key information in a location inconsistent with the procedure they actually studied, but consistent with the GOMS-based procedure.

Time Management in the Operating Room: An Analysis of the Dedicated Minimally Invasive Surgery Suite

PubMed Central

Hsiao, Kenneth C.; Machaidze, Zurab

2004-01-01

Background: Dedicated minimally invasive surgery suites are available that contain specialized equipment to facilitate endoscopic surgery. Laparoscopy performed in a general operating room is hampered by the multitude of additional equipment that must be transported into the room. The objective of this study was to compare the preparation times between procedures performed in traditional operating rooms versus dedicated minimally invasive surgery suites to see whether operating room efficiency is improved in the specialized room. Methods: The records of 50 patients who underwent laparoscopic procedures between September 2000 and April 2002 were retrospectively reviewed. Twenty-three patients underwent surgery in a general operating room and 18 patients in an minimally invasive surgery suite. Nine patients were excluded because of cystoscopic procedures undergone prior to laparoscopy. Various time points were recorded from which various time intervals were derived, such as preanesthesia time, anesthesia induction time, and total preparation time. A 2-tailed, unpaired Student t test was used for statistical analysis. Results: The mean preanesthesia time was significantly faster in the minimally invasive surgery suite (12.2 minutes) compared with that in the traditional operating room (17.8 minutes) (P=0.013). Mean anesthesia induction time in the minimally invasive surgery suite (47.5 minutes) was similar to time in the traditional operating room (45.7 minutes) (P=0.734). The average total preparation time for the minimally invasive surgery suite (59.6 minutes) was not significantly faster than that in the general operating room (63.5 minutes) (P=0.481). Conclusion: The amount of time that elapses between the patient entering the room and anesthesia induction is statically shorter in a dedicated minimally invasive surgery suite. Laparoscopic surgery is performed more efficiently in a dedicated minimally invasive surgery suite versus a traditional operating room. PMID:15554269

Surgery for children in low-income countries affected by humanitarian emergencies from 2008 to 2014: The Médecins Sans Frontières Operations Centre Brussels experience☆,☆☆,★,★★

PubMed Central

Flynn-O’Brien, Katherine T.; Trelles, Miguel; Dominguez, Lynette; Hassani, Ghulam Hiadar; Akemani, Clemence; Naseer, Aamer; Ntawukiruwabo, Innocent Bagura; Kushner, Adam L.; Rothstein, David H.; Stewart, Barclay T.

2018-01-01

Purpose Pediatric surgical care is deficient in developing countries disrupted by crisis. We aimed to describe pediatric surgical care at Médecins Sans Frontières-Brussels (MSF-OCB) projects to inform resource allocation and define the pediatric-specific skillset necessary for humanitarian surgical teams. Methods Procedures performed by MSF-OCB from July 2008 to December 2014 were reviewed. Project characteristics, patient demographics and clinical data were described. Multivariable logistic regression was performed to determine predictors of perioperative death. Results Of 109,828 procedures, 26,284 were performed for 24,576 children (22% of all procedures). The most common pediatric operative indication was trauma (13,984; 57%). Nine percent of all surgical indications were due to violence (e.g., land mines, firearms, gender-based violence, etc.). The majority of procedures (19,582; 75%) were general surgical, followed by orthopedic (4350; 17%), and obstetric/gynecologic/urologic (2135; 8%). Perioperative death was low (42; 0.17%); independent predictors of death included age <1 year, use of general anesthesia with a definitive airway, and operation during conflict. Conclusion Surgical care for children comprised nearly a quarter of all procedures performed by MSF-OCB between 2008 and 2014. Attention to trauma surgery and infant perioperative care is particularly needed. These findings are important when resourcing projects and training surgical staff for humanitarian missions. PMID:26454469

Surgery for children in low-income countries affected by humanitarian emergencies from 2008 to 2014: The Médecins Sans Frontières Operations Centre Brussels experience.

PubMed

Flynn-O'Brien, Katherine T; Trelles, Miguel; Dominguez, Lynette; Hassani, Ghulam Hiadar; Akemani, Clemence; Naseer, Aamer; Ntawukiruwabo, Innocent Bagura; Kushner, Adam L; Rothstein, David H; Stewart, Barclay T

2016-04-01

Pediatric surgical care is deficient in developing countries disrupted by crisis. We aimed to describe pediatric surgical care at Médecins Sans Frontières-Brussels (MSF-OCB) projects to inform resource allocation and define the pediatric-specific skillset necessary for humanitarian surgical teams. Procedures performed by MSF-OCB from July 2008 to December 2014 were reviewed. Project characteristics, patient demographics and clinical data were described. Multivariable logistic regression was performed to determine predictors of perioperative death. Of 109,828 procedures, 26,284 were performed for 24,576 children (22% of all procedures). The most common pediatric operative indication was trauma (13,984; 57%). Nine percent of all surgical indications were due to violence (e.g., land mines, firearms, gender-based violence, etc.). The majority of procedures (19,582; 75%) were general surgical, followed by orthopedic (4350; 17%), and obstetric/gynecologic/urologic (2135; 8%). Perioperative death was low (42; 0.17%); independent predictors of death included age <1year, use of general anesthesia with a definitive airway, and operation during conflict. Surgical care for children comprised nearly a quarter of all procedures performed by MSF-OCB between 2008 and 2014. Attention to trauma surgery and infant perioperative care is particularly needed. These findings are important when resourcing projects and training surgical staff for humanitarian missions. Copyright © 2016 Elsevier Inc. All rights reserved.

Analgesic effect of intraperitoneal local anesthetic in surgery: an overview of systematic reviews.

PubMed

Hamill, James K; Rahiri, Jamie-Lee; Hill, Andrew G

2017-05-15

Intraperitoneal local anesthetic (IPLA) reduces postoperative pain as shown by previous systematic reviews. The purpose of this review was to compare the efficacy of IPLA between different types of procedure and to formulate GRADE recommendations for the use of IPLA. A systematic search for systematic reviews of the effect of IPLA, versus no IPLA or placebo, on pain after any surgical procedure. Databases included in the study were MEDLINE, EMBASE, CDSR, and DARE. Two reviewers independently undertook searches, selected studies, extracted data, and assessed the risk of bias. Meta-analysis was by random effects. Recommendation was by GRADE. The main outcome measure was self-reported early postoperative pain scores. Searches uncovered nine systematic reviews. This study included randomized trials numbered 76, representing 4000 participants, 2022 in IPLA and 1978 in control groups. Six reviews scored at low risk of bias and three at high risk. Meta-analysis demonstrated that IPLA reduced the mean pain score (0-10 scale) by 0.95 point (95% confidence interval: 0.73-1.17). Excluding laparoscopic cholecystectomy, the effect size increased to 1.52 (95% confidence interval: 1.15-1.88). Heterogeneity was high overall at I 2  = 91.7% but on excluding laparoscopic cholecystectomy trials reduced to I 2  = 31.3%. IPLA could be considered a viable option for early postoperative analgesia in certain laparoscopic operations. Further research on the effect of IPLA on procedures other than laparoscopic cholecystectomy would help clarify its place in a postoperative analgesia protocol. Copyright © 2017 Elsevier Inc. All rights reserved.

Plication procedures—excisional and incisional corporoplasty and imbrication for Peyronie’s disease

PubMed Central

Chen, Roger; McCraw, Casey

2016-01-01

Plication procedures for the correction of Peyronie’s disease (PD) curvature are management options for PD patients. There are basically three types of procedures: excisional corporoplasty, incisional corporoplasty, and plication-only. This review is a compilation of English literature, peer-reviewed, published articles addressing these types of operations for Peyronie’s curvature correction, not congenital curvature. According to the urology literature, this surgical type was initially used for correction of curvature associated with hypospadias repair or congenital penile curvature. The procedures also, for the most part, historically became an alternative for plaque excision and graft repair, because of the difficulty with such repairs and the often-resultant erectile dysfunction (ED). A brief section traces some of the origins of these various repairs, followed by a brief section on the selection criteria for these types of surgery for the patient with PD penile curvature. We also review the significant articles in which the three types were presented with modifications. Finally, several articles that compare the various surgical repairs are summarized in the order that they appear in the literature. These types of surgery have become a mainstay for the surgical correction of penile curvature due to PD. PMID:27298779

A critical review of variables affecting the accuracy and false-negative rate of sentinel node biopsy procedures in early breast cancer.

