Microbial ecology laboratory procedures manual NASA/MSFC

NASA Technical Reports Server (NTRS)

Huff, Timothy L.

1990-01-01

An essential part of the efficient operation of any microbiology laboratory involved in sample analysis is a standard procedures manual. The purpose of this manual is to provide concise and well defined instructions on routine technical procedures involving sample analysis and methods for monitoring and maintaining quality control within the laboratory. Of equal importance is the safe operation of the laboratory. This manual outlines detailed procedures to be followed in the microbial ecology laboratory to assure safety, analytical control, and validity of results.

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.

The impact of intra-operative interruptions on surgeons' perceived workload: an observational study in elective general and orthopedic surgery.

PubMed

Weigl, Matthias; Antoniadis, Sophia; Chiapponi, Costanza; Bruns, Christiane; Sevdalis, Nick

2015-01-01

Surgeons' intra-operative workload is critical for effective and safe surgical performance. Detrimental conditions in the operating room (OR) environment may add to perceived workload and jeopardize surgical performance and outcomes. This study aims to evaluate the impact of different intra-operative workflow interruptions on surgeons' capacity to manage their workload safely and efficiently. This was an observational study of intra-operative interruptions and self-rated workload in two surgical specialties (general, orthopedic/trauma surgery). Intra-operative interruptions were assessed via expert observation using a well-validated observation tool. Surgeons, nurses, and anesthesiologists assessed their intra-operative workload directly after case completion based on three items of the validated Surgery Task Load Index (mental demand, situational stress, distraction). A total of 56 elective cases (35 open, 21 laparoscopic) with 94 workload ratings were included. Mean intra-operative duration was 1 h 37 min. Intra-operative interruptions were on average observed 9.78 times per hour. People who entered/exited the OR (30.6 %) as well as telephone-/beeper-related disruptions (23.6 %) occurred most often. Equipment and OR environment-related interruptions were associated with highest interference with team functioning particularly in laparoscopic procedures. After identifying task and procedural influences, partial correlational analyses revealed that case-irrelevant communications were negatively associated with surgeons' mental fatigue and situational stress, whereas surgeons' reported distraction was increased by case-irrelevant communication and procedural disruptions. OR nurses' and anesthesiologists' perceived workload was also related to intra-operative interruption events. Our study documents the unique contribution of different interruptions on surgeons' workload; whereas case-irrelevant communications may be beneficial for mental fatigue and stress in routine cases, procedural interruptions and case-irrelevant communication may contribute to surgeons' mental focus deteriorating. Well-designed OR environments, surgical leadership, and awareness can help to control unnecessary interruptions for effective and safe surgical care.

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.

40 CFR 243.201-2 - Recommended procedures: Operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... waste handling techniques, and in the proper operation of collection equipment, such as those presented in Operation Responsible: Safe Refuse Collection. (b) Personal protective equipment such as gloves... Standards for Subpart I—Personal Protective Equipment (29 CFR 1910.132 through 1910.137). (c) Scavenging...

40 CFR 243.201-2 - Recommended procedures: Operations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... waste handling techniques, and in the proper operation of collection equipment, such as those presented in Operation Responsible: Safe Refuse Collection. (b) Personal protective equipment such as gloves... Standards for Subpart I—Personal Protective Equipment (29 CFR 1910.132 through 1910.137). (c) Scavenging...

49 CFR Appendix E to Part 240 - Recommended Procedures for Conducting Skill Performance Tests

Code of Federal Regulations, 2010 CFR

2010-10-01

... tailor their testing procedures to the specific operational realities. This appendix contains FRA's..., headlight? —Couple to cars at a safe speed? —Properly control in train slack and buff forces? —Properly use...

49 CFR 240.207 - Procedures for making the determination on vision and hearing acuity.

Code of Federal Regulations, 2014 CFR

2014-10-01

... writing that the person can safely operate without using the device. [56 FR 28254, June 19, 1991, as... 49 Transportation 4 2014-10-01 2014-10-01 false Procedures for making the determination on vision... CERTIFICATION OF LOCOMOTIVE ENGINEERS Implementation of the Certification Process § 240.207 Procedures for...

49 CFR 240.207 - Procedures for making the determination on vision and hearing acuity.

Code of Federal Regulations, 2012 CFR

2012-10-01

... writing that the person can safely operate without using the device. [56 FR 28254, June 19, 1991, as... 49 Transportation 4 2012-10-01 2012-10-01 false Procedures for making the determination on vision... CERTIFICATION OF LOCOMOTIVE ENGINEERS Implementation of the Certification Process § 240.207 Procedures for...

49 CFR 240.207 - Procedures for making the determination on vision and hearing acuity.

Code of Federal Regulations, 2013 CFR

2013-10-01

... writing that the person can safely operate without using the device. [56 FR 28254, June 19, 1991, as... 49 Transportation 4 2013-10-01 2013-10-01 false Procedures for making the determination on vision... CERTIFICATION OF LOCOMOTIVE ENGINEERS Implementation of the Certification Process § 240.207 Procedures for...

Preliminary Human-in-the-Loop Assessment of Procedures for Very-Closely-Spaced Parallel Runways

NASA Technical Reports Server (NTRS)

Verma, Savita; Lozito, Sandra C.; Ballinger, Deborah S.; Trot, Greg; Hardy, Gordon H.; Panda, Ramesh C.; Lehmer, Ronald D.; Kozon, Thomas E.

2010-01-01

Demand in the future air transportation system concept is expected to double or triple by 2025 [1]. Increasing airport arrival rates will help meet the growing demand that could be met with additional runways but the expansion airports is met with environmental challenges for the surrounding communities when using current standards and procedures. Therefore, changes to airport operations can improve airport capacity without adding runways. Building additional runways between current ones, or moving them closer, is a potential solution to meeting the increasing demand, as addressed by the Terminal Area Capacity Enhancing Concept (TACEC). TACEC requires robust technologies and procedures that need to be tested such that operations are not compromised under instrument meteorological conditions. The reduction of runway spacing for independent simultaneous operations dramatically exacerbates the criticality of wake vortex incursion and the calculation of a safe and proper breakout maneuver. The study presented here developed guidelines for such operations by performing a real-time, human-in-the-loop simulation using precision navigation, autopilot-flown approaches, with the pilot monitoring aircraft spacing and the wake vortex safe zone during the approach.

7 CFR 58.633 - Color.

Code of Federal Regulations, 2011 CFR

2011-01-01

... SPECIFICATIONS FOR APPROVED PLANTS AND STANDARDS FOR GRADES OF DAIRY PRODUCTS 1 General Specifications for Dairy Plants Approved for USDA Inspection and Grading Service 1 Quality Specifications for Raw Material § 58... and Drug Administration as safe for human consumption. Operations and Operating Procedures ...

29 CFR 1910.420 - Safe practices manual.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR OCCUPATIONAL SAFETY AND HEALTH STANDARDS Commercial Diving Operations General Operations Procedures § 1910.420..., equipment failure, adverse environmental conditions, and medical illness and injury. [42 FR 37668, July 22...

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.

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

49 CFR 240.129 - Criteria for monitoring operational performance of certified engineers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... railroad's rules and practices for the safe operation of locomotives and trains; (2) Be designed so that... service. (c) The procedures shall: (1) Be designed to determine that the person possesses and routinely... operational performance monitoring will be conducted; (3) Be designed so that the locomotive engineer is...

75 FR 43906 - Hazardous Materials: Requirements for the Storage of Explosives During Transportation

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-27

... program in emergency response procedures for all employees working at the safe haven. NFPA 498 section 4.5... safe havens used for unattended storage of Division 1.1, 1.2, and 1.3 explosives. DATES: Comments must... circumstances and operational environment. B. Federal Motor Carrier Safety Regulations (FMCSRs), 49 CFR Parts...

Procedure-Authoring Tool Improves Safety on Oil Rigs

NASA Technical Reports Server (NTRS)

2014-01-01

Dark, cold, and dangerous environments are plentiful in space and on Earth. To ensure safe operations in difficult surroundings, NASA relies heavily on procedures written well ahead of time. Houston-based TRACLabs Inc. worked with Ames Research Center through the SBIR program to create an electronic procedure authoring tool, now used by NASA and companies in the oil and gas industry.

14 CFR 431.39 - Mission rules, procedures, contingency plans, and checklists.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Mission rules, procedures, contingency plans, and checklists. 431.39 Section 431.39 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION... safe conduct of mission operations during nominal and non-nominal vehicle flight. (b) Mission rules...

14 CFR 431.39 - Mission rules, procedures, contingency plans, and checklists.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Mission rules, procedures, contingency plans, and checklists. 431.39 Section 431.39 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION... safe conduct of mission operations during nominal and non-nominal vehicle flight. (b) Mission rules...

Software System Architecture Modeling Methodology for Naval Gun Weapon Systems

DTIC Science & Technology

2010-12-01

Weapon System HAR Hazard Action Report HERO Hazards of Electromagnetic Radiation to Ordnance IOC Initial Operational Capability... radiation to ordnance ; and combinations therein. Equipment, systems, or procedures and processes whose malfunction would hazard the safe manufacturing...NDI Non-Development Item OPEVAL Operational Evaluation ORDALTS Ordnance Alterations O&SHA Operating and Support Hazard Analysis PDA

Pressure Safety: Advanced Live 11459

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

Glass, George

Many Los Alamos National Laboratory (LANL) operations use pressure equipment and systems. Failure to follow proper procedures when designing or operating pressure systems can result in injuries to personnel and damage to equipment and/or the environment. This manual presents an overview of the requirements and recommendations that address the safe design and operation of pressure systems at LANL.

[The new Blood Law and new principles of transfusion therapy].

PubMed

Takahashi, Koki

2005-01-01

The new Blood Law for Self-sufficiency, Stable Supply of Safe Blood Products and Other Transfusion-related Rules was enacted in July 2003. In terms of the safety of blood products, improvement of screening tests and the introduction of the viral nucleic acid amplification test to shorten the so-called window period have markedly reduced the incidence of blood-borne virus transmission, although they cannot completely protect against transfusion-associated adverse reactions. Even with increasing blood safety, there remains an iatrogenic risk of ABO-mismatched transfusions without proper management systems and standard operation procedures. Fresh frozen plasma and plasma derivatives have been and continue to be used much more in Japan compared with the international standard. As a result, the shortage of domestic blood products remains an obstacle to achieving self-sufficiency. The goal of the new law is to provide safe transfusion therapy and achieve self-sufficiency in all blood products including plasma derivatives such as albumin solutions. To reach this goal medical professionals should recognize the necessity for safe and appropriate transfusions and establish new principles for improved transfusion therapy, including standard indications, safe operation procedure guidelines, and a 24-hour management system in each hospital.

Procedures in complex systems: the airline cockpit.

PubMed

Degani, A; Wiener, E L

1997-05-01

In complex human-machine systems, successful operations depend on an elaborate set of procedures which are specified by the operational management of the organization. These procedures indicate to the human operator (in this case the pilot) the manner in which operational management intends to have various tasks done. The intent is to provide guidance to the pilots and to ensure a safe, logical, efficient, and predictable (standardized) means of carrying out the objectives of the job. However, procedures can become a hodge-podge. Inconsistent or illogical procedures may lead to noncompliance by operators. Based on a field study with three major airlines, the authors propose a model for procedure development called the "Four P's": philosophy, policies, procedures, and practices. Using this model as a framework, the authors discuss the intricate issue of designing flight-deck procedures, and propose a conceptual approach for designing any set of procedures. The various factors, both external and internal to the cockpit, that must be considered for procedure design are presented. In particular, the paper addresses the development of procedures for automated cockpits--a decade-long, and highly controversial issue in commercial aviation. Although this paper is based on airline operations, we assume that the principles discussed here are also applicable to other high-risk supervisory control systems, such as space flight, manufacturing process control, nuclear power production, and military operations.

[The transrectus sheath preperitoneal procedure: a safe, effective and cheap surgical approach to inguinal hernia?].

PubMed

Prins, M W Wiesje; Voropai, D A Dasha; van Laarhoven, C J H M Kees; Akkersdijk, Willem L

2013-01-01

The main complication of surgery for inguinal hernia is chronic postoperative pain. This is often reported following the Lichtenstein procedure. A new, open surgical technique for the repair of inguinal hernia has been developed. This procedure is called the transrectus sheath preperitoneal procedure (TREPP). At TREPP a lightweight mesh with a ring made of memory metal is introduced into the preperitoneal space through the transrectus sheath. The first results of this operative technique are very promising: short operation time, short learning curve and not many patients with chronic postoperative pain. In a randomised, multi-centre study which will start mid-2013 (ISRCTN18591339), the TREPP procedure is compared with the transinguinal preperitoneal procedure. The primary outcome measure of this study is chronic postoperative pain.

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.

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.

Accurate, safe, and rapid method of intraoperative tumor identification for totally laparoscopic distal gastrectomy: injection of mixed fluid of sodium hyaluronate and patent blue.

PubMed

Nakagawa, Masatoshi; Ehara, Kazuhisa; Ueno, Masaki; Tanaka, Tsuyoshi; Kaida, Sachiko; Udagawa, Harushi

2014-04-01

In totally laparoscopic distal gastrectomy, determining the resection line with safe proximal margins is often difficult, particularly for tumors located in a relatively upper area. This is because, in contrast to open surgery, identifying lesions by palpating or opening the stomach is essentially impossible. This study introduces a useful method of tumor identification that is accurate, safe, and rapid. On the operation day, after inducing general anesthesia, a mixture of sodium hyaluronate and patent blue is injected into the submucosal layer of the proximal margin. When resecting stomach, all marker spots should be on the resected side. In all cases, the proximal margin is examined histologically by using frozen sections during the operation. From October 2009 to September 2011, a prospective study that evaluated this method was performed. A total of 34 patients who underwent totally laparoscopic distal gastrectomy were enrolled in this study. Approximately 5 min was required to complete the procedure. Proximal margins were negative in all cases, and the mean ± standard deviation length of the proximal margin was 23.5 ± 12.8 mm. No side effects, such as allergy, were encountered. As a method of tumor identification for totally laparoscopic distal gastrectomy, this procedure appears accurate, safe, and rapid.

Abstract Model of the SATS Concept of Operations: Initial Results and Recommendations

NASA Technical Reports Server (NTRS)

Dowek, Gilles; Munoz, Cesar; Carreno, Victor A.

2004-01-01

An abstract mathematical model of the concept of operations for the Small Aircraft Transportation System (SATS) is presented. The Concept of Operations consist of several procedures that describe nominal operations for SATS, Several safety properties of the system are proven using formal techniques. The final goal of the verification effort is to show that under nominal operations, aircraft are safely separated. The abstract model was written and formally verified in the Prototype Verification System (PVS).

Self-taught axillary vein access without venography for pacemaker implantation: prospective randomized comparison with the cephalic vein access.

PubMed

Squara, Fabien; Tomi, Julien; Scarlatti, Didier; Theodore, Guillaume; Moceri, Pamela; Ferrari, Emile

2017-12-01

Axillary vein access for pacemaker implantation is uncommon in many centres because of the lack of training in this technique. We assessed whether the introduction of the axillary vein technique was safe and efficient as compared with cephalic vein access, in a centre where no operators had any previous experience in axillary vein puncture. Patients undergoing pacemaker implantation were randomized to axillary or cephalic vein access. All three operators had no experience nor training in axillary vein puncture, and self-learned the technique by reading a published review. Axillary vein puncture was fluoroscopy-guided without contrast venography. Cephalic access was performed by dissection of delto-pectoral groove. Venous access success, venous access duration (from skin incision to guidewire or lead in superior vena cava), procedure duration, X-ray exposure, and peri-procedural (1 month) complications were recorded. results We randomized 74 consecutive patients to axillary (n = 37) or cephalic vein access (n = 37). Axillary vein was successfully accessed in 30/37 (81.1%) patients vs. 28/37 (75.7%) of cephalic veins (P = 0.57). Venous access time was shorter in axillary group than in cephalic group [5.7 (4.4-8.3) vs. 12.2 (10.5-14.8) min, P < 0.001], as well as procedure duration [34.8 (30.6-38.4) vs. 42.0 (39.1-46.6) min, P = 0.043]. X-ray exposure and peri-procedural overall complications were comparable in both groups. Axillary puncture was safe and faster than cephalic access even for the five first procedures performed by each operator. Self-taught axillary vein puncture for pacemaker implantation seems immediately safe and faster than cephalic vein access, when performed by electrophysiologists trained to pacemaker implantation but not to axillary vein puncture. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For Permissions, please email: journals.permissions@oup.com.

Learning curve of transumbilical single incision laparoscopic cholecystectomy (SILS): a preliminary study of 80 selected patients with benign gallbladder diseases.

PubMed

Qiu, Zhengjun; Sun, Jing; Pu, Ying; Jiang, Tao; Cao, Jun; Wu, Weidong

2011-09-01

Transumbilical single incision laparoscopic surgery (SILS) is a new laparoscopic procedure in which only one transumbilical incision is made, demonstrated as a scarless procedure. Here we report a single-center preliminary experience of transumbilical single incision laparoscopic cholecystectomy (SILC) in the treatment of benign gallbladder diseases, defining a single surgeon's learning curve. A total of 80 patients underwent SILC successfully by a single experienced laparoscopic surgeon. The operation was performed following the routine LC procedure. Then the perioperative demographics were recorded and the operative time was used to define the learning curve. The study group included 27 male and 53 female patients with gallstones (56 cases), cholesterol polyps (16 cases), an adenomatous polyp (3 cases), adenomyomatosis (1 case), or complex diseases (4 cases), and all consented to undergo SILC. No patient was converted to normal LC or open surgery. There were no perioperative port-related or surgical complications. The average operative time was 46.9 ± 14.6 min. The average postoperative hospital stay was 1.8 ± 1.3 days. The learning curve of the SILC procedures for this series of selected patients confirmed that SILC is a feasible, safe, and effective approach to the treatment of benign gallbladder diseases. For experienced laparoscopic surgeons, SILC is an easy and safe procedure. Patients benefit from milder pain, a lower incidence of port-related complications, better cosmesis, and fast recovery. The SILC procedure may become another option for the treatment of benign gallbladder diseases for selected patients.

JJ Stent Removal under Ultrasound Guidance in Women: It is Simple and Safe.

PubMed

Amer, Bernard; Gupta, Sandeep; Kanwar, Vijayendra S; Lodh, Bijit; Khumukcham, Somarendra; Akoijam, Kaku Singh

2014-12-01

With the increase in number of patients treated for urological problems with endoscopic procedures, the number of patients with JJ stent is also increasing. The amount of workload thus incurred multiplies, even to the point that, sometimes we waste more time in the operating room removing JJ stents than the actual endourological procedures. Here in our institute, we have devised a very simple and effective way of removing JJ stents in women and also determined the efficacy, safety and cost of JJ stent removal under ultrasound guidance in women in comparison to cystoscopic removal. Two hundred women attending the Department of Urology from July 2012 to July 2013 at RIMS hospital were randomly divided into two arms. One hundred women had their JJ stent removed with cystoscope and another 100 women had their JJ stent removed under ultrasound guidance using simple surgical tools available at the hospital. The primary comparative points were waiting time for operating room appointment date, cost of the procedure, time taken for the procedure, discomfort or pain felt by the patient and urethral injuries. In all the parameters, stent removal under ultrasound guidance was significantly better except for urethral injuries where both the procedures had similar outcomes. We concluded that JJ stent removal under ultrasound guidance in women was simple, effective and safe.

Developing standard operating procedures for gene drive research in disease vector mosquitoes.

PubMed

Adelman, Zach N; Pledger, David; Myles, Kevin M

2017-12-01

Numerous arthropod species represent potential targets for gene-drive-based population suppression or replacement, including those that transmit diseases, damage crops, or act as deleterious invasive species. Containment measures for gene drive research in arthropods have been discussed in the literature, but the importance of developing safe and effective standard operating procedures (SOPs) for these types of experiments has not been adequately addressed. Concisely written SOPs link safe work practices, containment measures, institutional training, and research-specific protocols. Here we discuss information to be considered by principal investigators, biosafety officers, and institutional biosafety committees as they work together to develop SOPs for experiments involving gene drive in arthropods, and describe various courses of action that can be used to maintain the effectiveness of SOPs through evaluation and revision. The information provided herein will be especially useful to investigators and regulatory personnel who may lack extensive experience working with arthropods under containment conditions.

76 FR 34157 - Taking and Importing Marine Mammals; Taking Marine Mammals Incidental to Operation and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-13

... during the May 1 to November 30 seasonal window, whenever possible, so that disturbance to North Atlantic... operations can safely be shut down and will document such activities in the data log. (B) Prior to leaving... LOA, sighting log requirements, and procedures for reporting injured or dead marine mammals. These...

Influence Operations and the Internet: A 21st Century Issue. Legal, Doctrinal and Policy Challenges in the Cyber World

DTIC Science & Technology

2010-02-17

create a single set of cyberlaws and procedures internationally in order to insure that there is no safe harbor for cyber criminals .”55 PUTTING IT ALL...TOGETHER – OPERATIONAL EXAMPLES Cyber criminals would include state and non-state actors threatening our security. Assuming all of the previous

A simulation facility for testing Space Station assembly procedures

NASA Technical Reports Server (NTRS)

Hajare, Ankur R.; Wick, Daniel T.; Shehad, Nagy M.

1994-01-01

NASA plans to construct the Space Station Freedom (SSF) in one of the most hazardous environments known to mankind - space. It is of the utmost importance that the procedures to assemble and operate the SSF in orbit are both safe and effective. This paper describes a facility designed to test the integration of the telerobotic systems and to test assembly procedures using a real-world robotic arm grappling space hardware in a simulated microgravity environment.

Development of maturity protocol for construction of NJDOT concrete structures

DOT National Transportation Integrated Search

1999-12-01

In-place tests can be used to estimate concrete strength during construction so that : construction operations can be performed safely or curing procedures can be terminated. : Compression tests pertaining to field cylinders do not represent the stre...

75 FR 67634 - Parts and Accessories Necessary for Safe Operation: Antilock Brake Systems

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-03

... trailer with an antilock brake system be equipped with an external malfunction indicator lamp. DATES: This... malfunction indicator lamp. FMCSA used the Agency's direct final rule procedures (75 FR 29915, May 28, 2010...

Per-Oral Endoscopic Myotomy (POEM) After Previous Laparoscopic Heller Myotomy Is Feasible and Safe in a Porcine Model.

PubMed

Miles, Luke F; Frelich, Matthew J; Gould, Jon C; Dua, Kulwinder S; Jensen, Eric S; Kastenmeier, Andrew S

2015-10-01

We sought to evaluate the feasibility, safety, and difficulty of performing the per-oral endoscopic myotomy (POEM) procedure in the setting of a prior Heller myotomy using a survival porcine model. Four pigs underwent laparoscopic Heller myotomy with Dor partial anterior fundoplication followed by the POEM performed 4 weeks later. Two additional pigs served as controls, undergoing only the POEM. All procedures were completed without complications. The revisional POEM was not significantly more difficult than POEM controls based on procedure time, POEM procedure components, or procedure difficulty scores. Revisional POEM had a longer mean operative time when compared with Heller myotomy (126.0 vs. 83.8 min; P<0.01) but had a lower total difficulty score (28.6 vs. 52.1; P≪0.01). A POEM after previous Heller myotomy is safe and feasible in the porcine model and has potential as an option for patients suffering from recurrent or persistent symptoms after failed surgical myotomy.

Resection and primary anastomosis without diverting ileostomy for left colon emergencies: is it a safe procedure?

PubMed

Jiménez Fuertes, Montiel; Costa Navarro, David

2012-05-01

Large-bowel obstruction and perforation are still frequently occurring entities for the acute care surgeon. In these cases, Hartmann's procedure is the most commonly used surgical technique. However, recent papers demonstrate that colon resection and primary anastomosis (RPA) in the emergency setting is a safe and feasible procedure. We present our series of left colon resection and primary anastomosis procedures from Torrevieja Hospital (Alicante, Spain), performed without bowel irrigation or a diverting ileostomy. Thirty-two RPA procedures were performed in emergency settings for perforation or obstruction, or both, during an 18-month period. The following data were prospectively collected: age, gender, nationality, diagnoses, ASA score, body mass index (BMI), POSSUM score (Physiological and Operative Severity Score for the enumeration of Mortality and morbidity), and the score according to the Hinchey classification. Furthermore, duration of the operation, length of postoperative hospital stay, and mortality and morbidity data were recorded. Sixteen of these patients were diagnosed with acute diverticulitis, 14 patients with neoplasm (of which 9 cases had obstruction, 2 cases had perforation, and 3 cases had both), and foreign body perforation in the remaining 2 cases. The mean hospital stay was 7.8 (range, 4-10) days. The physiological POSSUM score was 24.4 (range, 15-39), and the surgical POSSUM score was 19.8 (range, 16-24). None of the patients died (0% mortality). Seven patients developed some kind of complication (21.9%), all of which were managed conservatively. The results of this study suggest that RPA for left colon obstruction and perforation in emergency settings can be safely performed in certain surgical conditions.

Transvaginal laparoscopically assisted endoscopic cholecystectomy: preliminary clinical results for a series of 43 cases in China.

PubMed

Niu, Jun; Song, Wei; Yan, Ming; Fan, Wei; Niu, Weibo; Liu, Enyu; Peng, Cheng; Lin, Pengfei; Li, Peng; Khan, Abdul Qadir

2011-04-01

Transvaginal cholecystectomy has been performed successfully at several research institutions worldwide using natural orifice transluminal endoscopic surgery (NOTES) techniques. However, it is a growing new surgical concept in China. Several technical challenges hinder the safe clinical application of NOTES. This study investigated transvaginal endoscopic cholecystectomy performed with the assistance of a single umbilical trocar and achieved helpful initial clinical experience. From May 2009 to April 2010, a total of 43 transvaginal human cholecystectomies were performed. A single umbilical trocar was used for safe access and laparoscopic assistance during the operation. After the gallbladder had been removed through the vagina, the colpotomy was closed with absorbable stitches under direct vision. In addition, Student's t-test was performed for two samples to estimate the superiority of NOTES over a conventional laparoscopic cholecystectomy (LC) operation. The procedure was successfully completed for all the patients. No intra- or post-operative complications occurred. The patients recovered promptly after surgery, and all were satisfied with ideal cosmetic outcomes. The postoperative pain, hospital stay, and cost of hospitalization with NOTES were much less than with conventional LC operations. Although endoscopic instruments specifically designed for NOTES are not available, the addition of an umbilical trocar is an optimal way to allow safe performance of NOTES procedures in an easily reproducible manner. The authors' initial experience demonstrates that this hybrid technique is potentially feasible and effective for reducing postoperative pain and recovery times while improving the cosmetic results of transvaginal cholecystectomy.

Reevaluation of needlescopic surgery.

PubMed

Tagaya, Nobumi; Kubota, Keiichi

2012-01-01

Although the use of single-incision laparoscopic surgery (SILS) has spread rapidly, most procedures employ additional needlescopic instruments to ensure safety and shorten the operation time. Therefore, on the basis of results obtained in our department, the present study was conducted to reevaluate the current state of needlescopic surgery (NS) to improve the cosmetic results and postoperative quality of life of patients and to reduce cost and degree of stress on surgeons. Between May 1998 and February 2011, we performed NS in 202 patients. The diagnoses included gallbladder diseases in 151 patients, spontaneous pneumothorax in 11, thyroid tumor and axillary lymph node metastases in 10 patients each, splenic cyst and appendicitis in 4 patients each, idiopathic thrombocytopenic purpura and postoperative abdominal wall hernia in 3 patients each, primary aldosteronism and hepatic cyst in 2 patients each, and adhesional bowel obstruction and gastric stromal tumor in 1 patient each. Under general anesthesia, one 12-mm and tow or three 2- or 3-mm ports were introduced into the operative field. The specimen was retrieved via the 12-mm wound using a plastic bag. The operations were completed in all patients without the need to convert to an open procedure. In 8 (5.3%) of the 151 cholecystectomies, a change to 5-mm instruments was required. There were no perioperative complications. Pertinent technical points included avoidance of direct organ mobilization to minimize injury, rotation of the operating table and utilization of organ gravity to create a better operative field, minimum use of needlescope to ensure safe maneuvering, and improvement of the bi-hand technique. NS is a safe and feasible procedure that allows experienced surgeons to achieve minimally invasive surgery with low morbidity, without the need to convert to a conventional or open procedure.

The German registry for natural orifice translumenal endoscopic surgery: report of the first 551 patients.

PubMed

Lehmann, Kai S; Ritz, Jörg P; Wibmer, Andreas; Gellert, Klaus; Zornig, Carsten; Burghardt, Jens; Büsing, Martin; Runkel, Norbert; Kohlhaw, Kay; Albrecht, Roland; Kirchner, Tom G; Arlt, Georg; Mall, Julian W; Butters, Michael; Bulian, Dirk R; Bretschneider, Jörgen; Holmer, Christoph; Buhr, Heinz J

2010-08-01

To analyze patient outcome in the first 14 months of the German natural orifice translumenal endoscopic surgery (NOTES) registry (GNR). NOTES is a new surgical concept, which permits scarless intra-abdominal operations through natural orifices, such as the mouth, vagina, rectum, or urethra. The GNR was established as a nationwide outcome database to allow the monitoring and safe introduction of this technique in Germany. The GNR was designed as a voluntary database with online access. All surgeons in Germany who performed NOTES procedures were requested to participate in the registry. The GNR recorded demographical and therapy data as well as data on the postoperative course. A total of 572 target organs were operated in 551 patients. Cholecystectomies accounted for 85.3% of all NOTES procedures. All procedures were performed in female patients using transvaginal hybrid technique. Complications occurred in 3.1% of all patients, conversions to laparoscopy or open surgery in 4.9%. In cholecystectomies, institutional case volume, obesity, and age had substantial effect on conversion rate, operation length, and length of hospital stay, but no effect on complications. Despite the fact that NOTES has just recently been introduced, the technique has already gained considerable clinical application. Transvaginal hybrid NOTES cholecystectomy is a practicable and safe alternative to laparoscopic resection even in obese or older patients.

Designing Flight-Deck Procedures

NASA Technical Reports Server (NTRS)

Degani, Asaf; Wiener, L.; Shafto, Mike (Technical Monitor)

1995-01-01

A complex human-machine system consists of more than merely one or more human operators and a collection of hardware components. In order to operate a complex system successfully, the human-machine system must be supported by an organizational infrastructure of operating concepts, rules, guidelines, and documents. The coherency of such operating concepts, in terms of consistency and logic, is vitally important for the efficiency and safety of any complex system. In high-risk endeavors such as aircraft operations, space flight, nuclear power production, manufacturing process control, and military operations, it is essential that such support be flawless, as the price of operational error can be high. When operating rules are not adhered to, or the rules are inadequate for the task at hand, not only will the system's goals be thwarted, but there may also be tragic human and material consequences. To ensure safe and predictable operations, support to the operators, in this case flight crews, often comes in the form of standard operating procedures. These provide the crew with step-by-step guidance for carrying out their operations. Standard procedures do indeed promote uniformity, but they do so at the risk of reducing the role of human operators to a lower level. Management, however, must recognize the danger of over-procedurization, which fails to exploit one of the most valuable assets in the system, the intelligent operator who is "on the scene." The alert system designer and operations manager recognize that there cannot be a procedure for everything, and the time will come in which the operators of a complex system will face a situation for which there is no written procedure. Procedures, whether executed by humans or machines, have their place, but so does human cognition.

Unsupervised laparoscopic appendicectomy by surgical trainees is safe and time-effective.

PubMed

Wong, Kenneth; Duncan, Tristram; Pearson, Andrew

2007-07-01

Open appendicectomy is the traditional standard treatment for appendicitis. Laparoscopic appendicectomy is perceived as a procedure with greater potential for complications and longer operative times. This paper examines the hypothesis that unsupervised laparoscopic appendicectomy by surgical trainees is a safe and time-effective valid alternative. Medical records, operating theatre records and histopathology reports of all patients undergoing laparoscopic and open appendicectomy over a 15-month period in two hospitals within an area health service were retrospectively reviewed. Data were analysed to compare patient features, pathology findings, operative times, complications, readmissions and mortality between laparoscopic and open groups and between unsupervised surgical trainee operators versus consultant surgeon operators. A total of 143 laparoscopic and 222 open appendicectomies were reviewed. Unsupervised trainees performed 64% of the laparoscopic appendicectomies and 55% of the open appendicectomies. There were no significant differences in complication rates, readmissions, mortality and length of stay between laparoscopic and open appendicectomy groups or between trainee and consultant surgeon operators. Conversion rates (laparoscopic to open approach) were similar for trainees and consultants. Unsupervised senior surgical trainees did not take significantly longer to perform laparoscopic appendicectomy when compared to unsupervised trainee-performed open appendicectomy. Unsupervised laparoscopic appendicectomy by surgical trainees is safe and time-effective.

Air traffic control : role of FAA's modernization program in reducing delays and congestion

DOT National Transportation Integrated Search

2001-05-10

The National Airspace System (NAS) is a complex collection of systems, procedures, facilities, aircraft, and people. Because these components are interconnected and interdependent, they must work together as one system to ensure safe operations. The ...

Target Trailing With Safe Navigation With Colregs for Maritime Autonomous Surface Vehicles

NASA Technical Reports Server (NTRS)

Kuwata, Yoshiaki (Inventor); Aghazarian, Hrand (Inventor); Huntsberger, Terrance L. (Inventor); Howard, Andrew B. (Inventor); Wolf, Michael T. (Inventor); Zarzhitsky, Dimitri V. (Inventor)

2014-01-01

Systems and methods for operating autonomous waterborne vessels in a safe manner. The systems include hardware for identifying the locations and motions of other vessels, as well as the locations of stationary objects that represent navigation hazards. By applying a computational method that uses a maritime navigation algorithm for avoiding hazards and obeying COLREGS using Velocity Obstacles to the data obtained, the autonomous vessel computes a safe and effective path to be followed in order to accomplish a desired navigational end result, while operating in a manner so as to avoid hazards and to maintain compliance with standard navigational procedures defined by international agreement. The systems and methods have been successfully demonstrated on water with radar and stereo cameras as the perception sensors, and integrated with a higher level planner for trailing a maneuvering target.

[Short-term efficacy of da Vinci robotic surgical system on rectal cancer in 101 patients].

PubMed

Zeng, Dong-Zhu; Shi, Yan; Lei, Xiao; Tang, Bo; Hao, Ying-Xue; Luo, Hua-Xing; Lan, Yuan-Zhi; Yu, Pei-Wu

2013-05-01

To investigate the feasibility and safety of da Vinci robotic surgical system in rectal cancer radical operation, and to summarize its short-term efficacy and clinical experience. Data of 101 cases undergoing da Vinci robotic surgical system for rectal cancer radical operation from March 2010 to September 2012 were retrospectively analyzed. Evaluation was focused on operative procedure, complication, recovery and pathology. All the 101 cases underwent operation successfully and safely without conversion to open procedure. Rectal cancer radical operation with da Vinci robotic surgical system included 73 low anterior resections and 28 abdominoperineal resections. The average operative time was (210.3±47.2) min. The average blood lose was (60.5±28.7) ml without transfusion. Lymphadenectomy harvest was 17.3±5.4. Passage of first flatus was (2.7±0.7) d. Distal margin was (5.3±2.3) cm without residual cancer cells. The complication rate was 6.9%, including anastomotic leakage(n=2), perineum incision infection(n=2), pulmonary infection (n=2), urinary retention (n=1). There was no postoperative death. The mean follow-up time was(12.9±8.0) months. No local recurrence was found except 2 cases with distant metastasis. Application of da Vinci robotic surgical system in rectal cancer radical operation is safe and patients recover quickly The short-term efficacy is satisfactory.

Supporting the future nuclear workforce with computer-based procedures

DOE PAGES

Oxstrand, Johanna; Le Blanc, Katya

2016-05-01

Here we see that computer-based tools have dramatically increased ease and efficiency of everyday tasks. Gone are the days of paging through a paper catalog, transcribing product numbers, and calculating totals. Today, a consumer can find a product online with a simple search engine, and then purchase it in a matter of a few clicks. Paper catalogs have their place, but it is hard to imagine life without on-line shopping sites. All tasks conducted in a nuclear power plant are guided by procedures, which helps ensure safe and reliable operation of the plants. One prominent goal of the nuclear industrymore » is to minimize the risk of human errors. To achieve this goal one has to ensure tasks are correctly and consistently executed. This is partly achieved by training and by a structured approach to task execution, which is provided by procedures and work instructions. Procedures are used in the nuclear industry to direct workers' actions in a proper sequence. The governing idea is to minimize the reliance on memory and choices made in the field. However, the procedure document may not contain sufficient information to successfully complete the task. Therefore, the worker might have to carry additional documents such as turnover sheets, operation experience, drawings, and other procedures to the work site. The nuclear industry is operated with paper procedures like paper catalogs of the past. A field worker may carry a large stack of documents needed to complete a task to the field. Even though the paper process has helped keep the industry safe for decades, there are limitations to using paper. Paper procedures are static (i.e., the content does not change after the document is printed), difficult to search, and rely heavily on the field worker’s situational awareness and ability to consistently meet the high expectation of human performance excellence. With computer-based procedures (CBPs) that stack of papers may be reduced to the size of a small tablet or even a smart phone. Instead of manually matching equipment identification numbers listed in the procedure with the number on the physical equipment the field worker can simply scan a barcode to ensure the correct valve is opened while simultaneously creating a record. Instead of navigating through a maze of cross-references, CBPs enable intelligent work path navigation which accounts for past decisions and observation, thereby enabling more efficient and safe task completion.« less

Supporting the future nuclear workforce with computer-based procedures

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

Oxstrand, Johanna; Le Blanc, Katya

Here we see that computer-based tools have dramatically increased ease and efficiency of everyday tasks. Gone are the days of paging through a paper catalog, transcribing product numbers, and calculating totals. Today, a consumer can find a product online with a simple search engine, and then purchase it in a matter of a few clicks. Paper catalogs have their place, but it is hard to imagine life without on-line shopping sites. All tasks conducted in a nuclear power plant are guided by procedures, which helps ensure safe and reliable operation of the plants. One prominent goal of the nuclear industrymore » is to minimize the risk of human errors. To achieve this goal one has to ensure tasks are correctly and consistently executed. This is partly achieved by training and by a structured approach to task execution, which is provided by procedures and work instructions. Procedures are used in the nuclear industry to direct workers' actions in a proper sequence. The governing idea is to minimize the reliance on memory and choices made in the field. However, the procedure document may not contain sufficient information to successfully complete the task. Therefore, the worker might have to carry additional documents such as turnover sheets, operation experience, drawings, and other procedures to the work site. The nuclear industry is operated with paper procedures like paper catalogs of the past. A field worker may carry a large stack of documents needed to complete a task to the field. Even though the paper process has helped keep the industry safe for decades, there are limitations to using paper. Paper procedures are static (i.e., the content does not change after the document is printed), difficult to search, and rely heavily on the field worker’s situational awareness and ability to consistently meet the high expectation of human performance excellence. With computer-based procedures (CBPs) that stack of papers may be reduced to the size of a small tablet or even a smart phone. Instead of manually matching equipment identification numbers listed in the procedure with the number on the physical equipment the field worker can simply scan a barcode to ensure the correct valve is opened while simultaneously creating a record. Instead of navigating through a maze of cross-references, CBPs enable intelligent work path navigation which accounts for past decisions and observation, thereby enabling more efficient and safe task completion.« less

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.

On the design of flight-deck procedures

NASA Technical Reports Server (NTRS)

Degani, Asaf; Wiener, Earl L.

1994-01-01

In complex human-machine systems, operations, training, and standardization depend on a elaborate set of procedures which are specified and mandated by the operational management of the organization. The intent is to provide guidance to the pilots, to ensure a logical, efficient, safe, and predictable means of carrying out the mission objectives. In this report the authors examine the issue of procedure use and design from a broad viewpoint. The authors recommend a process which we call 'The Four P's:' philosophy, policies, procedures, and practices. We believe that if an organization commits to this process, it can create a set of procedures that are more internally consistent, less confusing, better respected by the flight crews, and that will lead to greater conformity. The 'Four-P' model, and the guidelines for procedural development in appendix 1, resulted from cockpit observations, extensive interviews with airline management and pilots, interviews and discussion at one major airframe manufacturer, and an examination of accident and incident reports. Although this report is based on airline operations, we believe that the principles may be applicable to other complex, high-risk systems, such as nuclear power production, manufacturing process control, space flight, and military operations.

Lear jet telescope system

NASA Technical Reports Server (NTRS)

Erickson, E. F.; Goorvitch, D.; Dix, M. G.; Hitchman, M. J.

1974-01-01

The telescope system was designed as a multi-user facility for observations of celestial objects at infrared wavelengths, where ground-based observations are difficult or impossible due to the effects of telluric atmospheric absorption. The telescope is mounted in a Lear jet model 24B which typically permits 70 min. of observing per flight at altitudes in excess of 45,000 ft (13 km). Telescope system installation is discussed, along with appropriate setup and adjustment procedures. Operation of the guidance system is also explained, and checklists are provided which pertain to the recommended safe operating and in-flight trouble-shooting procedures for the equipment.

Computer Based Procedures for Field Workers - FY16 Research Activities

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

Oxstrand, Johanna; Bly, Aaron

The Computer-Based Procedure (CBP) research effort is a part of the Light-Water Reactor Sustainability (LWRS) Program, which provides the technical foundations for licensing and managing the long-term, safe, and economical operation of current nuclear power plants. One of the primary missions of the LWRS program is to help the U.S. nuclear industry adopt new technologies and engineering solutions that facilitate the continued safe operation of the plants and extension of the current operating licenses. One area that could yield tremendous savings in increased efficiency and safety is in improving procedure use. A CBP provides the opportunity to incorporate context-driven jobmore » aids, such as drawings, photos, and just-in-time training. The presentation of information in CBPs can be much more flexible and tailored to the task, actual plant condition, and operation mode. The dynamic presentation of the procedure will guide the user down the path of relevant steps, thus minimizing time spent by the field worker to evaluate plant conditions and decisions related to the applicability of each step. This dynamic presentation of the procedure also minimizes the risk of conducting steps out of order and/or incorrectly assessed applicability of steps. This report provides a summary of the main research activities conducted in the Computer-Based Procedures for Field Workers effort since 2012. The main focus of the report is on the research activities conducted in fiscal year 2016. The activities discussed are the Nuclear Electronic Work Packages – Enterprise Requirements initiative, the development of a design guidance for CBPs (which compiles all insights gained through the years of CBP research), the facilitation of vendor studies at the Idaho National Laboratory (INL) Advanced Test Reactor (ATR), a pilot study for how to enhance the plant design modification work process, the collection of feedback from a field evaluation study at Plant Vogtle, and path forward to commercialize INL’s CBP system.« less

Safe Operation of Mobile Unmanned Ground Vehicle (UGV) Systems

DTIC Science & Technology

2010-07-13

vehicle could go during uncommanded movement and full throttle acceleration. 4. TEST PROCEDURES. 4.1 Vehicle Subsystem Tests. These tests identify...time required to go from straight ahead to full deflection in one direction. (sec) i. Observations on ability of the remote operator to maintain...were well below the lateral acceleration limits of the vehicle resulting in very predictable handling traits. The primary concern , albeit subjective

Mammary artery harvesting using the Da Vinci Si robotic system

PubMed Central

Canale, Leonardo Secchin; Bonatti, Johannes

2014-01-01

Internal mammary artery harvesting is an essential part of any coronary artery bypass operation. Totally endoscopic coronary artery bypass graft surgery has become reality in many centers as a safe and effective alternative to conventional surgery in selected patients. Internal mammary artery harvesting is the initial part of the procedure and should be performed equally safely if one wants to achieve excellence in patency rates for the bypass. We here describe the technique for mammary harvesting with the Da Vinci Si robotic system. PMID:24896171

Task-shifting of orthopaedic surgery to non-physician clinicians in Malawi: effective and safe?