PubMed

Vijayakumar, Vani; Boerner, Philip S; Jani, Ashesh B; Vijayakumar, Srinivasan

2005-05-01

Radionuclide sentinel lymph node localization and biopsy is a staging procedure that is being increasingly used to evaluate patients with invasive breast cancer who have clinically normal axillary nodes. The most important prognostic indicator in patients with invasive breast cancer is the axillary node status, which must also be known for correct staging, and influences the selection of adjuvant therapies. The accuracy of sentinel lymph node localization depends on a number of factors, including the injection method, the operating surgeon's experience and the hospital setting. The efficacy of sentinel lymph node mapping can be determined by two measures: the sentinel lymph node identification rate and the false-negative rate. Of these, the false-negative rate is the most important, based on a review of 92 studies. As sentinel lymph node procedures vary widely, nuclear medicine physicians and radiologists must be acquainted with the advantages and disadvantages of the various techniques. In this review, the factors that influence the success of different techniques are examined, and studies which have investigated false-negative rates and/or sentinel lymph node identification rates are summarized.

A Review of Simulators with Haptic Devices for Medical Training.

PubMed

Escobar-Castillejos, David; Noguez, Julieta; Neri, Luis; Magana, Alejandra; Benes, Bedrich

2016-04-01

Medical procedures often involve the use of the tactile sense to manipulate organs or tissues by using special tools. Doctors require extensive preparation in order to perform them successfully; for example, research shows that a minimum of 750 operations are needed to acquire sufficient experience to perform medical procedures correctly. Haptic devices have become an important training alternative and they have been considered to improve medical training because they let users interact with virtual environments by adding the sense of touch to the simulation. Previous articles in the field state that haptic devices enhance the learning of surgeons compared to current training environments used in medical schools (corpses, animals, or synthetic skin and organs). Consequently, virtual environments use haptic devices to improve realism. The goal of this paper is to provide a state of the art review of recent medical simulators that use haptic devices. In particular we focus on stitching, palpation, dental procedures, endoscopy, laparoscopy, and orthopaedics. These simulators are reviewed and compared from the viewpoint of used technology, the number of degrees of freedom, degrees of force feedback, perceived realism, immersion, and feedback provided to the user. In the conclusion, several observations per area and suggestions for future work are provided.

Critical Drivers for Safety Culture: Examining Department of Energy and U.S. Army Operational Experiences - 12382

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lowes, Elizabeth A.

2012-07-01

Evaluating operational incidents can provide a window into the drivers most critical to establishing and maintaining a strong safety culture, thereby minimizing the potential project risk associated with safety incidents. By examining U.S. Department of Energy (DOE) versus U.S. Army drivers in terms of regulatory and contract requirements, programs implemented to address the requirements, and example case studies of operational events, a view of the elements most critical to making a positive influence on safety culture is presented. Four case studies are used in this evaluation; two from DOE and two from U.S. Army experiences. Although the standards guiding operationsmore » at these facilities are different, there are many similarities in the level of hazards, as well as the causes and the potential consequences of the events presented. Two of the incidents examined, one from a DOE operation and the other from a U.S. Army facility, resulted in workers receiving chemical burns. The remaining two incidents are similar in that significant conduct of operations failures occurred resulting in high-level radioactive waste (in the case of the DOE facility) or chemical agent (in the case of the Army facility) being transferred outside of engineering controls. A review of the investigation reports for all four events indicates the primary causes to be failures in work planning leading to ineffective hazard evaluation and control, lack of procedure adherence, and most importantly, lack of management oversight to effectively reinforce expectations for safe work planning and execution. DOE and Army safety programs are similar, and although there are some differences in contractual requirements, the expectations for safe performance are essentially the same. This analysis concludes that instilling a positive safety culture comes down to management leadership and engagement to (1) cultivate an environment that values a questioning attitude and (2) continually reinforce expectations for the appropriate level of rigor in work planning and procedure adherence. A review of the root causes and key contributing causes to the events indicate: - Three of the four root cause analyses cite lack of management engagement (oversight, involvement, ability to recognize issues, etc.) as a root cause to the events. - Two of the four root cause analyses cite work planning failures as a root cause to the events and all cause analyses reflect work planning failures as contributing factors to the events. - All events with the exception of the Tuba City plant shutdown indicate procedure noncompliance as a key contributor; in the case of Tuba City the procedure issues were primarily related to a lack of procedures, or a lack of sufficiently detailed procedures. - All events included discussion or suggestion of a lack of a questioning attitude, either on the part of management/supervision, work planners, or workers. This analysis suggests that the most critical drivers to safety culture are: - Management engagement, - Effective work planning and procedures, and - Procedure adherence with a questioning attitude to ensure procedural problems are identified and fixed. In high-hazard operational environments the importance of robust work planning processes and procedure adherence cannot be overstated. However, having the processes by themselves is not enough. Management must actively engage in expectation setting and ensure work planning that meets expectations for hazard analysis and control, develop a culture that encourages incident reporting and a questioning attitude, and routinely observe work performance to reinforce expectations for adherence to procedures/work control documents. In conclusion, the most critical driver to achieving a workforce culture that supports safe and effective project performance can be summarized as follows: 'Management engagement to continually reinforce expectations for work planning processes and procedure adherence in an environment that cultivates a questioning attitude'. (authors)« less

Guidewire retention following central venous catheterisation: a human factors and safe design investigation.

PubMed

Horberry, Tim; Teng, Yi-Chun; Ward, James; Patil, Vishal; Clarkson, P John

2014-01-01

Central Venous Catheterisation (CVC) has occasionally been associated with cases of retained guidewires in patients after surgery. In theory, this is a completely avoidable complication; however, as with any human procedure, operator error leading to guidewires being occasionally retained cannot be fully eliminated. The work described here investigated the issue in an attempt to better understand it both from an operator and a systems perspective, and to ultimately recommend appropriate safe design solutions that reduce guidewire retention errors. Nine distinct methods were used: observations of the procedure, a literature review, interviewing CVC end-users, task analysis construction, CVC procedural audits, two human reliability assessments, usability heuristics and a comprehensive solution survey with CVC end-users. The three solutions that operators rated most highly, in terms of both practicality and effectiveness, were: making trainees better aware of the potential guidewire complications and strongly emphasising guidewire removal in CVC training, actively checking that the guidewire is present in the waste tray for disposal, and standardising purchase of central line sets so that differences that may affect chances of guidewire loss is minimised. Further work to eliminate/engineer out the possibility of guidewires being retained is proposed.

Chapter 1. Introduction. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

PubMed

Sprung, Charles L; Cohen, Robert; Adini, Bruria

2010-04-01

In December 2007, the European Society of Intensive Care Medicine established a Task Force to develop standard operating procedures (SOPs) for operating intensive care units (ICU) during an influenza epidemic or mass disaster. To provide direction for health care professionals in the preparation and management of emergency ICU situations during an influenza epidemic or mass disaster, standardize activities, and promote coordination and communication among the medical teams. Based on a literature review and contributions of content experts, a list of essential categories for managing emergency situations in the ICU were identified. Based on three cycles of a modified Delphi process, consensus was achieved regarding the categories. A primary author along with an expert group drafted SOPs for each category. Based on the Delphi cycles, the following key topics were found to be important for emergency preparedness: triage, infrastructure, essential equipment, manpower, protection of staff and patients, medical procedures, hospital policy, coordination and collaboration with interface units, registration and reporting, administrative policies and education. The draft SOPs serve as benchmarks for emergency preparedness and response of ICUs to emergencies or outbreak of pandemics.

Dysphagia in infants after open heart procedures.