PubMed

Wilhelm, Torsten J; Dzimbiri, Kondwani; Sembereka, Victoria; Gumeni, Martin; Bach, Olaf; Mothes, Henning

2017-10-01

There is a shortage of orthopaedic surgeons in Malawi. Orthopaedic clinical officers (OCOs) treat trauma patients and occasionally perform major orthopaedic surgery. No studies have assessed the efficacy and safety of their work. The aim of this study was to evaluate their contribution to major orthopaedic surgery at Zomba Central Hospital. Data about orthopaedic procedures during 2006-2010 were collected from theatre books. We selected major amputations and open reductions and plating for outcome analysis and collected details from files. We compared patients operated by OCOs alone ('OCOs alone' group) and by surgeons or OCOs assisted by surgeons ('Surgeon present' group). OCOs performed 463/1010 major (45.8%) and 1600/1765 minor operations (90.7%) alone. There was no difference in perioperative outcome between both groups. OCOs carry out a large proportion of orthopaedic procedures with good clinical results. Shifting of clinical tasks including major orthopaedic surgery can be safe. Further prospective studies are recommended.

Laparoscopic retroperitoneal lymph-node dissection with the waterjet is technically feasible and safe in testis-cancer patient.

PubMed

Corvin, Stefan; Sturm, Wolfgang; Schlatter, Evelin; Anastasiadis, Aristotelis; Kuczyk, Markus; Stenzl, Arnulf

2005-09-01

The acceptance of open retroperitoneal lymph node dissection (RPLND) for stage I and II nonseminomatous testicular cancer has decreased because of the intraoperative and postoperative morbidity of the procedure. Laparoscopic RPLND is a minimally invasive and safe alternative for low-stage germ-cell tumors. It is, however, technically demanding and should therefore be performed only in experienced centers. The purpose of the present study was to evaluate the waterjet technique for laparoscopic RPLND. A series of 18 patients with clinical stage I testis cancer (group A) and 7 patients who had received chemotherapy for stage II disease (group B) underwent laparoscopic RPLND at our institution. The procedure was performed identically to the open approach using the modified template according to Weissbach and associates. The waterjet was used for removal of lymphatic tissue from the aorta and the vena cava, as well as from the sympathetic trunk. The operation was completed in all patients without conversion to open surgery. The mean operating time was 232 +/- 48 minutes. The waterjet was able to remove lymphatic tissue easily and atraumatically. At pressures of 20 bar, the lymph-node capsule remained completely intact, thus avoiding tumor-cell spread. Antegrade ejaculation could be preserved in all patients, who, to date, show no evidence of disease. The waterjet allows the safe and complete removal of lymphatic tissue, leaving vulnerable anatomic structures intact. It can decrease the learning curve of laparoscopic RPLND and contribute to better acceptance of this procedure.

Laparoscopic pancreatectomy: Indications and outcomes

PubMed Central

Liang, Shuyin; Hameed, Usmaan; Jayaraman, Shiva

2014-01-01

The application of minimally invasive approaches to pancreatic resection for benign and malignant diseases has been growing in the last two decades. Studies have demonstrated that laparoscopic distal pancreatectomy (LDP) is feasible and safe, and many of them show that compared to open distal pancreatectomy, LDP has decreased blood loss and length of hospital stay, and equivalent post-operative complication rates and short-term oncologic outcomes. LDP is becoming the procedure of choice for benign or small low-grade malignant lesions in the distal pancreas. Minimally invasive pancreaticoduodenectomy (MIPD) has not yet been widely adopted. There is no clear evidence in favor of MIPD over open pancreaticoduodenectomy in operative time, blood loss, length of stay or rate of complications. Robotic surgery has recently been applied to pancreatectomy, and many of the advantages of laparoscopy over open surgery have been observed in robotic surgery. Laparoscopic enucleation is considered safe for patients with small, benign or low-grade malignant lesions of the pancreas that is amenable to parenchyma-preserving procedure. As surgeons’ experience with advanced laparoscopic and robotic skills has been growing around the world, new innovations and breakthrough in minimally invasive pancreatic procedures will evolve. PMID:25339811

Current surgical treatment for chronic pancreatitis.

PubMed

Aimoto, Takayuki; Uchida, Eiji; Nakamura, Yoshiharu; Yamahatsu, Kazuya; Matsushita, Akira; Katsuno, Akira; Cho, Kazumitsu; Kawamoto, Masao

2011-01-01

Chronic pancreatitis (CP) is a painful, yet benign inflammatory process of the pancreas. Surgical management should be individualized because the pain is multifactorial and its mechanisms vary from patient to patient. Two main pathogenetic theories for the mechanisms of pain in CP have been proposed: the neurogenic theory and the theory of increased intraductal/intraparenchymal pressures. The latter theory is strongly supported by the good results of drainage procedures in the surgical management of CP. Other possible contributing factors include pancreatic ischemia; a centrally sensitized pain state; and the development of complications, such as pseudocysts and stenosis of the duodenum or common bile duct. Common indications for surgery include intractable pain, suspicion of neoplasm, and complications that cannot be resolved with radiological or endoscopic treatments. Operative procedures have been historically classified into 4 categories: decompression procedures for diseased and obstructed pancreatic ducts; resection procedures for the proximal, distal, or total pancreas; denervation procedures of the pancreas; and hybrid procedures. Pancreaticoduodenectomy and pylorus-preserving pancreaticoduodenectomy, once the standard operations for patients with CP, have been replaced by hybrid procedures, such as duodenum-preserving pancreatic head resection, the Frey procedure, and their variants. These procedures are safe and effective in providing long-term pain relief and in treating CP-related complications. Hybrid procedures should be the operations of choice for patients with CP.

Laser safety programs in general surgery.

PubMed

Lanzafame, R J

1994-06-01

General surgery represents a speciality where, while any procedure can be performed with lasers, there are no procedures for which the laser is the sine quo non. The general surgeon may perform a variety of procedures with a multitude of laser wavelengths and technologies. Laser safety in general surgery requires a multidisciplinary approach. Effective laser safety requires the oversight of the hospital's "laser usage committee" and "laser safety officer" while providing a workable framework for daily laser use in a variety of clinical scenarios simultaneously. This framework must be user-friendly rather than oppressive. This presentation will describe laser safety at the Rochester General Hospital, a tertiary care, community-based teaching hospital. The safety program incorporates the following components: input to physician credentialing and training, education and in-servicing of nursing and technical personnel, equipment purchase and maintenance, quality assurance, and safety monitoring. The University of Rochester general surgery residency training program mandates laser training during the PGY-2 year. This program stresses the safe use of lasers and provides the basis for graded hands-on experience during the surgical residency. The greatest challenge for laser safety in general surgery centers on the burgeoning field of minimally invasive surgery. Safety assurance must be balanced so as to maintain a safe operating-room environment while ensuring patient safety and the ability to permit the surgery to proceed efficiently. Safety measures for laparoscopic procedures must be sensitive to the needs of the surgical team while not providing confusing signals for the "gallery" observers. This task is critical for the safe operation of lasers in general surgery. Effective laser safety in general surgery requires constant vigilance tempered with sensitivity to the needs of the surgeon and the patient as laser technology and its applications continue to evolve.

What is the safety of nonemergent operative procedures performed at night? A study of 10,426 operations at an academic tertiary care hospital using the American College of Surgeons national surgical quality program improvement database.

PubMed

Turrentine, Florence E; Wang, Hongkun; Young, Jeffrey S; Calland, James Forrest

2010-08-01

Ever-increasing numbers of in-house acute care surgeons and competition for operating room time during normal daytime business hours have led to an increased frequency of nonemergent general and vascular surgery procedures occurring at night when there are fewer residents, consultants, nurses, and support staff available for assistance. This investigation tests the hypothesis that patients undergoing such procedures after hours are at increased risk for postoperative morbidity and mortality. Clinical data for 10,426 operative procedures performed over a 5-year period at a single academic tertiary care hospital were obtained from the American College of Surgeons National Surgical Quality Improvement Program Database. The prevalence of preoperative comorbid conditions, postoperative length of stay, morbidity, and mortality was compared between two cohorts of patients: one who underwent nonemergent operative procedures at night and other who underwent similar procedures during the day. Subsequent statistical comparisons utilized chi tests for comparisons of categorical variables and F-tests for continuous variables. Patients undergoing procedures at night had a greater prevalence of serious preoperative comorbid conditions. Procedure complexity as measured by relative value unit did not differ between groups, but length of stay was longer after night procedures (7.8 days vs. 4.3 days, p < 0.0001). Patients undergoing nonemergent general and vascular surgery procedures at night in an academic medical center do not seem to be at increased risk for postoperative morbidity or mortality. Performing nonemergent procedures at night seems to be a safe solution for daytime overcrowding of operating rooms.

The Small Aircraft Transportation System (SATS), Higher Volume Operations (HVO) Off-Nominal Operations

NASA Technical Reports Server (NTRS)

Baxley, B.; Williams, D.; Consiglio, M.; Conway, S.; Adams, C.; Abbott, T.

2005-01-01

The ability to conduct concurrent, multiple aircraft operations in poor weather, at virtually any airport, offers an important opportunity for a significant increase in the rate of flight operations, a major improvement in passenger convenience, and the potential to foster growth of charter operations at small airports. The Small Aircraft Transportation System, (SATS) Higher Volume Operations (HVO) concept is designed to increase traffic flow at any of the 3400 nonradar, non-towered airports in the United States where operations are currently restricted to one-in/one-out procedural separation during Instrument Meteorological Conditions (IMC). The concept's key feature is pilots maintain their own separation from other aircraft using procedures, aircraft flight data sent via air-to-air datalink, cockpit displays, and on-board software. This is done within the Self-Controlled Area (SCA), an area of flight operations established during poor visibility or low ceilings around an airport without Air Traffic Control (ATC) services. The research described in this paper expands the HVO concept to include most off-nominal situations that could be expected to occur in a future SATS environment. The situations were categorized into routine off-nominal operations, procedural deviations, equipment malfunctions, and aircraft emergencies. The combination of normal and off-nominal HVO procedures provides evidence for an operational concept that is safe, requires little ground infrastructure, and enables concurrent flight operations in poor weather.

Initial Investigations of Controller Tools and Procedures for Schedule-Based Arrival Operations with Mixed Flight-Deck Interval Management Equipage

NASA Technical Reports Server (NTRS)

Callantine, Todd J.; Cabrall, Christopher; Kupfer, Michael; Omar, Faisal G.; Prevot, Thomas

2012-01-01

NASA?s Air Traffic Management Demonstration-1 (ATD-1) is a multi-year effort to demonstrate high-throughput, fuel-efficient arrivals at a major U.S. airport using NASA-developed scheduling automation, controller decision-support tools, and ADS-B-enabled Flight-Deck Interval Management (FIM) avionics. First-year accomplishments include the development of a concept of operations for managing scheduled arrivals flying Optimized Profile Descents with equipped aircraft conducting FIM operations, and the integration of laboratory prototypes of the core ATD-1 technologies. Following each integration phase, a human-in-the-loop simulation was conducted to evaluate and refine controller tools, procedures, and clearance phraseology. From a ground-side perspective, the results indicate the concept is viable and the operations are safe and acceptable. Additional training is required for smooth operations that yield notable benefits, particularly in the areas of FIM operations and clearance phraseology.

Hybrid procedure for orbital venous malformation in the endovascular operation room.

PubMed

Cheng, A C O; Li, E Y M; Chan, T C Y; Wong, A C W; Chan, P C M; Poon, W W L; Fung, D H S; Yuen, H K L

2015-08-01

To describe a hybrid procedure for orbital venous malformation in the endovascular operating room (EVOR). Five consecutive patients with venous malformation in the periocular and orbital region were included. All patients received a one-stage direct puncture venogram, image-guided glue injection, and surgical resection in the EVOR equipped with a biplane digital subtraction angiography system (BDSAS). The mean age at the time of operation was 37.4 years (range, 22-69 years). The mean operative time was 193 min (range, 138-324 min). No intraoperative complications were noted. The mean follow-up duration was 18.8 months (range, 10-24 months). Three patients had complete removal of the vascular lesions. At the latest follow-up, no recurrence of symptoms related to the lesions was noted. All patients had an uneventful recovery and satisfactory outcome. The hybrid procedure of orbital venous malformation in the EVOR is a novel application in ophthalmology. It is a safe and well-controlled procedure with real-time high-quality BDSAS surveillance to facilitate surgical resection. Its success requires collaboration between the interventional radiologist, the surgeon, and the ophthalmologist.

Functional Requirements Document for HALE UAS Operations in the NAS: Step 1. Version 3

NASA Technical Reports Server (NTRS)

2006-01-01

The purpose of this Functional Requirements Document (FRD) is to compile the functional requirements needed to achieve the Access 5 Vision of "operating High Altitude, Long Endurance (HALE) Unmanned Aircraft Systems (UAS) routinely, safely, and reliably in the national airspace system (NAS)" for Step 1. These functional requirements could support the development of a minimum set of policies, procedures and standards by the Federal Aviation Administration (FAA) and various standards organizations. It is envisioned that this comprehensive body of work will enable the FAA to establish and approve regulations to govern safe operation of UAS in the NAS on a routine or daily "file and fly" basis. The approach used to derive the functional requirements found within this FRD was to decompose the operational requirements and objectives identified within the Access 5 Concept of Operations (CONOPS) into the functions needed to routinely and safely operate a HALE UAS in the NAS. As a result, four major functional areas evolved to enable routine and safe UAS operations for an on-demand basis in the NAS. These four major functions are: Aviate, Navigate, Communicate, and Avoid Hazards. All of the functional requirements within this document can be directly traceable to one of these four major functions. Some functions, however, are traceable to several, or even all, of these four major functions. These cross-cutting functional requirements support the "Command / Control: function as well as the "Manage Contingencies" function. The requirements associated to these high-level functions and all of their supporting low-level functions are addressed in subsequent sections of this document.

A Simulation Study of Instrument Meteorological Condition Approaches to Dual Parallel Runways Spaced 3400 and 2500 Feet Apart Using Flight-Deck-Centered Technology

NASA Technical Reports Server (NTRS)

Waller, Marvin C.; Scanlon, Charles H.

1999-01-01

A number of our nations airports depend on closely spaced parallel runway operations to handle their normal traffic throughput when weather conditions are favorable. For safety these operations are curtailed in Instrument Meteorological Conditions (IMC) when the ceiling or visibility deteriorates and operations in many cases are limited to the equivalent of a single runway. Where parallel runway spacing is less than 2500 feet, capacity loss in IMC is on the order of 50 percent for these runways. Clearly, these capacity losses result in landing delays, inconveniences to the public, increased operational cost to the airlines, and general interruption of commerce. This document presents a description and the results of a fixed-base simulation study to evaluate an initial concept that includes a set of procedures for conducting safe flight in closely spaced parallel runway operations in IMC. Consideration of flight-deck information technology and displays to support the procedures is also included in the discussions. The procedures and supporting technology rely heavily on airborne capabilities operating in conjunction with the air traffic control system.

AMO EXPRESS: A Command and Control Experiment for Crew Autonomy Onboard the International Space Station

NASA Technical Reports Server (NTRS)

Cornelius, Randy; Frank, Jeremy; Garner, Larry; Haddock, Angie; Stetson, Howard; Wang, Lui

2015-01-01

The Autonomous Mission Operations project is investigating crew autonomy capabilities and tools for deep space missions. Team members at Ames Research Center, Johnson Space Center and Marshall Space Flight Center are using their experience with ISS Payload operations and TIMELINER to: move earth based command and control assets to on-board for crew access; safely merge core and payload command procedures; give the crew single action intelligent operations; and investigate crew interface requirements.

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.

Evaluation of combinations of procedures in cesarean section.

PubMed

Stark, M; Chavkin, Y; Kupfersztain, C; Guedj, P; Finkel, A R

1995-03-01

To evaluate a procedure for cesarean section, consisting of a number of surgical techniques adopted from various sources and further developed. The principal elements of the cesarean section procedure followed were: the Joel-Cohen method for opening the abdomen, suturing the uterus in one layer, and non-closure of the visceral and parietal peritoneal layers. The postoperative recovery of women who underwent this procedure (JCl--group) was compared with that of women who had undergone a Pfannenstiel incision, in which the uterus is sutured in two layers, and both peritoneal layers sutured (Pf2++ group). The incidence of postoperative febrile morbidity was 7.7% in the JCl--group compared with 19.8% in the Pf2++ group (P < 0.05). Adhesions were found in 6.3% of repeat operations after the JCl--operation compared with 28.8% after the Pf2++ operation (P < 0.05), and there was a non-significant trend toward fewer postoperative analgesics in the JCl--group. The cesarean section procedure we have devised is not only safe, but has a lower risk of long- and short-term complications.

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.

Tricuspid valve excision using off-pump inflow occlusion technique: role of intra-operative trans-esophageal echocardiography.

PubMed

Gadhinglajkar, Shrinivas; Sreedhar, Rupa; Karunakaran, Jayakumar; Misra, Manoranjan; Somasundaram, Ganesh; Mathew, Thomas

2010-01-01

A pacing system infection may lead to infective endocarditis and systemic sepsis. Tricuspid valve surgery may be required if the valve is severely damaged in the process of endocarditis. Although, cardiopulmonary bypass is the safe choice for performing right-heart procedures, it may carry risk of inducing systemic inflammatory response and multi-organ dysfunction. Some studies have advocated TV surgery without institution of CPB. We report tricuspid valve excision using the off-pump inflow occlusion technique in a 68-year-old man. We also describe role of intra-operative TEE as a monitoring tool at different stages of the surgical procedure.

Robot-assisted rectopexy is a safe and feasible option for treatment of rectal prolapse.

PubMed

Haahr, Camilla; Jakobsen, Henrik Loft; Gögenur, Ismail

2014-05-01

Rectal prolapse is seen in up to one in 100 elderly women and results in symptoms such as incontinence, mucus secretion and constipation. The aim of this study was to present short- and longterm outcomes after robot-assisted rectopexy in patients with rectal prolapse. All patients diagnosed with rectal prolapse at our institution underwent robot-assisted rectopexy. Data regarding the surgical procedure and post-operative morbidity were collected retrospectively. Patients were contacted to register long-term results regarding recurrence, incontinence and satisfaction. A total of 24 consecutive patients underwent robot-assisted rectopexy from October 2010 to July 2012. Data regarding their long-term outcome was available for 18 patients at follow-up (average ten months). 50% of the patients suffered from faecal incontinence before surgery (n = 9/18, 50%). The mean age at surgery was 72 years (28-93 years). The mean duration of surgery was 123 min. (70-245 min.). The median length of stay in hospital was 4.1 days (0-15 days). There was one procedure-related complication (small-bowel obstruction) resulting in reoperation. At the time of follow-up, two patients (11%) had a subjective recurrence of rectal prolapse, and three patients (17%) had faecal incontinence. 89% were satisfied with the operation, and 94% would recommend this operation to other patients with the same condition. Robot-assisted rectopexy is a safe procedure for patients with rectal prolapse and is associated with acceptable functional outcomes and recurrence rates. There is no evidence in the literature of advantages compared with the corresponding laparoscopic procedure. not relevant. not relevant.

Flying SATS Higher Volume Operations: Training, Lessons Learned, and Pilots' Experiences

NASA Technical Reports Server (NTRS)

Conway, Sheila; Williams, Dan; Adams, Catherine; Consiglio, Maria; Murdoch, Jennifer

2005-01-01

Developments in aviation, including new surveillance technologies and quicker, more economical small aircraft, have been identified as driving factors in a potential expansion of the use of non-towered, non-radar airports. The Small Aircraft Transportation System (SATS) project has developed the Higher Volume Operations (HVO) concept that enables pilots to safely arrive and depart these airports in instrument conditions at an increased rate as compared to today's procedures. This is achieved by transferring some traffic management tasks to centralized, ground-based automation, while assigning others to participating pilots aided by on-board tools. This paper describes strategies and lessons learned while training pilots to fly these innovative operations. Pilot approaches to using the experimental displays and dynamic altering systems during training are discussed. Potential operational benefits as well as pit-falls and frustrations expressed by subjects while learning to fly these new procedures are presented. Generally, pilots were comfortable with the procedures and the training process, and expressed interest in its near-term implementation.

A comparative study of female sterilization via modified Uchida and silver clip techniques in rural China.

PubMed

Qiu, Hongyan; Li, Li; Wu, Shangchun; Liang, Hong; Yuan, Wei; He, Yingqin

2011-03-01

To compare the specific effects of 2 female sterilization methods: the modified Uchida technique and the application of silver clips. A total of 2198 women living in rural areas who were still of reproductive age but opting for sterilization were enrolled. The participants were randomly divided into 2 groups, and underwent sterilization by either modified Uchida technique or silver clips. Information on acceptability, operation conditions, effectiveness, adverse effects, and complaints was collected 3, 6, and 12 months after the procedure. No significant difference in effectiveness, adverse effects or chief complaints between the 2 procedures was found. Differences in operative outcome, bleeding volume during the procedure, and operation time were found. A shorter operation time and less bleeding for the silver clip method indicated that female sterilization by this technique was as safe as that by modified Uchida technique. Copyright © 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Complications of thoracentesis: incidence, risk factors, and strategies for prevention.

PubMed

Cantey, Eric P; Walter, James M; Corbridge, Thomas; Barsuk, Jeffrey H

2016-07-01

Although thoracentesis is generally considered safe, procedural complications are associated with increased morbidity, mortality, and healthcare costs. In this article, we review the risk factors and prevention of the most common complications of thoracentesis including pneumothorax, bleeding (chest wall hematoma and hemothorax), and re-expansion pulmonary edema. Recent data support the importance of operator expertise and the use of ultrasound in reducing the risk of iatrogenic pneumothorax. Although coagulopathy or thrombocytopenia and the use of anticoagulant or antiplatelet medications have traditionally been viewed as contraindications to thoracentesis, new evidence suggests that patients may be able to safely undergo thoracentesis without treating their bleeding risk. Re-expansion pulmonary edema, a rare complication of thoracentesis, is felt to result in part from the generation of excessively negative pleural pressure. When and how to monitor changes in pleural pressure during thoracentesis remains a focus of ongoing study. Major complications of thoracentesis are uncommon. Clinician awareness of risk factors for procedural complications and familiarity with strategies that improve outcomes are essential components for safely performing thoracentesis.

49 CFR 216.13 - Special notice for repairs-locomotive.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION SPECIAL NOTICE AND EMERGENCY ORDER PROCEDURES: RAILROAD TRACK... not safe to operate in the service to which it is put, whether by reason of nonconformity with the FRA Railroad Locomotive Safety Standards set forth in part 229 of this chapter or the FRA Railroad Locomotive...

14 CFR 21.316 - Responsibility of holder.

Code of Federal Regulations, 2010 CFR

2010-01-01

... CERTIFICATION PROCEDURES FOR PRODUCTS AND PARTS Approval of Materials, Parts, Processes, and Appliances § 21.316... conforms to its approved design and is in a condition for safe operation; (d) Mark the PMA article for...) Have access to design data necessary to determine conformity and airworthiness for each article...

49 CFR 240.211 - Procedures for making the determination on performance skills.

Code of Federal Regulations, 2010 CFR

2010-10-01

... performance skills. 240.211 Section 240.211 Transportation Other Regulations Relating to Transportation... determination on performance skills. (a) Each railroad, prior to initially certifying or recertifying any person... demonstrated, in accordance with the requirements of § 240.127 of this part, the skills to safely operate...

49 CFR 240.211 - Procedures for making the determination on performance skills.

Code of Federal Regulations, 2011 CFR

2011-10-01

... performance skills. 240.211 Section 240.211 Transportation Other Regulations Relating to Transportation... determination on performance skills. (a) Each railroad, prior to initially certifying or recertifying any person... demonstrated, in accordance with the requirements of § 240.127 of this part, the skills to safely operate...

Medical examinations for radiation workers

NASA Technical Reports Server (NTRS)

Alexander, R. E.

1969-01-01

The NASA radiological protection policy allows an employee to be assigned work in a radiologically controlled area only if all of the following conditions are met: (1) The area must be radiologically safe for the intended operations; (2) the employee must be medically fit; (3) the employee must be properly trained; (4) appropriate radiation protection procedures must be prepared; (5) appropriate dosimetric, survey, surveillance and reporting procedures must be implemented; and (6) adequate controls and records must be established.

Improving the safety and quality of nursing care through standardized operating procedures in Bosnia and Herzegovina.

PubMed

Ausserhofer, Dietmar; Rakic, Severin; Novo, Ahmed; Dropic, Emira; Fisekovic, Eldin; Sredic, Ana; Van Malderen, Greet

2016-06-01

We explored how selected 'positive deviant' healthcare facilities in Bosnia and Herzegovina approach the continuous development, adaptation, implementation, monitoring and evaluation of nursing-related standard operating procedures. Standardized nursing care is internationally recognized as a critical element of safe, high-quality health care; yet very little research has examined one of its key instruments: nursing-related standard operating procedures. Despite variability in Bosnia and Herzegovina's healthcare and nursing care quality, we assumed that some healthcare facilities would have developed effective strategies to elevate nursing quality and safety through the use of standard operating procedures. Guided by the 'positive deviance' approach, we used a multiple-case study design to examine a criterion sample of four facilities (two primary healthcare centres and two hospitals), collecting data via focus groups and individual interviews. In each studied facility, certification/accreditation processes were crucial to the initiation of continuous development, adaptation, implementation, monitoring and evaluation of nursing-related SOPs. In one hospital and one primary healthcare centre, nurses working in advanced roles (i.e. quality coordinators) were responsible for developing and implementing nursing-related standard operating procedures. Across the four studied institutions, we identified a consistent approach to standard operating procedures-related processes. The certification/accreditation process is enabling necessary changes in institutions' organizational cultures, empowering nurses to take on advanced roles in improving the safety and quality of nursing care. Standardizing nursing procedures is key to improve the safety and quality of nursing care. Nursing and Health Policy are needed in Bosnia and Herzegovina to establish a functioning institutional framework, including regulatory bodies, educational systems for developing nurses' capacities or the inclusion of nursing-related standard operating procedures in certification/accreditation standards. © 2016 International Council of Nurses.

Data Sharing to Improve Close Approach Monitoring and Safety of Flight

NASA Astrophysics Data System (ADS)

Chan, Joseph; DalBello, Richard; Hope, Dean; Wauthier, Pascal; Douglas, Tim; Inghram, Travis

2009-03-01

Individual satellite operators have done a good job of developing the internal protocols and procedures to ensure the safe operation of their fleets. However, data sharing among operators for close approach monitoring is conducted in an ad-hoc manner during relocations, and there is currently no standardized agreement among operators on the content, format, and distribution protocol for data sharing. Crowding in geostationary orbit, participation by new commercial actors, government interest in satellite constellations, and highly maneuverable spacecraft all suggest that satellite operators will need to begin a dialogue on standard communication protocols and procedure to improve situation awareness. We will give an overview of the current best practices among different operators for close approach monitoring and discuss the concept of an active data center to improve data sharing, conjunction monitoring, and avoidance among satellite operators. We will also report on the progress and lessons learned from a Data Center prototype conducted by several operators over a one year period.

First 101 Robotic General Surgery Cases in a Community Hospital

PubMed Central

Robertson, Jarrod C.; Alrajhi, Sharifah

2016-01-01

Background and Objectives: The general surgeon's robotic learning curve may improve if the experience is classified into categories based on the complexity of the procedures in a small community hospital. The intraoperative time should decrease and the incidence of complications should be comparable to conventional laparoscopy. The learning curve of a single robotic general surgeon in a small community hospital using the da Vinci S platform was analyzed. Methods: Measured parameters were operative time, console time, conversion rates, complications, surgical site infections (SSIs), surgical site occurrences (SSOs), length of stay, and patient demographics. Results: Between March 2014 and August 2015, 101 robotic general surgery cases were performed by a single surgeon in a 266-bed community hospital, including laparoscopic cholecystectomies, inguinal hernia repairs; ventral, incisional, and umbilical hernia repairs; and colorectal, foregut, bariatric, and miscellaneous procedures. Ninety-nine of the cases were completed robotically. Seven patients were readmitted within 30 days. There were 8 complications (7.92%). There were no mortalities and all complications were resolved with good outcomes. The mean operative time was 233.0 minutes. The mean console operative time was 117.6 minutes. Conclusion: A robotic general surgery program can be safely implemented in a small community hospital with extensive training of the surgical team through basic robotic skills courses as well as supplemental educational experiences. Although the use of the robotic platform in general surgery could be limited to complex procedures such as foregut and colorectal surgery, it can also be safely used in a large variety of operations with results similar to those of conventional laparoscopy. PMID:27667913

First 101 Robotic General Surgery Cases in a Community Hospital.

PubMed

Oviedo, Rodolfo J; Robertson, Jarrod C; Alrajhi, Sharifah

2016-01-01

The general surgeon's robotic learning curve may improve if the experience is classified into categories based on the complexity of the procedures in a small community hospital. The intraoperative time should decrease and the incidence of complications should be comparable to conventional laparoscopy. The learning curve of a single robotic general surgeon in a small community hospital using the da Vinci S platform was analyzed. Measured parameters were operative time, console time, conversion rates, complications, surgical site infections (SSIs), surgical site occurrences (SSOs), length of stay, and patient demographics. Between March 2014 and August 2015, 101 robotic general surgery cases were performed by a single surgeon in a 266-bed community hospital, including laparoscopic cholecystectomies, inguinal hernia repairs; ventral, incisional, and umbilical hernia repairs; and colorectal, foregut, bariatric, and miscellaneous procedures. Ninety-nine of the cases were completed robotically. Seven patients were readmitted within 30 days. There were 8 complications (7.92%). There were no mortalities and all complications were resolved with good outcomes. The mean operative time was 233.0 minutes. The mean console operative time was 117.6 minutes. A robotic general surgery program can be safely implemented in a small community hospital with extensive training of the surgical team through basic robotic skills courses as well as supplemental educational experiences. Although the use of the robotic platform in general surgery could be limited to complex procedures such as foregut and colorectal surgery, it can also be safely used in a large variety of operations with results similar to those of conventional laparoscopy.

The Coast Guard Proceedings of the Marine Safety and Security Council: Spring 2016

DTIC Science & Technology

2016-04-01

PROCEEDINGS Spring 2016 Vol. 73, Number 1 Safety Management System Objectives 6 Safety Management Facilitates Safe Vessel Operation Vessel systems...crew, and operations. by LCDR Aaron W. Demo 9 Safety Management Systems to Prevent Pollution from Ships Standard procedures protect the environment...by LCDR Michael Lendvay 11 Dead Reckoning by Safety Management ? Check your course. by LCDR Corydon F. Heard IV Safety Management Systems and the Outer

Re-operative thyroid surgery: a 20-year prospective cohort study at a tertiary referral centre.

PubMed

Hardman, John C; Smith, J A; Nankivell, P; Sharma, N; Watkinson, J C

2015-06-01

Re-operative thyroid surgery is a relatively uncommon procedure complicated by distorted anatomy and post-operative tissue changes. Surgery may follow initial benign or malignant pathology. Published outcomes vary widely in the literature. This study aims to report our outcomes from re-operative thyroid surgery. Patient demographics and complication rates for consecutive thyroidectomies performed by a single surgeon at a tertiary centre were collected between 1993 and 2013. Outcomes in re-operative surgery are analysed and compared with local and national data. Cases of re-operative surgery following benign disease are further analysed for histology, re-presenting symptoms and time between procedures. Our cohort comprised 1,657 cases including 164 re-operative procedures (101 malignant, 63 benign). Within our cohort re-operative cases were on average 4 years older (mean 49.9 vs 45.9 years, p = 0.001) and had a higher incidence of haematoma formation (4.3 vs 1.7 %, p = 0.033) and transient recurrent laryngeal nerve palsy (5.5 vs 2.5 %, p = 0.044) compared to primary surgery. Rates of permanent hypocalcaemia (2.4 vs 1.8 %, p = 0.540) and permanent RLN palsy (1.8 vs 0.4 %, p = 0.051) were higher in the re-operative group but did not reach significance. Comparison of complications following re-operation for benign and malignant disease revealed no significant differences. Mean interval to re-operation for benign cases was 17.4 years with 74.6 % found to have multinodular goitre at repeat procedure. Re-operative procedures comprised around 10 % of thyroid surgery at our centre. Re-operative cases experienced more complications than primary surgery but permanent rates were low. Re-operative surgery may therefore be safely considered in experienced hands.

Spinal anesthesia for inguinal hernia repair in infants: a feasible and safe method even in emergency cases.

PubMed

Lambertz, A; Schälte, G; Winter, J; Röth, A; Busch, D; Ulmer, T F; Steinau, G; Neumann, U P; Klink, C D

2014-10-01

Inguinal hernia repair is the most frequently performed surgical procedure in infants and children. Especially in premature infants, prevalence reaches up to 30% in coincidence with high rates of incarceration during the first year of life. These infants carry an increased risk of complications due to general anesthesia. Thus, spinal anesthesia is a topic of growing interest for this group of patients. We hypothesized that spinal anesthesia is a feasible and safe option for inguinal hernia repair in infants even at high risk and cases of incarceration. Between 2003 and 2013, we operated 100 infants younger than 6 months with inguinal hernia. Clinical data were collected prospectively and retrospectively analyzed. Patients were divided into two groups depending on anesthesia procedure (spinal anesthesia, Group 1 vs. general anesthesia, Group 2). Spinal anesthesia was performed in 69 infants, and 31 infants were operated in general anesthesia, respectively. In 7 of these 31 infants, general anesthesia was chosen because of lumbar puncture failure. Infants operated in spinal anesthesia were significantly smaller (54 ± 4 vs. 57 ± 4 cm; p = 0.001), had a lower body weight (4,047 ± 1,002 vs. 5,327 ± 1,376 g; p < 0.001) and higher rate of prematurity (26 vs. 4%; p = 0.017) compared to those operated in general anesthesia. No complications related to surgery or to anesthesia were found in both groups. The number of relevant preexisting diseases was higher in Group 1 (11 vs. 3%; p = 0.54). Seven of eight emergent incarcerated hernia repairs were performed in spinal anesthesia (p = 0.429). Spinal anesthesia is a feasible and safe option for inguinal hernia repair in infants, especially in high-risk premature infants and in cases of hernia incarceration.

Acute normovolemic hemodilution is safe in neurosurgery.

PubMed

Oppitz, Paulo P; Stefani, Marco A

2013-01-01

To determine the safety of acute normovolemic hemodilution (ANH) for patients undergoing neurosurgical procedures. A group of 100 patients undergoing neurosurgical procedures was assigned prospectively to receive ANH. A group of 47 patients who underwent craniotomy for aneurysm clipping and standard anesthetic management was used as a control. Procedures conducted under ANH were performed without significant variations in physiologic parameters. Compared with controls, intraoperative blood loss, operative time, incidence and grade of complications, and length of hospital stay were similar between the two groups. Although the ANH group showed a difference in prothrombin levels before and after hemodilution procedures, the levels were still considered within physiologic parameters. Platelet counts and partial thromboplastin time (PTT) levels indicated no significant variations in either group. During the ANH procedure, a considerable reduction of brain oxygen extraction was observed in individuals with worse preoperative neurologic status (P < 0.05), indicating potential benefit. Among patients with cerebral aneurysm, patients with good initial clinical grades had better clinical results as indicated by Glasgow Outcome Scale scores (P < 0.02). ANH is a safe procedure for patients undergoing neurosurgical procedures. Further studies are necessary to confirm the improvement in brain oxygen extraction and the clinical impact. Nonetheless, patients undergoing aneurysm clipping with good clinical grades seem to profit from ANH. Copyright © 2013 Elsevier Inc. All rights reserved.

77 FR 71671 - Qualification of Drivers; Exemption Applications; Vision

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-03

... coupled with other factors. These factors--such as age, sex, geographic location, mileage driven and... recognize that the vision of an applicant may change and affect his/her ability to operate a CMV as safely... under procedures in effect at that time. Issued on: November 23, 2012. Larry W. Minor, Associate...

75 FR 42082 - Notice of Intent To Prepare an Environmental Impact Statement for the Recapitalization of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-20

... Energy (DOE) implementing procedures (10 CFR part 1021), the DOE Naval Nuclear Propulsion Program (NNPP... INFORMATION: The NNPP is responsible for all aspects of U.S. Navy nuclear power and propulsion. These responsibilities include design, maintenance, and safe operation of nuclear propulsion systems throughout their...

49 CFR 195.405 - Protection against ignitions and safe access/egress involving floating roofs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... accordance with API Recommended Practice 2003, unless the operator notes in the procedural manual (§ 195.402(c)) why compliance with all or certain provisions of API Recommended Practice 2003 is not necessary... removed from service for cleaning) are addressed in API Publication 2026. After October 2, 2000, the...

49 CFR 195.405 - Protection against ignitions and safe access/egress involving floating roofs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... accordance with API Recommended Practice 2003, unless the operator notes in the procedural manual (§ 195.402(c)) why compliance with all or certain provisions of API Recommended Practice 2003 is not necessary... removed from service for cleaning) are addressed in API Publication 2026. After October 2, 2000, the...

49 CFR 195.405 - Protection against ignitions and safe access/egress involving floating roofs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... accordance with API Recommended Practice 2003, unless the operator notes in the procedural manual (§ 195.402(c)) why compliance with all or certain provisions of API Recommended Practice 2003 is not necessary... removed from service for cleaning) are addressed in API Publication 2026. After October 2, 2000, the...

49 CFR 195.405 - Protection against ignitions and safe access/egress involving floating roofs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... accordance with API Recommended Practice 2003, unless the operator notes in the procedural manual (§ 195.402(c)) why compliance with all or certain provisions of API Recommended Practice 2003 is not necessary... removed from service for cleaning) are addressed in API Publication 2026. After October 2, 2000, the...

49 CFR 195.405 - Protection against ignitions and safe access/egress involving floating roofs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... accordance with API Recommended Practice 2003, unless the operator notes in the procedural manual (§ 195.402(c)) why compliance with all or certain provisions of API Recommended Practice 2003 is not necessary... removed from service for cleaning) are addressed in API Publication 2026. After October 2, 2000, the...

Children Assisted by Medical Technology in Educational Settings: Guidelines for Care.

ERIC Educational Resources Information Center

Haynie, Marilynn; And Others

The guidelines are written to assist school systems in establishing an environment for the safe and well-adapted functioning of children with chronic illness, physically disabling conditions, and medical dependency. The guidelines provide a basic structure for operations and suggested procedures intended to help schools and families as they…

Robotic Cholecystectomy Using the Newly Developed Korean Robotic Surgical System, Revo-i: A Preclinical Experiment in a Porcine Model.

PubMed

Kang, Chang Moo; Chong, Jae Uk; Lim, Jin Hong; Park, Dong Won; Park, Sung Jun; Gim, Suhyeon; Ye, Hye Jin; Kim, Se Hoon; Lee, Woo Jung

2017-09-01

One Korean company recently successfully produced a robotic surgical system prototype called Revo-i (MSR-5000). We, therefore, conducted a preclinical study for robotic cholecystectomy using Revo-i, and this is a report of the first case of robotic cholecystectomy performed using the Revo-i system in a preclinical porcine model. Revo-i consists of a surgeon console (MSRC-5000), operation cart (MSRO-5000) and vision cart (MSRV-5000), and a 40 kg-healthy female porcine was prepared for robotic cholecystectomy with general anesthesia. The primary end point was the safe completion of these procedures using Revo-i: The total operation time was 88 minutes. The dissection time was defined as the time from the initial dissection of the Calot area to the time to complete gallbladder detachment from the liver bed: The dissection time required 14 minutes. The surgical console time was 45 minutes. There was no gallbladder perforation or significant bleeding noted during the procedure. The porcine survived for two weeks postoperatively without any complications. Like the da Vinci surgical system, the Revo-i provides a three-dimensional operative view and allows for angulated instrument motion (forceps, needle-holders, clip-appliers, scissors, bipolar energy, and hook monopolar energy), facilitating an effective laparoscopic procedure. Our experience suggests that robotic cholecystectomy can be safely completed in a porcine model using Revo-i. © Copyright: Yonsei University College of Medicine 2017.

[Interdisciplinary teamwork in the OR: Identification and measurement of teamwork in the operating room].

PubMed

Passauer-Baierl, Stefanie; Baschnegger, Heiko; Bruns, Christiane; Weigl, Matthias

2014-01-01

Effective teamwork is one of the essentials in conducting successful and safe surgical procedures in the operating theatre (OT). The present paper aims to provide a selective review of various approaches describing effective interdisciplinary teamwork in the OT. Furthermore, it covers observational methods to assess OT teamwork with particular focus on Germany. Our definition of successful surgical teamwork is based on an already established classification system considering five criteria for effective and safe OT teams: coordination, communication, cooperation, leadership, and team monitoring. Well-defined and reliable measures are necessary to examine the quality of OT teamwork. Those methods should entail the special characteristics of the OT team. They should include all phases of the surgical procedure and incorporate all the professions involved (surgeons, surgical nurses, and anaesthetic staff). We conclude that research into methods for the assessment of OTs in Germany needs to be undertaken as a prerequisite to investigating the relationship between OT teamwork and its effects on patient safety and surgical quality. Copyright © 2013. Published by Elsevier GmbH.

Percutaneous tracheostomy in patients with cervical spine fractures--feasible and safe.

PubMed

Ben Nun, Alon; Orlovsky, Michael; Best, Lael Anson

2006-08-01

The aim of this study is to evaluate the short and long-term results of percutaneous tracheostomy in patients with documented cervical spine fracture. Between June 2000 and September 2005, 38 consecutive percutaneous tracheostomy procedures were performed on multi-trauma patients with cervical spine fracture. Modified Griggs technique was employed at the bedside in the general intensive care department. Staff thoracic surgeons and anesthesiologists performed all procedures. Demographics, anatomical conditions, presence of co-morbidities and complication rates were recorded. The average operative time was 10 min (6-15). Two patients had minor complications. One patients had minor bleeding (50 cc) and one had mild cellulitis. Nine patients had severe paraparesis or paraplegia prior to the PCT procedure and 29 were without neurological damage. There was no PCT related neurological deterioration. Twenty-eight patients were discharged from the hospital, 21 were decannulated. The average follow-up period was 18 months (1-48). There was no delayed, procedure related, complication. These results demonstrate that percutaneous tracheostomy is feasible and safe in patients with cervical spine fracture with minimal short and long-term morbidity. We believe that percutaneous tracheostomy is the procedure of choice for patients with cervical spine fracture who need prolonged ventilatory support.

Minimally invasive thyroid nodulectomy reduces post-operative hypothyroidism when compared with thyroid lobectomy.

PubMed

Sarkis, Leba M; Norlen, Olov; Sywak, Mark; Delbridge, Leigh

2017-05-01

It has been a long-standing surgical tenet that the minimum surgical procedure for a single thyroid nodule is lobectomy. Such an approach, however, has been associated with a significant incidence of post-operative hypothyroidism with patients becoming medication dependent for life. Thermal sealing devices have enabled local nodule excision to be undertaken safely with preservation of more residual thyroid mass. The aim of this study was to determine if this approach was associated with a reduction in post-operative hypothyroidism. This is a retrospective cohort study comprising 351 patients treated between January 2010 and December 2012. Patients were assessed at 6-8-week review. Subclinical hypothyroidism was defined as a thyroid-stimulating hormone (TSH) >4.5 mIU/L, with clinical hypothyroidism defined as both an elevated TSH and presence of clinical symptoms requiring thyroxine replacement. One hundred and ninety patients underwent open thyroid lobectomy, 86 a minimally invasive thyroid lobectomy and 75 a minimally invasive nodulectomy. There was no difference in post-operative hypothyroidism after lobectomy whether by the open (22.1%) or minimally invasive (22.1%) technique. However, after minimally invasive nodulectomy, post-operative hypothyroidism was less than one quarter (5.3%) of that following lobectomy overall (22.1%, P < 0.01). There were no differences in post-operative complications between any of the groups. Minimally invasive local nodule excision can be performed safely, with the potential for significantly reducing the rate of post-operative hypothyroidism. As such, the procedure should be considered for appropriately selected patients. © 2014 Royal Australasian College of Surgeons.