PubMed

Yi, Sook-Hee; Kim, Sang-Jun; Huh, June; Jun, Tae-Gook; Cheon, Hee Jung; Kwon, Jeong-Yi

2013-06-01

The aims of this study were to evaluate the prevalence and the clinical predictors of dysphagia and to determine the characteristics of videofluoroscopic swallowing study findings in infants after open heart procedures. This study is a retrospective review of 146 infants who underwent open heart surgery. The infants with dysphagia were compared with those without dysphagia. The videofluoroscopic swallowing study findings of the infants with dysphagia were also evaluated. Of the 146 infants who underwent open heart surgery, 35 (24.0%) had dysphagia symptoms. The infants with dysphagia had lower body weight at operation, more malformation syndromes, longer operation times, and more complex operations than did the infants without dysphagia. In addition, the infants with dysphagia required more time to achieve full oral feeding and had longer hospital stays. Thirty-three infants underwent videofluoroscopic swallowing study: 32 (97.0%) exhibited at least one abnormal finding among the videofluoroscopic swallowing study parameters and 21 (63.6%) exhibited tracheal aspiration. Given the high rate of aspiration in the infants who underwent open heart procedures, monitoring and prompt recognition of the signs and the risk factors of dysphagia may substantially improve infant care with oral feeding and reduce the duration of hospital stays.

The surgical treatment of acromegaly.

PubMed

Buchfelder, Michael; Schlaffer, Sven-Martin

2017-02-01

Surgical extraction of as much tumour mass as possible is considered the first step of treatment in acromegaly in many centers. In this article the potential benefits, disadvantages and limitations of operative acromegaly treatment are reviewed. Pertinent literature was selected to provide a review covering current indications, techniques and results of operations for acromegaly. The rapid reduction of tumour volume is an asset of surgery. To date, in almost all patients, minimally invasive, transsphenoidal microscopic or endoscopic approaches are employed. Whether a curative approach is feasible or a debulking procedure is planned, can be anticipated on the basis of preoperative magnetic resonance imaging. The radicality of adenoma resection essentially depends on localization, size and invasive character of the tumour. The normalization rates of growth hormone and IGF-1 secretion, respectively, depend on tumour-related factors such as size, extension, the presence or absence of invasion and the magnitude of IGF-1 and growth hormone oversecretion. However, also surgeon-related factors such as experience and patient load of the centers have been shown to strongly affect surgical results and the rate of complications. As compared to most medical treatments, surgery is relatively cheap since the costs occur only once and not repeatedly. There are several new technical gadgets which aid in the surgical procedure: navigation and variants of intraoperative imaging. For the mentioned reasons, current algorithms of acromegaly management suggest an initial operation, unless the patients are unfit for surgery, refuse an operation or only an unsatisfactory resection is anticipated. A few suggestions are made when a re-operation could be considered.

Improving and monitoring air quality.

PubMed

DuPont, André

2018-05-01

Since the authorization of the Clean Air Act Amendments of 1990, the air quality in the USA has significantly improved because of strong public support. The lessons learned over the last 25 years are being shared with the policy analysts, technical professionals, and scientist who endeavor to improve air quality in their communities. This paper will review how the USA has achieved the "high" standard of air quality that was envisioned in the early 1990s. This document will describe SO 2 gas emission reduction technology and highlight operation of emission monitoring technology. This paper describes the basic process operation of an air pollution control scrubber. A technical review of measures required to operate and maintain a large-scale pollution control system will be described. Also, the author explains how quality assurance procedures in performance of continuous emission monitoring plays a significant role in reducing air pollution.

How does sagittal imbalance affect the appropriateness of surgical indications and selection of procedure in the treatment of degenerative scoliosis? Findings from the RAND/UCLA Appropriate Use Criteria study.

PubMed

Daubs, Michael D; Brara, Harsimran S; Raaen, Laura B; Chen, Peggy Guey-Chi; Anderson, Ashaunta T; Asch, Steven M; Nuckols, Teryl K

2018-05-01

Degenerative lumbar scoliosis (DLS) is often associated with sagittal imbalance, which may affect patients' health outcomes before and after surgery. The appropriateness of surgery and preferred operative approaches has not been examined in detail for patients with DLS and sagittal imbalance. The goals of this article were to describe what is currently known about the relationship between sagittal imbalance and health outcomes among patients with DLS and to determine how indications for surgery in patients with DLS differ when sagittal imbalance is present. This study included a literature review and an expert panel using the RAND/University of California at Los Angeles (UCLA) Appropriateness Method. To develop appropriate use criteria for DLS, researchers at the RAND Corporation recently employed the RAND/UCLA Appropriateness Method, which involves a systematic review of the literature and multidisciplinary expert panel process. Experts reviewed a synopsis of published literature and rated the appropriateness of five common operative approaches for 260 different clinical scenarios. In the present work, we updated the literature review and compared panelists' ratings in scenarios where imbalance was present versus absent. This work was funded by the Collaborative Spine Research Foundation, a group of surgical specialty societies and device manufacturers. On the basis of 13 eligible studies that examined sagittal imbalance and outcomes in patients with DLS, imbalance was associated with worse functional status in the absence of surgery and worse symptoms and complications postoperatively. Panelists' ratings demonstrated a consistent pattern across the diverse clinical scenarios. In general, when imbalance was present, surgery was more likely to be appropriate or necessary, including in some situations where surgery would otherwise be inappropriate. For patients with moderate to severe symptoms and imbalance, a deformity correction procedure was usually appropriate and frequently necessary, except in some patients with severe risk factors for complications. Conversely, procedures that did not correct imbalance, when present, were usually inappropriate. Clinical experts agreed that sagittal imbalance is a major factor affecting both when surgery is appropriate and which type of procedure is preferred among patients with DLS. Copyright © 2018 Elsevier Inc. All rights reserved.

Total aortic arch replacement with the frozen elephant trunk technique: 10-year follow-up single-centre experience.

PubMed

Ius, Fabio; Fleissner, Felix; Pichlmaier, Maximilian; Karck, Matthias; Martens, Andreas; Haverich, Axel; Shrestha, Malakh

2013-11-01

Since August 2001, the frozen elephant trunk (FET) technique has been used at our institution to treat degenerative or dissecting aneurysms involving the aortic arch and descending aorta as a potential 'single-stage' procedure. The aim of this study was to review our FET experience and to present the 10-year results. Between August 2001 and January 2012, 131 patients underwent FET implant with three different prostheses: the custom-made Chavan-Haverich (n = 66), the Jotec E-vita (n = 30) and the Vascutek Thoraflex (n = 35) prostheses. Concomitant procedures included aortic valve-sparing operations (David, n = 17) and aortic root replacement (Bentall, n = 25). Patient records and the first postoperative and last available computer tomography (CT) were retrospectively reviewed. Incidence of rethoracotomy for bleeding, stroke, spinal cord injury, prolonged ventilatory support (>96 h) and acute renal failure requiring dialysis were 18, 11, 1, 41 and 16%, respectively. In-hospital mortality was 15%. The mean follow-up was 42 ± 37 (range 1-134 months). At 1, 5 and 10 years, survivals were 82 ± 3, 72 ± 5 and 58 ± 8%, respectively. Freedoms from distal aortic operation were 81 ± 4, 67 ± 5 and 43 ± 13%, respectively. Thirty-six patients underwent 40 distal aortic operations, either open surgical (n = 22, 55%) or endovascular (n = 18, 45%). Chronic aortic dissection was identified as an independent risk factor for distal aortic operation (odds ratio = 3.8; 95% confidence interval 1.5-9.3; P = 0.004). At last CT control, false-lumen thrombosis rates up to 93% were achieved around the stent graft. An FET concept adds to the armament of the surgeon in the treatment of complex and diverse aortic arch pathologies. The preoperative patient risk profile explains the postoperative morbidity and in-hospital mortality. The FET can potentially be still a 'one-stage' procedure in selected patients. However, the extension of FET to patients with extensive aortic aneurysms has led to an increase in second-stage procedures.

Emetogenicity-risk procedures in same day surgery center of an academic university hospital in United States: a retrospective cost-audit of postoperative nausea vomiting management.

PubMed

Gupta, Deepak; Haber, Halim

2014-06-01

Despite the variable results of published studies, it is imperative for ambulatory surgery centers to self-audit local cost-implications for post-operative nausea and vomiting (PONV) management. Our retrospective cost-audit assessed if there were comparative peri-anesthesia care cost-trends among patients who had undergone Low-Emetogenicity-Risk Procedures (LERP), Moderate-Emetogenicity-Risk Procedures (MERP) and Severe-Emetogenicity-Risk Procedures (SERP). This study was a review of Same Day Surgery Center practices in an academic university hospital setting during a three-year period (2010-2012). The patient lists were accessed from CIS and CITRIX App Bar for time audit and OR (operating room) schedule reports. Subsequently, OR pharmacy department ran a search for peri-operative anti-emetics and opioids that were billed for the patients at Same Day Surgery Center for the review period. The primary outcomes were the comparative costs/charges of these medications and comparative durations/ charges for these patients' stay in the post-anesthesia care unit (PACU). Secondary outcomes analyzed in the study included peri-anesthesia durations. A total of 8,657 patient records were analyzed. Almost all analyzed variables revealed statistically significant inter-variable positive correlations. The patients' age was significantly (P < 0.001) different among LERP/MERP/SERP patients (LERP: 48.8 +/- 14.7 years; MERP: 61.8 +/- 14.6 years; SERP: 51.3 +/- 14.5 years). In regards to primary and secondary outcomes, the statistical significant differences among LERP/MERP/SERP patients (after correcting for both patients' age as well as patients' sex) were only achieved for preoperative times (P = 0.002; Power = 0.9), operating room recovery times (P = 0.003; Power = 0.9), PACU stay times (P < 0.001; Power = 1.0), and PACU charges (P < 0.001; Power = 1.0). PACU stay times and PACU charges were significantly higher in patients who had undergone SERP as compared to patients who had undergone LERP or MERP at our Same Day Surgery Center.

Anderson-Hynes pyeloplasty: are we all really on the same page?

PubMed

Adam, Ahmed; Smith, Grahame H H

2016-03-01

The Anderson-Hynes pyeloplasty (AHP) is a surgical technique used in the management of pelvi-ureteric junction obstruction. This operation has been performed for over six decades and has etched its name in the annals of urology. But are we all really referring to the same procedure? A systematic review of the Ovid MEDLINE(R) and Ovid OLDMEDLINE(R) database from 1946 to 20 June 2014 was performed for the terms 'Anderson and Hynes' and 'Anderson-Hynes', with later restriction to the title of journal article. Each respective author's descriptive images (figures/photographic) of technique performed was compared with the original procedure. Non-English figure legends were translated using online translational tools. In total, 242 articles were retrieved. Streamlining this search to articles with the above search terms restricted to article title revealed 58 (34 English/24 non-English) articles. Only 29/58 papers had referenced the original procedure. Operative images were present in 17/58 of the articles claiming to have performed the AHP. Within these papers, only 7/17 articles depicted both the L-shaped cut and pelvic flap. Diverse variations were observed in the remainder 10/17 articles. This was a worldwide phenomenon, observed more commonly in recent decades and when minimally invasive techniques were used. The AHP is often not performed as was originally described. Over the decades, surgeons have unknowingly attributed variations to this procedure. Based on this review, a novel 'geometric classification' system has been proposed to better define the dismembered pyeloplasty. © 2015 Royal Australasian College of Surgeons.

Annual Report by Aerospace Safety Advisory Panel

NASA Technical Reports Server (NTRS)

1980-01-01

Elements of the shuttle program that directly affect the mission success and crew safety were investigated. These elements included the shuttle orbiter, the main engine, the solid rocket boosters, avionic system, ground support equipment and the approach and landing operations. The thermal protection systems were studied in detail. Crew training and ground simulation test procedures were reviewed.

Standard Operating Procedures for Collecting Data Requested by the Federal Government.

ERIC Educational Resources Information Center

New Jersey State Dept. of Education, Trenton. Office of Management Information.

Federal requests to collect data from local school systems originate at the federal program level; and through a series of processes, are placed before the Council of Chief State School Officers' (CCSSO) Committee on Evaluation and Information Systems (CEIS) for review. The New Jersey CEIS Coordinator is located within the Office of Management…

AUTOMOTIVE DIESEL MAINTENANCE 2 UNIT IV, AUTOMATIC TRANSMISSIONS--HYDRAULICS (PART II).

ERIC Educational Resources Information Center

Human Engineering Inst., Cleveland, OH.

THIS MODULE OF A 25-MODULE COURSE IS DESIGNED TO DEVELOP AN UNDERSTANDING OF THE OPERATION AND MAINTENANCE OF VALVES UTILIZED IN HYDRAULIC TRANSMISSIONS USED ON DIESEL POWERED VEHICLES. TOPICS ARE (1) REVIEWING FACTS ABOUT PUMPS, (2) USING VALVES FOR CONTROL, (3) TROUBLESHOOTING PROCEDURES ON RELIEF VALVES, (4) USING DIRECTIONAL CONTROL VALVES,…

Issues of Conducting Research on Setting Events: Measurement and Control of Dependent and Independent Variables.

ERIC Educational Resources Information Center

Mahon, Karen L.; Shores, Richard E.; Buske, Carla J.

1999-01-01

This article reviews experiments that do not demonstrate the existence of setting events and some that include appropriate procedures for investigating setting events. It considers setting events to be a fourth term of an operant, and suggests that precise measurement and control of the three-term contingency is necessary. (Author/CR)

78 FR 25487 - Final License Renewal Interim Staff Guidance LR-ISG-2012-01: Wall Thinning Due to Erosion Mechanisms

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-01

....'' This LR-ISG revises an NRC staff-recommended aging management program (AMP) in NUREG-1801, Revision 2, ``Generic Aging Lessons Learned (GALL) Report,'' and the NRC staff's aging management review procedure and... for piping and components within the scope of the Requirements for Renewal of Operating Licenses for...

75 FR 43496 - Board of Visitors, Defense Language Institute Foreign Language Center

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-26

..., operating procedures review, and oath. DLIFLC functional areas will be discussed. Public's Accessibility to... space, this meeting is open to the public. Seating is on a first-come basis. No member of the public attending open meetings will be allowed to present questions from the floor or speak to any issue under...

A review of virtual reality based training simulators for orthopaedic surgery.

PubMed

Vaughan, Neil; Dubey, Venketesh N; Wainwright, Thomas W; Middleton, Robert G

2016-02-01

This review presents current virtual reality based training simulators for hip, knee and other orthopaedic surgery, including elective and trauma surgical procedures. There have not been any reviews focussing on hip and knee orthopaedic simulators. A comparison of existing simulator features is provided to identify what is missing and what is required to improve upon current simulators. In total 11 hip replacements pre-operative planning tools were analysed, plus 9 hip trauma fracture training simulators. Additionally 9 knee arthroscopy simulators and 8 other orthopaedic simulators were included for comparison. The findings are that for orthopaedic surgery simulators in general, there is increasing use of patient-specific virtual models which reduce the learning curve. Modelling is also being used for patient-specific implant design and manufacture. Simulators are being increasingly validated for assessment as well as training. There are very few training simulators available for hip replacement, yet more advanced virtual reality is being used for other procedures such as hip trauma and drilling. Training simulators for hip replacement and orthopaedic surgery in general lag behind other surgical procedures for which virtual reality has become more common. Further developments are required to bring hip replacement training simulation up to date with other procedures. This suggests there is a gap in the market for a new high fidelity hip replacement and resurfacing training simulator. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

Biobanking human endometrial tissue and blood specimens: standard operating procedure and importance to reproductive biology research and diagnostic development.