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

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

Roger Lew; Ronald L. Boring; Thomas A. Ulrich

Operators of critical processes, such as nuclear power production, must contend with highly complex systems, procedures, and regulations. Developing human-machine interfaces (HMIs) that better support operators is a high priority for ensuring the safe and reliable operation of critical processes. Human factors engineering (HFE) provides a rich and mature set of tools for evaluating the performance of HMIs, but the set of tools for developing and designing HMIs is still in its infancy. Here we propose that Microsoft Windows Presentation Foundation (WPF) is well suited for many roles in the research and development of HMIs for process control.

Three trocar laparoscopic Roux-en-y gastric bypass: a novel technique en route to the single-incision laparoscopic approach.

PubMed

Saber, Alan A; Elgamal, Mohamed H; El-Ghazaly, Tarek H; Elian, Alain R; Dewoolkar, Aditya V; Akl, Abir Hassan

2010-01-01

Laparoscopic Roux-en-Y gastric bypass is the gold standard bariatric procedure. Typically, the procedure necessitates five to seven small skin incisions for trocar placement. The senior author (AA Saber) has developed a three-trocar approach for laparoscopic Roux-en-Y gastric bypass. Sixteen patients underwent triple-incision laparoscopic Roux-en-Y gastric bypass between May 2009 and August 2009. The same surgeon performed all surgical interventions. The umbilicus was the main point of entry for all patients and the same operative technique and perioperative protocol were used in all patients. A total of sixteen triple-incision laparoscopic Roux-en-Y gastric bypasses were performed. The procedures were successfully performed in all patients. Mean operating time was 145.4 min. None of the patients required conversion to an open procedure. There were no mortalities or post-operative technical complications noted during the immediate post-operative period. Three trocar laparoscopic Roux-en-Y gastric bypass is safe, technically feasible and reproducible. This technique may be considered a "precursor" to single-incision laparoscopic Roux-en-Y gastric bypass. Copyright 2009 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Electrocautery skin incision for neurosurgery procedures--technical note.

PubMed

Nitta, Naoki; Fukami, Tadateru; Nozaki, Kazuhiko

2011-01-01

The reluctance to incise skin with electrocautery is partly attributable to concerns about excessive scarring and poor wound healing. However, recently no difference was reported in wound complications between the cold scalpel and electrocautery scalpel. We assessed the safety and efficacy of electrocautery skin incision in 22 scalp incisions, including 4 cases of reoperation. Electrocautery skin incisions were created using a sharp needle electrode. The generator unit was set on cutting mode, with power of 6 W and 330 kHz sinusoid waveform. Subcutaneous dissections also used the sharp needle electrode, set on coagulating mode, with power of 10 W and 1 MHz pulse-modulated waveform. Galea incisions used a standard blade tip, set on coagulating mode, with power of 20 W and 1 MHz pulse-modulated waveform. Skin incision with the sharp needle electrode caused no charring of the wound. Little bleeding or oozing were observed and skin clips were not necessary. No wound complication such as necrosis or infection occurred. Electrocautery skin incisions for re-operations were also performed safely without complications. Electrocautery skin incision is sufficiently safe procedure not only for first operation but also for re-operation. Electrocautery skin incision is efficacious, especially for extended operation times, because of little blood loss from the edges of skin incision and possible avoidance of skin edge necrosis or alopecia caused by skin clips.

Simple Circumcision Device: Proof-of-Concept for a Single-visit, Adjustable Device to Facilitate Safe Adult Male Circumcision

PubMed Central

Hotaling, James M; Leddy, Laura S; Haider, Mahum A; Mossanen, Matthew; Bailey, Michael R; MacConaghy, Brian; Olson, Francis; Krieger, John N

2014-01-01

Objective To conduct a proof-of-concept study to determine the potential utility of a novel, adjustable single-visit, disposable device to facilitate rapid adult circumcision. Design Prospective pilot trial of a novel surgical device Setting Tertiary care Veterans Administration medical center Patients 5 adult males Interventions Circumcisions performed by junior trainees using an adjustable, single-size surgical-assist device constructed by the University of Washington Applied Physics Laboratory. Main Outcome Measure(s) The attending surgeon and trainees completed standardized forms after each procedure to assess technical problems and ease of use. Follow-up visits were scheduled to evaluate adverse events, post-operative pain, cosmetic outcomes and participant satisfaction at 3, 8, 30 and 90 days post-operatively. Results The average operative time was 16.4 minutes. All cases were performed with local anesthesia and no case required electrocautery or conversion to standard surgery. At the post-operative day 3 visit all subjects were happy with their results and would recommend the procedure to another patient. One participant had a minor wound separation noted at the 30-day visit that resolved during follow-up. There were no wound infections, hematomas or other adverse events. Conclusions This proof-of-study suggests that the Simple Circumcision Device (SCD) may facilitate delivery of safe adult male circumcision services. PMID:24613534

Carbothermal Production of Magnesium: Csiro's Magsonic™ Process

NASA Astrophysics Data System (ADS)

Prentice, Leon H.; Nagle, Michael W.; Barton, Timothy R. D.; Tassios, Steven; Kuan, Benny T.; Witt, Peter J.; Constanti-Carey, Keri K.

Carbothermal production has been recognized as conceptually the simplest and cleanest route to magnesium metal, but has suffered from technical challenges of development and scale-up. Work by CSIRO has now successfully demonstrated the technology using supersonic quenching of magnesium vapor (the MagSonic™ Process). Key barriers to process development have been overcome: the experimental program has achieved sustained operation, no nozzle blockage, minimal reversion, and safe handling of pyrophoric powders. The laboratory equipment has been operated at industrially relevant magnesium vapor concentrations (>25% Mg) for multiple runs with no blockage. Novel computational fluid dynamics (CFD) modeling of the shock quenching and metal vapor condensation has informed nozzle design and is supported by experimental data. Reversion below 10% has been demonstrated, and magnesium successfully purified (>99.9%) from the collected powder. Safe operating procedures have been developed and demonstrated, minimizing the risk of powder explosion. The MagSonic™ Process is now ready to progress to significantly larger scale and continuous operation.

Operational flight evaluation of the two-segment approach for use in airline service

NASA Technical Reports Server (NTRS)

Schwind, G. K.; Morrison, J. A.; Nylen, W. E.; Anderson, E. B.

1975-01-01

United Airlines has developed and evaluated a two-segment noise abatement approach procedure for use on Boeing 727 aircraft in air carrier service. In a flight simulator, the two-segment approach was studied in detail and a profile and procedures were developed. Equipment adaptable to contemporary avionics and navigation systems was designed and manufactured by Collins Radio Company and was installed and evaluated in B-727-200 aircraft. The equipment, profile, and procedures were evaluated out of revenue service by pilots representing government agencies, airlines, airframe manufacturers, and professional pilot associations. A system was then placed into scheduled airline service for six months during which 555 two-segment approaches were flown at three airports by 55 airline pilots. The system was determined to be safe, easy to fly, and compatible with the airline operational environment.

Optimized autonomous operations of a 20 K space hydrogen sorption cryocooler

NASA Astrophysics Data System (ADS)

Borders, J.; Morgante, G.; Prina, M.; Pearson, D.; Bhandari, P.

2004-06-01

A fully redundant hydrogen sorption cryocooler is being developed for the European Space Agency Planck mission, dedicated to the measurement of the temperature anisotropies of the cosmic microwave background radiation with unprecedented sensitivity and resolution [Advances in Cryogenic Engineering 45A (2000) 499]. In order to achieve this ambitious scientific task, this cooler is required to provide a stable temperature reference (˜20 K) and appropriate cooling (˜1 W) to the two instruments on-board, with a flight operational lifetime of 18 months. During mission operations, communication with the spacecraft will be possible in a restricted time-window, not longer than 2 h/day. This implies the need for an operations control structure with the required robustness to safely perform autonomous procedures. The cooler performance depends on many operating parameters (such as the temperatures of the pre-cooling stages and the warm radiator), therefore the operation control system needs the capability to adapt to variations of these boundary conditions, while maintaining safe operating procedures. An engineering bread board (EBB) cooler was assembled and tested to evaluate the behavior of the system under conditions simulating flight operations and the test data were used to refine and improve the operation control software. In order to minimize scientific data loss, the cooler is required to detect all possible failure modes and to autonomously react to them by taking the appropriate action in a rapid fashion. Various procedures and schemes both general and specific in nature were developed, tested and implemented to achieve these goals. In general, the robustness to malfunctions was increased by implementing an automatic classification of anomalies in different levels relative to the seriousness of the error. The response is therefore proportional to the failure level. Specifically, the start-up sequence duration was significantly reduced, allowing a much faster activation of the system, particularly useful in case of restarts after inadvertent shutdowns arising from malfunctions in the spacecraft. The capacity of the system to detect J-T plugs was increased to the point that the cooler is able to autonomously identify actual contaminants clogging from gas flow reductions due to off-nominal operating conditions. Once a plug is confirmed, the software autonomously energizes, and subsequently turns off, a J-T defrost heater until the clog is removed, bringing the system back to normal operating conditions. In this paper, all the cooler Operational Modes are presented, together with the description of the logic structure of the procedures and the advantages they produce for the operations.

Transhepatic Hilar Approach for Perihilar Cholangiocarcinoma: Significance of Early Judgment of Resectability and Safe Vascular Reconstruction.

PubMed

Kuriyama, Naohisa; Isaji, Shuji; Tanemura, Akihiro; Iizawa, Yusuke; Kato, Hiroyuki; Murata, Yasuhiro; Azumi, Yoshinori; Kishiwada, Masashi; Mizuno, Shugo; Usui, Masanobu; Sakurai, Hiroyuki

2017-03-01

In the most common surgical procedure for perihilar cholangiocarcinoma, the margin status of the proximal bile duct is determined at the final step. Our procedure, the transhepatic hilar approach, confirms a cancer-negative margin status of the proximal bile duct first. We first performed a partial hepatic parenchymal transection to expose the hilar plate, and then transected the proximal bile duct to confirm margin status. Then, divisions of the hepatic artery and portal vein of the future resected liver are performed, followed by the residual hepatic parenchymal transection. The transhepatic hilar approach offers a wide surgical field for safe resection and reconstruction of the portal vein in the middle of the hepatectomy. We reviewed 23 patients with perihilar cholangiocarcinoma who underwent major hepatectomy using our procedure from 2011 to 2015. A combined vascular resection and reconstruction was carried out in 14 patients (60.9%). R0 resection was achieved in 17 patients (73.9%), and the overall 3-year survival rate was 52.9% (median survival time 52.4 months). The transhepatic hilar approach is useful and practicable regardless of local tumor extension, enabling us to determine tumor resectability and perform safe resection and reconstruction of the portal vein early in the operation.

Randomized clinical trial of laparoscopic versus open repair of the perforated peptic ulcer: the LAMA Trial.

PubMed

Bertleff, Mariëtta J O E; Halm, Jens A; Bemelman, Willem A; van der Ham, Arie C; van der Harst, Erwin; Oei, Hok I; Smulders, J F; Steyerberg, E W; Lange, Johan F

2009-07-01

Laparoscopic surgery has become popular during the last decade, mainly because it is associated with fewer postoperative complications than the conventional open approach. It remains unclear, however, if this benefit is observed after laparoscopic correction of perforated peptic ulcer (PPU). The goal of the present study was to evaluate whether laparoscopic closure of a PPU is as safe as conventional open correction. The study was based on a randomized controlled trial in which nine medical centers from the Netherlands participated. A total of 109 patients with symptoms of PPU and evidence of air under the diaphragm were scheduled to receive a PPU repair. After exclusion of 8 patients during the operation, outcomes were analyzed for laparotomy (n = 49) and for the laparoscopic procedure (n = 52). Operating time in the laparoscopy group was significantly longer than in the open group (75 min versus 50 min). Differences regarding postoperative dosage of opiates and the visual analog scale (VAS) for pain scoring system were in favor of the laparoscopic procedure. The VAS score on postoperative days 1, 3, and 7 was significant lower (P < 0.05) in the laparoscopic group. Complications were equally distributed. Hospital stay was also comparable: 6.5 days in the laparoscopic group versus 8.0 days in the open group (P = 0.235). Laparoscopic repair of PPU is a safe procedure compared with open repair. The results considering postoperative pain favor the laparoscopic procedure.

Terminal Area Procedures for Paired Runways

NASA Technical Reports Server (NTRS)

Lozito, Sandra; Verma, Savita Arora

2011-01-01

Parallel runway operations have been found to increase capacity within the National Airspace but poor visibility conditions reduce the use of these operations. The NextGen and SESAR Programs have identified the capacity benefits from increased use of closely-space parallel runway. Previous research examined the concepts and procedures related to parallel runways however, there has been no investigation of the procedures associated with the strategic and tactical pairing of aircraft for these operations. This simulation study developed and examined the pilot and controller procedures and information requirements for creating aircraft pairs for parallel runway operations. The goal was to achieve aircraft pairing with a temporal separation of 15s (+/- 10s error) at a coupling point that was about 12 nmi from the runway threshold. Two variables were explored for the pilot participants: two levels of flight deck automation (current-day flight deck automation and auto speed control future automation) as well as two flight deck displays that assisted in pilot conformance monitoring. The controllers were also provided with automation to help create and maintain aircraft pairs. Results show the operations in this study were acceptable and safe. Subjective workload, when using the pairing procedures and tools, was generally low for both controllers and pilots, and situation awareness was typically moderate to high. Pilot workload was influenced by display type and automation condition. Further research on pairing and off-nominal conditions is required however, this investigation identified promising findings about the feasibility of closely-spaced parallel runway operations.

Flight evaluation of two-segment approaches using area navigation guidance equipment

NASA Technical Reports Server (NTRS)

Schwind, G. K.; Morrison, J. A.; Nylen, W. E.; Anderson, E. B.

1976-01-01

A two-segment noise abatement approach procedure for use on DC-8-61 aircraft in air carrier service was developed and evaluated. The approach profile and procedures were developed in a flight simulator. Full guidance is provided throughout the approach by a Collins Radio Company three-dimensional area navigation (RNAV) system which was modified to provide the two-segment approach capabilities. Modifications to the basic RNAV software included safety protection logic considered necessary for an operationally acceptable two-segment system. With an aircraft out of revenue service, the system was refined and extensively flight tested, and the profile and procedures were evaluated by representatives of the airlines, airframe manufacturers, the Air Line Pilots Association, and the Federal Aviation Adminstration. The system was determined to be safe and operationally acceptable. It was then placed into scheduled airline service for an evaluation during which 180 approaches were flown by 48 airline pilots. The approach was determined to be compatible with the airline operational environment, although operation of the RNAV system in the existing terminal area air traffic control environment was difficult.

Investigation report: H Reactor mischarging incident

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

Vinther, A.P.

1964-05-01

All cold reactor start-up procedures require the vertical safety rods (VSR) to be withdrawn in pairs with specific waiting periods between each pair withdrawal. This rod withdrawal procedure will assure an early and safe detection of reactor criticality should reactor reactivity conditions be different than predicted so that proper corrective actions can be taken. During the paired VSR removal of H reactor on April 17, 1964, while preparing for reactor start-up, an extremely low level rising period was detected with six VSR's still in the reactor. The withdrawn VSR's were promptly re-inserted. During the next several days other process difficultiesmore » were encountered. H Processing personnel began investigating the possibility that a number of process tubes might have been mischarged; one shift's charging effort appeared to be suspect as longitudinal peaking appeared nearly twice as severe as normal in the distorted region. Following verification of a charging error in the suspect group of 171 tubes, that group of tubes was discharged and recharged with the proper charge make-up. On April 24, during VSR removal for start-up, low level criticality was detected with three VSR's still in the unit. The VSR's were re-inserted and Operational Physics analysis requested. Following installation of additional poisoning, the Operational Physics analysis uncovered a reactivity prediction error related to the prior operation with the skewed flux distribution. However, in this case, as on April 17, the procedural paired VSR withdrawal provided safe detection of the criticality condition in adequate time to take prompt corrective action. A successful reactor start-up was then achieved later on April 24, and reactor operation has been normal since that time. 4 figs.« less

76 FR 50318 - Qualification of Drivers; Exemption Applications; Vision

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-12

... predicting crash proneness from crash history coupled with other factors. These factors--such as age, sex... may change and affect his/her ability to operate a CMV as safely as in the past. As a condition of the... for a renewal under procedures in effect at that time. Issued on: August 5, 2011. Larry W. Minor...

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

Ionin, Andrey A.; Kozhushko, Svetlana E.; Kudryashov, Sergey I.

We have successfully fabricated in vitro femtosecond laser micro-incisions inside cornea and--for the first time--inside sclera mildly pre-cleared by a biocompatible and clinically safe (non-toxic) natural agent (replacive refractive index-matching 40%-glucose solution in water), with the tissues taken as fresh cool cuts of human cadaver eyes, and reported on basic operational conditions of the micro-surgical procedures.

Anesthetic management for carbon dioxide laser surgery of the larynx.

PubMed

Shaker, M H; Konchigeri, H N; Andrews, A H; Holinger, P H

1976-06-01

Fifty-one patients underwent 71 carbon dioxide laser procedures under general anesthesia for various intralaryngeal pathology. Anesthesia was induced with thiopental sodium, followed by succinylcholine to facilitate endotracheal intubation. For maintenance of anesthesia, 70% nitrous oxide was supplemented with halothane, enflurane or small doses of fentanyl. Succinylcholine, d-tubocurare or pancuronium were used to maintain muscular relaxation of jaw, pharyngeal and laryngeal muscles for a smooth lasing procedure. Small diameter (16-22 Fr.), red rubber, cuffed endotracheal tubes provided maximum working space, facilitated the controlled ventilation and reduced the explosion hazard of the anesthetic gases. Safely eyeglasses were used by all the personnel in the operating room against accidental injury to the cornea by the laser beam. Anesthetic management provided excellent operative conditions with maximum safety to the patient and the personnel in the operating room.

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.

Surgical treatment of obesity.

PubMed

Puzziferri, Nancy; Blankenship, Jeanne; Wolfe, Bruce M

2006-02-01

The surgical treatment of obesity has existed for over 50 yr. Surgical options have evolved from high-risk procedures infrequently performed, to safe, effective procedures increasingly performed. The operations used today provide significant durable weight loss, resolution or marked improvement of obesity-related comorbidities, and enhanced quality of life for the majority of patients. The effect of bariatric surgery on the neurohormonal regulation of energy homeostasis is not fully understood. Despite its effectiveness, less than 1% of obese patients are treated surgically. The perception that obesity surgery is unsafe remains a deterrent to care.

Use of robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy in a paediatric patient: problem encountered.

PubMed

Chan, Ivy H Y; Li, Florence H Q; Lan, Lawrence C L; Wong, Kenneth K Y; Yip, Peter K F; Tam, Paul K H

2015-10-01

This report is of robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy in a 12-year-old patient with detrusor underactivity and hereditary sensory neuropathy. The whole operation was performed in 555 minutes with no open conversion. The patient experienced one episode of stomal stenosis, which required dilatation. At 3-year follow-up, the patient had both stomal and urinary continence. This is a safe and effective procedure to create a means of urinary catheterisation with avoidance of a large unsightly scar and comparable clinical outcome to an open procedure.

Radiation exposure from fluoroscopy during orthopedic surgical procedures

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

Riley, S.A.

1989-11-01

The use of fluoroscopy has enabled orthopedic surgeons to become technically more proficient. In addition, these surgical procedures tend to have less associated patient morbidity by decreasing operative time and minimizing the area of the operative field. The trade-off, however, may be an increased risk of radiation exposure to the surgeon on an annual or lifetime basis. The current study was designed to determine the amount of radiation received by the primary surgeon and the first assistant during selected surgical procedures involving the use of fluoroscopy. Five body sites exposed to radiation were monitored for dosage. The results of thismore » study indicate that with appropriate usage, (1) radiation exposure from fluoroscopy is relatively low; (2) the surgeon's dominant hand receives the most exposure per case; and (3) proper maintenance and calibration of fluoroscopic machines are important factors in reducing exposure risks. Therefore, with proper precautions, the use of fluoroscopy in orthopedic procedures can remain a safe practice.« less

Protecting your eyes in the laser operating room.

PubMed

Sallavanti, R A

1995-01-01

1. Laser protective eyewear is nearly as important to the OR nurse as the surgical mask in an operating room where laser surgery is performed. 2. Most hospitals require OR personnel to wear protective eyewear during laser procedures in voluntary compliance with American National Standards Institute (ANSI) Z136.3 for the safe use of lasers in health care facilities. 3. The basic steps to protecting your eyes are as follows: Select the appropriate eyewear (plastic or glass); make sure the eyewear fits properly; wear the protective lenses during laser testing and operation; and heed your laser safety officer.

[MINIMALLY INVASIVE PROCEDURE FOR CORRECTION OF PECTUS CARINATUM].

PubMed

Xu, Bing; Liu, Wenying

2015-04-01

To explore the method and experience in correction of pectus carinatum with minimally invasive procedure. Between June 2010 and January 2014, 30 patients with pectus carinatum were corrected by minimally invasive procedure. There were 21 boys and 9 girls whose average age was 13 years and 2 months (range, from 8 years and 10 months to 18 years and 9 months), including 24 cases of first operation, 2 recurrence after traditional pectus carinatum correction, and 4 cases secondary to median thoracotomy. Thirty patients had symmetric and asymmetric mild pectus carinatum. The operation was performed successfully in all patients, and no severe complication occurred. The operation time was 42-95 minutes (mean, 70 minutes). The bleeding volume during operation was 4-30 mL (mean, 10 mL). The time from operation to discharge was 6-10 days (mean, 7 days). The average time of follow-up was 25 months (range, 9-54 months). All surgical wound healed primarily with no infection. The X-ray films showed slight pneumothorax in 7 cases, and it was absorbed after 1 month without treatment. Loosening of internal fixation was found in 1 patient because of trauma at 6 months, and operation was performed again. The bar was removed at 2 years in 21 patients. The patients had good thoracic contour and normal activity. Minimally invasive procedure for correction of pectus carinatum is safe and will get satisfactory effect in maintaining thoracic contour. It has also less trauma and shorter operation time.

Transfascial vaginal tape (TFT): a simple, safe and cost-effective procedure for stress urinary incontinence. A preliminary study.

PubMed

Foglia, Giovanni; Mistrangelo, Emanuela; Lijoi, Davide; Alessandri, Franco; Ragni, Nicola

2007-07-01

To analyse prospectively the effectiveness of a new simple, minimally invasive, and cost-effective technique for the treatment of female urinary stress incontinence: the transfascial vaginal tape (TFT). In a prospective study, we enrolled 45 women undergoing TFT with or without hysterectomy and/or another pelvic reconstructive procedure between 1st December 2003 and 31st December. TFT consists of a tension-free urethrosuspension using a sling located at the mid-urethral level and placed laterally in the endopelvic fascia previously perforated. Follow-up evaluations were established at 3 and 6 months and at 1 year after the operation. During each follow-up, women underwent cough stress test and they answered to the "Incontinence quality of life questionnaire" (I-QOL), to the Patient Global Impression of Severity (PGI-S) and of Improvement (PGI-I) questions. Thirty-nine patients (88.9%) had a follow-up examination 1 year after surgery. Of these, 30 (76.9%) were defined cured, 6 (15.4%) improved and 3 (7.7%) failed. TFT procedure can be considered a simple, safe and cost-effective procedure for the treatment of stress urinary incontinence and can be an alternative to tension-free vaginal tape or transobturator route for sub-urethral tape procedures.

Terminal Area Procedures for Paired Runways

NASA Technical Reports Server (NTRS)

Lozito, Sandy

2011-01-01

Parallel Runway operations have been found to increase capacity within the National Airspace (NAS) however, poor visibility conditions reduce this capacity [1]. Much research has been conducted to examine the concepts and procedures related to parallel runways however, there has been no investigation of the procedures associated with the strategic and tactical pairing of aircraft for these operations. This study developed and examined the pilot and controller procedures and information requirements for creating aircraft pairs for parallel runway operations. The goal was to achieve aircraft pairing with a temporal separation of 15s(+/- 10s error) at a coupling point that is about 12 nmi from the runway threshold. Two variables were explored for the pilot participants: Two levels of flight deck automation (current-day flight deck automation, and a prototype future automation) as well as two flight deck displays that assisted in pilot conformance monitoring. The controllers were also provided with automation to help create and maintain aircraft pairs. Data showed that the operations in this study were found to be acceptable and safe. Workload when using the pairing procedures and tools was generally low for both controllers and pilots, and situation awareness (SA) was typically moderate to high. There were some differences based upon the display and automation conditions for the pilots. Future research should consider the refinement of the concepts and tools for pilot and controller displays and automation for parallel runway concepts.

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.

Surgical treatment of chronic pancreatitis using Frey's procedure: a Brazilian 16-year single-centre experience.

PubMed

Gestic, Martinho Antonio; Callejas-Neto, Francisco; Chaim, Elinton Adami; Utrini, Murillo Pimentel; Cazzo, Everton; Pareja, Jose Carlos

2011-04-01

Surgical treatment of chronic pancreatitis is indicated for intractable pain. Frey's procedure is an accepted treatment for this disease. The aim of the present study was to describe a single-centre experience in the treatment of chronic pancreatitis using Frey's procedure. A retrospective analysis of 73 patients who underwent a Frey's procedure between 1991 to 2007 and had at least 1 year of follow-up. Demographics, indication for surgery, peri-operative complications and late outcomes were analysed. The median age was 39.9 years. Seventy out of the 73 (95.8%) patients were male. The median pre-operative body mass index (BMI) was 19.1 kg/m(2). All patients had abdominal pain, 34 (46.6%) of them daily and 13 (17.8%) weekly, with moderate or severe intensity in 98.6% (n= 72). The aetiology was secondary to alcohol in 70 patients (95.9%), with a median consumption of 278 g per day. The surgical morbidity rate was 28.7%; there were no deaths. Median post-operative follow-up was 77.0 months; 64 patients (91.4%) had complete pain relief and post-operative BMI was 22.4 kg/m(2) (P<0.001). All patients with pre-operative endocrine and exocrine insufficiencies showed no reversal of the situation. New onset insufficiencies appeared late. Frey's procedure was a safe and effective therapeutic option for the surgical treatment of patients with intractable pain caused by chronic pancreatitis. © 2011 International Hepato-Pancreato-Biliary Association.

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

Evolution of the Whipple procedure at the Massachusetts General Hospital.

PubMed

Fernández-del Castillo, Carlos; Morales-Oyarvide, Vicente; McGrath, Deborah; Wargo, Jennifer A; Ferrone, Cristina R; Thayer, Sarah P; Lillemoe, Keith D; Warshaw, Andrew L

2012-09-01

Since Allen O. Whipple published his seminal paper in 1935, the procedure that bears his name has been performed widely throughout the world and is now a common operation in major medical centers. The goal of this study was to investigate the evolution of pancreatoduodenectomy at the Massachusetts General Hospital (MGH). We sought to identify all pancreatoduodenectomies performed at the MGH since 1935. Cases were obtained from a computerized database, hospital medical records, and the MGH historical archive. Demographics, diagnosis, intraoperative variables and short-term surgical outcomes were recorded. The first pancreatoduodenectomy at the MGH was carried out in 1941; since then, 2,050 Whipple procedures have been performed. Pancreatic ductal adenocarcinoma was the most frequent indication (36%). Pylorus preservation has been the most important variation in technique, accounting for 45% of Whipple procedures in the 1980s; observation of frequent delayed gastric emptying after this procedure led to decline in its use. Pancreatic fistula was the most frequent complication (13%). Operative blood replacement and reoperation rates have decreased markedly over time; the most frequent indication for reoperation was intra-abdominal bleeding. Mortality has decreased from 45% to 0.8%, with sepsis and hypovolemic shock being the most frequent causes of death. Mean duration of hospital stay has decreased from >30 to 9.5 days, along with an increasing readmission rate (currently 19%). The Whipple procedure in the 21st century is a well-established operation. Improvements in operative technique and perioperative care have contributed in making it a safe operation that continues evolving. Copyright © 2012 Mosby, Inc. All rights reserved.

Frameless robotically targeted stereotactic brain biopsy: feasibility, diagnostic yield, and safety.

PubMed

Bekelis, Kimon; Radwan, Tarek A; Desai, Atman; Roberts, David W

2012-05-01

Frameless stereotactic brain biopsy has become an established procedure in many neurosurgical centers worldwide. Robotic modifications of image-guided frameless stereotaxy hold promise for making these procedures safer, more effective, and more efficient. The authors hypothesized that robotic brain biopsy is a safe, accurate procedure, with a high diagnostic yield and a safety profile comparable to other stereotactic biopsy methods. This retrospective study included 41 patients undergoing frameless stereotactic brain biopsy of lesions (mean size 2.9 cm) for diagnostic purposes. All patients underwent image-guided, robotic biopsy in which the SurgiScope system was used in conjunction with scalp fiducial markers and a preoperatively selected target and trajectory. Forty-five procedures, with 50 supratentorial targets selected, were performed. The mean operative time was 44.6 minutes for the robotic biopsy procedures. This decreased over the second half of the study by 37%, from 54.7 to 34.5 minutes (p < 0.025). The diagnostic yield was 97.8% per procedure, with a second procedure being diagnostic in the single nondiagnostic case. Complications included one transient worsening of a preexisting deficit (2%) and another deficit that was permanent (2%). There were no infections. Robotic biopsy involving a preselected target and trajectory is safe, accurate, efficient, and comparable to other procedures employing either frame-based stereotaxy or frameless, nonrobotic stereotaxy. It permits biopsy in all patients, including those with small target lesions. Robotic biopsy planning facilitates careful preoperative study and optimization of needle trajectory to avoid sulcal vessels, bridging veins, and ventricular penetration.

10 CFR 51.23 - Temporary storage of spent fuel after cessation of reactor operation-generic determination of no...

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 2 2011-01-01 2011-01-01 false Temporary storage of spent fuel after cessation of reactor... Procedures § 51.23 Temporary storage of spent fuel after cessation of reactor operation—generic determination... necessary, spent fuel generated in any reactor can be stored safely and without significant environmental...

10 CFR 51.23 - Temporary storage of spent fuel after cessation of reactor operation-generic determination of no...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Temporary storage of spent fuel after cessation of reactor... Procedures § 51.23 Temporary storage of spent fuel after cessation of reactor operation—generic determination... necessary, spent fuel generated in any reactor can be stored safely and without significant environmental...

Small-Item Vapor Test Method, FY11 Release

DTIC Science & Technology

2012-07-01

to this test procedure is provided alphabetically in the following list: absorption: The uptake of a contaminant INTO the volume of a material. The... powders , wipes), or gas-phase (fumigants, including aerosols). decontamination process: The process of making any person, object, or area safe by...with another contaminant. Generally, bare metals and glass are nonsorptive materials for some agents. operational decontamination: Decontamination

76 FR 4735 - Standard on Fire Brigades; Extension of the Office of Management and Budget's (OMB) Approval of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-26

... level of training and type of personal protective equipment (PPE) necessary for these members to perform..., including any personal information you provide, are placed in the public docket without change, and may be... review by the members enables them to use operational procedures and equipment in a safe manner to avoid...

Transforming Undergraduate Students into Junior Researchers: Oxidation-Reduction Sequence as a Problem-Based Case Study

ERIC Educational Resources Information Center

Saloranta, Tiina; Lo¨nnqvist, Jan-Erik; Eklund, Patrik C.

2016-01-01

In our upper-level undergraduate laboratory course in organic chemistry we focus on a research-oriented task in a context-based and problem-based learning approach. The course starts with a preliminary training period where the students learn how to safely and independently perform synthesis and purification procedures and to operate the most…

Production Line Materials. Youth Training Scheme. Core Exemplar Work Based Project.

ERIC Educational Resources Information Center

Further Education Staff Coll., Blagdon (England).

This trainer's guide is intended to assist supervisors of work-based career training projects in helping students understand the operation of an assembly line, including safe working procedures. The guide is one in a series of core curriculum modules that is intended for use in combination on- and off-the-job programs to familiarize youth with the…

Redo Laparoscopic Gastric Bypass: One-Step or Two-Step Procedure?

PubMed

Theunissen, Caroline M J; Guelinckx, Nele; Maring, John K; Langenhoff, Barbara S

2016-11-01

The adjustable gastric band (AGB) is a bariatric procedure that used to be widely performed. However, AGB failure-signifying band-related complications or unsatisfactory weight loss, resulting in revision surgery (redo operations)-frequently occurs. Often this entails a conversion to a laparoscopic Roux-en-Y gastric bypass (LRYGB). This can be performed as a one-step or two-step (separate band removal) procedure. Data were collected from patients operated from 2012 to 2014 in a single bariatric centre. We compared 107 redo LRYGB after AGB failure with 1020 primary LRYGB. An analysis was performed of the one-step vs. two-step redo procedures. All redo procedures were performed by experienced bariatric surgeons. No difference in major complication rate was seen (2.8 vs. 2.3 %, p = 0.73) between redo and primary LRYGB, and overall complication severity for redos was low (mainly Clavien-Dindo 1 or 2). Weight loss results were comparable for primary and redo procedures. The one-step and two-step redos were comparable regarding complication rates and readmissions. The operating time for the one-step redo LRYGB was 136 vs. 107.5 min for the two-step (median, p < 0.001), excluding the operating time of separate AGB removal (mean 61 min, range 36-110). Removal of a failed AGB and LRYGB in a one-step procedure is safe when performed by experienced bariatric surgeons. However, when erosion or perforation of the AGB occurs, we advise caution and would perform the redo LRYGB as a two-step procedure. Equal weights can be achieved at 1 year post redo LRYGB as after primary LRYGB procedures.

[Total laparoscopic hysterectomy--indications and complications of 158 patients].

PubMed

Malinowski, Andrzej; Makowska, Justyna; Antosiak, Beata

2013-04-01

Hysterectomy is one of the most common gynecological procedures. Development of modern laparoscopic techniques made it a crucial tool in contemporary gynecology both in diagnosis and treatment. Increasing experience and improved laparoscopic instruments enabled gynecologists to extend indications for laparoscopic procedures as well as the range of the operation itself. 1) to present data (particularly perioperative) of patients who underwent laparoscopic hysterectomy 2) to analyze various information including: indication for the procedure, surgery duration, evaluation of different parameters like: volume of the excised uterus, postoperative HB and HCT drop, length of hospital stay as well as short- and long-term complications. The analysis included peri- and postoperative data of 158 patients who underwent laparoscopic hysterectomy. Indication for hysterectomy and duration of operation were analyzed. Uterine volume, postoperative HB and HCT drop, time of hospital stay and complications were evaluated. In the study a description of the method of laparoscopic hysterectomy was presented. Mean time of procedure was 68 min. (58-135 min.). Basing on operational protocols, the time of operation was measured from the moment laparoscopy started until the patient was fully awake after anesthesia. No adjustments were made for longer anesthetic recovery period. Estimated blood loss was 166.6 ml. Mean HB drop was 1.29 g/dl (0, 1-3 g/dl). Mean volume of the excised uterus was 108.24 cm3 (25.27-440.86 cm3). In 44 patients (27.84%) bilateral salpingo-oophorectomy was performed. In 4 cases (2.53%) there was an indication for postoperative antibiotics. None of the patients required blood transfusion or conversion to open surgery or the need to re-operate. Mean hospital stay after the surgery was 2.9 days. Overall, only 2 patients suffered long-term complications (1.26%): three weeks after the surgery urethro-vaginal fistulas occurred due to thermal injury to the ureter. That complication was noted during the first year of using this technique. Between 2008 and 2011 that type of adverse effect was not reported. The analysis included perioperative and postoperative data of 158 patients who underwent laparoscopic hysterectomy. Data suggest that patients benefit from this procedure which is safe, associated with short postoperative recovery time, minimal blood loss and low complication rate, as well as good plastic result. We recommend laparoscopic hysterectomy as an alternative to open hysterectomy in cases when it can be safely performed.

The Effect of Product Safety Courses on the Adoption and Outcomes of LESS Surgery

PubMed Central

Toomey, Paul G.; Ross, Sharona B.; Choung, Edward; Donn, Natalie; Vice, Michelle; Luberice, Kenneth; Albrink, Michael

2015-01-01

Background and Objectives: As technology in surgery evolves, the medical instrument industry is inevitability involved in promoting the use and appropriate (ie, effective and safe) application of its products. This study was undertaken to evaluate industry-supported product safety courses in laparoendoscopic single-site (LESS) surgery, by using the metrics of surgeons' adoption of the technique, safety of the procedure, and surgeons' perception of the surgery. Methods: LESS surgery courses that involved didactic lectures, operative videos, operation observation, collaborative learning, and simulation, were attended by 226 surgeons. With Florida Hospital Tampa Institutional Review Board approval, the surgeons were queried before and immediately after the course, to assess their attitudes toward LESS surgery. Then, well after the course, the surgeons were contacted, repeatedly if necessary, to complete questionnaires. Results: Before the course, 82% of the surgeons undertook more than 10 laparoscopic operations per month. Immediately after the course, 86% were confident that they were prepared to perform LESS surgery. Months after the course, 77% of the respondents had adopted LESS surgery, primarily cholecystectomy; 59% had added 1 or more trocars in 0–20% of their procedures; and 73% held the opinion that operating room observation was the most helpful learning experience. Complications with LESS surgery were noted 12% of the time. Advantages of the technique were better cosmesis (58%) and patient satisfaction (38%). Disadvantages included risk of complications (37%) and higher technical demand (25%). Seventy-eight percent viewed LESS surgery as an advancement in surgical technique. Conclusion: In multifaceted product safety courses, operating room observation is thought to provide the most helpful instruction for those wanting to undertake LESS surgery. The procedure has been safely adopted by surgeons who frequently perform laparoscopies. The tradeoff is in performing a more difficult technique to obtain better cosmesis for the patient. We must continue to conduct critical evaluations of product safety courses for the introduction of new technology in surgery. PMID:26045652

The Effect of Product Safety Courses on the Adoption and Outcomes of LESS Surgery.

PubMed

Toomey, Paul G; Ross, Sharona B; Choung, Edward; Donn, Natalie; Vice, Michelle; Luberice, Kenneth; Albrink, Michael; Rosemurgy, Alexander S

2015-01-01

As technology in surgery evolves, the medical instrument industry is inevitability involved in promoting the use and appropriate (ie, effective and safe) application of its products. This study was undertaken to evaluate industry-supported product safety courses in laparoendoscopic single-site (LESS) surgery, by using the metrics of surgeons' adoption of the technique, safety of the procedure, and surgeons' perception of the surgery. LESS surgery courses that involved didactic lectures, operative videos, operation observation, collaborative learning, and simulation, were attended by 226 surgeons. With Florida Hospital Tampa Institutional Review Board approval, the surgeons were queried before and immediately after the course, to assess their attitudes toward LESS surgery. Then, well after the course, the surgeons were contacted, repeatedly if necessary, to complete questionnaires. Before the course, 82% of the surgeons undertook more than 10 laparoscopic operations per month. Immediately after the course, 86% were confident that they were prepared to perform LESS surgery. Months after the course, 77% of the respondents had adopted LESS surgery, primarily cholecystectomy; 59% had added 1 or more trocars in 0-20% of their procedures; and 73% held the opinion that operating room observation was the most helpful learning experience. Complications with LESS surgery were noted 12% of the time. Advantages of the technique were better cosmesis (58%) and patient satisfaction (38%). Disadvantages included risk of complications (37%) and higher technical demand (25%). Seventy-eight percent viewed LESS surgery as an advancement in surgical technique. In multifaceted product safety courses, operating room observation is thought to provide the most helpful instruction for those wanting to undertake LESS surgery. The procedure has been safely adopted by surgeons who frequently perform laparoscopies. The tradeoff is in performing a more difficult technique to obtain better cosmesis for the patient. We must continue to conduct critical evaluations of product safety courses for the introduction of new technology in surgery.

At least seven days delayed stenting using minimalist immediate mechanical intervention (MIMI) in ST-segment elevation myocardial infarction: the SUPER-MIMI study.

PubMed

Mester, Petru; Bouvaist, Helene; Delarche, Nicolas; Bouisset, Frédéric; Abdellaoui, Mohamed; Petiteau, Pierre-Yves; Dubreuil, Olivier; Boueri, Ziad; Chettibi, Mohamed; Souteyrand, Géraud; Madiot, Hend; Belle, Loic

2017-07-20

The aim of this study was to ascertain whether a minimalist immediate mechanical intervention (MIMI) aiming to restore an optimal Thrombolysis In Myocardial Infarction (TIMI) flow in the culprit artery, followed ≥7 days later by a second percutaneous coronary intervention with intentional stenting, is safe in patients with ST-segment elevation myocardial infarction and large thrombotic burden. SUPER-MIMI was a prospective, observational trial conducted between January 2014 and April 2015 in 14 French centres. A total of 155 patients were enrolled. The pharmacological therapy was left to the operator's discretion. Eighty-one patients (52.3%) had glycoprotein IIb/IIIa inhibitors (GPI) initiated before the end of the first procedure. The median (interquartile range [IQR]) delay between the two procedures was eight (seven to 12) days. Infarct-related artery reocclusion between the two procedures (primary endpoint) occurred in two patients (1.3%), neither of whom received GPI treatment. TIMI flow was maintained or improved between the end of the first procedure and the beginning of the second procedure in all patients. Thrombotic burden and stenosis severity diminished significantly between the two procedures. Stents were ultimately implanted in 97 patients (62.6%). Deferred stenting (≥7 days) in patients with a high thrombus burden was safe on a background of GPI therapy.

Anesthetic approach to high-risk patients and prolonged awake craniotomy using dexmedetomidine and scalp block.

PubMed

Garavaglia, Marco M; Das, Sunit; Cusimano, Michael D; Crescini, Charmagne; Mazer, C David; Hare, Gregory M T; Rigamonti, Andrea

2014-07-01

Awake craniotomy with intraoperative speech or motor testing is relatively contraindicated in cases requiring prolonged operative times and in patients with severe medical comorbidities including anxiety, anticipated difficult airway, obesity, large tumors, and intracranial hypertension. The anesthetic management of neurosurgical patients who possess these contraindications but would be optimally treated by an awake procedure remains unclear. We describe a new anesthetic approach for awake craniotomy that did not require any airway manipulation, utilizing a bupivacaine-based scalp nerve block, and dexmedetomidine as the primary hypnotic-sedative agent. Using this technique, we provided optimal operative conditions to perform awake craniotomy facilitating safe tumor resection, while utilizing intraoperative electrocorticography for motor and speech mapping in a cohort of 10 patients at a high risk for airway compromise and complications associated with patient comorbidities. All patients underwent successful awake craniotomy, intraoperative mapping, and tumor resection with adequate sedation for up to 9 hours (median 3.5 h, range 3 to 9 h) without any loss of neurological function, airway competency, or the need to provide any active rescue airway management. We report 4 of these cases that highlight our experience: 1 case required prolonged surgery because of the complexity of tumor resection and 3 patients had important medical comorbidities and/or relative contraindication for an awake procedure. Dexmedetomidine, with concurrent scalp block, is an effective and safe anesthetic approach for awake craniotomy. Dexmedetomidine facilitates the extension procedure complexity and duration in patients who might traditionally not be considered to be candidates for this procedure.