PubMed

Sheldon, Elizabeth; Vo, Kim Chi; McIntire, Ramsey A; Aghajanova, Lusine; Zelenko, Zara; Irwin, Juan C; Giudice, Linda C

2011-05-01

To develop a standard operating procedure (SOP) for collection, transport, storage of human endometrial tissue and blood samples, subject and specimen annotation, and establishing sample priorities. The SOP synthesizes sound scientific procedures, the literature on ischemia research, sample collection and gene expression profiling, good laboratory practices, and the authors' experience of workflow and sample quality. The National Institutes of Health, University of California, San Francisco, Human Endometrial Tissue and DNA Bank. Women undergoing endometrial biopsy or hysterectomy for nonmalignant indications. Collecting, processing, storing, distributing endometrial tissue and blood samples under approved institutional review board protocols and written informed consent from participating subjects. Standard operating procedure. The SOP addresses rigorous and consistent subject annotation, specimen processing and characterization, strict regulatory compliance, and a reference for researchers to track collection and storage times that may influence their research. The comprehensive and systematic approach to the procurement of human blood and endometrial tissue in this SOP ensures the high quality, reliability, and scientific usefulness of biospecimens made available to investigators by the National Institutes of Health, University of California, San Francisco, Human Endometrial Tissue and DNA Bank. The detail and perspective in this SOP also provides a blueprint for implementation of similar collection programs at other institutions. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Long-term outcomes and social independence level after arterial switch operation.

PubMed

Yamazaki, Akira; Yamamoto, Noboru; Sakamoto, Takahiko; Ishihara, Kazuaki; Iwata, Yusuke; Matsumura, Goki; Kurosawa, Hiromi

2008-02-01

Various issues regarding the long-term survivors of arterial switch operation (ASO) have been clarified according to the improvement of surgical mortality. We reviewed the long-term results and social independence level after ASO. Two hundred and four (204) patients who had undergone ASO more than 15 years ago were studied retrospectively. ASO was performed as a primary operation (group I, n=99) or as a secondary operation (group II, n=105). Lecompte procedure was performed in 197 patients, modified Aubert procedure in 5, and original Jatene procedure in 2. There were 11 late deaths. Kaplan-Meier survival rate (not including operative deaths) was 94.9% at 10 years and 94.9% at 15 years in group I, and 96.9% at 10 years and 94.4% at 15 years in group II. Forty-eight reoperations were performed (aortic valve replacement in 6, aortic valvoplasty in 2, Konno procedure in 1, double valve replacement in 1, right ventricular outflow tract reconstruction in 35). The reoperation-free rate including late death was 82.2% at 10 years and 75.7% at 15 years in group I, and 88.2% at 10 years and 78.1% at 15 years in group II. One hundred and seventy-eight patients were classified as NYHA class I and 7 patients as class II. All the patients except those with mental disorder (1) or neurodevelopmental impairment (3) were attending school or working. There was no significant difference in left ventricular function between group I and II, both showing values within the normal range. The long-term (>15 years) outcome of ASO survivors was satisfactory. Most patients showed excellent cardiac function and were socially independent.

Duration of hospital stay following orthognathic surgery at the jordan university hospital.

PubMed

Jarab, Fadi; Omar, Esam; Bhayat, Ahmed; Mansuri, Samir; Ahmed, Sami

2012-09-01

Major oral and maxillofacial surgery procedures have been routinely performed on an inpatient basis in order to manage both, the recovery from anesthesia and any unpredictable morbidity that may be associated with the surgery. The use of inpatient beds is extremely expensive and if the surgical procedures could be done on an outpatient setting, it would reduce the costs and the need for inpatient care. The aim was to determine the length of hospital stay (LHS) and the factors which influence the LHS following orthognathic surgery at the Jordan University Hospital over 5 years (2005-2009). This was a retrospective record review of patients who underwent orthognathic surgery at Jordan University Hospital between 2005 and 2009. The variables were recorded on a data capture form which was adapted and developed from previous studies. Descriptive and analytical statistical methods were used to correlate these variables to the LHS. Ninety two patients were included in the study and 74% of them were females. The mean age was 23.7 years and the mean LHS was 4 days. The complexity of the procedure, length of operation time, intensive care unit (ICU) stay and year of operation were significantly correlated with a positive LHS (P < 0.05). Patients' hospital stay was directly related to the complexity of the orthognathic procedure, the operation time, time spent in ICU and the year in which the operation was done. There was a significant reduction in the LHS over the progressing years and this could be due to an increase in experience and knowledge of the operators and an improvement in the hospital facilities.

Burr Hole Washout versus Craniotomy for Chronic Subdural Hematoma: Patient Outcome and Cost Analysis

PubMed Central

Regan, Jacqueline M.; Worley, Emmagene; Shelburne, Christopher; Pullarkat, Ranjit; Watson, Joseph C.

2015-01-01

Chronic subdural hematomas (CSDH), which are frequently encountered in neurosurgical practice, are, in the majority of cases, ideally treated with surgical drainage. Despite this common practice, there is still controversy surrounding the best surgical procedure. With lack of clear evidence of a superior technique, surgeons are free to base the decision on other factors that are not related to patient care. A retrospective chart review of 119 patients requiring surgical drainage of CSDH was conducted at a large tertiary care center over a three-year period. Of the cases reviewed, 58 patients underwent craniotomy, while 61 patients underwent burr hole washout. The study focused on re-operation rates, mortality, and morbidity, as measured by Glasgow coma scores (GCS), discharge Rankin disability scores, and discharge disposition. Secondary endpoints included length of stay and cost of procedure. Burr hole washout was superior to craniotomy with respect to patient outcome, length of stay and recurrence rates. In both study groups, patients required additional surgical procedures (6.6% of burr hole patients and 24.1% of craniotomy patients) (P = 0.0156). Of the patients treated with craniotomy, 51.7% were discharged home, whereas 65.6% of the burr hole patients were discharged home. Patients who underwent burr hole washout spent a mean of 78.8 minutes in the operating suite while the patients undergoing craniotomy spent 129.4 minutes (P < 0.001). The difference in mean cost per patient, based solely on operating time, was $2,828 (P < 0.001). This does not include the further cost due to additional procedures and hospital stay. The mean length of stay after surgical intervention was 3 days longer for the craniotomy group (P = 0.0465). Based on this retrospective study, burr hole washout is superior for both patients’ clinical and financial outcome; however, prospective long-term multicenter clinical studies are required to verify these findings. PMID:25611468

Burr hole washout versus craniotomy for chronic subdural hematoma: patient outcome and cost analysis.

PubMed

Regan, Jacqueline M; Worley, Emmagene; Shelburne, Christopher; Pullarkat, Ranjit; Watson, Joseph C

2015-01-01

Chronic subdural hematomas (CSDH), which are frequently encountered in neurosurgical practice, are, in the majority of cases, ideally treated with surgical drainage. Despite this common practice, there is still controversy surrounding the best surgical procedure. With lack of clear evidence of a superior technique, surgeons are free to base the decision on other factors that are not related to patient care. A retrospective chart review of 119 patients requiring surgical drainage of CSDH was conducted at a large tertiary care center over a three-year period. Of the cases reviewed, 58 patients underwent craniotomy, while 61 patients underwent burr hole washout. The study focused on re-operation rates, mortality, and morbidity, as measured by Glasgow coma scores (GCS), discharge Rankin disability scores, and discharge disposition. Secondary endpoints included length of stay and cost of procedure. Burr hole washout was superior to craniotomy with respect to patient outcome, length of stay and recurrence rates. In both study groups, patients required additional surgical procedures (6.6% of burr hole patients and 24.1% of craniotomy patients) (P = 0.0156). Of the patients treated with craniotomy, 51.7% were discharged home, whereas 65.6% of the burr hole patients were discharged home. Patients who underwent burr hole washout spent a mean of 78.8 minutes in the operating suite while the patients undergoing craniotomy spent 129.4 minutes (P < 0.001). The difference in mean cost per patient, based solely on operating time, was $2,828 (P < 0.001). This does not include the further cost due to additional procedures and hospital stay. The mean length of stay after surgical intervention was 3 days longer for the craniotomy group (P = 0.0465). Based on this retrospective study, burr hole washout is superior for both patients' clinical and financial outcome; however, prospective long-term multicenter clinical studies are required to verify these findings.

Bladder injuries during laparoscopic orchiopexy: incidence and lessons learned.

PubMed

Hsieh, Michael H; Bayne, Aaron; Cisek, Lars J; Jones, Eric A; Roth, David R

2009-07-01

Laparoscopic orchiopexy is a safe operation. However, the bladder can be injured during creation of the transperitoneal tunnel for the cryptorchid testis. We reviewed our experience with this complication. We searched the operative notes of patients who had undergone laparoscopic orchiopexy between August 15, 2002 and October 1, 2008, and identified bladder injuries and their treatment. A total of 93 patients underwent laparoscopic orchiopexies for 101 undescended testes during the study interval, with 3 procedures resulting in bladder injuries. The 3 operations varied with regard to whether the injury was recognized intraoperatively or postoperatively, and repaired in an open or laparoscopic fashion. Bladder injury during laparoscopic orchiopexy is a rare but serious complication that can be managed by an open or laparoscopic approach. We recommend placement of a urethral catheter and syringe assisted drainage of all urine from the bladder at the beginning of the operation, careful perivesical dissection particularly in children with prior inguinal surgery, filling and emptying of the bladder during the procedure, and maintaining a high index of suspicion especially when hematuria is observed.

Development of Facial Rejuvenation Procedures: Thirty Years of Clinical Experience with Face Lifts

PubMed Central

Kim, Byung Jun; Choi, Jun Ho

2015-01-01

Facial rejuvenation procedures can be roughly divided into face lift surgery and nonoperative, less invasive procedures, such as fat grafts, fillers, botulinum toxin injections, thread lifts, or laserbrasion. Face lift surgery or rhytidectomy is the procedure most directly associated with rejuvenation, due to its fundamental ability to restore the anatomical changes caused by aging. Various methods of face lift surgery have been developed over the last hundred years, thanks to advances in the understanding of facial anatomy and the mechanisms of aging, as well as the dedication of innovative surgeons. However, no generally applicable standard method exists, because the condition of each patient is different, and each operative method has advantages and disadvantages. Specific characteristics of the skin of Asians and their skeletal anatomy should be considered when determining the operative method to be used on Asian patients. Plastic surgeons should improve their ability to analyze the original aesthetic properties and problem areas of each patient, drawing on scientific knowledge about the aging process, and they should develop the skills necessary to perform various rejuvenative techniques. In the present article, we reviewed various face lift procedures and the current methods of modified double plane face lift, based on our clinical experience of over 30 years. PMID:26430622

Ligation of Intersphincteric Fistula Tract Is Suitable for Recurrent Anal Fistulas from Follow-Up of 16 Months.

PubMed

Xu, Yansong; Tang, Weizhong

2017-01-01

Since 2007, ligation of the intersphincteric fistula tract (LIFT) for the management of anal fistula was all introduced with initial success and excitement. It remains controversial which surgical procedure is suitable for transsphincteric fistula, especially to complex anal fistula. This retrospective study was designed to evaluate the results in patients with recurrent anal fistula by LIFT. A retrospective study of 55 complex fistula patients who underwent LIFT procedure in a single medical center was analyzed. Patients and fistula characteristics, complications, and recurrences were reviewed. All 55 patients underwent the procedure with a median follow-up of 16 months. Median operative time was 44 (range 23-88) minutes. Of the 55 patients, 33 (60%) healed completely and did not require any further surgical treatment at end of follow-up. Twenty-two (40%) recurrences and six complications were observed. Compared with patients who had undergone more than two surgical procedures, LIFT was more suitable for patients who had undergone one to two surgical procedures, and significant difference was observed in number of operations before LIFT ( p = 0.002). Clinicians can consider the use of LIFT for the treatment of recurrent anal fistulas. A larger number of patients and prospective study are needed to be performed.

Learning curves for urological procedures: a systematic review.

PubMed

Abboudi, Hamid; Khan, Mohammed Shamim; Guru, Khurshid A; Froghi, Saied; de Win, Gunter; Van Poppel, Hendrik; Dasgupta, Prokar; Ahmed, Kamran

2014-10-01

To determine the number of cases a urological surgeon must complete to achieve proficiency for various urological procedures. The MEDLINE, EMBASE and PsycINFO databases were systematically searched for studies published up to December 2011. Studies pertaining to learning curves of urological procedures were included. Two reviewers independently identified potentially relevant articles. Procedure name, statistical analysis, procedure setting, number of participants, outcomes and learning curves were analysed. Forty-four studies described the learning curve for different urological procedures. The learning curve for open radical prostatectomy ranged from 250 to 1000 cases and for laparoscopic radical prostatectomy from 200 to 750 cases. The learning curve for robot-assisted laparoscopic prostatectomy (RALP) has been reported to be 40 procedures as a minimum number. Robot-assisted radical cystectomy has a documented learning curve of 16-30 cases, depending on which outcome variable is measured. Irrespective of previous laparoscopic experience, there is a significant reduction in operating time (P = 0.008), estimated blood loss (P = 0.008) and complication rates (P = 0.042) after 100 RALPs. The available literature can act as a guide to the learning curves of trainee urologists. Although the learning curve may vary among individual surgeons, a consensus should exist for the minimum number of cases to achieve proficiency. The complexities associated with defining procedural competence are vast. The majority of learning curve trials have focused on the latest surgical techniques and there is a paucity of data pertaining to basic urological procedures. © 2013 The Authors. BJU International © 2013 BJU International.

Management of LVAD Patients for Noncardiac Surgery: A Single-Institution Study.

PubMed

Nelson, Eric W; Heinke, Timothy; Finley, Alan; Guldan, G J; Gaddy, Parker; Matthew Toole, J; Mims, Ryan; Abernathy, J H

2015-08-01

To describe the experience regarding the perioperative management of patients with left ventricular assist devices (LVADs) who require anesthesia while undergoing noncardiac surgery (NCS) at a single medical center. Retrospective chart review Academic medical center Patients with LVADs Medical records from April 1, 2009 through January 31, 2014 were reviewed for patients who underwent Heartmate II LVAD placement at this facility. Individual records were reviewed for NCS after LVAD placement, specifically investigating perioperative and anesthetic management. Seventy-one patients underwent LVAD placement during this time period. Thirty-five patients (49%) underwent a total of 101 NCS procedures. Arterial catheters were placed in 19 patients (19%), and 33 patients (33%) were intubated for their procedure. No complications or perioperative mortality occurred related to the NCS. Noncardiac surgery is becoming more common in patients with LVADs. Anesthetic management of these patients outside of the cardiac operating room is limited. Patients with Heartmate II LVADs can safely undergo noncardiac surgery. Copyright © 2015 Elsevier Inc. All rights reserved.

Femtosecond phacoemulsification: the business and the medicine.

PubMed

Uy, Harvey S; Edwards, Keith; Curtis, Nick

2012-01-01

PURPOSE FOR REVIEW: Phacoemulsification is the preferred method for cataract surgery in the developed world. The number of phacoemulsification procedures performed annually is expected to increase as the population ages. Femtosecond cataract surgery offers several surgical advantages over conventional phacoemulsification and has already attained commercial application in some countries. The purpose of this review is to outline the benefits, risks and commercial issues of femtosecond lasers as applied to cataract surgery. Cataract surgeons are adopting femtosecond technology to perform laser capsulotomy, lens fragmentation, clear cornea incisions and limbal relaxing incisions. Femtosecond lasers clearly perform these surgical steps with greater precision and reproducibility. Further benefits such as improved postoperative refractive results and reduced complication rates are being investigated. Commercial issues have invariably arisen such as cost of installation and operation, value proposition and return on investment. Femtosecond cataract surgery is an evolving procedure that can potentially lead to better and safer surgical outcomes. This review presents the currently available scientific evidence and discusses some of the relevant financial issues concerning this technology.

Procedural virtual reality simulation in minimally invasive surgery.