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.

Surgical care in the isolated military hospital.

PubMed

Lukish, J R; Gill, G G; McCoy, T R

2001-01-01

To maintain the health of service members and their families throughout the world, the Department of Defense has established several isolated military hospitals (IHs). The operational environment of IHs is such that illness and traumatic injury requiring surgical intervention is common. This study sought to examine the general and orthopedic surgical experience at an IH to determine whether surgical care could be provided in an effective and safe manner. All patients evaluated by the general and orthopedic surgeon at Guantanamo Bay Naval Hospital from October 1, 1998, to April 1, 1999, were included in this study. The following data were retrospectively reviewed: patient demographic data, diagnosis, initial and follow-up care, medical evacuation data, operative procedures, and complications. There were 336 patients who presented for surgical evaluation, resulting in 660 follow-up appointments during the study period. There were 31 medical evacuations (3 emergent). The surgical services performed 122 major operative procedures. There were 58 inpatient admissions. There was 1 death, and surgical complications occurred in 2 patients, for an overall morbidity and mortality of 1.4% and 0.7%, respectively. Our data show that an IH is capable of providing surgical care, including care for traumatic injuries, in a safe manner. This is the first study that provides objective evidence that general and orthopedic surgery at an IH can be provided within the standard of care.

Ketamine. A solution to procedural pain in burned children.

PubMed

Groeneveld, A; Inkson, T

1992-09-01

Our experience has shown ketamine to be a safe and effective method of providing pain relief during specific procedures in burned children. It renders high doses of narcotics unnecessary and offers children the benefit of general anesthesia without the requirement of endotracheal intubation and a trip to the operating room. The response of parents and staff to the use of ketamine has been positive. Parents often experience feelings of guilt following injury to a child and are eager to employ methods that reduce their child's pain. So far, no parent has refused the administration of ketamine; some have even asked that it be used during subsequent procedures on their child. With adequate pre-procedure teaching, parents are prepared for the possible occurrence of emergent reactions and can assist in reorienting the child during recovery. Staff have found that the stress of doing painful procedures on children is reduced when ketamine is used. The procedures tend to be quicker and the predicament of working on a screaming, agitated child is eliminated. At the same time, nursing staff have had to get used to the nystagmic gaze of the children and accept that these patients are truly anesthetized even though they might move and talk. Despite the success we and others have had with ketamine, several questions about its use in burn patients remain unanswered. The literature does not answer such questions as: Which nursing measures reduce the incidence of emergent reactions? How many ketamine anesthetics can safely be administered to one individual? How does the frequency of administration relate to tolerance in a burn patient? Are there detrimental effects of frequent or long-term use? Clearly, an understanding of these questions is necessary to determine the safe boundaries of ketamine use in burn patients. Ketamine is not a panacea for the problem of pain in burned children. But it is one means of managing procedural pain, which is, after all, a significant clinical factor in treatment and recovery.

Protection of the CERN Large Hadron Collider

NASA Astrophysics Data System (ADS)

Schmidt, R.; Assmann, R.; Carlier, E.; Dehning, B.; Denz, R.; Goddard, B.; Holzer, E. B.; Kain, V.; Puccio, B.; Todd, B.; Uythoven, J.; Wenninger, J.; Zerlauth, M.

2006-11-01

The Large Hadron Collider (LHC) at CERN will collide two counter-rotating proton beams, each with an energy of 7 TeV. The energy stored in the superconducting magnet system will exceed 10 GJ, and each beam has a stored energy of 362 MJ which could cause major damage to accelerator equipment in the case of uncontrolled beam loss. Safe operation of the LHC will therefore rely on a complex system for equipment protection. The systems for protection of the superconducting magnets in case of quench must be fully operational before powering the magnets. For safe injection of the 450 GeV beam into the LHC, beam absorbers must be in their correct positions and specific procedures must be applied. Requirements for safe operation throughout the cycle necessitate early detection of failures within the equipment, and active monitoring of the beam with fast and reliable beam instrumentation, mainly beam loss monitors (BLM). When operating with circulating beams, the time constant for beam loss after a failure extends from apms to a few minutes—failures must be detected sufficiently early and transmitted to the beam interlock system that triggers a beam dump. It is essential that the beams are properly extracted on to the dump blocks at the end of a fill and in case of emergency, since the beam dump blocks are the only elements of the LHC that can withstand the impact of the full beam.

Audit of operative hysteroscopies among infertile women in a resource-poor setting.

PubMed

Ugboaja, Joseph O; Oguejiofor, Charlotte B; Ogelle, Onyecherelam M

2018-04-01

To evaluate the operative hysteroscopy procedures performed among infertile women at two hospitals in Nigeria. A prospective case series was undertaken among all patients with infertility who underwent operative hysteroscopy between November 2015 and April 2017. The outcome measures included the frequency and type of operative hysteroscopy and the reproductive outcome. The series included 159 women, 70.4% (n=112) of whom had abnormal findings at hysteroscopy. A total of 162 operative hysteroscopic procedures were performed; the most common procedures were adhesiolysis (76 [46.9%]), polypectomy (28 [17.3%]), and septum resection/incision (17 [10.5%]). The instruments used were mainly scissors (65 [40.1%]) and a resectoscope (52 [32.1%]). Complete removal of the lesions was achieved in 86.4% (n=140) of the procedures and a normal cavity in 87.0% (n=141). The complication rate was 6.8% (n=11); the most common complication was minor hemorrhage (5 [3.1%]). The main challenges included poor distention (10 [6.2%]) and poor vision (8 [4.9%]). Menstrual normalization was achieved in 64 (40.3%) of the patients, the cumulative pregnancy rate was 19.5% (n=31), and the live birth rate was 3.8% (n=6). Operative hysteroscopy was feasible and safe in the present resource-poor region. There is a need to build capacity for the performance of hysteroscopy to facilitate the management of infertility in the region. © 2017 International Federation of Gynecology and Obstetrics.

Surgical harvesting of bone graft from the ilium: point of view.

PubMed

Russell, J L; Block, J E

2000-12-01

Autologous bone harvested from the ilium is commonly used as a grafting material in surgical reconstructive and arthrodesis procedures to ensure a satisfactory postoperative outcome. However, operative removal of bone from the iliac crest requires an additional surgical procedure with a distinct set of postoperative complications. We provide a comprehensive literature synthesis of the incidence and severity of complications reported to be associated with this commonly practiced procedure. Most severe complications are rare, but chronic pain at the donor site exceeding three months in duration occurs frequently and can be particularly bothersome to patients. Alternative grafting materials that are safe and effective are sorely needed. Copyright 2000 Harcourt Publishers Ltd.

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.

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

Flight Technical Error Analysis of the SATS Higher Volume Operations Simulation and Flight Experiments

NASA Technical Reports Server (NTRS)

Williams, Daniel M.; Consiglio, Maria C.; Murdoch, Jennifer L.; Adams, Catherine H.

2005-01-01

This paper provides an analysis of Flight Technical Error (FTE) from recent SATS experiments, called the Higher Volume Operations (HVO) Simulation and Flight experiments, which NASA conducted to determine pilot acceptability of the HVO concept for normal operating conditions. Reported are FTE results from simulation and flight experiment data indicating the SATS HVO concept is viable and acceptable to low-time instrument rated pilots when compared with today s system (baseline). Described is the comparative FTE analysis of lateral, vertical, and airspeed deviations from the baseline and SATS HVO experimental flight procedures. Based on FTE analysis, all evaluation subjects, low-time instrument-rated pilots, flew the HVO procedures safely and proficiently in comparison to today s system. In all cases, the results of the flight experiment validated the results of the simulation experiment and confirm the utility of the simulation platform for comparative Human in the Loop (HITL) studies of SATS HVO and Baseline operations.

Fibre-endoscopic dilatation of peptic oesophageal strictures.

PubMed

Salo, J A; Ala-Kulju, K; Kalima, T

1987-01-01

51 patients with dysphagia caused by peptic oesophageal stricture due to primary or secondary reflux oesophagitis were treated by fibre-endoscope and Eder-Puestow dilatations under local anaesthesia and sedation, between 1976 and 1984. There was one death (2%) attributable to the procedure (perforation) and complications arose in three (6%) patients (perforation, pneumonia). The dilatation was successful in 96% but two patients (4%) had to be operated on because of undilatable stricture. Follow-up data was available for the other 44 patients for periods of one to eight (mean 2.8) years later. The stricture was cured by dilatation and antireflux treatment (conservative or operative) in all patients and 98% of them were able to eat solid food and improve their nutritional status. During follow-up 22 patients (50%) were asymptomatic and 22 (50%) had dysphagia or/and reflux symptoms. At endoscopy oesophagitis was healed with conservative or operative treatment in 25 patients (57%). It is concluded that fibre-endoscopic dilatation of peptic oesophageal strictures with the Eder-Puestow system combined with conservative or operative antireflux treatment, is a simple and safe procedure and gives good results in almost all patients. Surgical procedures aimed at total correction of the stricture are indicated only rarely in intractable cases.

Flight Experiment Investigation of General Aviation Self-Separation and Sequencing Tasks

NASA Technical Reports Server (NTRS)

Murdoch, Jennifer L.; Ramiscal, Ermin R.; McNabb, Jennifer L.; Bussink, Frank J. L.

2005-01-01

A new flight operations concept called Small Aircraft Transportation System (SATS) Higher Volume Operations (HVO) was developed to increase capacity during Instrument Meteorological Conditions (IMC) at non-towered, non-radar airports by enabling concurrent operations of multiple aircraft. One aspect of this concept involves having pilots safely self-separate from other aircraft during approaches into these airports using appropriate SATS HVO procedures. A flight experiment was conducted to determine if instrument-rated general aviation (GA) pilots could self-separate and sequence their ownship aircraft, while following a simulated aircraft, into a non-towered, non-radar airport during simulated IMC. Six GA pilots' workload levels and abilities to perform self-separation and sequencing procedures while flying a global positioning system (GPS) instrument approach procedure were examined. The results showed that the evaluation pilots maintained at least the minimum specified separation between their ownship aircraft and simulated traffic and maintained their assigned landing sequence 100-percent of the time. Neither flight path deviations nor subjective workload assessments were negatively impacted by the additional tasks of self-separating and sequencing during these instrument approaches.

Reliability of Cascaded THz Frequency Chains with Planar GaAs Circuits

NASA Technical Reports Server (NTRS)

Maiwald, Frank; Schlecht, Erich; Lin, Robert; Ward, John; Pearson, John; Siegel, Peter; Mehdi, Imran

2004-01-01

Planar GaAs Schottky diodes will be utilized for all of the LO chains on the HIPI instrument for the Herschel Space Observatory. A better understanding of device degradation mechanisms is desirable in order to specify environmental and operational conditions that do not reduce device life times. Failures and degradation associated with ESD (Electrostatic Discharge), high temperatures, DC currents and RF induced current and heating have been investigated. The goal is to establish a procedure to obtain the safe operating range for a given frequency multiplier.

Human Factors Analysis to Improve the Processing of Ares-1 Launch Vehicle

NASA Technical Reports Server (NTRS)

Stambolian, Damon B.; Dippolito, Gregory M.; Nyugen, Bao; Dischinger, Charles; Tran, Donald; Henderson, Gena; Barth, Tim

2011-01-01

This slide presentation reviews the use of Human Factors analysis in improving the ground processing procedures for the Ares-1 launch vehicle. The light vehicle engineering designers for Ares-l launch vehicle had to design the flight vehicle for effective, efficient and safe ground operations in the cramped dimensions in a rocket design. The use of a mockup of the area where the technician would be required to work proved to be a very effective method to promote the collaboration between the Ares-1 designers and the ground operations personnel.

Methodology for analyzing environmental quality indicators in a dynamic operating room environment.

PubMed

Gormley, Thomas; Markel, Troy A; Jones, Howard W; Wagner, Jennifer; Greeley, Damon; Clarke, James H; Abkowitz, Mark; Ostojic, John

2017-04-01

Sufficient quantities of quality air and controlled, unidirectional flow are important elements in providing a safe building environment for operating rooms. To make dynamic assessments of an operating room environment, a validated method of testing the multiple factors influencing the air quality in health care settings needed to be constructed. These include the following: temperature, humidity, particle load, number of microbial contaminants, pressurization, air velocity, and air distribution. The team developed the name environmental quality indicators (EQIs) to describe the overall air quality based on the actual measurements of these properties taken during the mock surgical procedures. These indicators were measured at 3 different hospitals during mock surgical procedures to simulate actual operating room conditions. EQIs included microbial assessments at the operating table and the back instrument table and real-time analysis of particle counts at 9 different defined locations in the operating suites. Air velocities were measured at the face of the supply diffusers, at the sterile field, at the back table, and at a return grille. The testing protocol provided consistent and comparable measurements of air quality indicators between institutions. At 20 air changes per hour (ACH), and an average temperature of 66.3°F, the median of the microbial contaminants for the 3 operating room sites ranged from 3-22 colony forming units (CFU)/m 3 at the sterile field and 5-27 CFU/m 3 at the back table. At 20 ACH, the median levels of the 0.5-µm particles at the 3 sites were 85,079, 85,325, and 912,232 in particles per cubic meter, with a predictable increase in particle load in the non-high-efficiency particulate air-filtered operating room site. Using a comparison with cleanroom standards, the microbial and particle counts in all 3 operating rooms were equivalent to International Organization for Standardization classifications 7 and 8 during the mock surgical procedures. The EQI protocol was measurable and repeatable and therefore can be safely used to evaluate air quality within the health care environment to provide guidance for operational practices and regulatory requirements. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Total laparoscopic reversal of Hartmann's procedure.

PubMed

Masoni, Luigi; Mari, Francesco Saverio; Nigri, Giuseppe; Favi, Francesco; Pindozzi, Fioralba; Dall'Oglio, Anna; Pancaldi, Alessandra; Brescia, Antonio

2013-01-01

Hartmann's procedure is still performed in those cases in which colorectal anastomosis might be unsafe. Reversal of Hartmann's procedure (HR) is considered a major surgical procedure with a high morbidity (55 to 60%) and mortality rate (0 to 4%). To decrease these rates, laparoscopic Hartmann's reversal procedure was successfully experienced. We report our totally laparoscopic Hartmann's reversal technique. Between 2004 and 2010 we performed 27 HRs with a totally laparoscopic approach. The efficacy and safety of this technique were demonstrated evaluating the operative data, postoperative complications, and the outcome of the patients. There were no open conversions or major intraoperative complications. Anastomotic leaking occurred in one patient requiring an ileostomy; one patient needed a blood transfusion and one had a nosocomial pneumonia. The mean postoperative hospitalization was 5.7 days. Laparoscopic HR is a feasible and safe procedure and can be considered a valid alternative to open HR.

Femtosecond Laser Micro-structuring Of Transparent Materials And Its Ophthalmologic Applications

NASA Astrophysics Data System (ADS)

Ionin, Andrey A.; Kozhushko, Svetlana E.; Kudryashov, Sergey I.; Seleznev, Leonid V.; Sinitsyn, Dmitry V.; Zakharov, Stanislav D.; Alekhin, Alexander I.; Kourylyova, Irina M.; Kuz'min, Kirill K.; Likhvantseva, Vera G.; Samoylov, Michail V.

2010-10-01

We have successfully fabricated in vitro femtosecond laser micro-incisions inside cornea and—for the first time—inside sclera mildly pre-cleared by a biocompatible and clinically safe (non-toxic) natural agent (replacive refractive index-matching 40%-glucose solution in water), with the tissues taken as fresh cool cuts of human cadaver eyes, and reported on basic operational conditions of the micro-surgical procedures.

Pressure system recertification at NASA-Langley Research Center

NASA Technical Reports Server (NTRS)

Hudson, C. M.; Ramsey, J. W., Jr.

1983-01-01

Langley Research Center pressure systems are being recertified to ensure safe operation of these systems. The procedures for recertifying these pressure systems are reviewed. Generally, the analysis and inspection requirements outlined in the appropriate national consensus codes are followed. In some instances where the requirements of these codes are not met. The systems are analyzed further, repaired, modified and/or tested to demonstrate their structural integrity.

Developing Performance Measures for Manned-Unmanned Teaming Skills

DTIC Science & Technology

2015-02-01

Moves aircraft to safe area Utilize standardized radio communication and signal operating procedures Perform BDA Utilize Standard report formats...UAS does not conduct BDA ; assumes target is destroyed without verification UAS evaluates target; reports BDA to engaging aircraft (or...ground unit) after prompting UAS evaluates target; proactively reports BDA to engaging aircraft (or ground unit) 1 2 3 4 5 1 2 3 4 5 B

Strengthening safety compliance in nuclear power operations: a role-based approach.

PubMed

Martínez-Córcoles, Mario; Gracia, Francisco J; Tomás, Inés; Peiró, José M

2014-07-01

Safety compliance is of paramount importance in guaranteeing the safe running of nuclear power plants. However, it depends mostly on procedures that do not always involve the safest outcomes. This article introduces an empirical model based on the organizational role theory to analyze the influence of legitimate sources of expectations (procedures formalization and leadership) on workers' compliance behaviors. The sample was composed of 495 employees from two Spanish nuclear power plants. Structural equation analysis showed that, in spite of some problematic effects of proceduralization (such as role conflict and role ambiguity), procedure formalization along with an empowering leadership style lead to safety compliance by clarifying a worker's role in safety. Implications of these findings for safety research are outlined, as well as their practical implications. © 2014 Society for Risk Analysis.

Development of a Flexible Computerized Management Infrastructure for a Commercial Nuclear Power Plant

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

Ali, Syed Firasat; Hajek, Brian K.; Usman, Shoaib

The report emphasizes smooth transition from paper-based procedure systems (PBPSs) to computer-based procedure systems (CBPSs) for the existing commercial nuclear power plants in the U.S. The expected advantages and of the transition are mentioned including continued, safe and efficient operation of the plants under their recently acquired or desired extended licenses. The report proposes a three-stage survey to aid in developing a national strategic plan for the transition from PBPSs to CBPSs. It also includes a comprehensive questionnaire that can be readily used for the first stage of the suggested survey.

[In the case of "difficult" tracheotomy].

PubMed

Nowak, Katarzyna; Szyfter, Witold

2008-01-01

Difficulties from open surgical procedures are common. The severity and frequency of these occurences depends on several factors: anatomic, physiologic, kind of local patology and skills and experience of operator. The incidents of undesires outcomes during tracheostomy can not be exactly predictet because interactions of the above issues. This paper consider some of difficulties observed in our department from January 2000 to July 2007. Tracheotomy is usssually a safe procedure, but complication ranging could be high in the following conditions: morbid obesy, a short and thick neck, cervical stiffness, tumors and infiltrantions of the neck, thyroid gland tumors.

Training for laparoscopic pancreaticoduodenectomy.

PubMed

Kuroki, Tamotsu; Fujioka, Hikaru

2018-05-10

In recent years, laparoscopic procedures have developed rapidly, and the reports of laparoscopic pancreatic resection including laparoscopic pancreaticoduodenectomy (LPD) have increased in number. Although LPD is a complex procedure with high mortality, the training system for LPD remains unestablished. Ensuring patient safety is extremely important, even in challenging surgeries such a LPD. At present, several tools have been developed for surgical education to ensure patient safety preoperatively, such as video learning, virtual reality simulators, and cadaver training. Although LPD is reported as a safe and feasible choice, LPD is still a challenging operation. An LPD training system should be established with a board-certified system.

Intra-operative device closure of perimembranous ventricular septal defect without cardiopulmonary bypass under guidance of trans-epicardial echocardiography: a single center experience.

PubMed

Sun, Yong; Zhu, Peng; Zhou, Pengyu; Guo, Yilong; Zheng, Shao-Yi

2016-05-27

Intraoperative device closure of perimembranous ventricular septal defect(VSD) through a lower mini-sternotomy is safe, less invasive, and has excellent surgical and cosmetic outcomes. Our study is to evaluate the feasibility of closing VSD under guidance of trans-epicardial echocardiography. We reviewed the clinical course of 41 patients referred to our institution for minimally invasive closure of perimembranous VSD. The trans-epicardial echocardiography(TEE) was used to monitor the whole procedure to guide the positioning of device and evaluate the operative effect instantly after operation. The procedure was successfully done in 38 patients(92.6 %) with mean age of 1.2 ± 1.5 years(range 0.5-6.1 years),mean weight of 10.78 ± 6.87 kg(range 5.2 ~ 26 kg) and VSD size of 5.1 ± 1.13 mm(range 5 ~ 10 mm). Three cases failed, including two cases whose guide-wires could not pass through VSDs and one case whose occluder could not repair VSD well. Three patients had tiny residual shunts because of the shifting of occluders. There were no major complications such as arrhythmia, valve regurgitation and the failure of occluder during follow-up(Mean 2.3 ± 1.2 years). TEE provided superior imaging of shapes and surrounding structures of the VSDs, and guide-wires passing through VSDs. Intraoperative device closure of perimembranous VSD through a lower mini-sternotomy without cardiopulmonary bypass appears to be a safe and effective procedure. The use of trans-epicardial echocardiography provides useful information for intraoperative device closure of VSD.

The Small Aircraft Transportation System (SATS), Higher Volume Operations (HVO) Concept and Research

NASA Technical Reports Server (NTRS)

Baxley, B.; Williams, D.; Consiglio, M.; Adams, C.; Abbott, T.

2005-01-01

The ability to conduct concurrent, multiple aircraft operations in poor weather at virtually any airport offers an important opportunity for a significant increase in the rate of flight operations, a major improvement in passenger convenience, and the potential to foster growth of operations at small airports. The Small Aircraft Transportation System, (SATS) Higher Volume Operations (HVO) concept is designed to increase capacity at the 3400 non-radar, non-towered airports in the United States where operations are currently restricted to one-in/one-out procedural separation during low visibility or ceilings. The concept s key feature is that pilots maintain their own separation from other aircraft using air-to-air datalink and on-board software within the Self-Controlled Area (SCA), an area of flight operations established during poor visibility and low ceilings around an airport without Air Traffic Control (ATC) services. While pilots self-separate within the SCA, an Airport Management Module (AMM) located at the airport assigns arriving pilots their sequence based on aircraft performance, position, winds, missed approach requirements, and ATC intent. The HVO design uses distributed decision-making, safe procedures, attempts to minimize pilot and controller workload, and integrates with today's ATC environment. The HVO procedures have pilots make their own flight path decisions when flying in Instrument Metrological Conditions (IMC) while meeting these requirements. This paper summarizes the HVO concept and procedures, presents a summary of the research conducted and results, and outlines areas where future HVO research is required. More information about SATS HVO can be found at http://ntrs.nasa.gov.

A Unique BSL-3 Cryo-Electron Microscopy Laboratory at UTMB

PubMed Central

Sherman, Michael B.; Freiberg, Alexander N.; Razmus, Dennis; Yazuka, Shintaro; Koht, Craig; Hilser, Vincent J.; Lemon, Stanley M.; Brocard, Anne-Sophie; Zimmerman, Dee; Chiu, Wah; Watowich, Stanley J.; Weaver, Scott C.

2010-01-01

This article describes a unique cryo-electron microscopy (CryoEM) facility to study the three-dimensional organization of viruses at biological safety level 3 (BSL-3). This facility, the W. M. Keck Center for Virus Imaging, has successfully operated for more than a year without incident and was cleared for select agent studies by the Centers for Disease Control and Prevention (CDC). Standard operating procedures for the laboratory were developed and implemented to ensure its safe and efficient operation. This facility at the University of Texas Medical Branch (Galveston, TX) is the only such BSL-3 CryoEM facility approved for select agent research. PMID:21852942

Radioactive waste management in a hospital.

PubMed

Khan, Shoukat; Syed, At; Ahmad, Reyaz; Rather, Tanveer A; Ajaz, M; Jan, Fa

2010-01-01

Most of the tertiary care hospitals use radioisotopes for diagnostic and therapeutic applications. Safe disposal of the radioactive waste is a vital component of the overall management of the hospital waste. An important objective in radioactive waste management is to ensure that the radiation exposure to an individual (Public, Radiation worker, Patient) and the environment does not exceed the prescribed safe limits. Disposal of Radioactive waste in public domain is undertaken in accordance with the Atomic Energy (Safe disposal of radioactive waste) rules of 1987 promulgated by the Indian Central Government Atomic Energy Act 1962. Any prospective plan of a hospital that intends using radioisotopes for diagnostic and therapeutic procedures needs to have sufficient infrastructural and manpower resources to keep its ambient radiation levels within specified safe limits. Regular monitoring of hospital area and radiation workers is mandatory to assess the quality of radiation safety. Records should be maintained to identify the quality and quantity of radioactive waste generated and the mode of its disposal. Radiation Safety officer plays a key role in the waste disposal operations.

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.

76 FR 37014 - Expedited Approval of Alternative Test Procedures for the Analysis of Contaminants Under the Safe...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-24

...; Analysis and Sampling Procedures AGENCY: Environmental Protection Agency (EPA). ACTION: Final rule. SUMMARY... Contaminants Under the Safe Drinking Water Act; Analysis and Sampling Procedures. 75 FR 32295. June 8, 2010...

Contact laser prostatectomy in a patient on chronic anticoagulation

NASA Astrophysics Data System (ADS)

Mueller, Edward J.

1995-05-01

The `gold standard' therapy for patients with symptomatic bladder outlet obstruction secondary to benign prostatic hyperplasia has always been electrocautery TURP. However, in patients with medical problems requiring chronic anticoagulation, this procedure is contraindicated due to the extreme risk of hemorrhage, both during the procedure and the immediate post operative period. With the recent development of contact laser prostatectomy the patient on chronic anticoagulation can safely undergo the procedure. Herein, I present a case of a 60 year old with significant bladder outlet obstruction yielding an AUA symptom score of 18. The patient had a history of multiple episodes of deep venous thrombosis of the left leg with three prior pulmonary emboli. He was maintained on chronic anticoagulation with alternating days of 3.5 mg. and 5.0 mg. of warfarin sodium (coumadin). Preoperative cystoscopy showed a 4 cm prostatic fossa obstructed by tri-lobar hypertrophy, with large kissing lateral lobes and visual obstruction from the verumontanum. The patient underwent a contact laser prostatectomy with the SLT Nd:YAG laser at 50 watts. There was minimal bleeding both during the procedure and in the immediate postoperative period. At three months post-op the AUA symptom score had decreased to 2. This case demonstrated that contact laser prostatectomy can be safely and effectively performed in patients on chronic anticoagulation.

Aircraft loss-of-control prevention and recovery: A hybrid control strategy

NASA Astrophysics Data System (ADS)

Dongmo, Jean-Etienne Temgoua

The Complexity of modern commercial and military aircrafts has necessitated better protection and recovery systems. With the tremendous advances in computer technology, control theory and better mathematical models, a number of issues (Prevention, Reconfiguration, Recovery, Operation near critical points, ... etc) moderately addressed in the past have regained interest in the aeronautical industry. Flight envelope is essential in all flying aerospace vehicles. Typically, flying the vehicle means remaining within the flight envelope at all times. Operation outside the normal flight regime is usually subject to failure of components (Actuators, Engines, Deflection Surfaces) , pilots's mistakes, maneuverability near critical points and environmental conditions (crosswinds...) and in general characterized as Loss-Of-Control (LOC) because the aircraft no longer responds to pilot's inputs as expected. For the purpose of this work, (LOC) in aircraft is defined as the departure from the safe set (controlled flight) recognized as the maximum controllable (reachable) set in the initial flight envelope. The LOC can be reached either through failure, unintended maneuvers, evolution near irregular points and disturbances. A coordinated strategy is investigated and designed to ensure that the aircraft can maneuver safely in their constraint domain and can also recover from abnormal regime. The procedure involves the computation of the largest controllable (reachable) set (Safe set) contained in the initial prescribed envelope. The problem is posed as a reachability problem using Hamilton-Jacobi Partial Differential Equation (HJ-PDE) where a cost function is set to he minimized along trajectory departing from the given set. Prevention is then obtained by computing the controller which would allow the flight vehicle to remain in the maximum controlled set in a multi-objective set up. Then the recovery procedure is illustrated with a two-point boundary value problem. Once illustrate, a set of control strategies is designed for recovery purpose ranging from nonlinear smooth regulators with Hamilton Jacobi-Hellman (HJB) formulation to the switching controllers with High Order Sliding Mode Controllers (HOSMC). A coordinated strategy known as a high level supervisor is then implemented using the multi-models concept where models operate in specified safe regions of the state space.

Nonintubated uniportal VATS pulmonary anatomical resections

PubMed Central

Navarro-Martinez, Jose; Bolufer, Sergio; Lirio, Francisco; Sesma, Julio; Corcoles, Juan Manuel

2017-01-01

Nonintubated procedures have widely developed during the last years, thus nowadays major anatomical resections are performed in spontaneously breathing patients in some centers. In an attempt for combining less invasive surgical approaches with less aggressive anesthesia, nonintubated uniportal video-assisted thoracic surgery (VATS) lobectomies and segmentectomies have been proved feasible and safe, but there are no comparative trials and the evidence is still poor. A program in nonintubated uniportal major surgery should be started in highly experienced units, overcoming first a learning period performing minor procedures and a training program for the management of potential crisis situations when operating on these patients. A multidisciplinary approach including all the professionals in the operating room (OR), emergency protocols and a comprehensive knowledge of the special physiology of nonintubated surgery are mandatory. Some concerns about regional analgesia, vagal block for cough reflex control and oxygenation techniques, combined with some specific surgical tips can make safer these procedures. Specialists must remember an essential global concept: all the efforts are aimed at decreasing the invasiveness of the whole procedure in order to benefit patients’ intraoperative status and postoperative recovery. PMID:29078680

Nonintubated uniportal VATS pulmonary anatomical resections.

PubMed

Galvez, Carlos; Navarro-Martinez, Jose; Bolufer, Sergio; Lirio, Francisco; Sesma, Julio; Corcoles, Juan Manuel

2017-01-01

Nonintubated procedures have widely developed during the last years, thus nowadays major anatomical resections are performed in spontaneously breathing patients in some centers. In an attempt for combining less invasive surgical approaches with less aggressive anesthesia, nonintubated uniportal video-assisted thoracic surgery (VATS) lobectomies and segmentectomies have been proved feasible and safe, but there are no comparative trials and the evidence is still poor. A program in nonintubated uniportal major surgery should be started in highly experienced units, overcoming first a learning period performing minor procedures and a training program for the management of potential crisis situations when operating on these patients. A multidisciplinary approach including all the professionals in the operating room (OR), emergency protocols and a comprehensive knowledge of the special physiology of nonintubated surgery are mandatory. Some concerns about regional analgesia, vagal block for cough reflex control and oxygenation techniques, combined with some specific surgical tips can make safer these procedures. Specialists must remember an essential global concept: all the efforts are aimed at decreasing the invasiveness of the whole procedure in order to benefit patients' intraoperative status and postoperative recovery.

Use of a mobile tower-based robot--The initial Xi robot experience in surgical oncology.

PubMed

Yuh, Bertram; Yu, Xian; Raytis, John; Lew, Michael; Fong, Yuman; Lau, Clayton

2016-01-01

The da Vinci Xi platform provides expanded movement of the arms relative to the base, theoretically allowing increased versatility in complex multi-field or multi-quadrant surgery. We describe the initial Xi experience in oncologic surgery at a tertiary cancer center. One hundred thirty unique robot-assisted procedures were performed using the Xi between 2014 and 2015, 112 of which were oncology surgeries. For procedures involving multiple quadrants, the robot was re-targeted. Complications were assessed according to Martin criteria and the Clavien-Dindo classification up to 90 days after operation. Thirteen different operations were performed in five oncology subspecialties (urology, gynecology, thoracic, hepatobiliary, and gastrointestinal surgery). Median operative times ranged from 183 min for nephroureterectomy to 543 min for esophagogastrectomy. Median estimated blood loss did not exceed 200 ml for any of the categorized procedures . No patients were transfused intraoperatively and no positioning injuries occurred. Conversions to open operation occurred in three cases (2.7%), though not related to complications or technical considerations. Overall complication rate was 26% with major complication rate of 4%. Readmissions were necessary in 11 (10%) patients. The da Vinci Xi can be safely assimilated into a surgical oncology program. The Xi offers versatility to various oncologic procedures with satisfactory complication and readmission rates. © 2015 Wiley Periodicals, Inc.

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.

Lessons Learned With Laparoscopic Management of Complicated Grades of Acute Appendicitis

PubMed Central

Gomes, Carlos Augusto; Junior, Cleber Soares; Costa, Evandro de Freitas Campos; Alves, Paula de Assis Pereira; de Faria, Carolina Vieira; Cangussu, Igor Vitoi; Costa, Luisa Pires; Gomes, Camila Couto; Gomes, Felipe Couto

2014-01-01

Background Laparoscopy has not been consolidated as the approach of first choice in the management of complicated appendicitis. Methodological flaws and absence of disease stratification criteria have been implicated in that less evidence. The objective is to study the safe and effectiveness of laparoscopy in the management of complicated appendicitis according to laparoscopic grading system. Method From January 2008 to January 2011, 154 consecutive patients who underwent a laparoscopic appendectomy for complicated appendicitis were evaluated in the prospective way. The patient’s age ranged from 12 to 75 years old (31.7 ± 13.3) and 58.3% were male. Complicated appendicitis refers to gangrenous and/or perforated appendix and were graded as 3A (segmental necrosis), 3B (base necrosis), 4A (abscess), 4B (regional peritonitis) and 5 (diffuse peritonitis). The outcomes including operative time, infection complication, operative complications and conversion rate were chosen to evaluate the procedure. Results The grade 3A was the most frequent with 50 (32.4%) patients. The mean operative time was 69.4 ± 26.3 minutes. The grade 4A showed the highest mean operative time (80.1 ± 26.7 minutes). The wound and intra-abdominal infection rates were 2.6 and 4.6%, respectively. The base necrosis was the most important factor associated with the conversion (5.2%). The grades 4A and 5 were associated with greater possibility of intra-abdominal collection. There were no operative complications. Conclusion The laparoscopic management of all complicated grades of acute appendicitis is safe and effective and should be the procedure of first choice. The laparoscopic grading system allows us to assess patients in the same disease stage. PMID:24883151

Positioning of the patient during shoulder surgery: an inexpensive, safe and easy technique.

PubMed

Van Tongel, Alexander; Hardeman, François; Karelse, Anne; de Wilde, Lieven

2013-01-01

The knowledge of shoulder pathology has improved tremendously in the last decades, and shoulder surgery is increasingly performed because of new treatment options and better operative results. Nowadays most surgical shoulder procedures are performed in the sitting or semi-sitting (beach chair) position. Stability of the patient and the ability to flex, extend and rotate the shoulder during surgery are crucial to improve exposure of the surgical field and lower the risk of perioperative complications. We developed an easy, safe and inexpensive surgical set-up providing a very good posterior, superior and anterior access to the shoulder in the sitting or semi-sitting position. In this technique, the patient is placed supine with the head at the foot end of the table and the body positioned slightly eccentrically with the back being supported by the leg plate contralateral to the operative side, avoiding any contact with the scapula of the operative side. A neck support is attached on an extra bar at the contralateral side and accommodated to the patient's lordosis. Next, the leg plate on the operative side is removed, and the head and the body are secured to the table with adhesive dressing. This way a stable positioning of the patient is obtained during the whole procedure, and the shoulder girdle is completely free. The set-up can accommodate patients of different stature and weight without the need to adapt the technique. This position also gives the possibility to provide an excellent radiographic view of the shoulder during operative fracture treatment. Our technique further allows a significant reduction in costs. A surgical table, extra bar, additional arm support and neck support are usually available and can be used in different settings, without the need for a specific shoulder table.

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.

Cost Savings and Patient Experiences of a Clinic-Based, Wide-Awake Hand Surgery Program at a Military Medical Center: A Critical Analysis of the First 100 Procedures.

PubMed

Rhee, Peter C; Fischer, Michelle M; Rhee, Laura S; McMillan, Ha; Johnson, Anthony E

2017-03-01

Wide-awake, local anesthesia, no tourniquet (WALANT) hand surgery was developed to improve access to hand surgery care while optimizing medical resources. Hand surgery in the clinic setting may result in substantial cost savings for the United States Military Health Care System (MHS) and provide a safe alternative to performing similar procedures in the operating room. A prospective cohort study was performed on the first 100 consecutive clinic-based WALANT hand surgery procedures performed at a military medical center from January 2014 to September 2015 by a single hand surgeon. Cost savings analysis was performed by using the Medical Expense and Performance Reporting System, the standard cost accounting system for the MHS, to compare procedures performed in the clinic versus the operating room during the study period. A study specific questionnaire was obtained for 66 procedures to evaluate the patient's experience. For carpal tunnel release (n = 34) and A1 pulley release (n = 33), there were 85% and 70% cost savings by having the procedures performed in clinic under WALANT compared with the main operating room, respectively. During the study period, carpal tunnel release, A1 pulley release, and de Quervain release performed in the clinic instead of the operating room amounted to $393,100 in cost savings for the MHS. There were no adverse events during the WALANT procedure. A clinic-based WALANT hand surgery program at a military medical center results in considerable cost savings for the MHS. Economic/Decision Analysis IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Does speed matter? The impact of operative time on outcome in laparoscopic surgery

PubMed Central

Jackson, Timothy D.; Wannares, Jeffrey J.; Lancaster, R. Todd; Rattner, David W.

2012-01-01

Introduction Controversy exists concerning the importance of operative time on patient outcomes. It is unclear whether faster is better or haste makes waste or similarly whether slower procedures represent a safe, meticulous approach or inexperienced dawdling. The objective of the present study was to determine the effect of operative time on 30-day outcomes in laparoscopic surgery. Methods Patients who underwent laparoscopic general surgery procedures (colectomy, cholecystectomy, Nissen fundoplication, inguinal hernia, and gastric bypass) from the ACS-NSQIP 2005–2008 participant use file were identified. Exclusion criteria were defined a priori to identify same-day admission, elective procedures. Operative time was divided into deciles and summary statistics were analyzed. Univariate analyses using a Cochran-Armitage test for trend were completed. The effect of operative time on 30-day morbidity was further analyzed for each procedure type using multivariate regression controlling for case complexity and additional patient factors. Patients within the highest deciles were excluded to reduce outlier effect. Results A total of 76,748 elective general surgical patients who underwent laparoscopic procedures were analyzed. Univariate analyses of deciles of operative time demonstrated a statistically significant trend (p \\ 0.0001) toward increasing odds of complications with increasing operative time for laparoscopic colectomy (n = 10,135), cholecystectomy (n = 37,407), Nissen fundoplication (n = 4,934), and gastric bypass (n = 17,842). The trend was not found to be significant for laparoscopic inguinal hernia repair (n = 6,430; p = 0.14). Multivariate modeling revealed the effect of operative time to remain significant after controlling for additional patient factors. Conclusion Increasing operative time was associated with increased odds of complications and, therefore, it appears that speed may matter in laparoscopic surgery. These analyses are limited in their inability to adjust for all patient factors, potential confounders, and case complexities. Additional hierarchical multivariate analyses at the surgeon level would be important to examine this relationship further. PMID:21298533

Does speed matter? The impact of operative time on outcome in laparoscopic surgery.

PubMed

Jackson, Timothy D; Wannares, Jeffrey J; Lancaster, R Todd; Rattner, David W; Hutter, Matthew M

2011-07-01

Controversy exists concerning the importance of operative time on patient outcomes. It is unclear whether faster is better or haste makes waste or similarly whether slower procedures represent a safe, meticulous approach or inexperienced dawdling. The objective of the present study was to determine the effect of operative time on 30-day outcomes in laparoscopic surgery. Patients who underwent laparoscopic general surgery procedures (colectomy, cholecystectomy, Nissen fundoplication, inguinal hernia, and gastric bypass) from the ACS-NSQIP 2005-2008 participant use file were identified. Exclusion criteria were defined a priori to identify same-day admission, elective procedures. Operative time was divided into deciles and summary statistics were analyzed. Univariate analyses using a Cochran-Armitage test for trend were completed. The effect of operative time on 30-day morbidity was further analyzed for each procedure type using multivariate regression controlling for case complexity and additional patient factors. Patients within the highest deciles were excluded to reduce outlier effect. A total of 76,748 elective general surgical patients who underwent laparoscopic procedures were analyzed. Univariate analyses of deciles of operative time demonstrated a statistically significant trend (p<0.0001) toward increasing odds of complications with increasing operative time for laparoscopic colectomy (n=10,135), cholecystectomy (n=37,407), Nissen fundoplication (n=4,934), and gastric bypass (n=17,842). The trend was not found to be significant for laparoscopic inguinal hernia repair (n=6,430; p=0.14). Multivariate modeling revealed the effect of operative time to remain significant after controlling for additional patient factors. Increasing operative time was associated with increased odds of complications and, therefore, it appears that speed may matter in laparoscopic surgery. These analyses are limited in their inability to adjust for all patient factors, potential confounders, and case complexities. Additional hierarchical multivariate analyses at the surgeon level would be important to examine this relationship further.

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

Das, Raj, E-mail: rajdas@nhs.net, E-mail: raj.das@stgeorges.nhs.uk; Lucatelli, Pierleone, E-mail: pierleone.lucatelli@gmail.com; Wang, Haofan, E-mail: wwhhff123@gmail.com

AimA clear understanding of operator experience is important in improving technical success whilst minimising patient risk undergoing endovascular procedures, and there is the need to ensure that trainees have the appropriate skills as primary operators. The aim of the study is to retrospectively analyse uterine artery embolisation (UAE) procedures performed by interventional radiology (IR) trainees at an IR training unit analysing fluoroscopy times and radiation dose as surrogate markers of technical skill.MethodsTen IR fellows were primary operator in 200 UAE procedures over a 5-year period. We compared fluoroscopy times, radiation dose and complications, after having them categorised according to threemore » groups: Group 1, initial five, Group 2, >5 procedures and Group 3, penultimate five UAE procedures. We documented factors that may affect screening time (number of vials employed and use of microcatheters).ResultsMean fluoroscopy time was 18.4 (±8.1), 17.3 (±9.0), 16.3 (±8.4) min in Groups 1, 2 and 3, respectively. There was no statistically significant difference between these groups (p > 0.05) with respect to fluoroscopy time or radiation dose. Analysis after correction for confounding factors showed no statistical significance (p > 0.05). All procedures were technically successful, and total complication rate was 4 %.ConclusionUAE was chosen as a highly standardised procedure followed by IR practitioners. Although there is a non-significant trend for shorter screening times with experience, technical success and safety were not compromised with appropriate Consultant supervision, which illustrates a safe construct for IR training. This is important and reassuring information for patients undergoing a procedure in a training unit.« less

Comparison of treatment costs of laparoscopic and open surgery.

PubMed

Śmigielski, Jacek A; Piskorz, Łukasz; Koptas, Włodzimierz

2015-09-01

Laparoscopy has been a standard procedure in most medical centres providing surgical services for many years. Both the range and number of laparoscopic procedures performed are constantly increasing. Over the last decade, laparoscopic procedures have been successfully applied both in emergency and oncological surgery. However, treatment costs have become a more important factor in choosing between open or laparoscopic procedures. To present the total real costs of open and laparoscopic cholecystectomy, appendectomy and sigmoidectomy. Between 1 May 2010 and 30 March 2015 in the Department of Thoracic Surgery, General and Oncological Surgery, Medical University of Lodz, and in the Department of General Surgery of the Saint John of God Hospital, Lodz, doctors performed 1404 cholecystectomies, 392 appendectomies and 88 sigmoidectomies. A total of 97% of the cholecystectomy procedures were laparoscopic and 3% were open. Similarly, 22% of total appendectomies were laparoscopic and 78% were open, while 9% of sigmoidectomies were laparoscopic and 91% open. The requirement for single-use equipment in laparoscopic procedures increases the expense. However, after adding up all other costs, surprisingly, differences between the costs of laparoscopic and open procedures ranged from 451 PLN/€ 114 for laparoscopic operations to 611 PLN/€ 153 for open operations. Laparoscopic cholecystectomy, considered the standard surgery for treating gallbladder diseases, is cheaper than open cholecystectomy. Laparoscopic appendectomy and sigmoidectomy are safe methods of minimally invasive surgery, slightly more expensive than open operations. Of all the analyzed procedures, one-day laparoscopic cholecystectomy is the most profitable. The costs of both laparoscopic and open sigmoidectomy are greatly underestimated in Poland.