PubMed

Våpenstad, Cecilie; Buzink, Sonja N

2013-02-01

Simulation of procedural tasks has the potential to bridge the gap between basic skills training outside the operating room (OR) and performance of complex surgical tasks in the OR. This paper provides an overview of procedural virtual reality (VR) simulation currently available on the market and presented in scientific literature for laparoscopy (LS), flexible gastrointestinal endoscopy (FGE), and endovascular surgery (EVS). An online survey was sent to companies and research groups selling or developing procedural VR simulators, and a systematic search was done for scientific publications presenting or applying VR simulators to train or assess procedural skills in the PUBMED and SCOPUS databases. The results of five simulator companies were included in the survey. In the literature review, 116 articles were analyzed (45 on LS, 43 on FGE, 28 on EVS), presenting a total of 23 simulator systems. The companies stated to altogether offer 78 procedural tasks (33 for LS, 12 for FGE, 33 for EVS), of which 17 also were found in the literature review. Although study type and used outcomes vary between the three different fields, approximately 90 % of the studies presented in the retrieved publications for LS found convincing evidence to confirm the validity or added value of procedural VR simulation. This was the case in approximately 75 % for FGE and EVS. Procedural training using VR simulators has been found to improve clinical performance. There is nevertheless a large amount of simulated procedural tasks that have not been validated. Future research should focus on the optimal use of procedural simulators in the most effective training setups and further investigate the benefits of procedural VR simulation to improve clinical outcome.

Redefining the Surgical Council of Resident Education (SCORE) Curriculum: A Comparison with the Operative Experiences of Graduated General Surgical Residents.

PubMed

Strosberg, David S; Quinn, Kristen M; Abdel-Misih, Sherif R; Harzman, Alan E

2018-04-01

Our objective was to investigate the number and classify surgical operations performed by general surgery residents and compare these with the updated Surgical Council on Resident Education (SCORE) curriculum. We performed a retrospective review of logged surgical cases from general surgical residents who completed training at a single center from 2011 to 2015. The logged cases were correlated with the operations extracted from the SCORE curriculum. Hundred and fifty-one procedures were examined; there were 98 "core" and 53 "advanced" cases as determined by the SCORE. Twenty-eight residents graduated with an average of 1017 major cases. Each resident completed 66 (67%) core cases and 17 (32%) advanced cases an average of one or more times with 39 (40%) core cases and 6 (11%) advanced cases completed five or more times. Core procedures that are infrequently or not performed by residents should be identified in each program to focus on resident education.

Obtaining accreditation by the pharmacy compounding accreditation board, part 2: developing essential standard operating procedures.

PubMed

Cabaleiro, Joe

2007-01-01

A key component of qualifying for accreditation with the Pharmacy Compounding Accreditation Board is having a set of comprehensive standard operating procedures that are being used by the pharmacy staff. The three criteria in standard operating procedures for which the Pharmacy Compounding Accreditation Board looks are: (1)written standard operating procedures; (2)standard operating procedures that reflect what the organization actualy does; and (3) whether the written standard operating procedures are implemented. Following specified steps in the preparation of standard operating procedures will result in procedures that meet Pharmacy Compounding Accreditation Board Requirements, thereby placing pharmacies one step closer to qualifying for accreditation.

Improving Performance During Image-Guided Procedures

PubMed Central

Duncan, James R.; Tabriz, David

2015-01-01

Objective Image-guided procedures have become a mainstay of modern health care. This article reviews how human operators process imaging data and use it to plan procedures and make intraprocedural decisions. Methods A series of models from human factors research, communication theory, and organizational learning were applied to the human-machine interface that occupies the center stage during image-guided procedures. Results Together, these models suggest several opportunities for improving performance as follows: 1. Performance will depend not only on the operator’s skill but also on the knowledge embedded in the imaging technology, available tools, and existing protocols. 2. Voluntary movements consist of planning and execution phases. Performance subscores should be developed that assess quality and efficiency during each phase. For procedures involving ionizing radiation (fluoroscopy and computed tomography), radiation metrics can be used to assess performance. 3. At a basic level, these procedures consist of advancing a tool to a specific location within a patient and using the tool. Paradigms from mapping and navigation should be applied to image-guided procedures. 4. Recording the content of the imaging system allows one to reconstruct the stimulus/response cycles that occur during image-guided procedures. Conclusions When compared with traditional “open” procedures, the technology used during image-guided procedures places an imaging system and long thin tools between the operator and the patient. Taking a step back and reexamining how information flows through an imaging system and how actions are conveyed through human-machine interfaces suggest that much can be learned from studying system failures. In the same way that flight data recorders revolutionized accident investigations in aviation, much could be learned from recording video data during image-guided procedures. PMID:24921628

Model of Procedure Usage – Results from a Qualitative Study to Inform Design of Computer-Based Procedures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Johanna H Oxstrand; Katya L Le Blanc

The nuclear industry is constantly trying to find ways to decrease the human error rate, especially the human errors associated with procedure use. As a step toward the goal of improving procedure use performance, researchers, together with the nuclear industry, have been looking at replacing the current paper-based procedures with computer-based procedure systems. The concept of computer-based procedures is not new by any means; however most research has focused on procedures used in the main control room. Procedures reviewed in these efforts are mainly emergency operating procedures and normal operating procedures. Based on lessons learned for these previous efforts wemore » are now exploring a more unknown application for computer based procedures - field procedures, i.e. procedures used by nuclear equipment operators and maintenance technicians. The Idaho National Laboratory, the Institute for Energy Technology, and participants from the U.S. commercial nuclear industry are collaborating in an applied research effort with the objective of developing requirements and specifications for a computer-based procedure system to be used by field operators. The goal is to identify the types of human errors that can be mitigated by using computer-based procedures and how to best design the computer-based procedures to do this. The underlying philosophy in the research effort is “Stop – Start – Continue”, i.e. what features from the use of paper-based procedures should we not incorporate (Stop), what should we keep (Continue), and what new features or work processes should be added (Start). One step in identifying the Stop – Start – Continue was to conduct a baseline study where affordances related to the current usage of paper-based procedures were identified. The purpose of the study was to develop a model of paper based procedure use which will help to identify desirable features for computer based procedure prototypes. Affordances such as note taking, markups, sharing procedures between fellow coworkers, the use of multiple procedures at once, etc. were considered. The model describes which affordances associated with paper based procedures should be transferred to computer-based procedures as well as what features should not be incorporated. The model also provides a means to identify what new features not present in paper based procedures need to be added to the computer-based procedures to further enhance performance. The next step is to use the requirements and specifications to develop concepts and prototypes of computer-based procedures. User tests and other data collection efforts will be conducted to ensure that the real issues with field procedures and their usage are being addressed and solved in the best manner possible. This paper describes the baseline study, the construction of the model of procedure use, and the requirements and specifications for computer-based procedures that were developed based on the model. It also addresses how the model and the insights gained from it were used to develop concepts and prototypes for computer based procedures.« less

CESA-1 receiver design review. Phase 1. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1980-07-01

The Central Electrica Solar de Almeria CESA-1 is a 1.0 MWe water/steam solar central receiver electric power plant being built by the Spanish in Almeria, Spain. Centro de Estudios de la Energia (CEE) is responsible for the management, design, and construction of the project. At the request of the Solar Energy Research Institute and with the approval of the Department of Energy, Sandia National Laboratories, Livermore is providing technical assistance in areas unique to solar applications to CEE. At the request of CEE, Sandia contracted with Foster Wheeler Development Corporation (FWDC) to critically review and evaluate the CESA-1 receiver design.more » Foster Wheeler Iberia (FWI) was subcontracted to FWDC to coordinate efforts with CEE in Madrid. The FWDC program which was started on July 9, 1979, was subdivided into three tasks: (1) design basis review: critical review of the receiver design specifications and requirements; (2) design review and analyses: critical review of thermal/hydraulic, structural, and materials aspects of the receiver design and the design and analysis procedures used by the designer in critical areas of the design; and (3) operational review: critical review of receiver instrumentation and controls and the operational and safety aspects of the receiver. Results of the design review and evaluation are presented. (WHK)« less

Brachioplasty outcomes: a review of a multipractice cohort.