Robot-assisted general surgery.

PubMed

Hazey, Jeffrey W; Melvin, W Scott

2004-06-01

With the initiation of laparoscopic techniques in general surgery, we have seen a significant expansion of minimally invasive techniques in the last 16 years. More recently, robotic-assisted laparoscopy has moved into the general surgeon's armamentarium to address some of the shortcomings of laparoscopic surgery. AESOP (Computer Motion, Goleta, CA) addressed the issue of visualization as a robotic camera holder. With the introduction of the ZEUS robotic surgical system (Computer Motion), the ability to remotely operate laparoscopic instruments became a reality. US Food and Drug Administration approval in July 2000 of the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA) further defined the ability of a robotic-assist device to address limitations in laparoscopy. This includes a significant improvement in instrument dexterity, dampening of natural hand tremors, three-dimensional visualization, ergonomics, and camera stability. As experience with robotic technology increased and its applications to advanced laparoscopic procedures have become more understood, more procedures have been performed with robotic assistance. Numerous studies have shown equivalent or improved patient outcomes when robotic-assist devices are used. Initially, robotic-assisted laparoscopic cholecystectomy was deemed safe, and now robotics has been shown to be safe in foregut procedures, including Nissen fundoplication, Heller myotomy, gastric banding procedures, and Roux-en-Y gastric bypass. These techniques have been extrapolated to solid-organ procedures (splenectomy, adrenalectomy, and pancreatic surgery) as well as robotic-assisted laparoscopic colectomy. In this chapter, we review the evolution of robotic technology and its applications in general surgical procedures.

Prepare to protect: Operating and maintaining a tornado safe room.

PubMed

Herseth, Andrew; Goldsmith-Grinspoon, Jennifer; Scott, Pataya

2017-06-01

Operating and maintaining a tornado safe room can be critical to the effective continuity of business operations because a firm's most valuable asset is its people. This paper describes aspects of operations and maintenance (O&M) for existing tornado safe rooms as well as a few planning and design aspects that affect the ultimate operation of a safe room for situations where a safe room is planned, but not yet constructed. The information is based on several Federal Emergency Management Agency safe room publications that provide guidance on emergency management and operations, as well as the design and construction of tornado safe rooms.

Oral surgery in a patient with cirrhosis and thrombocytopenia: a case report.

PubMed

Patel, Seena; Perry, Maureen Munnelly; Spolarich, Ann Eshenaur

2016-01-01

While most oral surgical procedures can be safely performed in an outpatient setting, certain medical conditions may present a higher chance of postoperative complications. In particular, those predisposing the patient to bleeding abnormalities pose a potential risk when performing such treatments. The authors report a case involving full-mouth extractions in a patient with cirrhosis and thrombocytopenia after obtaining a platelet transfusion. A 62-year-old Caucasian female presented to a university special care dental clinic requiring extractions. Her pertinent medical history was remarkable for cirrhosis and thrombocytopenia, with a platelet count of 32,000/uL. Upon medical consultation, the patient was appointed for a prophylactic platelet transfusion. The surgery was rendered uneventfully, and the patient achieved adequate hemostasis without hospitalization. Patients with cirrhosis pose a potential bleeding risk with dental surgical procedures. Pre-operative medical consultation, review of pertinent laboratory values, and prophylactic platelet transfusion allow these patients to be managed safely in an outpatient setting. © 2015 Special Care Dentistry Association and Wiley Periodicals, Inc.

Prehospital Use of Plasma for Traumatic Hemorrhage

DTIC Science & Technology

2014-06-01

known reagent B- cells o Mix o Spin in centrifuge for 15 seconds o Read for agglutination macroscopically o If agglutination is present, the unit...of days in the hospital, number of days on a ventilator, number of operations, number of infections, and cumulative utilization of blood products...procedure development and the items to be accomplished follow: GOALS:  Safe and adequate delivery, storage, and handover of plasma from Blood

Endoscopic sphenopalatine artery ligation for acute idiopathic epistaxis. Do anatomical variation and a limited evidence base raise questions regarding its place in management?

PubMed

Ellinas, A; Jervis, P; Kenyon, G; Flood, L M

2017-04-01

Endoscopic sphenopalatine artery ligation is widely accepted as effective and safe for acute spontaneous epistaxis that is unresponsive to conservative management. As with many new procedures, it has been progressively adopted as common practice, despite a limited evidence base for its efficacy. Early reviews called for comparative trials to support its adoption, but subsequent literature largely consists of case series and narrative reviews. These have attempted to derive an algorithm to establish its place in management, but consensus is still lacking. Intuitively, although there are theoretical objections, an operation regarded as relatively simple, fast and safe hardly seems to demand high-level evidence of efficacy. Rhinologists may be influenced by years of personal experience and success with the technique. However, estimates of the effect size and the added contribution to traditional surgical management are lacking. If the procedure could be shown to dramatically influence outcome, it should be standard practice and indispensable for all patients requiring operative intervention. This paper systematically examined the literature, appraising the anatomical basis for such an approach and evidence for its efficacy. It questions whether any units unable to consistently offer endoscopic sphenopalatine artery ligation should be undertaking surgical management of acute epistaxis.

Non-invasive ventilation after surgery in amyotrophic lateral sclerosis.

PubMed

Olivieri, C; Castioni, C A; Livigni, S; Bersano, E; Cantello, R; Della Corte, F; Mazzini, L

2014-04-01

Surgery in patients affected by amyotrophic lateral sclerosis (ALS) presents a particular anesthetic challenge because of the risk of post-operative pulmonary complications. We report on the use of non-invasive ventilation (NIV) to prevent post-operative pulmonary complications (PPCs) in nine patients affected by ALS enrolled in a phase-1 clinical trial with stem cell transplantation. All patients were treated with autologous mesenchymal stem cells implanted into the spinal cord with a surgical procedure. Anesthesia was induced with propofol and maintained with remifentanil and sevoflurane. No muscle relaxant was used. After awakening and regain of spontaneous breathing, patients were tracheally extubated. Non-invasive ventilation through nasal mask was delivered and non-invasive positive pressure ventilation and continuous positive pressure ventilation were started. The average time on NIV after surgery was 3 h and 12 min. All patients regained stable spontaneous breathing after NIV discontinuation and had no episodes of respiratory failure until the following day. Our case series suggest that the use of NIV after surgery can be a safe strategy to prevent PPCs in patients affected by ALS. The perioperative procedure we chose for these patients appeared safe even in patients with advanced functional stage of the disease. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Design Guidance for Computer-Based Procedures for Field Workers

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

Oxstrand, Johanna; Le Blanc, Katya; Bly, Aaron

Nearly all activities that involve human interaction with nuclear power plant systems are guided by procedures, instructions, or checklists. Paper-based procedures (PBPs) currently used by most utilities have a demonstrated history of ensuring safety; however, improving procedure use could yield significant savings in increased efficiency, as well as improved safety through human performance gains. The nuclear industry is constantly trying to find ways to decrease human error rates, especially human error rates associated with procedure use. As a step toward the goal of improving field workers’ procedure use and adherence and hence improve human performance and overall system reliability, themore » U.S. Department of Energy Light Water Reactor Sustainability (LWRS) Program researchers, together with the nuclear industry, have been investigating the possibility and feasibility of replacing current paper-based procedures with computer-based procedures (CBPs). PBPs have ensured safe operation of plants for decades, but limitations in paper-based systems do not allow them to reach the full potential for procedures to prevent human errors. The environment in a nuclear power plant is constantly changing, depending on current plant status and operating mode. PBPs, which are static by nature, are being applied to a constantly changing context. This constraint often results in PBPs that are written in a manner that is intended to cover many potential operating scenarios. Hence, the procedure layout forces the operator to search through a large amount of irrelevant information to locate the pieces of information relevant for the task and situation at hand, which has potential consequences of taking up valuable time when operators must be responding to the situation, and potentially leading operators down an incorrect response path. Other challenges related to use of PBPs are management of multiple procedures, place-keeping, finding the correct procedure for a task, and relying on other sources of additional information to ensure a functional and accurate understanding of the current plant status (Converse, 1995; Fink, Killian, Hanes, and Naser, 2009; Le Blanc, Oxstrand, and Waicosky, 2012). This report provides design guidance to be used when designing the human-system interaction and the design of the graphical user interface for a CBP system. The guidance is based on human factors research related to the design and usability of CBPs conducted by Idaho National Laboratory, 2012 - 2016.« less

Unmanned Aerial Systems Traffic Management (UTM): Safely Enabling UAS Operations in Low-Altitude Airspace

NASA Technical Reports Server (NTRS)

Rios, Joseph

2016-01-01

Currently, there is no established infrastructure to enable and safely manage the widespread use of low-altitude airspace and UAS flight operations. Given this, and understanding that the FAA faces a mandate to modernize the present air traffic management system through computer automation and significantly reduce the number of air traffic controllers by FY 2020, the FAA maintains that a comprehensive, yet fully automated UAS traffic management (UTM) system for low-altitude airspace is needed. The concept of UTM is to begin by leveraging concepts from the system of roads, lanes, stop signs, rules and lights that govern vehicles on the ground today. Building on its legacy of work in air traffic management (ATM), NASA is working with industry to develop prototype technologies for a UAS Traffic Management (UTM) system that would evolve airspace integration procedures for enabling safe, efficient low-altitude flight operations that autonomously manage UAS operating in an approved low-altitude airspace environment. UTM is a cloud-based system that will autonomously manage all traffic at low altitudes to include UASs being operated beyond visual line of sight of an operator. UTM would thus enable safe and efficient flight operations by providing fully integrated traffic management services such as airspace design, corridors, dynamic geofencing, severe weather and wind avoidance, congestion management, terrain avoidance, route planning re-routing, separation management, sequencing spacing, and contingency management. UTM removes the need for human operators to continuously monitor aircraft operating in approved areas. NASA envisions concepts for two types of UTM systems. The first would be a small portable system, which could be moved between geographical areas in support of operations such as precision agriculture and public safety. The second would be a Persistent system, which would support low-altitude operations in an approved area by providing continuous automated coverage. Both would require persistent communication, navigation, and surveillance (CNS) coverage to track, ensure, and monitor conformance. UTM is creating an airspace management tool that allows the ATM system to accommodate the number of UAS that will operate in the low altitude airspace. The analogy is just because we have a car, whether its autonomous or someone is driving, does not diminish the need for a road or road signs or rules of the road.

Peroral endoscopic myotomy: An emerging minimally invasive procedure for achalasia

PubMed Central

Vigneswaran, Yalini; Ujiki, Michael B

2015-01-01

Peroral endoscopic myotomy (POEM) is an emerging minimally invasive procedure for the treatment of achalasia. Due to the improvements in endoscopic technology and techniques, this procedure allows for submucosal tunneling to safely endoscopically create a myotomy across the hypertensive lower esophageal sphincter. In the hands of skilled operators and experienced centers, the most common complications of this procedure are related to insufflation and accumulation of gas in the chest and abdominal cavities with relatively low risks of devastating complications such as perforation or delayed bleeding. Several centers worldwide have demonstrated the feasibility of this procedure in not only early achalasia but also other indications such as redo myotomy, sigmoid esophagus and spastic esophagus. Short-term outcomes have showed great clinical efficacy comparable to laparoscopic Heller myotomy (LHM). Concerns related to postoperative gastroesophageal reflux remain, however several groups have demonstrated comparable clinical and objective measures of reflux to LHM. Although long-term outcomes are necessary to better understand durability of the procedure, POEM appears to be a promising new procedure. PMID:26468336

Safety Assurance in NextGen

NASA Technical Reports Server (NTRS)

HarrisonFleming, Cody; Spencer, Melissa; Leveson, Nancy; Wilkinson, Chris

2012-01-01

The generation of minimum operational, safety, performance, and interoperability requirements is an important aspect of safely integrating new NextGen components into the Communication Navigation Surveillance and Air Traffic Management (CNS/ATM) system. These requirements are used as part of the implementation and approval processes. In addition, they provide guidance to determine the levels of design assurance and performance that are needed for each element of the new NextGen procedures, including aircraft, operator, and Air Navigation and Service Provider. Using the enhanced Airborne Traffic Situational Awareness for InTrail Procedure (ATSA-ITP) as an example, this report describes some limitations of the current process used for generating safety requirements and levels of required design assurance. An alternative process is described, as well as the argument for why the alternative can generate more comprehensive requirements and greater safety assurance than the current approach.

[Gastroplasty: complications and their prevention].

PubMed

Schlienger, J L; Meyer, L; Rohr, S; Pradignac, A; Perrin, A E; Meyer, C; Simon, C

2003-02-01

Bariatric surgery is now frequently proposed for the treatment of morbid or complicated obesity since the introduction of minimally invasive laparoscopic anti-obesity operations such as the adjustable silicone gastric binding gastroplasty. However this reversible procedure in not always as safe as presumed and the results in weight loss may be sometimes disappointing. Side effects are common and early or late complications occured in more than 20% out of the patients. They are favoured by post operative eating disorders. Nutritional consequences are probably underestimated and are not limited to uncomfortable digestive symptoms. Some deficiencies in micronutriments have been described. The worsening of previous eating disorders or psychosocial abnormalities are not seldom. Gastroplasty is not an harmless procedure. A good selection in patients, a regular follow up, nutritional advices and psychosocial management by a multidisciplinar team are required to reduce complications after gastroplasty.

The Efficacy of Simultaneous Breast Reconstruction and Contralateral Balancing Procedures in Reducing the Need for Second Stage Operations

PubMed Central

Clarke-Pearson, Emily M; Vornovitsky, Michael; Dayan, Joseph H; Samson, William; Sultan, Mark R

2014-01-01

Background Patients having unilateral breast reconstruction often require a second stage procedure on the contralateral breast to improve symmetry. In order to provide immediate symmetry and minimize the frequency and extent of secondary procedures, we began performing simultaneous contralateral balancing operations at the time of initial reconstruction. This study examines the indications, safety, and efficacy of this approach. Methods One-hundred and two consecutive breast reconstructions with simultaneous contralateral balancing procedures were identified. Data included patient age, body mass index (BMI), type of reconstruction and balancing procedure, specimen weight, transfusion requirement, complications and additional surgery under anesthesia. Unpaired t-tests were used to compare BMI, specimen weight and need for non-autologous transfusion. Results Average patient age was 48 years. The majority had autologous tissue-only reconstructions (94%) and the rest prosthesis-based reconstructions (6%). Balancing procedures included reduction mammoplasty (50%), mastopexy (49%), and augmentation mammoplasty (1%). Average BMI was 27 and average reduction specimen was 340 grams. Non-autologous blood transfusion rate was 9%. There was no relationship between BMI or reduction specimen weight and need for transfusion. We performed secondary surgery in 24% of the autologous group and 100% of the prosthesis group. Revision rate for symmetry was 13% in the autologous group and 17% in the prosthesis group. Conclusions Performing balancing at the time of breast reconstruction is safe and most effective in autologous reconstructions, where 87% did not require a second operation for symmetry. PMID:25276646

Reliability analysis applied to structural tests

NASA Technical Reports Server (NTRS)

Diamond, P.; Payne, A. O.

1972-01-01

The application of reliability theory to predict, from structural fatigue test data, the risk of failure of a structure under service conditions because its load-carrying capability is progressively reduced by the extension of a fatigue crack, is considered. The procedure is applicable to both safe-life and fail-safe structures and, for a prescribed safety level, it will enable an inspection procedure to be planned or, if inspection is not feasible, it will evaluate the life to replacement. The theory has been further developed to cope with the case of structures with initial cracks, such as can occur in modern high-strength materials which are susceptible to the formation of small flaws during the production process. The method has been applied to a structure of high-strength steel and the results are compared with those obtained by the current life estimation procedures. This has shown that the conventional methods can be unconservative in certain cases, depending on the characteristics of the structure and the design operating conditions. The suitability of the probabilistic approach to the interpretation of the results from full-scale fatigue testing of aircraft structures is discussed and the assumptions involved are examined.

Flexible rotor balancing by the influence coefficient method. Part 1: Evaluation of the exact point-speed and least squares procedures

NASA Technical Reports Server (NTRS)

Tessarzik, J. M.

1972-01-01

The practical aspects of balancing real, flexible rotors were investigated through inclusion of rotor out-of-roundness data at the measurement probe locations. The computer program was demonstrated to be fully capable of handling out-of-roundness data in the investigation. Testing was performed predominantly with a machine having a 41-inch long, 126-pound rotor. This rotor was operated over a speed range encompassing three rotor-bearing system critical speeds. Both balancing procedures were evaluated for several different conditions of initial rotor unbalance. Safe (and slow) passage through all the critical speeds was obtained after two or three balancing runs in most cases. The Least Squares procedure was found to be generally equivalent in capability to the Exact Point-Speed procedure for the configurations studies. (U)

Unmanned Aircraft System Control and ATC Communications Bandwidth Requirements

NASA Technical Reports Server (NTRS)

Henriksen, Steve

2008-01-01

There are significant activities taking place to establish the procedures and requirements for safe and routine operation of unmanned aircraft systems (UAS) in the National Airspace System (NAS). Among the barriers to overcome in achieving this goal is the lack of sufficient frequency spectrum necessary for the UAS control and air traffic control (ATC) communications links. This shortcoming is compounded by the fact that the UAS control communications links will likely be required to operate in protected frequency spectrum, just as ATC communications links are, because they relate to "safety and regularity of flight." To support future International Telecommunications Union (ITU) World Radio Conference (WRC) agenda items concerning new frequency allocations for UAS communications links, and to augment the Future Communications Study (FCS) Technology Evaluation Group efforts, NASA Glenn Research Center has sponsored a task to estimate the UAS control and ATC communications bandwidth requirements for safe, reliable, and routine operation of UAS in the NAS. This report describes the process and results of that task. The study focused on long-term bandwidth requirements for UAS approximately through 2030.

Hypobaric spinal anesthesia in the operative management of orthopedic emergencies in geriatric patients.

PubMed

Sidi, A; Pollak, D; Floman, Y; Davidson, J T

1984-07-01

Hypobaric spinal anesthesia was administered to 40 patients undergoing lower limb surgery. Twenty-nine of the patients were debilitated geriatric patients who presented with orthopedic emergencies, in most cases a fractured hip. Hypobaric spinal anesthesia was found to be a simple and safe procedure that provided adequate analgesia. Due to its inherent nature, hypobaric spinal anesthesia does not necessitate positioning of the patient on the injured, painful side (unlike hyperbaric spinal or epidural anesthesia) and, therefore, facilitates a smooth and painless transfer of the patient to the operating table. Complications encountered were similar to those following hyperbaric anesthesia.

Microcomputer keeps watch at Emerald Mine

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

Not Available

1987-04-01

This paper reviews the computerized mine monitoring system set up at the Emerald Mine, SW Pennsylvania, USA. This coal mine has pioneered the automation of many production and safety features and this article covers their work in fire detection and conveyor belt monitoring. A central computer control room can safely watch over the whole underground mining operation using one 25 inch colour monitor. These new data-acquisition systems will lead the way, in the future, to safer move efficient coal mining. Multi-point monitoring of carbon monoxide, heat anomalies, toxic gases and the procedures in conveyor belt operation from start-up to closedown.

Objective assessment of operator performance during ultrasound-guided procedures.

PubMed

Tabriz, David M; Street, Mandie; Pilgram, Thomas K; Duncan, James R

2011-09-01

Simulation permits objective assessment of operator performance in a controlled and safe environment. Image-guided procedures often require accurate needle placement, and we designed a system to monitor how ultrasound guidance is used to monitor needle advancement toward a target. The results were correlated with other estimates of operator skill. The simulator consisted of a tissue phantom, ultrasound unit, and electromagnetic tracking system. Operators were asked to guide a needle toward a visible point target. Performance was video-recorded and synchronized with the electromagnetic tracking data. A series of algorithms based on motor control theory and human information processing were used to convert raw tracking data into different performance indices. Scoring algorithms converted the tracking data into efficiency, quality, task difficulty, and targeting scores that were aggregated to create performance indices. After initial feasibility testing, a standardized assessment was developed. Operators (N = 12) with a broad spectrum of skill and experience were enrolled and tested. Overall scores were based on performance during ten simulated procedures. Prior clinical experience was used to independently estimate operator skill. When summed, the performance indices correlated well with estimated skill. Operators with minimal or no prior experience scored markedly lower than experienced operators. The overall score tended to increase according to operator's clinical experience. Operator experience was linked to decreased variation in multiple aspects of performance. The aggregated results of multiple trials provided the best correlation between estimated skill and performance. A metric for the operator's ability to maintain the needle aimed at the target discriminated between operators with different levels of experience. This study used a highly focused task model, standardized assessment, and objective data analysis to assess performance during simulated ultrasound-guided needle placement. The performance indices were closely related to operator experience.

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.

[Laparoscopic-assisted vaginal hysterectomy after multiple abdominal surgeries--case study].

PubMed

Malinowski, Andrzej; Wiecka-Płusa, Monika; Mołas, Justyna

2009-11-01

At present the laparoscopic-assisted vaginal hysterectomy (LAVH) is the most widespread and most frequently executed variation of hysterectomy. It is an effective and safe operating alternative for the traditional way--abdominal hysterectomy. Good cosmetic effects, short post-operative stay at hospital and, first of all, a small risk of intra- and postoperative complications are the major driving factors justifying the choice of this method of surgery. In the following article we describe a case of a 43-year-old woman who underwent many interventions in the peritoneal cavity (abdominal surgery) and was shortlisted for the laparoscopic-assisted vaginal hysterectomy. The cause of the operation was recurrent bilateral ovary cystis that could not be treated neither conservatively nor surgically, as well as the uterus myoma leading to abnormal uterus bleeding and hypermenorrhoea. Surgery in patients who have previously undergone abdominal operations is always difficult and the risk of complications is high indeed. In this case, while selecting the method of the next surgical procedure, surgeons must not exclude the vaginal and laparoscopic methods, or use them simultaneously. Experiences of other surgeons, as well as the unique case of a treated patient, show that previous abdominal surgical procedures are not a contraindication for either vaginal or laparoscopic procedures, and in some cases they might be safer than yet another laparotomy.

Application of a real-time three-dimensional navigation system to various oral and maxillofacial surgical procedures.

PubMed

Ohba, Seigo; Yoshimura, Hitoshi; Ishimaru, Kyoko; Awara, Kousuke; Sano, Kazuo

2015-09-01

The aim of this study was to confirm the effectiveness of a real-time three-dimensional navigation system for use during various oral and maxillofacial surgeries. Five surgeries were performed with this real-time three-dimensional navigation system. For mandibular surgery, patients wore acrylic surgical splints when they underwent computed tomography examinations and the operation to maintain the mandibular position. The incidence of complications during and after surgery was assessed. No connection with the nasal cavity or maxillary sinus was observed at the maxilla during the operation. The inferior alveolar nerve was not injured directly, and any paresthesia around the lower lip and mental region had disappeared within several days after the surgery. In both maxillary and mandibular cases, there was no abnormal hemorrhage during or after the operation. Real-time three-dimensional computer-navigated surgery allows minimally invasive, safe procedures to be performed with precision. It results in minimal complications and early recovery.

Intelligent Multisensor Prodder for Training Operators in Humanitarian Demining

PubMed Central

Fernández, Roemi; Montes, Héctor; Armada, Manuel

2016-01-01

Manual prodding is still one of the most utilized procedures for identifying buried landmines during humanitarian demining activities. However, due to the high number of accidents reported during its practice, it is considered an outmoded and risky procedure and there is a general consensus about the need of introducing upgrades for enhancing the safety of human operators. With the aim of contributing to reduce the number of demining accidents, this paper presents an intelligent multisensory system for training operators in the use of prodders. The proposed tool is able to provide to deminers useful information in two critical issues: (a) the amount of force exerted on the target and if it is greater than the safe limit and, (b) to alert them when the angle of insertion of the prodder is approaching or exceeding a certain dangerous limit. Results of preliminary tests show the feasibility and reliability of the proposed design and highlight the potential benefits of the tool. PMID:27347963

Intelligent Multisensor Prodder for Training Operators in Humanitarian Demining.

PubMed

Fernández, Roemi; Montes, Héctor; Armada, Manuel

2016-06-24

Manual prodding is still one of the most utilized procedures for identifying buried landmines during humanitarian demining activities. However, due to the high number of accidents reported during its practice, it is considered an outmoded and risky procedure and there is a general consensus about the need of introducing upgrades for enhancing the safety of human operators. With the aim of contributing to reduce the number of demining accidents, this paper presents an intelligent multisensory system for training operators in the use of prodders. The proposed tool is able to provide to deminers useful information in two critical issues: (a) the amount of force exerted on the target and if it is greater than the safe limit and, (b) to alert them when the angle of insertion of the prodder is approaching or exceeding a certain dangerous limit. Results of preliminary tests show the feasibility and reliability of the proposed design and highlight the potential benefits of the tool.

Off-pump repair of a post-infarct ventricular septal defect: the 'Hamburger procedure'

PubMed Central

Barker, Thomas A; Ng, Alexander; Morgan, Ian S

2006-01-01

We report a novel off-pump technique for the surgical closure of post-infarct ventricular septal defects (VSDs). The case report describes the peri-operative management of a 76 year old lady who underwent the 'Hamburger procedure' for closure of her apical VSD. Refractory cardiogenic shock meant that traditional patch repairs requiring cardiopulmonary bypass would be poorly tolerated. We show that echocardiography guided off-pump posterior-anterior septal plication is a safe, effective method for closing post-infarct VSDs in unstable patients. More experience is required to ascertain whether this technique will become an accepted alternative to patch repairs. PMID:16722552

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.

[Prevention of adverse effects in latex allergic patients: organizing a latex safe operating theatre].

PubMed

Bonalumi, Sabrina; Barbonaglia, Patrizia; Bertocchi, Carmen

2006-01-01

In 2001 the General Health Direction of Region Lombardia approved (decree n. 22303) a guideline for the prevention of latex allergic reactions in patients and health care workers. This document provides general recommendations in order to standardize behaviors in regional health care facilities. The reason is due to a rise in the incident of reactions to latex products in the last 20 years. Nowadays the prevalence is higher in certain risk groups (subjected to frequent and repeated exposures) rather than the general population. The aim of the project was to organize a latex safe operating theatre in the Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena of Milan (Fondazione) and to standardize behaviors in order to prevent adverse effects in latex allergic patients. Thanks to the literature review and the creation of a multidisciplinar team, we produced a protocol. Therefore, we requested manufacturers the certification of the latex content of their products. Results and conclusion. When latex allergic patients need to undergone surgery in our hospital, a latex safe operating theatre is organized by personnel following a multidisciplinar protocol. No allergic reactions were experienced during surgical procedures after the creation of an environment as free as possible from latex contamination. The project will involve an emergency room, one room or more of a ward and of the outpatients department.

24 CFR 761.23 - Grantee performance requirements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Operation Safe Home, Operation Weed and Seed, and the Safe Neighborhoods Action Program operating in the... emanating from other anti-crime and anti-drug programs, such as Operation Safe Home, Operation Weed and Seed...

24 CFR 761.23 - Grantee performance requirements.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Operation Safe Home, Operation Weed and Seed, and the Safe Neighborhoods Action Program operating in the... emanating from other anti-crime and anti-drug programs, such as Operation Safe Home, Operation Weed and Seed...

24 CFR 761.23 - Grantee performance requirements.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Operation Safe Home, Operation Weed and Seed, and the Safe Neighborhoods Action Program operating in the... emanating from other anti-crime and anti-drug programs, such as Operation Safe Home, Operation Weed and Seed...

Percutaneous dilatational versus conventional surgical tracheostomy in intensive care patients

PubMed Central

Youssef, Tarek F.; Ahmed, Mohamed Rifaat; Saber, Aly

2011-01-01

Background: Tracheostomy is usually performed in patients with difficult weaning from mechanical ventilation or some catastrophic neurologic insult. Conventional tracheostomy involves dissection of the pretracheal tissues and insertion of the tracheostomy tube into the trachea under direct vision. Percutaneous dilatational tracheostomy is increasingly popular and has gained widespread acceptance in many intensive care unit and trauma centers. Aim: Aim of the study was to compare percutaneous dilatational tracheostomy versus conventional tracheostomy in intensive care patients. Patients and Methods: 64 critically ill patients admitted to intensive care unit subjected to tracheostomy and randomly divided into two groups; percutaneous dilatational tracheostomy and conventional tracheostomy. Results: Mean duration of the procedure was similar between the two procedures while the mean size of tracheostomy tube was smaller in percutaneous technique. In addition, the Lowest SpO2 during procedure, PaCO2 after operation and intra-operative bleeding for both groups were nearly similar without any statistically difference. Postoperative infection after 7 days seen to be statistically lowered and the length of scar tend to be smaller among PDT patients. Conclusion: PDT technique is effective and safe as CST with low incidence of post operative complication. PMID:22361497

Radiation exposure to operator and patients during cardiac electrophysiology study, radiofrequency catheter ablation and cardiac device implantation procedures

NASA Astrophysics Data System (ADS)

Lee, C. H.; Cho, J. H.; Park, S. J.; Kim, J. S.; On, Y. K.; Huh, J.

2015-10-01

The purpose of this study was to measure the radiation exposure to operator and patient during cardiac electrophysiology study, radiofrequency catheter ablation and cardiac device implantation procedures and to calculate the allowable number of cases per year. We carried out 9 electrophysiology studies, 40 radiofrequency catheter ablation and 11 cardiac device implantation procedures. To measure occupational radiation dose and dose-area product (DAP), 13 photoluminescence glass dosimeters were placed at eyes (inside and outside lead glass), thyroids (inside and outside thyroid collar), chest (inside and outside lead apron), wrists, genital of the operator (inside lead apron), and 6 of photoluminescence glass dosimeters were placed at eyes, thyroids, chest and genital of the patient. Exposure time and DAP values were 11.7 ± 11.8 min and 23.2 ± 26.2 Gy cm2 for electrophysiology study; 36.5 ± 42.1 min and 822.4 ± 125.5 Gy cm2 for radiofrequency catheter ablation; 16.2 ± 9.3 min and 27.8 ± 16.5 Gy cm2 for cardiac device implantation procedure, prospectively. 4591 electrophysiology studies can be conducted within the occupational exposure limit for the eyes (150 mSv), and 658-electrophysiology studies with radiofrequency catheter ablation can be carried out within the occupational exposure limit for the hands (500 mSv). 1654 cardiac device implantation procedure can be conducted within the occupational exposure limit for the eyes (150 mSv). The amounts of the operator and patient's radiation exposure were comparatively small. So, electrophysiology study, radio frequency catheter ablation and cardiac device implantation procedures are safe when performed with modern equipment and optimized protective radiation protect equipment.

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.

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.

Feasibility study of solid oxide fuel cell engines integrated with sprinter gas turbines: Modeling, design and control

NASA Astrophysics Data System (ADS)

Jia, Zhenzhong; Sun, Jing; Dobbs, Herb; King, Joel

2015-02-01

Conventional recuperating solid oxide fuel cell (SOFC)/gas turbine (GT) system suffers from its poor dynamic capability and load following performance. To meet the fast, safe and efficient load following requirements for mobile applications, a sprinter SOFC/GT system concept is proposed in this paper. In the proposed system, an SOFC stack operating at fairly constant temperature provides the baseline power with high efficiency while the fast dynamic capability of the GT-generator is fully explored for fast dynamic load following. System design and control studies have been conducted by using an SOFC/GT system model consisting of experimentally-verified component models. In particular, through analysis of the steady-state simulation results, an SOFC operation strategy is proposed to maintain fairly constant SOFC power (less than 2% power variation) and temperature (less than 2 K temperature variation) over the entire load range. A system design procedure well-suited to the proposed system has also been developed to help determining component sizes and the reference steady-state operation line. In addition, control analysis has been studied for both steady-state and transient operations. Simulation results suggest that the proposed system holds the promise to achieve fast and safe transient operations by taking full advantage of the fast dynamics of the GT-generator.

Safe Reentry for False Aneurysm Operations in High-Risk Patients.

PubMed

Martinelli, Gian Luca; Cotroneo, Attilio; Caimmi, Philippe Primo; Musica, Gabriele; Barillà, David; Stelian, Edmond; Romano, Angelo; Novelli, Eugenio; Renzi, Luca; Diena, Marco

2017-06-01

In the absence of a standardized safe surgical reentry strategy for high-risk patients with large or anterior postoperative aortic false aneurysm (PAFA), we aimed to describe an effective and safe approach for such patients. We prospectively analyzed patients treated for PAFA between 2006 and 2015. According to the preoperative computed tomography scan examination, patients were divided into two groups according to the anatomy and extension of PAFA: in group A, high-risk PAFA (diameter ≥3 cm) developed in the anterior mediastinum; in group B, low-risk PAFA (diameter <3 cm) was situated posteriorly. For group A, a safe surgical strategy, including continuous cerebral, visceral, and coronary perfusion was adopted before resternotomy; group B patients underwent conventional surgery. We treated 27 patients (safe reentry, n = 13; standard approach, n = 14). Mean age was 60 years (range, 29 to 80); 17 patients were male. Mean interval between the first operation and the last procedure was 4.3 years. Overall 30-day mortality rate was 7.4% (1 patient in each group). No aorta-related mortality was observed at 1 and 5 years in either group. The Kaplan-Meier overall survival estimates at 1 and 5 years were, respectively, 92.3% ± 7.4% and 73.4% ± 13.4% in group A, and 92.9% ± 6.9% and 72.2% ± 13.9% in group B (log rank test, p = 0.830). Freedom from reoperation for recurrent aortic disease was 100% at 1 year and 88% at 5 years. The safe reentry technique with continuous cerebral, visceral, and coronary perfusion for high-risk patients resulted in early and midterm outcomes similar to those observed for low-risk patients undergoing conventional surgery. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Retroperitoneal Laparoscopic Ureterolithotomy for Proximal Ureteral Calculi in Selected Patients

PubMed Central

Hu, Qingfeng; Ding, Weihong; Gou, Yuancheng; Ho, Yatfaat; Xu, Ke; Gu, Bin; Sun, Chuanyu; Xia, Guowei; Ding, Qiang

2014-01-01

Objectives. To summarize our experience of retroperitoneal laparoscopic ureterolithotomy for ureteral calculi and evaluate the safety and efficiency of this procedure. Methods. We conducted a retrospective analysis of 197 patients with proximal ureteral calculi who accepted retroperitoneal laparoscopic ureterolithotomy from June 2005 to June 2014. Results. All procedures were performed successfully and the mean operating time and estimated blood loss were 87 min and 64 mL. The clearance rate was 98.5% and the rates of urine leak and ureteral stricture were 2.5% and 1.0%. Conclusions. Retroperitoneal laparoscopic ureterolithotomy is a safe and effective procedure for patients with complex stones or anatomic abnormalities, and, with experience of high volume series, it is also a reasonable choice as the primary treatment for such selected patients. PMID:25548791

[Operating Room Nurses' Experiences of Securing for Patient Safety].

PubMed

Park, Kwang Ok; Kim, Jong Kyung; Kim, Myoung Sook

2015-10-01

This study was done to evaluate the experience of securing patient safety in hospital operating rooms. Experiential data were collected from 15 operating room nurses through in-depth interviews. The main question was "Could you describe your experience with patient safety in the operating room?". Qualitative data from the field and transcribed notes were analyzed using Strauss and Corbin's grounded theory methodology. The core category of experience with patient safety in the operating room was 'trying to maintain principles of patient safety during high-risk surgical procedures'. The participants used two interactional strategies: 'attempt continuous improvement', 'immersion in operation with sharing issues of patient safety'. The results indicate that the important factors for ensuring the safety of patients in the operating room are manpower, education, and a system for patient safety. Successful and safe surgery requires communication, teamwork and recognition of the importance of patient safety by the surgical team.

Open lung biopsy performed in idiopathic pulmonary fibrosis is a safe procedure

PubMed Central

Halman, Joanna; Taniewska, Sonia; Burzyńska, Natalia; Piekarska, Anna; Sawicka, Wioletta

2017-01-01

Introduction Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease with a fatal prognosis. The diagnosis is made on the basis of high-resolution computed tomography and histological examination in selected cases. Aim To determine the risk of complications of open lung biopsy performed in patients with IPF. Material and methods We performed a retrospective analysis of 51 patients who underwent diagnostic excision of pulmonary parenchyma due to IPF in the period 1995–2014. We assessed the complication rate, length of drainage, postoperative period and 30-day mortality. We compared the results of treatment in the groups of patients operated on with thoracotomy and videothoracoscopy. Results The mean age of patients was 58 (47% female, 53% male) forced vital capacity (FVC) was 81%, forced expiratory volume in 1 s (FEV1) was 80% and body mass index (BMI) was 27 kg/m2. Thoracotomies (lateral, muscle sparing or anterior) were performed in 20 patients between 1995 and 2012 and videothoracoscopy in 31 patients operated on in the years 2009–2014. Patients in study groups did not differ considering age (p = 0.40), gender (p = 0.81), FVC (p = 0.08), FEV1 (p = 0.13) or BMI (p = 0.75). Postoperative complications occurred in 3.9% of patients (atrial arrhythmia 1.9% and recurrent pneumothorax 1.9%) with equal incidence in both study groups (p = 0.75). Median stay after thoracotomy was 4 days while after videothoracoscopy it was 3 days (p = 0.04). Conclusions Open lung biopsy performed on patients with IPF is a safe procedure. Open lung biopsy performed through thoracotomy could be as safe as through VATS, however is characterized by longer postoperative stay. PMID:29354175

Pelvic denervation procedures for dysmenorrhea.

PubMed

Ramirez, Christina; Donnellan, Nicole

2017-08-01

Chronic pelvic pain and dysmenorrhea are common conditions affecting reproductive-age women. Surgical pelvic denervation procedures may be a treatment option for women with midline dysmenorrhea, in which medical management is declined by the patient, ineffective at managing symptoms, or medically contraindicated. This review describes the surgical techniques and complications associated with pelvic denervation procedures as well as the current evidence for these procedures in women with primary dysmenorrhea and dysmenorrhea secondary to endometriosis. Presacral neurectomy is the preferred pelvic denervation procedure in patients with primary dysmenorrhea and midline chronic pelvic pain associated with endometriosis. In patients with endometriosis presacral neurectomy is a useful adjunct to excision or ablation of all endometrial lesions to improve postoperative pain relief. There is no additional patient benefit of performing combined presacral neurectomy and uterine nerve ablation procedures. Pelvic denervation procedures can be performed safely and quickly with a low risk of complication if the surgeon is knowledgeable and skilled in operating in the presacral space. Patients should be adequately counseled on expected success rates and potential complications associated with pelvic denervation procedures.

Obtaining maximal stability with a septal extension technique in East asian rhinoplasty.

PubMed

Jeong, Jae Yong

2014-01-01

Recently, in Korea, the septal extension graft from the septum or rib has become a common method of correcting a small or short nose. The success rate of this method has led to the blind faith that it provides superior tip projection and definition, and to the failure to notice its weaknesses. Even if there is a sufficient amount of cartilage, improper separation or fixation might waste the cartilage, resulting in an inefficient operation. Appropriate resection and effective fixation are essential factors for economical rhinoplasty. The septal extension graft is a remarkable procedure since it can control the nasal tip bidirectionally and three dimensionally. Nevertheless, it has a serious drawback since resection is responsible for septal weakness. Safe resection and firm reconstruction of the framework should be carried out. Operating on the basis of the principle of "safe harvest" and rebuilding the structures is important. Further, it is important to learn several techniques to manage septal weakness, insufficient cartilage quantity, and failure of the rigid frame during the surgery.

Laparoscopic repair of perforated peptic duodenal ulcer.

PubMed

Busić, Zeljko; Servis, Draien; Slisurić, Ferdinand; Kristek, Jozo; Kolovrat, Marijan; Cavka, Vlatka; Cavka, Mislav; Cupurdija, Kristijan; Patrlj, Leonardo; Kvesić, Ante

2010-03-01

Although prevalence of peptic ulcer is decreasing, the number of peptic ulcer perforations appears to be unchanged. This complication of peptic ulcer is traditionally surgically treated. In recent years, a number of papers have been published where the authors managed perforated duodenal peptic ulcer in selected patients using laparoscopic approach. Laparoscopic treatment of perforated duodenal ulcer has been described as safe and advantageous compared to open technique but advantages are still not clear due to small number of cases in published studies. Based on these recommendations we decided to establish our own protocol for laparoscopic treatment of perforated peptic duodenal ulcer. In this prospective study we evaluated the first 10 patients in whom we performed laparoscopic repair of perforated duodenal ulcer. There were no conversions to open procedure and no early postoperative complications. The patients were contacted by phone a year after the operation, and all were satisfied with the operation and the appearance of postoperative scars. We regard laparoscopic repair of selected patients with perforated duodenal ulcer as a safe and preferable treatment.

Radioactive Waste Management in A Hospital

PubMed Central

Khan, Shoukat; Syed, AT; Ahmad, Reyaz; Rather, Tanveer A.; Ajaz, M; Jan, FA

2010-01-01

Most of the tertiary care hospitals use radioisotopes for diagnostic and therapeutic applications. Safe disposal of the radioactive waste is a vital component of the overall management of the hospital waste. An important objective in radioactive waste management is to ensure that the radiation exposure to an individual (Public, Radiation worker, Patient) and the environment does not exceed the prescribed safe limits. Disposal of Radioactive waste in public domain is undertaken in accordance with the Atomic Energy (Safe disposal of radioactive waste) rules of 1987 promulgated by the Indian Central Government Atomic Energy Act 1962. Any prospective plan of a hospital that intends using radioisotopes for diagnostic and therapeutic procedures needs to have sufficient infrastructural and manpower resources to keep its ambient radiation levels within specified safe limits. Regular monitoring of hospital area and radiation workers is mandatory to assess the quality of radiation safety. Records should be maintained to identify the quality and quantity of radioactive waste generated and the mode of its disposal. Radiation Safety officer plays a key role in the waste disposal operations. PMID:21475524

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

Laparoscopic cholecystectomy for a left-sided gallbladder.

PubMed

Iskandar, Mazen E; Radzio, Agnes; Krikhely, Merab; Leitman, I Michael

2013-09-21

Cholecystectomy is a common procedure. Abnormalities in the anatomy of the biliary system are common but an abnormal location of the gallbladder is much rarer. Despite frequent pre-operative imaging, the aberrant location of the gallbladder is commonly discovered at surgery. This article presents a case of a patient with the gallbladder located to the left of the falciform ligament in the absence of situs inversus totalis that presented with right upper quadrant pain. A laparoscopic cholecystectomy was performed and it was noted that the cystic duct originated from the right side. The presence of a left sided gall bladder is often associated with various biliary, portal venous and other anomalies that might lead to intra-operative injuries. The spectrum of unusual positions and anatomical gallbladder abnormalities is reviewed in order to facilitate elective and emergent cholecystectomy as well as other hepatobiliary procedures. With proper identification of the anatomy, minimally invasive approaches are still considered safe.

Laparoscopic cholecystectomy for a left-sided gallbladder

PubMed Central

Iskandar, Mazen E; Radzio, Agnes; Krikhely, Merab; Leitman, I Michael

2013-01-01

Cholecystectomy is a common procedure. Abnormalities in the anatomy of the biliary system are common but an abnormal location of the gallbladder is much rarer. Despite frequent pre-operative imaging, the aberrant location of the gallbladder is commonly discovered at surgery. This article presents a case of a patient with the gallbladder located to the left of the falciform ligament in the absence of situs inversus totalis that presented with right upper quadrant pain. A laparoscopic cholecystectomy was performed and it was noted that the cystic duct originated from the right side. The presence of a left sided gall bladder is often associated with various biliary, portal venous and other anomalies that might lead to intra-operative injuries. The spectrum of unusual positions and anatomical gallbladder abnormalities is reviewed in order to facilitate elective and emergent cholecystectomy as well as other hepatobiliary procedures. With proper identification of the anatomy, minimally invasive approaches are still considered safe. PMID:24124340

[Usefulness of Laparoscopic Stoma Creation for Unresectable Colorectal Cancer].

PubMed

Ishimoto, Takeshi; Nishida, Tatsurou; Suzuki, Tomoyuki; Osawa, Rumi; Sai, Sojin; Kin, Shuichi; Fujita, Yoshifumi; Suganuma, Yasushi; Shirakata, Shuji; Nomi, Shinhachiro

2018-01-01

Laparoscopic stoma creation enables good visualization of viscera within the abdominal cavity to ensure adequate mobilization of the large intestine. Laparoscopic stoma creation/construction was indicated and performed at our hospital in 7 patients who were diagnosed with unresectable colorectal cancer between July 2015 and May 2017. Duringthe ileostomy procedure, we made a skin incision at the stoma site and performed a single-incision(3-port)laparoscopic surgery. For the colostomy procedure, we made a small incision at the umbilicus and mobilized the large intestine with laparoscopic dissection of any interveningadhesions. Operation time ranged between 34 and 127 minutes, and the volume of intraoperative blood loss was low in all cases. There were no fatal complications related to the operation. Laparoscopic stoma creation can be performed safely and may be useful for staging of malignant colorectal tumors and reducing the risk of complications.

Standard practice for cell sorting in a BSL-3 facility.

PubMed

Perfetto, Stephen P; Ambrozak, David R; Nguyen, Richard; Roederer, Mario; Koup, Richard A; Holmes, Kevin L

2011-01-01

Over the past decade, there has been a rapid growth in the number of BSL-3 and BSL-4 laboratories in the USA and an increase in demand for infectious cell sorting in BSL-3 laboratories. In 2007, the International Society for Advancement of Cytometry (ISAC) Biosafety Committee published standards for the sorting of unfixed cells and is an important resource for biosafety procedures when performing infectious cell sorting. Following a careful risk assessment, if it is determined that a cell sorter must be located within a BSL-3 laboratory, there are a variety of factors to be considered prior to the establishment of the laboratory. This chapter outlines procedures for infectious cell sorting in a BSL-3 environment to facilitate the establishment and safe operation of a BSL-3 cell sorting laboratory. Subjects covered include containment verification, remote operation, disinfection, personal protective equipment (PPE), and instrument-specific modifications for enhanced aerosol evacuation.

Standard Practice for Cell Sorting in a BSL-3 Facility

PubMed Central

Perfetto, Stephen P.; Ambrozak, David R.; Nguyen, Richard; Roederer, Mario; Koup, Richard A.; Holmes, Kevin L.

2016-01-01

Over the past decade, there has been a rapid growth in the number of BSL-3 and BSL-4 laboratories in the USA and an increase in demand for infectious cell sorting in BSL-3 laboratories. In 2007, the International Society for Advancement of Cytometry (ISAC) Biosafety Committee published standards for the sorting of unfixed cells and is an important resource for biosafety procedures when performing infectious cell sorting. Following a careful risk assessment, if it is determined that a cell sorter must be located within a BSL-3 laboratory, there are a variety of factors to be considered prior to the establishment of the laboratory. This chapter outlines procedures for infectious cell sorting in a BSL-3 environment to facilitate the establishment and safe operation of a BSL-3 cell sorting laboratory. Subjects covered include containment verification, remote operation, disinfection, personal protective equipment (PPE), and instrument-specific modifications for enhanced aerosol evacuation. PMID:21116997

Surgical Treatment for Chronic Pancreatitis: Past, Present, and Future

PubMed Central

Welte, Maria; Izbicki, Jakob R.; Bachmann, Kai

2017-01-01

The pancreas was one of the last explored organs in the human body. The first surgical experiences were made before fully understanding the function of the gland. Surgical procedures remained less successful until the discovery of insulin, blood groups, and finally the possibility of blood donation. Throughout the centuries, the surgical approach went from radical resections to minimal resections or only drainage of the gland in comparison to an adequate resection combined with drainage procedures. Today, the well-known and standardized procedures are considered as safe due to the high experience of operating surgeons, the centering of pancreatic surgery in specialized centers, and optimized perioperative treatment. Although surgical procedures have become safer and more efficient than ever, the overall perioperative morbidity after pancreatic surgery remains high and management of postoperative complications stagnates. Current research focuses on the prevention of complications, optimizing the patient's general condition preoperatively and finding the appropriate timing for surgical treatment. PMID:28819358

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.

Robotic digital subtraction angiography systems within the hybrid operating room.

PubMed

Murayama, Yuichi; Irie, Koreaki; Saguchi, Takayuki; Ishibashi, Toshihiro; Ebara, Masaki; Nagashima, Hiroyasu; Isoshima, Akira; Arakawa, Hideki; Takao, Hiroyuki; Ohashi, Hiroki; Joki, Tatsuhiro; Kato, Masataka; Tani, Satoshi; Ikeuchi, Satoshi; Abe, Toshiaki

2011-05-01

Fully equipped high-end digital subtraction angiography (DSA) within the operating room (OR) environment has emerged as a new trend in the fields of neurosurgery and vascular surgery. To describe initial clinical experience with a robotic DSA system in the hybrid OR. A newly designed robotic DSA system (Artis zeego; Siemens AG, Forchheim, Germany) was installed in the hybrid OR. The system consists of a multiaxis robotic C arm and surgical OR table. In addition to conventional neuroendovascular procedures, the system was used as an intraoperative imaging tool for various neurosurgical procedures such as aneurysm clipping and spine instrumentation. Five hundred one neurosurgical procedures were successfully conducted in the hybrid OR with the robotic DSA. During surgical procedures such as aneurysm clipping and arteriovenous fistula treatment, intraoperative 2-/3-dimensional angiography and C-arm-based computed tomographic images (DynaCT) were easily performed without moving the OR table. Newly developed virtual navigation software (syngo iGuide; Siemens AG) can be used in frameless navigation and in access to deep-seated intracranial lesions or needle placement. This newly developed robotic DSA system provides safe and precise treatment in the fields of endovascular treatment and neurosurgery.

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.

Digital computer operation of a nuclear reactor

DOEpatents

Colley, R.W.

1982-06-29

A method is described for the safe operation of a complex system such as a nuclear reactor using a digital computer. The computer is supplied with a data base containing a list of the safe state of the reactor and a list of operating instructions for achieving a safe state when the actual state of the reactor does not correspond to a listed safe state, the computer selects operating instructions to return the reactor to a safe state.

Digital computer operation of a nuclear reactor

DOEpatents

Colley, Robert W.

1984-01-01

A method is described for the safe operation of a complex system such as a nuclear reactor using a digital computer. The computer is supplied with a data base containing a list of the safe state of the reactor and a list of operating instructions for achieving a safe state when the actual state of the reactor does not correspond to a listed safe state, the computer selects operating instructions to return the reactor to a safe state.

The policy of the Laboratory is to provide a safe and healthy workplace for

Science.gov Websites

group within the Collider Accelerator (C-A) Department. The Advanced Accelerator Group, a group within ://www.tvdg.bnl.gov/index.html that also has links to the C-A and other BNL information. We hope your stay at policies are outlined in the Employees' Handbook, the BNL ES&H Standards the C-A Operations Procedure

Land Based Environmental Monitoring at Johnston Island - Disposal of Herbicide Orange

DTIC Science & Technology

1978-09-01

for man and other terrestrial species were reviewed to determine permissible intake levels. Observations in man are primarily expost facto judgements of...areas, and the ever present danger from the stored HO stocks, let the Air Force to conduct a study to I’ develop procedures for the ecologically safe...responsible for the siting and operation of personnel samplers. 3. AIR Surface trade winds were essentially constant throughout the study period with winds

Retroperitoneal endoscopic adrenalectomy is safe and effective.

PubMed

Schreinemakers, J M J; Kiela, G J; Valk, G D; Vriens, M R; Rinkes, I H M Borel

2010-11-01

The aim of this study was to review an experience with retroperitoneal endoscopic adrenalectomy (REA). This is the procedure of choice for adrenal tumours at this institution. Between 1997 and 2008, 112 REAs were performed in a single university centre. Data were retrieved retrospectively from a prospectively collected database, including information on patient demographics, surgical procedure, complications and hospital stay. One hundred and twelve REAs were carried out successfully in 105 patients, including seven bilateral adrenalectomies. Thirty-nine patients with unilateral adrenal disease had a phaeochromocytoma, of whom 16 had multiple endocrine neoplasia syndrome type 2, 21 patients had Cushing's disease and 20 had Conn's disease. Median body mass index was 27 (interquartile range 23-29) kg/m(2). The median duration of unilateral operations was 100 (90-130) min with a median blood loss of 5 ml. Median tumour size was 3.1 (2.0-4.4) cm. Conversion from REA to open surgery was needed in two patients. Seven patients experienced postoperative complications (2 major, 5 minor). One patient needed a reoperation. The median postoperative hospital stay was 3 days. A learning curve with a significant decrease in operating time was observed over the years. REA appears to be a safe and effective surgical technique for adrenal gland tumours up to 6 cm in diameter, with a minimal complication rate. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Same versus next day discharge after elective transradial PCI: The RAdial SAme Day DischArge after PCI trial. (The RASADDA-PCI trial).

PubMed

Rodriguez-Araujo, Gerardo; Cilingiroglu, Mehmet; Mego, David; Hakeem, Abdul; Lendel, Vasili; Cawich, Ian; Paixao, Andre; Marmagkiolis, Konstantinos; Flaherty, Patrick; Rollefson, William

2018-06-02

Transradial percutaneous coronary intervention (TR-PCI) has been increasingly popular over the last decade in the US. Previous studies have shown that same-day (SD) discharge after elective PCI is as safe as overnight (ON) observation. Our study was performed to assess the clinical and financial impact of early discharge in patients undergoing TR-PCI. This is a single center registry of patients undergoing elective TR-PCI. Timing of discharge was determined by the treating physician. (Groups: Same Day Discharge -SD-; Overnight Stay -ON-). Demographic data, procedural characteristics and adverse outcomes were recorded. Outcomes included 30 day-MACE and procedure- related complications, as well as total operative costs in patients from both groups. Propensity score matching for patient demographics, coronary symptoms and procedure indicators was used to compare both groups. The entire cohort included 852 patients (429 in SD group and 423 in ON group) and the propensity score matched groups of 245 patients in the SD group and 245 patients in the ON group. The two groups had no significant baseline clinical differences, and had similar clinical outcomes. Specifically, no significant difference was noted in procedural complications (3.7% vs 2.5%, p = 0.43), re-hospitalization (4.1% vs 4.1%, p = 0.92), re-intervention (2.5% vs 2.1%, p = 0.77), myocardial infarction (0% vs 0.08%, p = 0.15), stroke (0% vs 0%, p = 1.0) and all-cause mortality (0% vs 0%, p = 1.0). SD Group patients had a significant lower procedure-related cost compared to overnight stay patients ($3,346.45 vs $4,681.99, p < 0.0001) and lower 30-day post procedure-associated cumulative costs/total operating costs ($4,493.22 vs $7,112.21, p < 0.0001). In elective patients undergoing low risk TR-PCI, same-day discharge seems to be a safe and feasible clinical practice, with significant potential savings to the US healthcare system. Copyright © 2018 Elsevier Inc. All rights reserved.

The Resident-Run Minor Surgery Clinic: A Pilot Study to Safely Increase Operative Autonomy.

PubMed

Wojcik, Brandon M; Fong, Zhi Ven; Patel, Madhukar S; Chang, David C; Petrusa, Emil; Mullen, John T; Phitayakorn, Roy

General surgery training has evolved to align with changes in work hour restrictions, supervision regulations, and reimbursement practices. This has culminated in a lack of operative autonomy, leaving residents feeling inadequately prepared to perform surgery independently when beginning fellowship or practice. A resident-run minor surgery clinic increases junior resident autonomy, but its effects on patient outcomes have not been formally established. This pilot study evaluated the safety of implementing a resident-run minor surgery clinic within a university-based general surgery training program. Single institution case-control pilot study of a resident-run minor surgery clinic from 9/2014 to 6/2015. Rotating third-year residents staffed the clinic once weekly. Residents performed operations independently in their own procedure room. A supervising attending surgeon staffed each case prior to residents performing the procedure and viewed the surgical site before wound closure. Postprocedure patient complications and admissions to the hospital because of a complication were analyzed and compared with an attending control cohort. Massachusetts General Hospital General in Boston, MA; an academic tertiary care general surgery residency program. Ten third-year general surgery residents. Overall, 341 patients underwent a total of 399 procedures (110 in the resident clinic vs. 289 in the attending clinic). Minor surgeries included soft tissue mass excision (n = 275), abscess incision and drainage (n = 66), skin lesion excision (n = 37), skin tag removal (n = 15), and lymph node excision (n = 6). There was no significant difference in the overall rate of patients developing a postprocedure complication within 30 days (3.6% resident vs. 2.8% attending; p = 0.65); which persisted on multivariate analysis. Similar findings were observed for the rate of hospital admission resulting from a complication. Resident evaluations overwhelmingly supported the rotation, citing increased operative autonomy as the greatest strength. Implementation of a resident-run minor surgery clinic is a safe and effective method to increase trainee operative autonomy. The rotation is well suited for mid-level residents, as it provides an opportunity for realistic self-evaluation and focused learning that may enhance their operative experience during senior level rotations. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Evaluation of Selected Chemical Processes for Production of Low-cost Silicon, Phase 3. [using a fluidized bed reactor

NASA Technical Reports Server (NTRS)

Blocher, J. M., Jr.; Browning, M. F.

1979-01-01

The construction and operation of an experimental process system development unit (EPSDU) for the production of granular semiconductor grade silicon by the zinc vapor reduction of silicon tetrachloride in a fluidized bed of seed particles is presented. The construction of the process development unit (PDU) is reported. The PDU consists of four critical units of the EPSDU: the fluidized bed reactor, the reactor by product condenser, the zinc vaporizer, and the electrolytic cell. An experimental wetted wall condenser and its operation are described. Procedures are established for safe handling of SiCl4 leaks and spills from the EPSDU and PDU.

Apollo experience report: Manned thermal-vacuum testing of spacecraft

NASA Technical Reports Server (NTRS)

Mclane, J. C., Jr.

1974-01-01

Manned thermal-vacuum tests of the Apollo spacecraft presented many first-time problems in the areas of test philosophy, operational concepts, and program implementation. The rationale used to resolve these problems is explained and examined critically in view of actual experience. The series of 12 tests involving 1517 hours of chamber operating time resulted in the disclosure of numerous equipment and procedural deficiencies of significance to the flight mission. Test experience and results in view of subsequent flight experience confirmed that thermal-vacuum testing of integrated manned spacecraft provides a feasible, cost-effective, and safe technique with which to obtain maximum confidence in spacecraft flight worthiness early in the program.

Left ventricle to aorta valved conduit for relief of diffuse left ventricular outflow tract obstruction.

PubMed

Reder, R F; Dimich, I; Steinfeld, L; Litwak, R S

1977-06-01

Operative relief of congenital tunnel subaortic stenosis by means of local incision or excision, or both, has generally been unsatisfactory. The use of a valve-bearing conduit between the left ventricular apex and thoracic aorta offers a predictable means of bypassing the left ventricular outflow obstruction. The procedure was used in a 17 year old girl with an excellent hemodynamic result. The history of operative management with diverting plantation of valved conduits in this position have not been defined, but use of these prostheses appears advisable in severe subvalvular, valvular and supravalvular obstructions that are not readily amenable to predictable and safe surgical palliation. The operation may prove useful in selected cases of idiopathic hypertrophic obstructive cardiomyopathy.

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.

Disinfection of aircraft : Appropriate disinfectants and standard operating procedures for highly infectious diseases.

PubMed

Klaus, Joachim; Gnirs, Peter; Hölterhoff, Sabine; Wirtz, Angela; Jeglitza, Matthias; Gaber, Walter; Gottschalk, Rene

2016-12-01

For infectious diseases caused by highly pathogenic agents (e. g., Ebola/Lassa fever virus, SARS-/MERS-CoV, pandemic influenza virus) which have the potential to spread over several continents within only a few days, international Health Protection Authorities have taken appropriate measures to limit the consequences of a possible spread. A crucial point in this context is the disinfection of an aircraft that had a passenger on board who is suspected of being infected with one of the mentioned diseases. Although, basic advice on hygiene and sanitation on board an aircraft is given by the World Health Organization, these guidelines lack details on available and effective substances as well as standardized operating procedures (SOP). The purpose of this paper is to give guidance on the choice of substances that were tested by a laboratory of Lufthansa Technik and found compatible with aircraft components, as well as to describe procedures which ensure a safe and efficient disinfection of civil aircrafts. This guidance and the additional SOPs are made public and are available as mentioned in this paper.

Weather Requirements and Procedures for Step 1: High Altitude Long Endurance (HALE) Unmanned Aircraft System (UAS) Flight Operations in the National Air Space (NAS)

NASA Technical Reports Server (NTRS)

2007-01-01

This cover sheet is for version 2 of the weather requirements document along with Appendix A. The purpose of the requirements document was to identify and to list the weather functional requirements needed to achieve the Access 5 vision of "operating High Altitude, Long Endurance (HALE) Unmanned Aircraft Systems (UAS) routinely, safely, and reliably in the National Airspace System (NAS) for Step 1." A discussion of the Federal Aviation Administration (FAA) references and related policies, procedures, and standards is provided as basis for the recommendations supported within this document. Additional procedures and reference documentation related to weather functional requirements is also provided for background. The functional requirements and related information are to be proposed to the FAA and various standards organizations for consideration and approval. The appendix was designed to show that sources of flight weather information are readily available to UAS pilots conducting missions in the NAS. All weather information for this presentation was obtained from the public internet.

MRI-guided stereotactic neurosurgical procedures in a diagnostic MRI suite: Background and safe practice recommendations.

PubMed

Larson, Paul S; Willie, Jon T; Vadivelu, Sudhakar; Azmi-Ghadimi, Hooman; Nichols, Amy; Fauerbach, Loretta Litz; Johnson, Helen Boehm; Graham, Denise

2017-07-01

The development of navigation technology facilitating MRI-guided stereotactic neurosurgery has enabled neurosurgeons to perform a variety of procedures ranging from deep brain stimulation to laser ablation entirely within an intraoperative or diagnostic MRI suite while having real-time visualization of brain anatomy. Prior to this technology, some of these procedures required multisite workflow patterns that presented significant risk to the patient during transport. For those facilities with access to this technology, safe practice guidelines exist only for procedures performed within an intraoperative MRI. There are currently no safe practice guidelines or parameters available for facilities looking to integrate this technology into practice in conventional MRI suites. Performing neurosurgical procedures in a diagnostic MRI suite does require precautionary measures. The relative novelty of technology and workflows for direct MRI-guided procedures requires consideration of safe practice recommendations, including those pertaining to infection control and magnet safety issues. This article proposes a framework of safe practice recommendations designed for assessing readiness and optimization of MRI-guided neurosurgical interventions in the diagnostic MRI suite in an effort to mitigate patient risk. The framework is based on existing clinical evidence, recommendations, and guidelines related to infection control and prevention, health care-associated infections, and magnet safety, as well as the clinical and practical experience of neurosurgeons utilizing this technology. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.

Anesthetic issues and perioperative blood pressure management in patients who have cerebrovascular diseases undergoing surgical procedures.

PubMed

Jellish, W Scott

2006-11-01

Patients who have cerebrovascular disease and vascular insufficiency routinely have neurosurgical and nonneurosurgical procedures. Anesthetic priorities must provide a still bloodless operative field while maintaining cardiovascular stability and renal function. Patients who have symptoms or a history of cerebrovascular disease are at increased risk for stroke, cerebral hypoperfusion, and cerebral anoxia. Type of surgery and cardiovascular status are key concerns when considering neuroprotective strategies. Optimization of current condition is important for a good outcome; risks must be weighed against perceived benefits in protecting neurons. Anesthetic use and physiologic manipulations can reduce neurologic injury and assure safe and effective surgical care when cerebral hypoperfusion is a real and significant risk.

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.

Remote Excavation System technology evaluation report: Buried Waste Robotics Program

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

Not Available

1993-09-01

This document describes the results from the Remote Excavation System demonstration and testing conducted at the Idaho National Engineering Laboratory during June and July 1993. The purpose of the demonstration was to ascertain the feasibility of the system for skimming soil and removing various types of buried waste in a safe manner and within all regulatory requirements, and to compare the performances of manual and remote operation of a backhoe. The procedures and goals of the demonstration were previously defined in The Remote Excavation System Test Plan, which served as a guideline for evaluating the various components of the systemmore » and discussed the procedures used to conduct the tests.« less

Minor oral surgery without stopping daily low-dose aspirin therapy: a study of 51 patients.

PubMed

Madan, Gautam A; Madan, Sonal G; Madan, Gauri; Madan, A D

2005-09-01

The risk of excessive bleeding prompts physicians to stop low-dose long-term aspirin regimens before surgery, which puts the patient at risk from adverse thrombotic events. We hypothesize that most minor oral surgical procedures can be carried out safely without stopping low-dose aspirin. All minor oral surgery patients at our hospital (Madan Dental Hospital, Ahmedabad, India) from May 2002 to May 2003, who were also on long-term low-dose aspirin therapy regimens (acetylsalicylic acid 75 mg to 100 mg/day), were included. Investigation of bleeding time and platelet count was performed. If within normal limits, aspirin was not stopped before surgery. Patients were operated under local anesthesia on an outpatient basis. All wounds were sutured and followed up at 24, 48, and 72 hours, 1 week, and 2 weeks after the procedure. The study included 51 patients (32 males, 19 females), ranging in age from 45 to 70 years. Preoperative values were within normal limits for all patients. Aspirin was not stopped for a single patient. There was no excessive intraoperative bleeding in all cases except 1; there was no postoperative bleeding in all cases. We conclude that most minor oral surgery procedures can be carried out safely without stopping long-term low-dose aspirin regimen.

Managing direct oral anticoagulants in patients undergoing dentoalveolar surgery.

PubMed

Patel, J P; Woolcombe, S A; Patel, R K; Obisesan, O; Roberts, L N; Bryant, C; Arya, R

2017-02-24

Our objective was to describe our experience of managing a cohort of adult patients prescribed direct oral anticoagulants (DOACs) undergoing dentoalveolar procedures between November 2012 and May 2016. Prior to conducting a procedure a formal assessment was made of each patient's anticoagulation treatment. A specific plan was then formulated, balancing the risk of bleeding with the risk of thrombosis. Patients received a telephone consultation one week following treatment to assess any post-operative bleeding. Eighty-two patients underwent 111 oral surgical procedures, the majority of which were dental extractions. In the case of 35 (32%) procedures, advice was given to omit the DOAC, either before or after treatment. There was no bleeding following the majority of procedures. Persistent bleeding followed 15 (13.5%) procedures, of which 7 (6.3%) procedures required specific intervention. The majority of patients prescribed DOACs can undergo dentoalveolar procedures safely. Important considerations when planning treatment are: (i) when the patient usually takes their dose of DOAC, (ii) the time the procedure is performed and, (iii) when the DOAC is taken post-procedure. In our experience, if these factors are considered carefully, omission of DOAC doses is unlikely to be required for most patients.

Nonsurgical Medical Penile Girth Augmentation: Experience-Based Recommendations.

PubMed

Oates, Jayson; Sharp, Gemma

2017-10-01

Penile augmentation is increasingly sought by men who are dissatisfied with the size and/or appearance of their penis. However, augmentation procedures are still considered to be highly controversial with no standardized recommendations reported in the medical literature and limited outcome data. Nevertheless, these procedures continue to be performed in increasing numbers in private settings. Therefore, there is a need for safe, effective, and minimally invasive procedures to be developed, evaluated, and reported in the research literature. In this article, we focus particularly on girth enhancement procedures rather than lengthening procedures as penile girth appears to be particularly important for sexual satisfaction. We discuss the advantages and disadvantages of the common techniques to date, with a focus on the minimally invasive injectable girth augmentation techniques. Based on considerable operative experience, we offer our own suggestions for patient screening, technique selection, and perioperative care. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

Robot-assisted laparoscopic (RAL) procedures in general surgery.

PubMed

Alimoglu, Orhan; Sagiroglu, Julide; Atak, Ibrahim; Kilic, Ali; Eren, Tunc; Caliskan, Mujgan; Bas, Gurhan

2016-09-01

Robotics was introduced in clinical practice more than two decades ago, and it has gained remarkable popularity for a wide variety of laparoscopic procedures. We report our results of robot-assisted laparoscopic surgery (RALS) in the most commonly applied general surgical procedures. Ninety seven patients underwent RALS from 2009 to 2012. Indications for RALS were cholelithiasis, gastric carcinoma, splenic tumors, colorectal carcinoma, benign colorectal diseases, non-toxic nodular goiter and incisional hernia. Records of patients were analyzed for demographic features, intraoperative and postoperative complications and conversion to open surgery. Forty six female and 51 male patients were operated and mean age was 58,4 (range: 25-88). Ninety three out of 97 procedures (96%) were completed robotically, 4 were converted to open surgery and there were 15 postoperative complications. There was no mortality. Wide variety of procedures of general surgery can be managed safely and effectively by RALS. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Comparison of Radiofrequency-targeted Vertebral Augmentation With Balloon Kyphoplasty for the Treatment of Vertebral Compression Fractures: 2-Year Results.

PubMed

Bornemann, Rahel; Jansen, Tom R; Kabir, Koroush; Pennekamp, Peter H; Stüwe, Brit; Wirtz, Dieter C; Pflugmacher, Robert

2017-04-01

A retrospective study. The aim of this study was the evaluation of the safety and effectiveness of radiofrequency-targeted vertebral augmentation (RF-TVA) in comparison with balloon kyphoplasty (BK) for the treatment of acute painful vertebral compression fractures (VCFs) on the basis of matched pairs. Vertebroplasty and BK are the common surgical interventions for the treatment of VCF. Both are effective and safe but pose some risks such as adjacent fractures and cement leakage. In 2009, RF-TVA was introduced as an innovative augmentation procedure for the treatment of VCF. A total of 192 patients (116 female; 51-90 y) with VCF (n=303) at 1 to 3 levels were treated with RF-TVA or BK. Functionality (Oswestry Disability Index), pain (visual analogue scale), vertebral height (anterior, middle), and kyphotic angle were evaluated over a 2-year period (postoperatively, 3-4 d, 3, 6, 12, and 24 mo). In addition, operating time and occurrence of cement leakage were recorded. Pain and functionality were significantly improved after both treatments. In both groups, there was an increase in the vertebral height and a decrease in the kyphotic angle, which remained relatively consistent during 24 months. The incidence of cement leakage was 9.4% (n=9) in the RF-TVA group and 24.0% (n=25) in the BK group. The mean operating time with radiofrequency kyphoplasty was 25.9±9.9 minutes, and with balloon kyphoplasty 48.0±18.4 minutes. RF-TVA is a safe and effective procedure for the treatment of vertebral compression fractures when compared with BK. Improvement in pain and functional scores after RF-TVA are durable through 24 months postprocedure and remained better than those after BK at long-term follow-up. Operating time for RF-TVA is shorter and the risk of cement leakage is lower. Both procedures provided similar results in vertebral height restoration and reduction in the kyphotic angle.

How to train surgical residents to perform laparoscopic Roux-en-Y gastric bypass safely.

PubMed

Iordens, Gijs I T; Klaassen, René A; van Lieshout, Esther M M; Cleffken, Berry I; van der Harst, Erwin

2012-09-01

As a result of increasing numbers of patients with morbid obesity there is a worldwide demand for bariatric surgeons. The Roux-en-Y gastric bypass, nowadays performed mostly laparoscopically (LRYGB), has been proven to be a highly effective surgical treatment for morbid obesity. This procedure is technically demanding and requires a long learning curve. Little is known about implementing these demanding techniques in the training of the surgical resident. The aim of this study was to evaluate the safety and feasibility of the introduction of LRYGB into the training of surgical residents. All patients who underwent LRYGB between March 2006 and July 2010 were retrospectively analyzed. The procedure was performed by a surgical resident under strict supervision of a bariatric surgeon (group I) or by a bariatric surgeon (group II). The primary end point was the occurrence of complications. Secondary end points included operative time, days of hospitalization, rate of readmission, and reappearance in the emergency department (ED) within 30 days. A total of 409 patients were found eligible for inclusion in the study: 83 patients in group I and 326 in group II. There was a significant difference in operating time (129 min in group I vs. 116 min in group II; p < 0.001) and days of hospitalization. Postoperative complication rate, reappearance in the ED, and rate of readmission did not differ between the two groups. Our data suggest that under stringent supervision and with sufficient laparoscopic practice, implementation of LRYGB as part of surgical training is safe and results in only a slightly longer operating time. Complication rates, days of hospitalization, and the rates of readmission and reappearance in the ED within 30 days were similar between the both groups. These results should be interpreted by remembering that all procedures in group I were performed in a training environment so occasional intervention by a bariatric surgeon, when necessary, was inevitable.

How to get the best from robotic thoracic surgery.

PubMed

Ricciardi, Sara; Zirafa, Carmelina Cristina; Davini, Federico; Melfi, Franca

2018-04-01

The application of Robotic technology in thoracic surgery has become widespread in the last decades. Thanks to its advanced features, the robotic system allows to perform a broad range of complex operations safely and in a comfortable way, with valuable advantages related to low invasiveness. Regarding lung tumours, several studies have shown the benefits of robotic surgery including lower blood loss and improved lymph node removal when compared with other minimally invasive techniques. Moreover, the robotic instruments allow to reach deep and narrow spaces permitting safe and precise removal of tumours located in remote areas, such as retrosternal and posterior mediastinal spaces with outstanding postoperative and oncological results. One controversial finding about the application of robotic system is its high capital and running costs. For this reason, a limited number of centres worldwide are able to employ this groundbreaking technology and there are limited possibilities for the trainees to acquire the necessary skills in robotic surgery. Therefore, a training programme based on three steps of learning, associated with a solid surgical background and a consistent operating activity, are required to obtain effective results. Putting this highest technological innovation in the hand of expert surgeons we can assure safe and effective procedures getting the best from robotic thoracic surgery.

Construct Validity of Fresh Frozen Human Cadaver as a Training Model in Minimal Access Surgery

PubMed Central

Macafee, David; Pranesh, Nagarajan; Horgan, Alan F.

2012-01-01

Background: The construct validity of fresh human cadaver as a training tool has not been established previously. The aims of this study were to investigate the construct validity of fresh frozen human cadaver as a method of training in minimal access surgery and determine if novices can be rapidly trained using this model to a safe level of performance. Methods: Junior surgical trainees, novices (<3 laparoscopic procedure performed) in laparoscopic surgery, performed 10 repetitions of a set of structured laparoscopic tasks on fresh frozen cadavers. Expert laparoscopists (>100 laparoscopic procedures) performed 3 repetitions of identical tasks. Performances were scored using a validated, objective Global Operative Assessment of Laparoscopic Skills scale. Scores for 3 consecutive repetitions were compared between experts and novices to determine construct validity. Furthermore, to determine if the novices reached a safe level, a trimmed mean of the experts score was used to define a benchmark. Mann-Whitney U test was used for construct validity analysis and 1-sample t test to compare performances of the novice group with the benchmark safe score. Results: Ten novices and 2 experts were recruited. Four out of 5 tasks (nondominant to dominant hand transfer; simulated appendicectomy; intracorporeal and extracorporeal knot tying) showed construct validity. Novices’ scores became comparable to benchmark scores between the eighth and tenth repetition. Conclusion: Minimal access surgical training using fresh frozen human cadavers appears to have construct validity. The laparoscopic skills of novices can be accelerated through to a safe level within 8 to 10 repetitions. PMID:23318058

The learning curve of laparoendoscopic single-site (LESS) cholecystectomy: definable, short, and safe.

PubMed

Hernandez, Jonathan; Ross, Sharona; Morton, Connor; McFarlin, Kellie; Dahal, Sujat; Golkar, Farhaad; Albrink, Michael; Rosemurgy, Alexander

2010-11-01

The applications of laparoendoscopic single-site (LESS) surgery, including cholecystectomy, are occurring quickly, although little is generally known about issues associated with the learning curve of this new technique including operative time, conversion rates, and safety. We prospectively followed all patients undergoing LESS cholecystectomy, and compared operations undertaken at our institutions in cohorts of 25 patients with respect to operative times, conversion rates, and complications. One-hundred fifty patients of mean age 46 years underwent LESS cholecystectomy. No significant differences in operative times were demonstrable between any of the 25-patient cohorts operated on at our institution. A significant reduction in operative times (p < 0.001) after completion of 75 LESS procedures was, however, identified with the experience of a single surgeon. No significant reduction in the number of procedures requiring an additional trocar(s) or conversion to open operations was observed after completion of 25 LESS cholecystectomies. Complication rates were low, and not significantly different between any 25-patient cohorts. For surgeons proficient with multi-incision laparoscopic cholecystectomy, the learning curve for LESS cholecystectomy begins near proficiency. Operative complications and conversions were infrequent and unchanged across successive 25-patient cohorts, and were similar to those reported for multi-incision laparoscopic cholecystectomy after the learning curve. Copyright © 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Visual search behaviour during laparoscopic cadaveric procedures

NASA Astrophysics Data System (ADS)

Dong, Leng; Chen, Yan; Gale, Alastair G.; Rees, Benjamin; Maxwell-Armstrong, Charles

2014-03-01

Laparoscopic surgery provides a very complex example of medical image interpretation. The task entails: visually examining a display that portrays the laparoscopic procedure from a varying viewpoint; eye-hand coordination; complex 3D interpretation of the 2D display imagery; efficient and safe usage of appropriate surgical tools, as well as other factors. Training in laparoscopic surgery typically entails practice using surgical simulators. Another approach is to use cadavers. Viewing previously recorded laparoscopic operations is also a viable additional approach and to examine this a study was undertaken to determine what differences exist between where surgeons look during actual operations and where they look when simply viewing the same pre-recorded operations. It was hypothesised that there would be differences related to the different experimental conditions; however the relative nature of such differences was unknown. The visual search behaviour of two experienced surgeons was recorded as they performed three types of laparoscopic operations on a cadaver. The operations were also digitally recorded. Subsequently they viewed the recording of their operations, again whilst their eye movements were monitored. Differences were found in various eye movement parameters when the two surgeons performed the operations and where they looked when they simply watched the recordings of the operations. It is argued that this reflects the different perceptual motor skills pertinent to the different situations. The relevance of this for surgical training is explored.

Minimally Invasive Ultrasound-Guided Carpal Tunnel Release: Preliminary Clinical Results.

PubMed

Henning, P Troy; Yang, Lynda; Awan, Tariq; Lueders, Daniel; Pourcho, Adam M

2018-04-02

Ultrasound-guided carpal tunnel release was performed on 14 patients (18 wrists) using dynamic expansion of the transverse safe zone. Our patient population included able-bodied patients and those with impairments. The first 8 cases (12 wrists) underwent the procedure in an operating room, the remainder in an outpatient setting. No complications occurred, and all patients were able to immediately resume use of their hands without therapy. Improvements in the Quick Form of the Disabilities of the Arm, Shoulder, and Hand Index and Boston Carpal Tunnel Questionnaire at 3 months were comparable to results reported with mini-open and endoscopic release. Our results show that ultrasound-guided carpal tunnel release can be safely and effectively performed in an outpatient setting. © 2018 by the American Institute of Ultrasound in Medicine.

Serial office-based steroid injections for treatment of idiopathic subglottic stenosis.

PubMed

Hoffman, Matthew R; Coughlin, Adam R; Dailey, Seth H

2017-11-01

Current treatment options for idiopathic subglottic stenosis include endoscopic interventions, resection, and tracheotomy. Recently, serial office-based steroid injections were proposed as an alternative that may stabilize or induce regression of airway stenosis without the need for repeated operations. Procedure completion rate, pain, complications, effect on stenosis, time since the last operation, and limitations have not been described. Retrospective case series. Retrospective series of 19 patients undergoing serial office-based steroid injection for idiopathic subglottic stenosis. Outcome measures included completion rate, procedure-related pain scores, complications, percentage of airway stenosis, and time since the last operative intervention. Procedure completion rate was 98.8%. Average pain score during the procedure was 2.3 ± 1.7 on a 10-point scale. There were no immediate complications. One patient underwent awake tracheotomy 8 days after her second injection and was later decannulated. Average stenosis decreased from 35% ± 15% to 25% ± 15% (n = 16; P = .086) over the first of three injections and 40% ± 15% to 25% ± 10% to 20% ± 10% (n = 8; P = .002) for those patients completing two sets of three injections. Fourteen of 17 patients undergoing at least three injections have not returned to the operating room since the first injection. Office-based steroid injection represents a promising new treatment pathway for a disease that requires long-term management, offering a purely pharmacologic approach to a disorder that has traditionally been approached from a mechanical perspective. It is safe, well tolerated, and effective. Furthermore, it may help patients and physicians avoid repeated trips to the operating room and the associated risks. 4. Laryngoscope, 127:2475-2481, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Pre-operative Screening and Manual Drilling Strategies to Reduce the Risk of Thermal Injury During Minimally Invasive Cochlear Implantation Surgery.

PubMed

Dillon, Neal P; Fichera, Loris; Kesler, Kyle; Zuniga, M Geraldine; Mitchell, Jason E; Webster, Robert J; Labadie, Robert F

2017-09-01

This article presents the development and experimental validation of a methodology to reduce the risk of thermal injury to the facial nerve during minimally invasive cochlear implantation surgery. The first step in this methodology is a pre-operative screening process, in which medical imaging is used to identify those patients that present a significant risk of developing high temperatures at the facial nerve during the drilling phase of the procedure. Such a risk is calculated based on the density of the bone along the drilling path and the thermal conductance between the drilling path and the nerve, and provides a criterion to exclude high-risk patients from receiving the minimally invasive procedure. The second component of the methodology is a drilling strategy for manually-guided drilling near the facial nerve. The strategy utilizes interval drilling and mechanical constraints to enable better control over the procedure and the resulting generation of heat. The approach is tested in fresh cadaver temporal bones using a thermal camera to monitor temperature near the facial nerve. Results indicate that pre-operative screening may successfully exclude high-risk patients and that the proposed drilling strategy enables safe drilling for low-to-moderate risk patients.

Introduction and use of video-assisted endoscopic thyroidectomy for patients in Belarus affected by the Chernobyl nuclear disaster.

PubMed

Igarashi, Takehito; Shimizu, Kazuo; Yakubouski, Siarhei; Akasu, Haruki; Okamura, Ritsuko; Sugitani, Iwao; Jikuzono, Tomoo; Danilova, Larisa

2013-11-01

We developed video-assisted neck surgery (VANS) - a feasible, simple, and safe endoscopic thyroid procedure with cosmetic benefits - in 1998. To date, we have performed this procedure 633 times. We have also introduced the VANS method in Belarus, a country that was left contaminated by the Chernobyl nuclear disaster. From a mass screening, nine Belarusian patients, including two with papillary carcinoma of the thyroid, were selected to undergo an operation using the VANS method, performed by a single surgeon (author Shimizu). We compared indicating factors for minimally invasive surgery, specifically the operating time and blood loss, between the Belarusian cases and the 33 most recent cases performed at our institute in Tokyo. The procedures in Belarus were performed under very different working conditions than in Japan. However, operating time and blood loss improved for the Belarusian cases as the surgeon gained experience in this environment; all the cosmetic outcomes were excellent. Subsequently, over a 2-year period, surgeons in Belarus performed the VANS method, with modification, for 29 cases of thyroid tumor. The VANS method is easily learned by inexperienced surgeons without major technical problems. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

The Ross Procedure in Pediatric Patients: A 20-Year Experience of Ross Procedure in a Single Institution

PubMed Central

Yoon, Dong Woog; Yang, Ji-Hyuk; Jun, Tae-Gook; Park, Pyo Won

2017-01-01

Background The Ross/Ross-Konno procedure is considered a good option for irreparable aortic valve disease in pediatric patients because of its hemodynamic performance and potential for growth of the pulmonary autograft. This study is a review of the long-term results of our 20-year experience with the Ross and Ross-Konno operations in a single institution. Methods Between June 1995 and January 2016, 16 consecutive patients (mean age, 6.0±5.9 years; range, 16 days to 17.4 years) underwent either a Ross operation (n=9) or a Ross-Konno operation (n=7). The study included 12 males and 4 females, with a median follow-up period of 47 months (range, 6 to 256 months). Results There were no cases of in-hospital or late mortality. Six reoperations were performed in 5 patients. Four patients underwent right ventricular-pulmonary artery (RV-PA) conduit replacement. Two patients underwent concomitant replacement of the pulmonary autograft and RV-PA conduit 10 years and 8 years after the Ross operation, respectively. The rate of freedom from adverse outcomes of the pulmonary autograft was 88% and 70% at 5 and 10 years, respectively. The rate of freedom from valve-related reoperations was 79% and 63% at 5 and 10 years, respectively. Conclusion Pulmonary autografts demonstrated good durability with low mortality. The Ross/Ross-Konno procedure is a good option that can be performed safely in pediatric patients with aortic valve disease, even in a small-volume center. PMID:28795027

Revisional bariatric surgery for failed gastric banding in Asia: a review of choice of revisional procedure, surgical technique and postoperative complication rates.

PubMed

Bhasker, A; Gadgil, M; Muda, N H; Lotwala, V; Lakdawala, M A

2011-02-01

In Asia, long-term weight loss results of gastric banding have been unsatisfactory. Bands are associated with higher complication rates, which result in a high reoperation rate. The aim of this paper is to discuss the choice of revisional procedure, operative technique and evaluate the postoperative complication rates. Between January 2007 and January 2010, we operated on 41 patients who were included retrospectively in this series. The most common reason for band removal was failure to lose adequate weight. Of those patients, 40 underwent band removal and conversion to a revisional bariatric surgery concomitantly; one patient's procedure was deferred to a later date. LSG was performed in 26 and LRYGB in 15. The highlights of the operative technique were meticulous dissection, complete removal of the pseudocapsule, choosing the right stapler cartridge, oversewing and inverting the entire staple line, and complete dissection of the left crus and pars flaccid. The median duration of surgery was 85 min (range, 55-180 min). There was no conversion to open surgery. The median stay in the hospital was 4 d (range, 2-7 d). There were no leaks or any other major complications in the postoperative period. Concomitant revisional procedure after removal of gastric band is safe and feasible. The operative technique followed at our center has had an extremely low postoperative morbidity rate and a 0% leak rate. © 2010 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Blackwell Publishing Asia Pty Ltd.

Don't mess with H/sub 2/S

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

Not Available

1987-09-01

The American Petroleum Institute issued a report on ''Recommended Practices for Safe Drilling of Wells Containing Hydrogen Sulfide.'' The study (RP49) updates a first edition published in September 1974. It provides a solid overview of preventive steps that should be taken to safeguard crew and equipment when drilling through H/sub 2/S zones. Discussions cover personnel training, protective equipment, wellsite layout, rig and well equipment, general rig operations and contingency planning and emergency procedures. This article summarizes the report.