PubMed

Zomerlei, Terri A; Neaman, Keith C; Armstrong, Shannon D; Aitken, Marguerite E; Cullen, William T; Ford, Ronald D; Renucci, John D; VanderWoude, Douglas L

2013-04-01

Upper arm deformities secondary to massive weight loss or senile elastosis have led to an increased demand for aesthetic contouring procedures such as brachioplasty. The records of all patients who underwent a brachioplasty procedure from a multipractice medical center were reviewed. Outcomes measured included patient demographics, operative interventions, and postoperative course. Ninety-six patients were analyzed. Fifty-three patients (55.2 percent) underwent a concomitant procedure, with 53.1 percent undergoing arm liposuction at the time of brachioplasty. Major and minor complications rates were 17.7 percent and 44.8 percent, respectively. Common complications included hypertrophic scarring (24.0 percent) and infection (14.6 percent). The total revision rate was 22.9 percent, with residual contour deformity (40.9 percent of revisions) and hypertrophic scarring (36.4 percent of revisions) representing the most common causes for revision. Patients who underwent a previous bariatric procedure were at an increased risk of developing a major complication (p = 0.02). Concomitant upper arm liposuction and concomitant procedures were not associated with a significantly increased complication rate. Brachioplasty, despite being an effective treatment for contour irregularities of the upper arm, is associated with significant revision and complication rates. Post-bariatric surgery patients should be informed of the potential for increased complications. Additional procedures performed at the time of brachioplasty do not significantly increase complications. Liposuction of the upper arm can be performed safely in conjunction with brachioplasty.

Frey procedure for chronic pancreatitis in children: A single center experience.

PubMed

Ray, Sukanta; Sanyal, Sumit; Ghatak, Supriyo; Khamrui, Sujan; Biswas, Jayanta; Saha, Suman; Mandal, Tuhin Subhra; Chattopadhyay, Gautam

2015-11-01

There is paucity of literature regarding the Frey procedure for children with chronic pancreatitis. The purpose of this study is to present our experience with the Frey procedure in children. This is an observational retrospective review study. All children, who underwent a Frey procedure between August 2007 and May 2014 in the Department of Surgical Gastroenterology, Institute of Postgraduate Medical Education and Research, Kolkata, India were included in this study. Twenty four children were included in our study. There were 13 girls and 11 boys. Mean age at operation was 13.95years (range, 4 to 18years). Mean duration between the diagnosis of chronic pancreatitis and surgery was 4.41years (range, 1 to 14years). Frey procedure was performed after failure of medical or endoscopic therapy. Mean duration of operation and blood loss were 215minutes (range, 150-300minutes) and 177ml (range, 50 to 500ml) respectively. Average postoperative hospital stay was 8days (range, 5 to 16days). Five patients (21%) developed postoperative complications. There was no in hospital mortality and no patient required reoperation for postoperative complications. More than a median follow-up of 29months (range, 3-78months), 91% of the patients remained pain free. Frey procedure is safe and feasible in children with acceptable perioperative complications and good short-term pain control. Copyright © 2015 Elsevier Inc. All rights reserved.

Antegrade continence enemas improve quality of life in patients with medically-refractory encopresis.

PubMed

Church, Joseph T; Simha, Sidd; Wild, Laurie C; Teitelbaum, Daniel H; Ehrlich, Peter F

2017-05-01

Fecal incontinence is a socially debilitating problem for many children. We hypothesized that in selected patients with medically-refractory encopresis, placement of an appendicostomy or cecostomy tube for administration of antegrade continence enemas (ACE) would improve quality of life (QOL). We reviewed all patients with encopresis who underwent appendicostomy or cecostomy placement from 2003 to 2014 at our institution. We contacted subjects' parents by phone and administered 3 surveys: a survey reflecting current stooling habits, a disease-specific QOL survey, and the PedsQL™ QOL survey. QOL surveys were completed twice by parents, once reflecting pre-operative QOL, then again reflecting current QOL. Pre-procedure and post-procedure scores were compared by paired t-test. Ten patients underwent appendicostomy/cecostomy for encopresis. Eight completed phone surveys. All procedures were performed laparoscopically. All patients experienced fecal soiling pre-operatively, whereas 5/8 surveyed patients (63%) noted complete resolution of soiling post-procedure (p<0.01). General and disease-specific QOL improved from pre-procedure to post-procedure in the following domains: social habits, physical activity, ability to spend the night elsewhere, feeling, and overall QOL (p<0.05). PedsQL™ scores improved significantly in physical functioning, social functioning, and overall functioning (p<0.05). Antegrade continence enemas significantly improve quality of life in patients with medically-refractory encopresis, likely related to resolution of soiling. 4. Copyright © 2017. Published by Elsevier Inc.

40 CFR 792.81 - Standard operating procedures.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 33 2013-07-01 2013-07-01 false Standard operating procedures. 792.81... operating procedures. (a) A testing facility shall have standard operating procedures in writing, setting... data generated in the course of a study. All deviations in a study from standard operating procedures...

40 CFR 792.81 - Standard operating procedures.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 33 2012-07-01 2012-07-01 false Standard operating procedures. 792.81... operating procedures. (a) A testing facility shall have standard operating procedures in writing, setting... data generated in the course of a study. All deviations in a study from standard operating procedures...

40 CFR 792.81 - Standard operating procedures.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 32 2014-07-01 2014-07-01 false Standard operating procedures. 792.81... operating procedures. (a) A testing facility shall have standard operating procedures in writing, setting... data generated in the course of a study. All deviations in a study from standard operating procedures...

Achondroplasia and limb lengthening: Results in a UK cohort and review of the literature

PubMed Central

Donaldson, James; Aftab, Syed; Bradish, Christopher

2015-01-01

Aims We aim to review the results, complications and outcomes of a single surgeon's series of lower limb lengthening in patients with achondroplasia. Methods Ten achondroplastic children underwent limb lengthening. The patients, medical records and radiographs were reviewed. Results The average age at the time of the index operation was 7.8 years. A single surgeon undertook all procedures. The average total length gain was 20.5 cm. The commonest complication was a fractured femur after removal of the frame. Conclusion Although complication rates were high (70%), none were left with any long-term sequelae and all were pleased with the results. PMID:25829758

The ODDI Odyssey: Developing and Integrating Operations for the International Space Station

NASA Astrophysics Data System (ADS)

Deal, Ryan W.

2002-01-01

International Space Station (ISS) comprise the deliverable products (OP-01 Reports) of the Boeing Operations Data Development and Integration (ODDI) Integrated Product Team (IPT) to the NASA customer. The ODDI IPT's mission is to exceed the customer's expectations by providing high-quality data and sound techniques for assembling and operating the ISS. strategies in order to streamline the generation of operations products that the Mission Operations Directorate (MOD) utilizes for its crew and ground operations procedures development. Just as for other business practices, operations is a transformation process, converting inputs (resources) into outputs (products) based on a strategy that works best for the established competitive priorities of the operations organization. product reviews, and supporting other ISS operations duties (such as Mission Evaluation Room support) must be balanced with meeting schedules for delivery of the ODDI IPT's OP-01 Reports in accordance with the ISS assembly sequence timeline.

Piloting considerations for terminal area operations of civil tiltwing and tiltrotor aircraft

NASA Technical Reports Server (NTRS)

Hindson, William S.; Hardy, Gordon H.; Tucker, George E.; Decker, William A.

1993-01-01

The existing body of research to investigate airworthiness, performance, handling, and operational requirements for STOL and V/STOL aircraft was reviewed for its applicability to the tiltrotor and tiltwing design concepts. The objective of this study was to help determine the needs for developing civil certification criteria for these aircraft concepts. Piloting tasks that were considered included configuration and thrust vector management, glidepath control, deceleration to hover, and engine failure procedures. Flight control and cockpit display systems that have been found necessary to exploit the low-speed operating characteristics of these aircraft are described, and beneficial future developments are proposed.

3D imaging, 3D printing and 3D virtual planning in endodontics.

PubMed

Shah, Pratik; Chong, B S

2018-03-01

The adoption and adaptation of recent advances in digital technology, such as three-dimensional (3D) printed objects and haptic simulators, in dentistry have influenced teaching and/or management of cases involving implant, craniofacial, maxillofacial, orthognathic and periodontal treatments. 3D printed models and guides may help operators plan and tackle complicated non-surgical and surgical endodontic treatment and may aid skill acquisition. Haptic simulators may assist in the development of competency in endodontic procedures through the acquisition of psycho-motor skills. This review explores and discusses the potential applications of 3D printed models and guides, and haptic simulators in the teaching and management of endodontic procedures. An understanding of the pertinent technology related to the production of 3D printed objects and the operation of haptic simulators are also presented.