Single-incision laparoscopic surgery and conventional laparoscopic treatment of varicocele in adolescents: Comparison between two techniques.

PubMed

Marte, Antonio; Pintozzi, Lucia; Cavaiuolo, Silvia; Parmeggiani, Pio

2014-01-01

Single-incision laparoscopic surgery (SILS) has gained great popularity in paediatric surgery due to its minimally invasive approach and improved cosmetic results. Notwithstanding, reports describing its adoption in children are still fragmentary and some perplexities have been raised by some surgeons. We reviewed our experience with the SILS Palomo varicocelectomy procedure (SIL-V) in children and adolescents, comparing this group with a similar series operated using conventional laparoscopic varicocelectomy (CL-V). A total of 69 Palomo laparoscopic varicocelectomies were performed in patients aged 11-17 years from January 2011 to January 2013. Indications for surgery included grades II-III varicocele or ipsilateral testicular hypotrophy. The SIL-V procedure was performed in 44 patients with roticulating and conventional 5 mm instruments. Testicular vessels were isolated "en bloc," clipped and cut. Operating time, visual analogue scale and post-operative results were compared to a similar group of 25 patients operated with CL-V. No patient of the SIL-V group required conversion to conventional laparoscopy, none to open surgery. Mean operative time was 22 min (range: 19-28) in the SIL-V group, not significantly different compared with CL-V (mean 21 min, range: 18-25). All patients experienced a smooth recovery from surgery without any complications, and were discharged on day 1. No difficulties were found in the SIL-V group. The post-operative pain score was significantly better in SIL-V. The SIL-V procedure is safe and effective and allows a fast and efficient isolation of the vascular bundle. The use of conventional instruments is technically feasible in SIL-V.

Novel Approach to Treat Uncomplicated Sigmoid Volvulus Combining Minimally Invasive Surgery with Enhanced Recovery, in a Rural Hospital in Zambia.

PubMed

van der Naald, Niels; Prins, Marloes I; Otten, Kars; Kumwenda, Dayson; Bleichrodt, Robert P

2018-06-01

In sub-Saharan Africa, sigmoid volvulus is a frequent cause of bowel obstruction. The aim of this study was to evaluate the results of acute sigmoid resection and anastomosis via a mini-laparotomy in patients with uncomplicated sigmoid volvulus, following the principles of "Enhanced Recovery After Surgery (ERAS)", in a low-resource setting. Patients with uncomplicated sigmoid volvulus were operated acutely, via a mini-laparotomy, according to the principles of ERAS. Intraoperative complications, duration of operation, morbidity, mortality and length of hospital stay were evaluated, retrospectively. From 1 March 2012 to 1 September 2017, 31 consecutive patients were treated with acute sigmoid resection and anastomosis, via a mini-laparotomy. There were 29 men and 2 women, median age 57 (range 17-92) years. Patients were operated after a median period of 4 (range 1.5-18) hours. The median duration of the operative procedure was 50 (range 30-105) minutes. Two patients died (6.3%). One patient died during an uncomplicated operation. The cause of death is unknown. One patient with a newly diagnosed HIV infection had an anastomotic dehiscence. After Hartmann's procedure, he died on the 17th post-operative day as a result of a HIV-related double-sided pneumonia, without signs of abdominal sepsis. One patient had an urinary retention and 1 patient haematuria after bladder catheter insertion. Acute sigmoid resection and primary anastomosis via a mini-laparotomy for uncomplicated sigmoid volvulus, without preoperative endoscopic decompression is a safe procedure with a low morbidity and mortality.

International Society for the Advancement of Cytometry Cell Sorter Biosafety Standards

PubMed Central

Holmes, Kevin L.; Fontes, Benjamin; Hogarth, Philip; Konz, Richard; Monard, Simon; Pletcher, Charles H.; Wadley, Robert B.; Schmid, Ingrid; Perfetto, Stephen P.

2014-01-01

Flow cytometric cell sorting of biological specimens has become prevalent in basic and clinical research laboratories. These specimens may contain known or unknown infectious agents, necessitating precautions to protect instrument operators and the environment from biohazards arising from the use of sorters. To this end the International Society of Analytical Cytology (ISAC) was proactive in establishing biosafety guidelines in 1997 (Schmid et al., Cytometry 1997;28:99–117) and subsequently published revised biosafety standards for cell sorting of unfixed samples in 2007 (Schmid et al., Cytometry Part A J Int Soc Anal Cytol 2007;71A:414–437). Since their publication, these documents have become recognized worldwide as the standard of practice and safety precautions for laboratories performing cell sorting experiments. However, the field of cytometry has progressed since 2007, and the document requires an update. The new Standards provides guidance: (1) for laboratory design for cell sorter laboratories; (2) for the creation of laboratory or instrument specific Standard Operating Procedures (SOP); and (3) on procedures for the safe operation of cell sorters, including personal protective equipment (PPE) and validation of aerosol containment. PMID:24634405

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

78 FR 16051 - Vehicle/Track Interaction Safety Standards; High-Speed and High Cant Deficiency Operations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-13

...FRA is amending the Track Safety Standards and Passenger Equipment Safety Standards to promote the safe interaction of rail vehicles with the track over which they operate under a variety of conditions at speeds up to 220 m.p.h. The final rule revises standards for track geometry and safety limits for vehicle response to track conditions, enhances vehicle/track qualification procedures, and adds flexibility for permitting high cant deficiency train operations through curves at conventional speeds. The rule accounts for a range of vehicle types that are currently in operation, as well as vehicle types that may likely be used in future high-speed or high cant deficiency rail operations, or both. The rule is based on the results of simulation studies designed to identify track geometry irregularities associated with unsafe wheel/rail forces and accelerations, thorough reviews of vehicle qualification and revenue service test data, and consideration of international practices.

Current challenges in European oncology pharmacy practice.

PubMed

Hoppe-Tichy, Torsten

2010-03-01

The demand for pharmacy cancer services is expected to at least double over the next 10 years, as the population ages and new treatments are introduced. Safe and efficient handling of cytotoxic products minimises risks to staff and reduces medication errors. To identify and describe strategies for coping safely and effectively with heavier workloads in the hospital oncology pharmacy, currently and in the future. The PubMed database was searched for literature on approaches to safe handling of antineoplastic agents and to decreasing medication errors in the hospital pharmacy. Articles that were judged to be of prime importance to the hospital oncologist were reviewed. These safety concepts are put into the context of contemporary hospital oncology pharmacy practice through discussion of key issues, including increased demand, the role of the pharmacist in determining the hospital formulary, and growth in patient preferences for oral chemotherapy. Recommendations on best practices are also provided, based on relevant literature and author experience. Efficient, safe hospital pharmacy operations can be aided by capacity planning, dose banding, and knowledge of novel products and procedures that can reduce risks to health while increasing the number of patients who are safely treated. Consideration may also be given to the economic role of oncology pharmacists in formulary development.

Mentored retroperitoneal laparoscopic renal surgery in children: a safe approach to learning.

PubMed

Farhat, W; Khoury, A; Bagli, D; McLorie, G; El-Ghoneimi, A

2003-10-01

To review the feasibility of introducing advanced retroperitoneal renal laparoscopic surgery (RRLS) to a paediatric urology division, using the mentorship-training model. Although the scope of practice in paediatric urology is currently adapting endoscopic surgery into daily practice, most paediatric urologists in North America have had no formal training in laparoscopic surgery. The study included four paediatric urologists with 3-25 years of practice; none had had any formal laparoscopic training or ever undertaken advanced RRLS. An experienced laparoscopic surgeon (the mentor) assisted the learning surgeons over a year. The initial phases of learning incorporated detailed lectures, visualization through videotapes and 'hands-on' demonstration by the expert in the technique of the standardized steps for each type of surgery. Over 10 months, ablative and reconstructive RRLS was undertaken jointly by the surgeons and the mentor. After this training the surgeons operated independently. To prevent lengthy operations, conversion to open surgery was planned if there was no significant progression after 2 h of laparoscopic surgery. Over the 10 months of mentorship, 36 RRLS procedures were undertaken in 31 patients (28 ablative and eight reconstructive). In all cases the mentored surgeons accomplished both retroperitoneal access and the creation of a working space within the cavity. The group was able to initiate ablative RRLS but the mentor undertook all the reconstructive procedures. After the mentorship period, over 10 months, 12 ablative procedures were undertaken independently, and five other attempts at RRLS failed. Although the mentored approach can successfully and safely initiate advanced RRLS in a paediatric urology division, assessing the laparoscopic practice pattern after mentorship in the same group of trainees is warranted. Ablative RRLS is easier to learn for the experienced surgeon, but reconstructive procedures, e.g. pyeloplasty, require a high degree of skill in laparoscopic technique, which may only be acquired through formal training focusing primarily on suturing techniques.

Surgical resident involvement is safe for common elective general surgery procedures.

PubMed

Tseng, Warren H; Jin, Leah; Canter, Robert J; Martinez, Steve R; Khatri, Vijay P; Gauvin, Jeffrey; Bold, Richard J; Wisner, David; Taylor, Sandra; Chen, Steven L

2011-07-01

Outcomes of surgical resident training are under scrutiny with the changing milieu of surgical education. Few have investigated the effect of surgical resident involvement (SRI) on operative parameters. Examining 7 common general surgery procedures, we evaluated the effect of SRI on perioperative morbidity and mortality and operative time (OpT). The American College of Surgeons National Surgical Quality Improvement Program database (2005 to 2007) was used to identify 7 cases of nonemergent operations. Cases with simultaneous procedures were excluded. Logistic regression was performed across all procedures and within each procedure incorporating SRI, OpT, and risk-stratifying American College of Surgery National Surgical Quality Improvement Program morbidity and mortality probability scores, which incorporate multiple prognostic individual patient factors. Procedure-specific, SRI-stratified OpTs were compared using Wilcoxon rank-sum tests. A total of 71.3% of the 37,907 cases had SRI. Absolute 30-day morbidity for all cases with SRI and without SRI were 3.0% and 1.0%, respectively (p < 0.001); absolute 30-day mortality for all cases with SRI and without SRI were 0.1% and 0.08%, respectively (p < 0.001). After multivariate analysis by specific procedure, SRI was not associated with increased morbidity but was associated with decreased mortality during open right colectomy (odds ratio 0.32; p = 0.01). Across all procedures, SRI was associated with increased morbidity (odds ratio 1.14; p = 0.048) but decreased mortality (odds ratio 0.42; p < 0.001). Mean OpT for all procedures was consistently lower for cases without SRI. SRI has a measurable impact on both 30-day morbidity and mortality and OpT. These data have implications to the impact associated with surgical graduate medical education. Further studies to identify causes of patient morbidity and prevention strategies in surgical teaching environments are warranted. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Safe Disposal of Highly Reactive Chemicals.

ERIC Educational Resources Information Center

Lunn, George; Sansone, Eric B.

1994-01-01

Provides specific procedures for the disposal of a variety of highly reactive chemicals and reports the results of a study of their safe disposal. Disposal of some problematic sulfur-containing compounds are included. Procedures are based on a combination of literature review and author development. (LZ)

Evidence-based value of subcutaneous surgical wound drainage: the largest systematic review and meta-analysis.

PubMed

Kosins, Aaron M; Scholz, Thomas; Cetinkaya, Mine; Evans, Gregory R D

2013-08-01

The purpose of this study was to determine the evidenced-based value of prophylactic drainage of subcutaneous wounds in surgery. An electronic search was performed. Articles comparing subcutaneous prophylactic drainage with no drainage were identified and classified by level of evidence. If sufficient randomized controlled trials were included, a meta-analysis was performed using the random-effects model. Fifty-two randomized controlled trials were included in the meta-analysis, and subgroups were determined by specific surgical procedures or characteristics (cesarean delivery, abdominal wound, breast reduction, breast biopsy, femoral wound, axillary lymph node dissection, hip and knee arthroplasty, obesity, and clean-contaminated wound). Studies were compared for the following endpoints: hematoma, wound healing issues, seroma, abscess, and infection. Fifty-two studies with a total of 6930 operations were identified as suitable for this analysis. There were 3495 operations in the drain group and 3435 in the no-drain group. Prophylactic subcutaneous drainage offered a statistically significant advantage only for (1) prevention of hematomas in breast biopsy procedures and (2) prevention of seromas in axillary node dissections. In all other procedures studied, drainage did not offer an advantage. Many surgical operations can be performed safely without prophylactic drainage. Surgeons can consider omitting drains after cesarean section, breast reduction, abdominal wounds, femoral wounds, and hip and knee joint replacement. Furthermore, surgeons should consider not placing drains prophylactically in obese patients. However, drain placement following a surgical procedure is the surgeon's choice and can be based on multiple factors beyond the type of procedure being performed or the patient's body habitus. Therapeutic, II.

National study of utilization of male incontinence procedures.

PubMed

Chughtai, Bilal; Sedrakyan, Art; Isaacs, Abby J; Mao, Jialin; Lee, Richard; Te, Alexis; Kaplan, Steven

2016-01-01

We explored re-interventions and short and long term adverse events associated with procedures for male incontinence among Medicare beneficiaries. All inpatient and outpatient claims for a simple random sample of Medicare beneficiaries for 2000-2011 were queried to identify patients of interest. All male patients with an International Classification of Diseases, 9th Edition (ICD-9) diagnosis code for stress incontinence or mixed incontinence were included. Artificial urinary sphincter recipients, patients who underwent a sling operation and those receiving an injection of a bulking agent were identified with Current Procedure Terminology (CPT-4) and ICD-9 Procedure Codes. The entire cohort of 1,246 patients were operated on between 2001 and 2011. 34.9% of them received an artificial urinary sphincter (AUS), 28.7% with a bulking agent, and 36.4% with a sling. There were no statistically significant differences in demographics or comorbidities between the treatment groups, except that more sling patients were obese (P = 0.006) and fewer bulk patients had diabetes (P = 0.007). There are, however, significant changes in procedures selected over time (P < 0.001). In the first year and over the entire follow-up after surgery, patients treated with bulking agents had the most subsequent interventions (40.1% and 52.9%), followed by sling (10.4% and 15.5%), and AUS (2.3% and 20%) (P < 0.001). Post-operative and 90 day complications were low. All three treatments seem to be safe among Medicare beneficiaries with multiple comorbidities. The urological, infectious, and neurological complication occurrences were low. © 2014 Wiley Periodicals, Inc.

Medical personnel and patient dosimetry during coronary angiography and intervention

NASA Astrophysics Data System (ADS)

Efstathopoulos, Efstathios P.; Makrygiannis, Stamatis S.; Kottou, Sofia; Karvouni, Evangelia; Giazitzoglou, Eleftherios; Korovesis, Socrates; Tzanalaridou, Efthalia; Raptou, Panagiota D.; Katritsis, Demosthenes G.

2003-09-01

Percutaneous coronary interventions are associated with increased radiation exposure compared to most radiological examinations. This prospective study aimed at (1) measuring entrance doses for all in-room personnel, (2) performing an assessment of patient effective dose and intracoronary doses, (3) investigating the contribution of each projection to kerma-area product (KAP) and irradiation time, (4) comparing results with established DRL values in this clinical setting and (5) estimating the risk for fatal cancer to patients and operators. Measurements were performed during 40 consecutive procedures of coronary angiography (CA), half of which were followed by ad hoc coronary angioplasty (PTCA). KAP measurements were used for patients and thermoluminescent dosimetry for the in-room personnel. The mean KAP value per procedure for CA was 29 +/- 9 Gy cm2. Thirty four per cent of KAP was due to fluoroscopy, whereas the remainder (66%) was due to digital cine. Accordingly, the mean KAP value per PTCA procedure was 75 +/- 30 Gy cm2, and contribution of fluoroscopy is 57%. Effective dose per year was estimated to be 0.04-0.05 mSv y-1 for the primary operator, and 0.03-0.04 mSv y-1 for those assisting. Corresponding measurements for radiographer and nurse were below detectable level, implying minimal radiation hazards for them. Regarding radiation exposure, coronary intervention is considered a quite safe procedure for both patients and personnel in laboratories with modern equipment and experienced operators as long as standard safety precautions are considered. Exposure optimization though should be constantly sought through continuous review of procedures.

a Novel Image Acquisition and Processing Procedure for Fast Tunnel Dsm Production

NASA Astrophysics Data System (ADS)

Roncella, R.; Umili, G.; Forlani, G.

2012-07-01

In mining operations the evaluation of the stability condition of the excavated front are critic to ensure a safe and correct planning of the subsequent activities. The procedure currently used to this aim has some shortcomings: safety for the geologist, completeness of data collection and objective documentation of the results. In the last decade it has been shown that the geostructural parameters necessary to the stability analysis can be derived from high resolution digital surface models (DSM) of rock faces. With the objective to overcome the limitation of the traditional survey and to minimize data capture times, so reducing delays on mining site operations, a photogrammetric system to generate high resolution DSM of tunnels has been realized. A fast, effective and complete data capture method has been developed and the orientation and restitution phases have been largely automated. The survey operations take no more than required to the traditional ones; no additional topographic measurements other than those available are required. To make the data processing fast and economic our Structure from Motion procedure has been slightly modified to adapt to the peculiar block geometry while, the DSM of the tunnel is created using automatic image correlation techniques. The geomechanical data are sampled on the DSM, by using the acquired images in a GUI and a segmentation procedure to select discontinuity planes. To allow an easier and faster identification of relevant features of the surface of the tunnel, using again an automatic procedure, an orthophoto of the tunnel is produced. A case study where a tunnel section of ca. 130 m has been surveyed is presented.

Replacement of Expensive, Disposable Instruments With Old-fashioned Surgical Techniques for Improved Cost-effectiveness in Laparoscopic Hysterectomy

PubMed Central

Morrison, John E.

2004-01-01

Objective: Patients demand that health care and procedures in rural areas be provided by ambulatory surgery centers close to home. However, the reimbursement rate for such procedures in ambulatory centers is extremely low, so a standard classic intrafascial supracervical hysterectomy procedure needs to be more cost effective to be performed there. Instruments and disposable devices can make up ≥50% of hospital costs for this procedure, so any cost reduction has to focus on this aspect. Methods: We identified the 3 most expensive disposable devices: (1) an Endostapler, US $498 and 3 staple reloads, US $179 each; (2) a calibrated uterine resection tool 15 mm for encoring of the endocervical canal, US $853; and (3) a serrated edged macro morcellator for intraabdominal uterus morcellation, US $321, and substituted them using classic conservative surgical techniques. Results: From September 2001 to September 2002, we performed 26 procedures with this modified technique at an ambulatory surgery center with a follow-up of 6.7 (2 to 14) months. This modified operative technique was feasible; no conversions were necessary, and no complications occurred. Cost savings were US $2209 per procedure; additional costs were US $266.33 for suture material and an Endopouch, resulting in an overall savings of US $50 509.42. The disadvantage was an increase in operating room time of about 1 hour 20 minutes per case. Conclusion: These modifications in the classic intrafascial supracervical hysterectomy technique have proven to be feasible, safe, and highly cost effective, especially for a rural ambulatory surgery center. Long-term follow-up is necessary to further evaluate these operative modifications. PMID:15119671

Prioritizing essential surgery and safe anesthesia for the Post-2015 Development Agenda: operative capacities of 78 district hospitals in 7 low- and middle-income countries.

PubMed

LeBrun, Drake G; Chackungal, Smita; Chao, Tiffany E; Knowlton, Lisa M; Linden, Allison F; Notrica, Michelle R; Solis, Carolina V; McQueen, K A Kelly

2014-03-01

Surgery has been neglected in low- and middle-income countries for decades. It is vital that the Post-2015 Development Agenda reflect that surgery is an important part of a comprehensive global health care delivery model. We compare the operative capacities of multiple low- and middle-income countries and identify critical gaps in surgical infrastructure. The Harvard Humanitarian Initiative survey tool was used to assess the operative capacities of 78 government district hospitals in Bangladesh (n = 7), Bolivia (n = 11), Ethiopia (n = 6), Liberia (n = 11), Nicaragua (n = 10), Rwanda (n = 21), and Uganda (n = 12) from 2011 to 2012. Key outcome measures included infrastructure, equipment availability, physician and nonphysician surgical providers, operative volume, and pharmaceutical capacity. Seventy of 78 district hospitals performed operations. There was fewer than one surgeon or anesthesiologist per 100,000 catchment population in all countries except Bolivia. There were no physician anesthesiologists in any surveyed hospitals in Rwanda, Liberia, Uganda, or in the majority of hospitals in Ethiopia. Mean annual operations per hospital ranged from 374 in Nicaragua to 3,215 in Bangladesh. Emergency operations and obstetric operations constituted 57.5% and 40% of all operations performed, respectively. Availability of pulse oximetry, essential medicines, and key infrastructure (water, electricity, oxygen) varied widely between and within countries. The need for operative procedures is not being met by the limited operative capacity in numerous low- and middle-income countries. It is of paramount importance that this gap be addressed by prioritizing essential surgery and safe anesthesia in the Post-2015 Development Agenda. Copyright © 2014 Mosby, Inc. All rights reserved.

SOME PROBLEMS OF "SAFE DOSE" ESTIMATION

EPA Science Inventory

In environmental carcinogenic risk assessment, the usually defined "safe doses" appear subjective in some sense. n this paper a method of standardizing "safe doses" based on some objective parameters is introduced and a procedure of estimating safe doses under the competing risks...

Towards Robust Designs Via Multiple-Objective Optimization Methods

NASA Technical Reports Server (NTRS)

Man Mohan, Rai

2006-01-01

Fabricating and operating complex systems involves dealing with uncertainty in the relevant variables. In the case of aircraft, flow conditions are subject to change during operation. Efficiency and engine noise may be different from the expected values because of manufacturing tolerances and normal wear and tear. Engine components may have a shorter life than expected because of manufacturing tolerances. In spite of the important effect of operating- and manufacturing-uncertainty on the performance and expected life of the component or system, traditional aerodynamic shape optimization has focused on obtaining the best design given a set of deterministic flow conditions. Clearly it is important to both maintain near-optimal performance levels at off-design operating conditions, and, ensure that performance does not degrade appreciably when the component shape differs from the optimal shape due to manufacturing tolerances and normal wear and tear. These requirements naturally lead to the idea of robust optimal design wherein the concept of robustness to various perturbations is built into the design optimization procedure. The basic ideas involved in robust optimal design will be included in this lecture. The imposition of the additional requirement of robustness results in a multiple-objective optimization problem requiring appropriate solution procedures. Typically the costs associated with multiple-objective optimization are substantial. Therefore efficient multiple-objective optimization procedures are crucial to the rapid deployment of the principles of robust design in industry. Hence the companion set of lecture notes (Single- and Multiple-Objective Optimization with Differential Evolution and Neural Networks ) deals with methodology for solving multiple-objective Optimization problems efficiently, reliably and with little user intervention. Applications of the methodologies presented in the companion lecture to robust design will be included here. The evolutionary method (DE) is first used to solve a relatively difficult problem in extended surface heat transfer wherein optimal fin geometries are obtained for different safe operating base temperatures. The objective of maximizing the safe operating base temperature range is in direct conflict with the objective of maximizing fin heat transfer. This problem is a good example of achieving robustness in the context of changing operating conditions. The evolutionary method is then used to design a turbine airfoil; the two objectives being reduced sensitivity of the pressure distribution to small changes in the airfoil shape and the maximization of the trailing edge wedge angle with the consequent increase in airfoil thickness and strength. This is a relevant example of achieving robustness to manufacturing tolerances and wear and tear in the presence of other objectives.

Safety and efficacy of transurethral pneumatic lithotripsy for bladder calculi in children.

PubMed

Khosa, Ali Sher; Hussain, Muhammad; Hussain, Manzoor

2012-12-01

To determine the safety and efficacy of transurethral pneumatic lithotripsy for bladder calculi in children. The study included 100 children up to 15 years of age undergoing pneumatic cystolithoclast for bladder stones. The descriptive study was conducted from September 2006 to February 2007 at the Sindh Institute of Urology and Transplantation, Karachi. The inclusion criteria was children up to 15 years of age with a bladder stone of up to 3cm, pre-operative negative urine culture, no coagulopathy and fit for general anaesthesia. An X-ray and ultrasound of Kidney and Urinary Bladder (KUB) was mandatory. The procedure was done under general anaesthesia with a single dose of pre-operative antibiotic. A mini-scope of 4FR or a semi-rigid ureteroscope of 7/8.5 FR with pneumatic wolf lithoclast was used for the fragmentation of stones. Duration of procedure, any per-operative and post-operative complications and the duration of hospital stay were recorded. Post-operatively, the patient underwent ultrasound Kidney and Urinary Bladder at the first follow-up to assess stone clearance after one week. Mean patients age was 4.95 +/- 3.3 years. The male-to-female ratio was 11.5: 1 The mean hospital stay was 9.2 +/- 2.5 hours. The mean operating time was 25 (10 -65) minutes. Ten (10%) patients developed minor complications out of which 5 (5%) developed haematuria and 4 (4%) developed difficulty in passing urine. One (1%) of the patients developed post-operative retention of urine. All the patients were stone-free after the procedure. The transurethral pneumatic lithoclast is very effective and safe in children with bladder stones up to 3cm.

Prospective study of glove perforation in obstetrical and gynecological operations: are we safe enough?

PubMed

Malhotra, Monika; Sharma, Jai Bhagwan; Wadhwa, Leena; Arora, Raksha

2004-08-01

To assess the glove perforation rate, efficacy of double gloving, effect of duration of surgery, expertise of surgeon and operative urgency on the glove perforation rate in obstetrical and gynecologic operations. From February to September 2002, double glove protocol was made necessary for all major obstetrical and gynecologic procedures. The operating surgeon, first and second assistant were included in the study. Gloves damage was noted (overt by inspection, occult by hydroinsufflation technique). Of the 156 procedures included in study, 32 procedures were performed (all emergency operations) single-gloved because surgeons found double gloving clumsy (56%), made it difficult to tie knots due to lack of dexterity (24%), or were too tight (20%). One thousand one hundred and twenty single gloves were examined after each procedure by hydroinsufflation. The overall perforation rate was 13.6% (single versus double outer gloves, 13.8% versus l3.2%, P > 0.05). Matching perforations were found in six cases (4.6%). Thus, the protection offered by double gloves was 95.4% even if the outer gloves were perforated. Four inner gloves had preexisting perforations. Sixty unused gloves checked similarly revealed a perforation rate of 1.6%. Emergency cases had higher perforation rate compared to elective surgeries (16.6% versus 10.8%, P < 0.00 1). Surgeries lasting for more than 40 min had a higher perforation rate compared to those finished in less than or equal to 40 min (18.6% versus 7.6%, P < 0.001). The middle finger of the left hand was the most commonly involved. The surgeon, first assistant and second assistant were involved in 73.6, 23.3 and 3.2% cases, respectively. Double gloving offers considerable protection against exposure to contaminants in the blood and body fluids of the patient and should be made routine, especially in developing countries where HIV, hepatitis B and C are widely prevalent. Double gloving should be made mandatory in emergency procedures, which have a higher perforation rate due to operative urgency, and gloves should be changed in operations lasting for more than 40 min to ensure integrity of barrier.

Use of a multi-instrument access device in abdominoperineal resections

PubMed Central

van der Linden, Yoen TK; Boersma, Doeke; Bosscha, Koop; Lips, Daniel J; Prins, Hubert A

2016-01-01

BACKGROUND: Laparoscopic colorectal surgery results in less post-operative pain, faster recovery, shorter length of stay and reduced morbidity compared with open procedures. Less or minimally invasive techniques have been developed to further minimise surgical trauma and to decrease the size and number of incisions. This study describes the safety and feasibility of using an umbilical multi-instrument access (MIA) port (Olympus TriPort+) device with the placement of just one 12-mm suprapubic trocar in laparoscopic (double-port) abdominoperineal resections (APRs) in rectal cancer patients. PATIENTS AND METHODS: The study included 20 patients undergoing double-port APRs for rectal cancer between June 2011 and August 2013. Preoperative data were gathered in a prospective database, and post-operative data were collected retrospectively. RESULTS: The 20 patients (30% female) had a median age of 67 years (range 46-80 years), and their median body mass index (BMI) was 26 kg/m2 (range 20-31 kg/m2). An additional third trocar was placed in 2 patients. No laparoscopic procedures were converted to an open procedure. Median operating time was 195 min (range 115-306 min). A radical resection (R0 resection) was achieved in all patients, with a median of 14 lymph nodes harvested. Median length of stay was 8 days (range 5-43 days). CONCLUSION: Laparoscopic APR using a MIA trocar is a feasible and safe procedure. A MIA port might be of benefit as an extra option in the toolbox of the laparoscopic surgeon to further minimise surgical trauma. PMID:27279397

A streamlined protocol for the use of the semi-sitting position in neurosurgery: a report on 48 consecutive procedures.

PubMed

Ammirati, Mario; Lamki, Tariq Theeb; Shaw, Andrew Brian; Forde, Braxton; Nakano, Ichiro; Mani, Matharbootham

2013-01-01

The semi-sitting position has lost favor among neurosurgeons partly due to unproven assumptions of increased complications. Many complications have been associated with this position; the most feared: venous air embolism and paradoxical air embolism. We report on this retrospective study of the outcome over 4 years of 48 neurosurgical patients operated on consecutively using a standardized protocol: 41 (85%) in the semi-sitting position, and seven (15%) in the prone position. Procedures included: tumor resection (34), posterior fossa decompression (12), cyst resection (1) and resection of arteriovenous malformation (1). Pre-operative workup was standardized. Vigilant intra-operative observation was done by an experienced neuroanesthetist. Pertinent data was extracted from surgical records. Of the 48 patients, 10 (20.8%) were found to have a patent foramen ovale (PFO) on trans-esophageal echocardiography. Of these, four (40%) patients underwent procedures in the semi-sitting position while six (60%) did not. A clinically significant venous air embolism (VAE) was detected during 2 of the 41 semi-sitting procedures (4.9%). Neither patient suffered any obvious sequelae. No other morbidity was encountered associated with surgical position. Our study suggests that a model similar to ours is effective in preventing major complications associated with the semi-sitting position. The semi-sitting position is a safe, practical position that should be considered in appropriate cases. The fear of dreadful complications seems unwarranted. Copyright © 2012 Elsevier Ltd. All rights reserved.

The other side of the safety coin. [aerospace operations

NASA Technical Reports Server (NTRS)

Roth, Gilbert L.

1986-01-01

The development, inspection and testing requirements for successful production and launch and safe operation of spaceflight hardware are discussed. Emphasis is placed on paying acute attention to malfunctions, which could be caused by contaminants (particles in docking rings), insufficiently durable materials (Orbiter brakes), etc. Generic and specific problems which occur in propulsion, avionics, mechanical and computer systems and in configuration management, manufacturing and process control efforts are explored. Case histories of deficiencies found in LOX fuel lines, contaminated hydraulic control systems, the Solar Maximum Mission thermal insulation grommets, are summarized. Thorough inspection and testing procedures and design change recording during manufacture of spacecraft components are identified as requisites for successful space missions.

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).

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.

75 FR 75175 - Agency Information Collection Activities; Announcement of Office of Management and Budget...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-02

... that a collection of information entitled ``Procedures for the Safe and Sanitary Processing and...] Agency Information Collection Activities; Announcement of Office of Management and Budget Approval; Procedures for the Safe and Sanitary Processing and Importing of Fish and Fishery Products AGENCY: Food and...

Aviation Pilot Training I. Task Analyses: Semester II. Field Review Copy.

ERIC Educational Resources Information Center

Upchurch, Richard

This guide for aviation pilot training begins with a course description, resource information, and a course outline. Tasks/competencies are categorized into 12 concept/duty areas: understanding safe procedures in the flight environment; understanding safe procedures in the airport environment; understanding Federal Aviation Regulations concerning…

The Anaesthesia Gas Supply System

PubMed Central

Das, Sabyasachi; Chattopadhyay, Subhrajyoti; Bose, Payel

2013-01-01

The anaesthesia gas supply system is designed to provide a safe, cost-effective and convenient system for the delivery of medical gases at the point of-use. The doctrine of the anaesthesia gas supply system is based on four essential principles: Identity, continuity, adequacy and quality. Knowledge about gas supply system is an integral component of safe anaesthetic practice. Mishaps involving the malfunction or misuse of medical gas supply to operating theatres have cost many lives. The medical gases used in anaesthesia and intensive care are oxygen, nitrous oxide, medical air, entonox, carbon dioxide and heliox. Oxygen is one of the most widely used gases for life-support and respiratory therapy besides anaesthetic procedures. In this article, an effort is made to describe the production, storage and delivery of anaesthetic gases. The design of anaesthesia equipment must take into account the local conditions such as climate, demand and power supply. The operational policy of the gas supply system should have a backup plan to cater to the emergency need of the hospital, in the event of the loss of the primary source of supply. PMID:24249882

Subxiphoid uniportal video-assisted thoracoscopic surgery for synchronous bilateral lung resection.

PubMed

Yang, Xueying; Wang, Linlin

2018-01-01

With advancements in medical imaging and current emphasis on regular physical examinations, multiple pulmonary lesions increasingly are being detected, including bilateral pulmonary lesions. Video-assisted thoracic surgery is an important method for treating such lesions. Most of video-assisted thoracic surgeries for bilateral pulmonary lesions were two separate operations. Herein, we report a novel technique of synchronous subxiphoid uniportal video-assisted thoracic surgery for bilateral pulmonary lesions. Synchronous bilateral lung resection procedures were performed through a single incision (~4 cm, subxiphoid). This technique was used successfully in 11 patients with bilateral pulmonary lesions. There were no intraoperative deaths or mortality recorded at 30 days. Our results show that the subxiphoid uniportal thoracoscopic procedure is a safe and feasible surgical procedure for synchronous bilateral lung resection with less surgical trauma, postoperative pain and better cosmetic results in qualifying patients. Further analysis is ongoing, involving a larger number of subjects.

A novel technique to identify the nerve of origin in head and neck schwannomas.

PubMed

Ching, H H; Spinner, A G; Reeve, N H; Wang, R C

2018-04-18

Identifying the nerve of origin in head and neck schwannomas is a diagnostic challenge. Surgical management leads to a risk of permanent deficit. Accurate identification of the nerve would improve operative planning and patient counselling. Three patients with head and neck schwannomas underwent a diagnostic procedure hypothesised to identify the nerve of origin. The masses were infiltrated with 1 per cent lidocaine solution, and the patients were observed for neurological deficits. All three patients experienced temporary loss of nerve function after lidocaine injection. Facial nerve palsy, voice changes with documented unilateral same-side vocal fold paralysis, and numbness in the distribution of the maxillary nerve (V2), respectively, led to a likely identification of the nerve of origin. Injection of lidocaine into a schwannoma is a safe, in-office procedure that produces a temporary nerve deficit, which may enable accurate identification of the nerve of origin of a schwannoma. Identifying the nerve of origin enhances operative planning and patient counselling.

Joint NASA/USAF Airborne Field Mill Program - Operation and safety considerations during flights of a Lear 28 airplane in adverse weather

NASA Technical Reports Server (NTRS)

Fisher, Bruce D.; Phillips, Michael R.; Maier, Launa M.

1992-01-01

A NASA Langley Research Center Learjet 28 research airplane was flown in various adverse weather conditions in the vicinity of the NASA Kennedy Space Center from 1990-1992 to measure airborne electric fields during the Joint NASA/USAF Airborne Field Mill Program. The objective of this program was to characterize the electrical activity in various weather phenomena common to the NASA-Kennedy area in order to refine Launch Commit Criteria for natural and triggered lightning. The purpose of the program was to safely relax the existing launch commit criteria, thereby increasing launch availability and reducing the chance for weather holds and delays. This paper discusses the operational conduct of the flight test, including environmental/safety considerations, aircraft instrumentation and modification, test limitations, flight procedures, and the procedures and responsibilities of the personnel in the ground station. Airborne field mill data were collected for all the Launch Commit Criteria during two summer and two winter deployments. These data are now being analyzed.

Complications of hysteroscopic surgery: "Beyond the learning curve".

PubMed

Shveiky, David; Rojansky, Nathan; Revel, Ariel; Benshushan, Abraham; Laufer, Neri; Shushan, Asher

2007-01-01

To investigate the actual complication rate of hysteroscopic surgery performed by experienced endoscopic surgeons in a single medical center. A prospective descriptive study (Canadian Task Force classification III). An endoscopic gynecology unit at a tertiary care university hospital. Women from 21 to 82 (median 45.0) years, undergoing operative hysteroscopy for uterine disease. Operative hysteroscopy with glycine or saline solution used as an irrigation medium. Data of short-term complications were prospectively collected during surgery and at the 2-week follow-up visit. Six hundred procedures were investigated. The total complication rate was 3%, with 1% of uterine perforations. Two-thirds of the complications were related to cervical dilation or uterine entry, and infertility was found to be a risk factor. Hysteroscopic surgery, performed by a well-trained hysteroscopic surgeon, is a safe procedure with an overall complication rate of 3%. Most complications are related to cervical dilation or uterine entry techniques. Efforts therefore should be focused on identifying the patients at risk and finding novel techniques for cervical priming.

Development of a safe and pragmatic awake craniotomy program at Maine Medical Center.

PubMed

Rughani, Anand I; Rintel, Theodor; Desai, Rajiv; Cushing, Deborah A; Florman, Jeffrey E

2011-01-01

Awake craniotomy offers an excellent means of performing intraoperative mapping and optimizing surgical resection of brain tumors. Awake craniotomy relies on a strong collaboration between anesthesiologists, neurosurgeons, and operating room staff. The authors recently introduced awake craniotomy for tumor resection at the Maine Medical Center and propose that it can be performed safely, effectively, and efficiently in a high-volume community hospital. We describe a practical approach to performing awake craniotomy involving streamlined anesthetic protocols and simplified intraoperative testing parameters in a carefully selected group of patients. Our first 25 patients are retrospectively reviewed with particular attention to the anesthetic protocol, the extent of resection, the operative time, post-operative complications, the length of hospitalization, and their functional status at follow-up. The authors established an anesthetic protocol based primarily on midazolam, fentanyl, propofol, and local anesthetic. The authors note that all but one patient was able to tolerate the awake procedure. Gross total resection was achieved in nearly 80% of patients with a glial tumor. Operative time was short, averaging 159 minutes of entire anesthesia care. Length of stay averaged 3.7 days. Persistent new post-operative deficits were noted in 2 of 25 patients. There was no substantial difference in total hospital charges for patients undergoing awake craniotomy when compared to a matched historical control. With attention focused on patient selection and a streamlined anesthetic protocol, the authors were able to successfully implement an awake craniotomy protocol in a community setting with satisfying results, including low operative morbidity, short operative times, low anesthetic complications, and excellent patient tolerance.

Safe Surgery for All: Early Lessons from Implementing a National Government-Driven Surgical Plan in Ethiopia.

PubMed

Burssa, Daniel; Teshome, Atlibachew; Iverson, Katherine; Ahearn, Olivia; Ashengo, Tigistu; Barash, David; Barringer, Erin; Citron, Isabelle; Garringer, Kaya; McKitrick, Victoria; Meara, John; Mengistu, Abraham; Mukhopadhyay, Swagoto; Reynolds, Cheri; Shrime, Mark; Varghese, Asha; Esseye, Samson; Bekele, Abebe

2017-12-01

Recognizing the unmet need for surgical care in Ethiopia, the Federal Ministry of Health (FMOH) has pioneered innovative methodologies for surgical system development with Saving Lives through Safe Surgery (SaLTS). SaLTS is a national flagship initiative designed to improve access to safe, essential and emergency surgical and anaesthesia care across all levels of the healthcare system. Sustained commitment from the FMOH and their recruitment of implementing partners has led to notable accomplishments across the breadth of the surgical system, including but not limited to: (1) Leadership, management and governance-a nationally scaled surgical leadership and mentorship programme, (2) Infrastructure-operating room construction and oxygen delivery plan, (3) Supplies and logistics-a national essential surgical procedure and equipment list, (4) Human resource development-a Surgical Workforce Expansion Plan and Anaesthesia National Roadmap, (5) Advocacy and partnership-strong FMOH partnership with international organizations, including GE Foundation's SafeSurgery2020 initiative, (6) Innovation-facility-driven identification of problems and solutions, (7) Quality of surgical and anaesthesia care service delivery-a national peri-operative guideline and WHO Surgical Safety Checklist implementation, and (8) Monitoring and evaluation-a comprehensive plan for short-term and long-term assessment of surgical quality and capacity. As Ethiopia progresses with its commitment to prioritize surgery within its Health Sector Transformation Plan, disseminating the process and outcomes of the SaLTS initiative will inform other countries on successful national implementation strategies. The following article describes the process by which the Ethiopian FMOH established surgical system reform and the preliminary results of implementation across these eight pillars.

Surgical treatment of chronic pancreatitis--a 14 years experience.

PubMed

Stroescu, C; Dima, S; Scarlat, A; Ivanov, B; Bouaru, O; Ionescu, M; Vasilescu, C; Popescu, I

2010-01-01

Operative treatment of chronic pancreatitis is indicated for patients with intractable pain after failed medical and endoscopic treatment, or in the presence of complications of the disease. This study evaluates a single-center experience with operative management of chronic pancreatitis over a period of time of 14 years, regarding indication, surgical technique, early and late results. The records of 265 consecutive patients who underwent surgery for chronic pancreatitis between 1995 and 2008 were retrospectively reviewed and analyzed. Long-term outcomes were assessed by patient survey, with a median follow-up of 40 months. 265 patients underwent 275 operations for chronic pancreatitis with the main indication abdominal pain (46.8%), followed by suspected malignancy in 24.8% and recurrent episodes of acute pancreatitis in 18.6%. Resection procedures 54.5% (150), drainage procedures 1.09% (3), bypass and denervation procedures 44.36% (122) and exploratory laparotomy 3.27% (9) were performed with an overall morbidity of 22% and an in-hospital mortality rate of 2.64%. After a median follow-up of 40 months survival information was available for 137 patients (51.69%) with a 5-and actuarial survival rate of 74.7% and quality of life improvement in most patients, especially in the resected group. Our results suggest that in chronic pancreatitis the type of surgery has to be individualized in each patient (resection VS drainage) and organ preserving operations are safe and effective in providing long-term pain relief and in treating CP-related complications

The Small Aircraft Transportation System Higher Volume Operations (SATS HVO) Flight Experiment

NASA Technical Reports Server (NTRS)

Williams, Daniel M.; Murdoch, Jennifer L.; Adams, Catherine H.

2005-01-01

This paper provides a summary of conclusions from the Small Aircraft Transportation System (SATS) Higher Volume Operations (HVO) Flight Experiment which NASA conducted to determine pilot acceptability of the HVO concept for normal conditions. The SATS HVO concept improves efficiency at non-towered, non-radar airports in Instrument Meteorological Conditions (IMC) while achieving a level of safety equal to today s system. Reported are results from flight experiment data that indicate that the SATS HVO concept is viable. The success of the SATS HVO concept is based on acceptable pilot workload, performance, and subjective criteria when compared to the procedural control operations in use today at non-towered, non-radar controlled airfields in IMC. The HVO Flight Experiment, flown on NASA's Cirrus SR22, used a subset of the HVO Simulation Experiment scenarios and evaluation pilots in order to validate the simulation experiment results. HVO and Baseline (today s system) scenarios flown included: single aircraft arriving for a GPS non-precision approach; aircraft arriving for the approach with multiple traffic aircraft; and aircraft arriving for the approach with multiple traffic aircraft and then conducting a missed approach. Results reveal that all twelve low-time instrument-rated pilots preferred SATS HVO when compared to current procedural separation operations. These pilots also flew the HVO procedures safely and proficiently without additional workload in comparison to today s system (Baseline). Detailed results of pilot flight technical error, and their subjective assessments of workload and situation awareness are presented in this paper.

Sialoendoscopy for treatment of juvenile recurrent parotitis: The Brescia experience.

PubMed

Berlucchi, Marco; Rampinelli, Vittorio; Ferrari, Marco; Grazioli, Paola; Redaelli De Zinis, Luca O

2018-02-01

To evaluate the role of sialoendoscopy associated with steroid irrigation for juvenile recurrent parotitis (JRP) at a tertiary referral hospital. Clinical records of patients affected by JRP and treated with operative sialoendoscopy between June 2011 and April 2017 were retrospectively reviewed. Data on demographics, number of acute episodes per year before and after surgery, characteristics of the surgical procedure, hospitalization time, and rate of complications were collected. The outcome of the procedure was measured by comparing the number of episodes of parotid swelling before and after salivary endoscopic treatment. Twenty-three patients for a total of 34 operative sialoendoscopies were included in the study. Before the surgical endoscopic procedure, the mean number of parotid swelling was 10 episodes per year. At sialoendoscopy, typical endoscopic findings such as mucous plugs, stenosis of the duct, intraductal debris, and pale ductal appearance were evident. All patients were discharged on the first postoperative day. A significant decrease in the number of swelling episodes per year was observed compared to the preoperative rate (p = .0004). Complete resolution of the disorder was obtained in 35% of patients. Operative sialoendoscopy with steroid irrigation can be considered a valid therapeutic treatment for JRP. The technique is conservative, effective, safe, and, potentially repeatable. Short hospitalization time, rapid recovery, absence of peri-operative complications, and a high rate of good outcomes are the main advantages of this treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

Cost and morbidity analysis of chest port insertion in adults: Outpatient clinic versus operating room placement.

PubMed

Feo, Claudio F; Ginesu, Giorgio C; Bellini, Alessandro; Cherchi, Giuseppe; Scanu, Antonio M; Cossu, Maria Laura; Fancellu, Alessandro; Porcu, Alberto

2017-09-01

Totally implantable venous access devices (TIVADs) represent a convenient way for the administration of medications or nutrients. Traditionally, chest ports have been positioned by surgeons in the operating room, however there has been a transition over the years to port insertion by interventional radiologists in the radiology suite. The optimal method for chest port placement is still under debate. Data on all adult patients undergoing isolated chest port placement at our institution in a 12-year period were retrospectively reviewed. The aim of this cohort study was to compare cost and morbidity for chest port insertion in two different settings: outpatient clinic and operating room. Between 2003 and 2015 a total of 527 chest ports were placed in adult patients. Of them, 262 procedures were performed in the operating room and 265 procedures were undertaken in the outpatient clinic. Patient characteristics were similar and there was no significant difference in early (<30 days, p = 0.54) and late complications (30-120 days, p = 0.53). The average charge for placement of a chest port was 1270 Euros in the operating room versus 620 Euros in the outpatient clinic. Our results suggest that chest ports can be safely placed in most patients under local anesthesia in the office setting without fluoroscopy or ultrasound guidance. Future randomized controlled studies may evaluate if surgeons or interventional radiologists should routinely perform these procedures in a dedicated office setting and reserve more sophisticated facilities only for patients at high risk of technical failure.

Continuity of operations planning in college athletic programs: The case for incorporating Federal Emergency Management Guidelines.

PubMed

Hall, Stacey A; Allen, Brandon L; Phillips, Dennis

2016-01-01

College athletic departments have a responsibility to provide a safe environment for student-athletes; however, most colleges do not have a crisis management plan that includes procedures for displaced student-athletes or alternate facilities to perform athletic events. Continuity of operations planning ensures athletic programs are equipped to maintain essential functions during, or shortly after, a disruption of operations due to possible hazards. Previous studies have identified a lack of emergency preparedness and continuity planning in college athletic departments. The purpose of this article is to illustrate in detail one approach to disaster planning for college athletic departments, namely the Federal Emergency Management Agency (FEMA) continuity of operations framework. By adhering to FEMA guidelines and promoting a best practices model, athletic programs can effectively plan to address potential hazards, as well as protect the organization's brand, image, and financial sustainability after a crisis event.

[Experimental study of angiography using vascular interventional robot-2(VIR-2)].

PubMed

Tian, Zeng-min; Lu, Wang-sheng; Liu, Da; Wang, Da-ming; Guo, Shu-xiang; Xu, Wu-yi; Jia, Bo; Zhao, De-peng; Liu, Bo; Gao, Bao-feng

2012-06-01

To verify the feasibility and safety of new vascular interventional robot system used in vascular interventional procedures. Vascular interventional robot type-2 (VIR-2) included master-slave parts of body propulsion system, image navigation systems and force feedback system, the catheter movement could achieve under automatic control and navigation, force feedback was integrated real-time, followed by in vitro pre-test in vascular model and cerebral angiography in dog. Surgeon controlled vascular interventional robot remotely, the catheter was inserted into the intended target, the catheter positioning error and the operation time would be evaluated. In vitro pre-test and animal experiment went well; the catheter can enter any branch of vascular. Catheter positioning error was less than 1 mm. The angiography operation in animal was carried out smoothly without complication; the success rate of the operation was 100% and the entire experiment took 26 and 30 minutes, efficiency was slightly improved compared with the VIR-1, and the time what staff exposed to the DSA machine was 0 minute. The resistance of force sensor can be displayed to the operator to provide a security guarantee for the operation. No surgical complications. VIR-2 is safe and feasible, and can achieve the catheter remote operation and angiography; the master-slave system meets the characteristics of traditional procedure. The three-dimensional image can guide the operation more smoothly; force feedback device provides remote real-time haptic information to provide security for the operation.

Single-port videoscopic splanchnotomy for palliation of refractory chronic pancreatitis.

PubMed

Kuijpers, Michiel; Klinkenberg, Theo J; Bouma, Wobbe; Beese, Ulrich; DeJongste, Mike J; Mariani, Massimo A

2016-04-01

Interrupting the afferent signals that travel through the splanchnic nerves by multiportal thoracoscopic splanchnotomy can offer effective palliation in chronic pancreatitis. However, obtained results weaken after time, possibly necessitating repeat procedures. Given the palliative nature of this procedure, potential for iatrogenic damage should be kept at a minimum. So, in order to minimize invasiveness while optimizing repeatability, we sought to create an easily reproducible single-access port operative strategy. Four patients suffering from intractable pain due to chronic pancreatitis for >10 years (12.8 ± 5.9) underwent a single-port unilateral R5-R11 splanchnotomy. Postoperative recovery was uneventful. No operative complications were observed. All 4 patients experienced excellent pain relief with a significant improvement of Visual Analogue Scale pain scores (8.8 ± 1.0 preoperatively to 3.0 ± 1.2 postoperatively, P = 0.003). We report the first series of single-port video-assisted thoracoscopic surgical (VATS) splanchnotomy for palliation of intractable pain due to chronic pancreatitis. From this small study, single-port VATS splanchnotomy seems to be a safe and effective alternative to multiportal or open procedures. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Model of a training program in robotic surgery and its initial results.

PubMed

Madureira, Fernando Athayde Veloso; Varela, José Luís Souza; Madureira, Delta; D'Almeida, Luis Alfredo Vieira; Madureira, Fábio Athayde Veloso; Duarte, Alexandre Miranda; Vaz, Otávio Pires; Ramos, José Reinan

2017-01-01

to describe the implementation of a training program in robotic surgery and to point the General Surgery procedures that can be performed with advantages using the robotic platform. we conducted a retrospective analysis of data collected prospectively from the robotic surgery group in General and Colo-Retal Surgery at the Samaritan Hospital (Rio de Janeiro, Brazil), from October 2012 to December 2015. We describe the training stages and particularities. two hundred and ninety three robotic operations were performed in general surgery: 108 procedures for morbid obesity, 59 colorectal surgeries, 55 procedures in the esophago-gastric transition area, 16 cholecystectomies, 27 abdominal wall hernioplasties, 13 inguinal hernioplasties, two gastrectomies with D2 lymphadenectomy, one vagotomy, two diaphragmatic hernioplasties, four liver surgeries, two adrenalectomies, two splenectomies, one pancreatectomy and one bilio-digestive anastomosis. The complication rate was 2.4%, with no major complications. the robotic surgery program of the Samaritan Hospital was safely implemented and with initial results better than the ones described in the current literature. There seems to be benefits in using the robotic platform in super-obese patients, re-operations of obesity surgery and hiatus hernias, giant and paraesophageal hiatus hernias, ventral hernias with multiple defects and rectal resections.

OR.NET: a service-oriented architecture for safe and dynamic medical device interoperability.

PubMed

Kasparick, Martin; Schmitz, Malte; Andersen, Björn; Rockstroh, Max; Franke, Stefan; Schlichting, Stefan; Golatowski, Frank; Timmermann, Dirk

2018-02-23

Modern surgical departments are characterized by a high degree of automation supporting complex procedures. It recently became apparent that integrated operating rooms can improve the quality of care, simplify clinical workflows, and mitigate equipment-related incidents and human errors. Particularly using computer assistance based on data from integrated surgical devices is a promising opportunity. However, the lack of manufacturer-independent interoperability often prevents the deployment of collaborative assistive systems. The German flagship project OR.NET has therefore developed, implemented, validated, and standardized concepts for open medical device interoperability. This paper describes the universal OR.NET interoperability concept enabling a safe and dynamic manufacturer-independent interconnection of point-of-care (PoC) medical devices in the operating room and the whole clinic. It is based on a protocol specifically addressing the requirements of device-to-device communication, yet also provides solutions for connecting the clinical information technology (IT) infrastructure. We present the concept of a service-oriented medical device architecture (SOMDA) as well as an introduction to the technical specification implementing the SOMDA paradigm, currently being standardized within the IEEE 11073 service-oriented device connectivity (SDC) series. In addition, the Session concept is introduced as a key enabler for safe device interconnection in highly dynamic ensembles of networked medical devices; and finally, some security aspects of a SOMDA are discussed.

Robotic-Assisted Versus Laparoscopic Colectomy: Cost and Clinical Outcomes

PubMed Central

Davis, Bradley R.; Yoo, Andrew C.; Moore, Matt

2014-01-01

Background and Objectives: Laparoscopic colectomies, with and without robotic assistance, are performed to treat both benign and malignant colonic disease. This study compared clinical and economic outcomes for laparoscopic colectomy procedures with and without robotic assistance. Methods: Patients aged ≥18 years having primary inpatient laparoscopic colectomy procedures (cecectomy, right hemicolectomy, left hemicolectomy, and sigmoidectomy) identified by International Classification of Diseases, Ninth Edition procedure codes performed between 2009 and the second quarter of 2011 from the Premier Hospital Database were studied. Patients were matched to a control cohort using propensity scores for disease, comorbidities, and hospital characteristics and were matched 1:1 for specific colectomy procedure. The outcomes of interest were hospital cost of laparoscopic robotic-assisted colectomy compared with traditional laparoscopic colectomy, surgery time, adverse events, and length of stay. Results: Of 25 758 laparoscopic colectomies identified, 98% were performed without robotic assistance and 2% were performed with robotic assistance. After matching, 1066 patients remained, 533 in each group. Lengths of stay were not significantly different between the matched cohorts, nor were rates of major, minor, and/or surgical complications. Inpatient procedures with robotic assistance were significantly more costly than those without robotic assistance ($17 445 vs $15 448, P = .001). Operative times were significantly longer for robotic-assisted procedures (4.37 hours vs 3.34 hours, P < .001). Conclusion: Segmental colectomies can be performed safely by either laparoscopic or robotic-assisted methods. Increased per-case hospital costs for robotic-assisted procedures and prolonged operative times suggest that further investigation is warranted when considering robotic technology for routine laparoscopic colectomies. PMID:24960484

Robotic-assisted versus laparoscopic colectomy: cost and clinical outcomes.

PubMed

Davis, Bradley R; Yoo, Andrew C; Moore, Matt; Gunnarsson, Candace

2014-01-01

Laparoscopic colectomies, with and without robotic assistance, are performed to treat both benign and malignant colonic disease. This study compared clinical and economic outcomes for laparoscopic colectomy procedures with and without robotic assistance. Patients aged ≥18 years having primary inpatient laparoscopic colectomy procedures (cecectomy, right hemicolectomy, left hemicolectomy, and sigmoidectomy) identified by International Classification of Diseases, Ninth Edition procedure codes performed between 2009 and the second quarter of 2011 from the Premier Hospital Database were studied. Patients were matched to a control cohort using propensity scores for disease, comorbidities, and hospital characteristics and were matched 1:1 for specific colectomy procedure. The outcomes of interest were hospital cost of laparoscopic robotic-assisted colectomy compared with traditional laparoscopic colectomy, surgery time, adverse events, and length of stay. Of 25,758 laparoscopic colectomies identified, 98% were performed without robotic assistance and 2% were performed with robotic assistance. After matching, 1066 patients remained, 533 in each group. Lengths of stay were not significantly different between the matched cohorts, nor were rates of major, minor, and/or surgical complications. Inpatient procedures with robotic assistance were significantly more costly than those without robotic assistance ($17,445 vs $15,448, P = .001). Operative times were significantly longer for robotic-assisted procedures (4.37 hours vs 3.34 hours, P < .001). Segmental colectomies can be performed safely by either laparoscopic or robotic-assisted methods. Increased per-case hospital costs for robotic-assisted procedures and prolonged operative times suggest that further investigation is warranted when considering robotic technology for routine laparoscopic colectomies.

Safety of liposuction using exclusively tumescent local anesthesia in 3,240 consecutive cases.

PubMed

Habbema, Louis

2009-11-01

Many surgeons consider liposuction using tumescent local anesthesia (TLA) to be a safe technique, but when TLA has been combined with other techniques, such as general anesthesia or intravenous medication, or when the guidelines associated with TLA have been violated, serious complications and deaths have occurred. This has resulted in uncertainty concerning the safety of liposuction using TLA, which this article seeks to resolve. To investigate whether liposuction using TLA is a safe procedure. The same surgeon performed liposuction using exclusively TLA in 3,240 procedures. Detailed records were kept of the complications that occurred. In a series of 3,240 procedures, no deaths occurred, and no complications requiring hospitalization were experienced. In nine cases, complications developed that needed further action. Liposuction using exclusively TLA is a proven safe procedure provided that the existing guidelines are meticulously followed.

[Natural orifice trans-luminal endoscopic surgery (notes)--a new era in general surgery].

PubMed

Elazary, Ram; Horgan, Santiago; Talamini, Mark A; Rivkind, Avraham I; Mintz, Yoav

2008-10-01

Four years ago, a new surgical technique was presented, the natural orifice trans-luminal endoscopic surgery (NOTES). This technique provides an incisionless operation. The surgical devices are inserted into the peritoneal cavity through the gastrointestinal or the urogenital tracts. Today, a cholecystectomy can be performed using an advanced endoscope inserted through the stomach or the vagina. The advantages of NOTES are: reduced post operative pain, no hernias, no surgical wounds infections and better cosmetic results. The disadvantages are: difficulties in achieving safe enterotomy closure or a leak proof anastomosis, it necessitates performing more operations compared to open or laparoscopic operations in order to obtain the skills for performing these operations, and difficulties of acquiring satisfactory endoscopic vision due to lack of advanced technology. Several NOTES operations have already been performed in humans. However, many other surgical procedures were tested in laboratory animals. Development and improvement of surgical devices may promote this surgical modality in the future.

A new operation technique for uterine prolapse: Vaginally-assisted laparoscopic sacrohysteropexy

PubMed Central

Sanverdi, İlhan; Kılıççı, Çetin; Polat, Mesut; Özkaya, Enis; Kılıç, Sami Gökhan; Dizdar, Merve; Karateke, Ateş

2017-01-01

Objective: To describe the new surgical technique and report the safety and feasibility of vaginally-assisted laparoscopic sacrohysteropexy (VALSH). Materials and Methods: Thirty-three women with stage 3 or more uterine prolapse underwent VALSH operation. Patients were followed up for 12 months for mesh-related complications and improvements of symptoms. The operation had three sections; 1st laparoscopic, 2nd vaginal, 3rd laparoscopic. Results: The mean age, gravidity, and parity of the study population were 46.5 years (range, 25-68 years), 4.3 (1-9), and 2.9 (1-6), respectively. The mean duration of operation was 59.5 min (range, 20-120 min). There were significant differences between the pre- and post-operative values of pelvic organ prolapse quantification parameters, which were favorable in the latter evaluation (p<0.001); total vaginal length was preserved after surgery (p>0.05). Conclusion: VALSH is a safe and minimally-invasive procedure in uterovaginal prolapse, with favorable anatomic and functional outcomes at 12 months post-operatively. PMID:29085709

Is non-operative management still justified in the treatment of adhesive small bowel obstruction in children?

PubMed

Nasir, Abdulrasheed A; Abdur-Rahman, Lukman O; Bamigbola, Kayode T; Oyinloye, Adewale O; Abdulraheem, Nurudeen T; Adeniran, James O

2013-01-01

Adhesive small bowel obstruction (ASBO) is a feared complication after abdominal operations in both children and adults. The optimal management of ASBO in the pediatric population is debated. The aim of the present study was to examine the safety and effectiveness of non-operative management in ASBO. A retrospective review of 33 patients who were admitted for ASBO over a 5-year period was carried out. Follow-up data were available for 29 patients. Demographic, clinical, and operative details and outcomes were collected for these patients. Data analysis was done with SPSS version 15.0. P ≤ 0.05 was regarded as significant. Out of 618 abdominal surgeries within the 5-year period, 34 admissions were recorded from 29 patients at the follow-up period of 1-28 months. There were 19 boys (65.5%). The median age of patients was 4.5 years. Typhoid intestinal perforation (n = 7), intussusception (n = 6), intestinal malrotation (n = 5), and appendicitis (n = 4) were the major indications for a prior abdominal surgery leading to ASBO. Twenty-five patients (73.5%) developed SBO due to adhesions within the first year of the primary procedure. Of the 34 patients admitted with ASBO, 18 (53%) underwent operative intervention and 16 (47%) were successfully managed non-operatively. There were no differences in sex (P = 0.24), initial procedure (P = 0.12), age, duration of symptoms, and time to re-admission between the patients who responded to non-operative management and those who underwent operative intervention. However, the length of hospital stay was significantly shorter in the non-operative group (P < 0.0001). Five (14.7%) patients had small bowel resection. A 43-day-old child who initially underwent Ladd's procedure died within 15 h of re-admission while being prepared for surgery, accounting for the only mortality (3.4%). Non-operative management is still a safe and preferred approach in selected patients with ASBO. However, 53% eventually required surgery.

Empirical models for use in designing decompression procedures for space operations

NASA Technical Reports Server (NTRS)

Conkin, Johnny; Edwards, Benjamin F.; Waligora, James M.; Horrigan, David J., Jr.

1987-01-01

Empirical models for predicting the incidence of Type 1 altitude decompression sickness (DCS) and venous gas emboli (VGE) during space extravehicular activity (EVA), and for use in designing safe denitrogenation decompression procedures are developed. The models are parameterized using DCS and VGE incidence data from NASA and USAF manned altitude chamber decompression tests using 607 male and female subject tests. These models, and procedures for their use, consist of: (1) an exponential relaxation model and procedure for computing tissue nitrogen partial pressure resulting from a specified prebreathing and stepped decompression sequence; (2) a formula for calculating Tissue Ratio (TR), a tissue decompression stress index; (3) linear and Hill equation models for predicting the total incidence of VGE and DCS attendant with a particular TR; (4) graphs of cumulative DCS and VGE incidence (risk) versus EVA exposure time at any specified TR; and (5) two equations for calculating the average delay period for the initial detection of VGE or indication of Type 1 DCS in a group after a specific denitrogenation decompression procedure. Several examples of realistic EVA preparations are provided.

29 CFR 1918.86 - Roll-on roll-off (Ro-Ro) operations (see also § 1918.2, Ro-Ro operations, and § 1918.25).

Code of Federal Regulations, 2011 CFR

2011-07-01

... simultaneous use of the ramp by vehicles and pedestrians. (d) Ramp maintenance. Ramps shall be properly... ramp inclines safely. (j) Safe speeds. Power driven vehicles used in Ro-Ro operations shall be operated at speeds that are safe for prevailing conditions. (k) Ventilation. Internal combustion engine-driven...

Multiple curved descending approaches and the air traffic control problem

NASA Technical Reports Server (NTRS)

Hart, S. G.; Mcpherson, D.; Kreifeldt, J.; Wemple, T. E.

1977-01-01

A terminal area air traffic control simulation was designed to study ways of accommodating increased air traffic density. The concepts that were investigated assumed the availability of the microwave landing system and data link and included: (1) multiple curved descending final approaches; (2) parallel runways certified for independent and simultaneous operation under IFR conditions; (3) closer spacing between successive aircraft; and (4) a distributed management system between the air and ground. Three groups each consisting of three pilots and two air traffic controllers flew a combined total of 350 approaches. Piloted simulators were supplied with computer generated traffic situation displays and flight instruments. The controllers were supplied with a terminal area map and digital status information. Pilots and controllers also reported that the distributed management procedure was somewhat more safe and orderly than the centralized management procedure. Flying precision increased as the amount of turn required to intersect the outer mark decreased. Pilots reported that they preferred the alternative of multiple curved descending approaches with wider spacing between aircraft to closer spacing on single, straight in finals while controllers preferred the latter option. Both pilots and controllers felt that parallel runways are an acceptable way to accommodate increased traffic density safely and expeditiously.

Separation, Aspiration, and Fat Equalization: SAFE Liposuction Concepts for Comprehensive Body Contouring.

PubMed

Wall, Simeon H; Lee, Michael R

2016-12-01

Separation, aspiration, and fatty equilibration (SAFE) liposuction uses a process approach to body contouring and minimizes injury to surrounding structures. The multistep process allows for (1) fat separation, (2) lipoaspiration, and (3) fat equalization. The purpose of this study was to review both outcomes and complications of primary SAFE liposuction. Retrospective chart review was completed of patients undergoing SAFE liposuction from January of 2006 to January of 2011. Patient selection was limited to those undergoing liposuction alone with no adjuvant excisional procedures. Data were collected regarding demographics, body mass index, operative details, and outcomes. Seven hundred thirty-four patients were identified as having undergone SAFE liposuction. One hundred twenty-nine patients were found to have been treated with liposuction alone. Patient age ranged from 18 to 42 years and body mass index ranged from 18 to 42 kg/m (mean, 26.3 kg/m). Seven patients (5.4 percent) underwent treatment of the face and neck, six patients (4.7 percent) underwent treatment of upper extremities, 13 patients (10.1 percent) underwent treatment of the chest, 20 patients (15.5 percent) underwent treatment of lower extremities, 32 patients (24.8 percent) underwent treatment of the circumferential trunk, and 51 patients (39.5 percent) underwent treatment of circumferential trunk and additional area(s). No major complications occurred. Five of the 129 patients (3.87 percent) developed the minor complication of seroma formation. SAFE liposuction is a multistep process approach to body contouring consisting of (1) fat separation, (2) lipoaspiration, and (3) fat equalization. The results of this study show such technique to be safe and effective. Therapeutic, IV.

Is Office-Based Surgery Safe? Comparing Outcomes of 183,914 Aesthetic Surgical Procedures Across Different Types of Accredited Facilities.

PubMed

Gupta, Varun; Parikh, Rikesh; Nguyen, Lyly; Afshari, Ashkan; Shack, R Bruce; Grotting, James C; Higdon, K Kye

2017-02-01

There has been a dramatic rise in office-based surgery. However, due to wide variations in regulatory standards, the safety of office-based aesthetic surgery has been questioned. This study compares complication rates of cosmetic surgery performed at office-based surgical suites (OBSS) to ambulatory surgery centers (ASCs) and hospitals. A prospective cohort of patients undergoing cosmetic surgery between 2008 and 2013 were identified from the CosmetAssure database (Birmingham, AL). Patients were grouped by type of accredited facility where the surgery was performed: OBSS, ASC, or hospital. The primary outcome was the incidence of major complication(s) requiring emergency room visit, hospital admission, or reoperation within 30 days postoperatively. Potential risk factors including age, gender, body mass index (BMI), smoking, diabetes, type of procedure, and combined procedures were reviewed. Of the 129,007 patients (183,914 procedures) in the dataset, the majority underwent the procedure at ASCs (57.4%), followed by hospitals (26.7%) and OBSS (15.9%). Patients operated in OBSS were less likely to undergo combined procedures (30.3%) compared to ASCs (31.8%) and hospitals (35.3%, P < .01). Complication rates in OBSS, ASCs, and hospitals were 1.3%, 1.9%, and 2.4%, respectively. On multivariate analysis, there was a lower risk of developing a complication in an OBSS compared to an ASC (RR 0.67, 95% CI 0.59-0.77, P < .01) or a hospital (RR 0.59, 95% CI 0.52-0.68, P < .01). Accredited OBSS appear to be a safe alternative to ASCs and hospitals for cosmetic procedures. Plastic surgeons should continue to triage their patients carefully based on other significant comorbidities that were not measured in this present study. LEVEL OF EVIDENCE 3. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

Structural Health Management of Damaged Aircraft Structures Using the Digital Twin Concept

NASA Technical Reports Server (NTRS)

Seshadri, Banavara R.; Krishnamurthy, Thiagarajan

2017-01-01

The development of multidisciplinary integrated Structural Health Management (SHM) tools will enable accurate detection, and prognosis of damaged aircraft under normal and adverse conditions during flight. As part of the digital twin concept, methodologies are developed by using integrated multiphysics models, sensor information and input data from an in-service vehicle to mirror and predict the life of its corresponding physical twin. SHM tools are necessary for both damage diagnostics and prognostics for continued safe operation of damaged aircraft structures. The adverse conditions include loss of control caused by environmental factors, actuator and sensor faults or failures, and structural damage conditions. A major concern in these structures is the growth of undetected damage/cracks due to fatigue and low velocity foreign object impact that can reach a critical size during flight, resulting in loss of control of the aircraft. To avoid unstable, catastrophic propagation of damage during a flight, load levels must be maintained that are below a reduced load-carrying capacity for continued safe operation of an aircraft. Hence, a capability is needed for accurate real-time predictions of damage size and safe load carrying capacity for structures with complex damage configurations. In the present work, a procedure is developed that uses guided wave responses to interrogate damage. As the guided wave interacts with damage, the signal attenuates in some directions and reflects in others. This results in a difference in signal magnitude as well as phase shifts between signal responses for damaged and undamaged structures. Accurate estimation of damage size, location, and orientation is made by evaluating the cumulative signal responses at various pre-selected sensor locations using a genetic algorithm (GA) based optimization procedure. The damage size, location, and orientation is obtained by minimizing the difference between the reference responses and the responses obtained by wave propagation finite element analysis of different representative cracks, geometries, and sizes.

Life characteristics assessment of the communications technology satellite transmitter experiment package

NASA Technical Reports Server (NTRS)

Smetana, J.; Curren, A. N.

1979-01-01

The performance characteristics of the transmitter experiment package (TEP) aboard the Communications Technology Satellite (CTS) measured during its first 2 years in orbit are presented. The TEP consists of a nominal 200 watt output stage tube (OST), a supporting power processing system (PPS), and a variable conductance heat pipe system (VCHPS). The OST, a traveling wave tube augmented with a 10 stage depressed collector has an overall saturated average efficiency of 51.5 percent and an average saturated radio frequency (rf) output power at center band frequency of 240 watts. The PPS operated with a measured efficiency of 86.5 to 88.5 percent. The VCHPS, using three pipes to conduct heat from the PPS and the OST to a 52 by 124 centimeter radiator fin, maintained the PPS baseplate temperature below 50 C for all operating conditions. The TEP performance characteristics presented include frequency response, rf output power, thermal performance, and efficiency. Communications characteristics were evaluated by using both video and audio modulated signals. On four occasions, the TEP experienced temporary thermal control system malfunctions. The anomalies were terminated safely, and the problem was investigated because of the potential for TEP damage due to the signficant temperature increases. Safe TEP operating procedures were established.

Pre-flight risk assessment in Emergency Medical Service (EMS) helicopters

NASA Technical Reports Server (NTRS)

Shively, R. J.

1992-01-01

The Emergency Medical Service (EMS) industry has been the subject of several television and newspaper articles (Harvey and Jensen, 1987) which emphasized the negative aspects, (e.g., fatalities and high accident rates), rather than the life saving services performed. Until recently, the accident rate of the EMS industry has been five times as high as that of other civil helicopters. This high accident rate has been coupled with the dramatic rise in the number of programs. The industry has built from a single service at its inception in 1972, to over 180 in 1987 (Spray, 1987), to the point that 93 percent of the contiguous U.S. is now covered by some type of EMS service. These factors prompted the National Transportation Safety Board (NTSB) to study the accidents that occurred between May 11, 1978 and December 3, 1986 (NTSB, 1988). The NTSB report concluded that 'Sound pilot judgment is central to safe flight operations.' They further stated that '... factors unique to EMS helicopter operations--such as the influence of the mission itself, program competition, and EMS program management perspectives--can drastically influence pilot judgment during the EMS mission.' One of the most difficult decisions that a pilot must make is whether to accept or decline a mission. A pre-flight risk assessment system (SAFE) was developed at NASA-Ames Research Center for civil EMS operations to aid pilots in making this decision objectively. The ability of the SAFE system to predict mission risk profiles was tested at an EMS facility. The results of this field study demonstrated that the usefulness of SAFE was highly dependent on the type of mission flown. SAFE is now being modified so that it can 'learn' with each mission flown. For example, after flying a mission to a particular site, an EMS pilot would input information about this mission into the system, such as new buildings, wires, or approach procedures. Then, the next time a pilot flew a similar mission or one to the same area, this additional information would be taken into account in computing a risk assessment.

The role of lasers in modern urology.

PubMed

Dołowy, Łukasz; Krajewski, Wojciech; Dembowski, Janusz; Zdrojowy, Romuald; Kołodziej, Anna

2015-01-01

The functioning of modern urological departments and the high level of service they provide is possible through, among other things, the use of modern laser techniques. Open operations have been replaced by minimally invasive procedures, and classical surgical tools by advanced lasers. The search for new applications with lasers began as technology developed. Among many devices available, holmium, diode and thulium lasers are currently the most popular. Depending on the wavelength, the absorption by water and hemoglobin and the depth of penetration, lasers can be used for coagulation, vaporization and enucleation. In many centres, after all the possibilities of pharmacological treatment have been exhausted, lasers are used as the primary treatment for patients with benign prostatic hyperplasia, with therapeutic results that are better than those obtained through open or endoscopic operations. The use of lasers in the treatment of urolithiasis, urinary strictures and bladder tumours has made treatment of older patients with multiple comorbidities safe, without further necessity to modify the anticoagulant drug treatment. Laser procedures are additionally less invasive, reduce hospitalization time and enable a shorter bladder catheterization time, sometimes even eliminating the need for bladder catherterization completely. Such procedures are also characterized by more stable outcomes and a lower number of reoperations. There are also indications that with the increased competition among laser manufacturers, decreased purchase and maintenance costs, and increased operational safety, laser equipment will become mandatory and indispensable asset in all urology wards.

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.

Prevention of Infection in Orthopedic Prosthetic Surgery.

PubMed

Chirca, Ioana; Marculescu, Camelia

2017-06-01

Total joint arthroplasty is a generally safe orthopedic procedure; however, infection is a potentially devastating complication. Multiple risk factors have been identified for development of prosthetic joint infections. Identification of patients at risk and preoperative correction of known risk factors, such as smoking, diabetes mellitus, anemia, malnutrition, and decolonization of Staphylococcus carriers, represent well-established actions to decrease the infection risk. Careful operative technique, proper draping and skin preparation, and appropriate selection and dosing of antimicrobials for perioperative prophylaxis are also very important in prevention of infection. Published by Elsevier Inc.

Disk suspension method: a novel and safe technique for the retraction of the liver during laparoscopic surgery (with video).

PubMed

Shibao, Kazunori; Higure, Aiichiro; Yamaguchi, Koji

2011-08-01

A good operative field is important for safe operations, but it is sometimes difficult to obtain a satisfactory operative field in laparoscopic upper abdominal surgery. We developed a novel and safe technique for the retraction of the liver and falciform ligament during laparoscopic surgery, and evaluated its technical feasibility and safety. Forty-three patients with gastric cancer were divided into two groups: disk suspension group (DS group; snake retractor and elastic band fixation with a silicon disk), and fixed retractor group (FR group; snake retractor and nonelastic band fixation without a silicon disk). To evaluate liver damage during retraction, we measured the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels preoperatively and on postoperative day (POD) 1. In the DS group, all liver lobes were adequately retracted and the hepatoduodenal and gastrohepatic ligaments were fully exposed. This procedure took less than 3 min. On the other hand, 5 of 18 patients of the FR group had insufficient surgical fields for laparoscopic gastrectomy because of soft and/or large livers. Although the preoperative AST and ALT levels were not different between the two groups, the DS group did not display increases in both AST and ALT levels, whereas the FR group showed increases in both on POD 1 (AST: 50.2 ± 8.4 IU/l vs. 124.2 ± 37.7 IU/l, P = 0.07; and ALT: 35.6 ± 6.4 IU/l vs. 106.1 ± 36.2 IU/l, P = 0.07). No complications related to the liver retraction were observed in the DS group. However, liver congestion was evident in six patients and minor liver injury in two patients of the FR group during the esophagojejunostomy. The DS method is a simple and safe and provides a better surgical field during laparoscopic surgery of the upper abdomen without damaging the liver.

Technique of antroduodenectomy without ulcer excision as a safe alternative treatment for bleeding chronic duodenal ulcers.

PubMed

Guinier, David; Destrumelle, Nicolas; Denue, Pierre Olivier; Mathieu, Pierre; Heyd, Bruno; Mantion, Georges Andre

2009-05-01

The treatment of a bleeding chronic posterior duodenal ulcer, with bleeding recurrence or persistence despite endoscopic therapy, requires surgical treatment and constitutes a challenge for the surgeon; furthermore such chronic ulcers are often wide and sclerotic, so the surgeon needs to avoid the risk of recurrent bleeding if conservative surgery is applied. If radical surgery must be performed, the greater risk involves duodenal leakage, hepatic hilar injury, or pancreatic injury. This study aimed to evaluate the efficacy and complications arising from a surgical procedure, described by Dubois in 1971 (Gastrectomy and gastroduodenal anastomosis for post-bulbar ulcers and peptic ulcers of the second part of the duodenum. J Chir 101:177-186). This operation involves antroduonectomy with gastroduodenal anastomosis. It is similar to a Billroth I gastrectomy but without dissection of the ulcer. We retrospectively studied the medical data of patients who underwent this procedure for the treatment of bleeding chronic posterior duodenal ulcers during the past 20 years. There were 28 such patients admitted to our institution for emergency surgery, who went on to be treated by the Dubois procedure. Ulcerous disease was efficiently treated without rebleeding or duodenal leakage. The mortality rate was 17%; most deaths resulted from medical failure in older patients suffering from massive bleeding. The rate of medical complications reached 21%. Surgical complications developed in 14% of patients. The Dubois antroduodenectomy is a safe and effective surgical procedure for the treatment of bleeding chronic duodenal ulcers. The number of fatal outcomes among patients with this condition remains high, particularly in older and vulnerable patients experiencing massive bleeding.

NASA Battery Working Group - 2007-2008: Battery Task Summary Report

NASA Technical Reports Server (NTRS)

Manzo, Michelle

2008-01-01

This presentation provides a summary of the 2007-2008 NASA Battery Working Group efforts completed in support of the NASA Engineering Safety Center (NESC). The effort covered a series of pro-active tasks that address the following: Binding Procurements -- guidelines related to requirements for the battery system that should be considered at the time of contract award Wet Life of Ni-H2 Batteries -- issues/strategies for effective storage and impact of long-term storage on performance and life Generic Guidelines for Lithium-ion Safety, Handling and Qualification -- Standardized approaches developed and risk assessments (1) Lithium-ion Performance Assessment -- survey of manufacturers and capabilities to meet mission needs. Guidelines document generated (2) Conditions Required for using Pouch Cells in Aerospace Missions -- focus on corrosion, thermal excursions and long-term performance issues. Document defining requirements to maintain performance and life (3) High Voltage Risk Assessment -- focus on safety and abuse tolerance of battery module assemblies. Recommendations of features required for safe implementation (4) Procedure for Determination of Safe Charge Rates -- evaluation of various cell chemistries and recommendation of safe operating regimes for specific cell designs

Thorascopic Sympathectomy Performed Using Laser

PubMed Central

Black, SA; Taylor, FGM; Russell, MH; Ariga, R; Thomas, MH

2008-01-01

INTRODUCTION Thorascopic sympathectomy is accepted as an effective treatment for palmar hyperhidrosis, facial blushing and to a lesser extent for digital ischaemia and axillary hyperhidrosis. PATIENTS AND METHODS Data were collected retrospectively on patients undergoing thorascopic sympathectomy at St Peter's Hospital between 1987 and 2006. Patients were followed up by telephone interview. RESULTS A total of 233 thorascopic sympathectomy procedures were performed by a single operator in 123 patients. Ages ranged from 9–71 years and 75 were women. In patients, 105 had a bilateral and 13 a unilateral procedure, 5 patients had a bilateral procedure performed in two stages. In 6 upper limbs, the procedure could not be done. Overall, 110 patients (90%) had the procedure performed for palmar hyperhidrosis, 8 (6%) for facial blushing and in 5 (4%) patients the operation was performed for digital ischaemia with tissue loss. There were no deaths and all patients were discharged on day 1 following the procedure. Complications included bleeding (2), pulmonary oedema (1) and failed procedure (2); however, no incidences of Horner's syndrome occurred. Only 40 of 123 (32.5%) patients gave follow-up information. Of this small group, 33 of 40 (83%) were cured, 4 of 40 (10%) were better, 2 of 40 (5%) were unchanged and 1 patient was worse. Only 22 out of 40 (55%) of these patients were troubled by compensatory sweating, with only 4 of 40 (10%) reporting this as a major problem. CONCLUSIONS Thorascopic sympathectomy is safe and can be carried out as a single bilateral procedure in the majority of cases. The laser allows the use of a single port, requires less dissection than surgical or clipping techniques, is more precise than diathermy and may be less likely to cause a Horner's syndrome. PMID:18325216

The Next Step in Deployment of Computer Based Procedures For Field Workers: Insights And Results From Field Evaluations at Nuclear Power Plants

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

Oxstrand, Johanna; Le Blanc, Katya L.; Bly, Aaron

The paper-based procedures currently used for nearly all activities in the commercial nuclear power industry have a long history of ensuring safe operation of the plants. However, there is potential to greatly increase efficiency and safety by improving how the human operator interacts with the procedures. One way to achieve these improvements is through the use of computer-based procedures (CBPs). A CBP system offers a vast variety of improvements, such as context driven job aids, integrated human performance tools (e.g., placekeeping, correct component verification, etc.), and dynamic step presentation. The latter means that the CBP system could only display relevantmore » steps based on operating mode, plant status, and the task at hand. A dynamic presentation of the procedure (also known as context-sensitive procedures) will guide the operator down the path of relevant steps based on the current conditions. This feature will reduce the operator’s workload and inherently reduce the risk of incorrectly marking a step as not applicable and the risk of incorrectly performing a step that should be marked as not applicable. The research team at the Idaho National Laboratory has developed a prototype CBP system for field workers, which has been evaluated from a human factors and usability perspective in four laboratory studies. Based on the results from each study revisions were made to the CBP system. However, a crucial step to get the end users' (e.g., auxiliary operators, maintenance technicians, etc.) acceptance is to put the system in their hands and let them use it as a part of their everyday work activities. In the spring 2014 the first field evaluation of the INL CBP system was conducted at a nuclear power plant. Auxiliary operators conduct a functional test of one out of three backup air compressors each week. During the field evaluation activity, one auxiliary operator conducted the test with the paper-based procedure while a second auxiliary operator followed along with the computer-based procedure. After each conducted functional test the operators were asked a series of questions designed to provide feedback on the feasibility to use a CBP system in the plant and the general user experience of the CBP system. This paper will describe the field evaluation and its results in detail. For example, the result shows that the context driven job aids and the incorporated human performance tools are much liked by the auxiliary operators. The paper will describe and present initial findings from a second field evaluation conducted at second nuclear utility. For this field evaluation a preventive maintenance work order for the HVAC system was used. In addition, there will be a description of the method and objective of two field evaluations planned to be conducted late 2014 or early 2015.« less

Intraoperative endovascular ultrasonography

NASA Astrophysics Data System (ADS)

Eton, Darwin; Ahn, Samuel S.; Baker, J. D.; Pensabene, Joseph; Yeatman, Lawrence S.; Moore, Wesley S.

1991-05-01

The early experience using intra-operative endovascular ultrasonography (EU) is reported in eight patients undergoing lower extremity revasularization. In four patients, intra-operative EU successfully characterized inflow stenoses that were inadequately imaged with pre- operative arteriography. Two patients were found to have hemodynamically significant inflow stenoses, and were treated with intra-operative balloon angioplasty followed by repeat EU. The other two patients were found to have non-hemodynamically significant inflow stenoses requiring no treatment. Additional outflow procedures were required in all four patients. In the remaining four patients, EU was used to evaluate the completeness of TEC rotary atherectomy, of Hall oscillatory endarterectomy, of thrombectomy of the superficial femoral and popliteal arteries, and of valve lysis during in situ saphenous vein grafting, respectively. In the latter case, the valve leaflets were not clearly seen. In the other cases, EU assisted the surgeon. Angioscopy and angiography were available for comparison. In one case, angioscopy failed because of inability to clear the field while inspecting retrograde the limb of an aorto-bi-femoral graft. EU however was possible. No complications of EU occurred. EU is a safe procedure indicated when characterization of a lesion is needed prior to an intervention or when evaluation of the intervention's success is desired. We did not find it useful in valve lysis for in-site grafting.

General paediatric surgery for patients aged under 5 years: a 5-year experience at a district general hospital.

PubMed

Kwok, C-S; Gordon, A C

2016-09-01

Introduction The gradual shift of general paediatric surgery (GPS) provision from district general hospitals (DGH) to specialised units is well recognised in the UK. The consequences of centralisation include a reduction in exposure to GPS for current surgical trainees. The GPS practice of a DGH is examined here. Methods All operations performed on children aged under 5 years over a 5-year period were identified using the local electronic operation database. Electronic hospital records and clinic letters were accessed to collect data on demographics, operations performed and outcome measures. Results 472 GPS operations were performed on children between the age of 22 days and 5 years between 2009 and 2014, of which 43 were on an emergency basis and 105 were performed on patients aged less than 1 year. Three patients were admitted following day case surgery. Six patients were readmitted within 30 days. Complication rates for all procedures and the four most common procedures were similar to those found in published literature. Conclusions GPS for patients aged less than 5 years is comparatively safe in the DGH setting. The training opportunities available at DGHs are invaluable to surgical trainees and vital for sustaining the future provision of GPS by such hospitals.

Application of robotics in general surgery: initial experience.

PubMed

Nguyen, Ninh T; Hinojosa, Marcelo W; Finley, David; Stevens, Melinda; Paya, Mahbod

2004-10-01

Robotic surgery was recently approved for clinical use in general abdominal surgery. The aim of this study was to review our experience with the da Vinci surgical system during laparoscopic general surgical procedures. Eighteen patients underwent robotically assisted laparoscopic abdominal surgery between June 2002 and March 2003. Main outcome measures were operative time, room setup time, robotic arm-positioning and surgical time, blood loss, conversion to laparoscopy, length of stay, and morbidity. The types of robotically assisted laparoscopic procedures were excision of gastric leiomyoma (n = 1), Heller myotomy (n = 1), cholecystectomy (n = 2), gastric banding (n = 2), Nissen fundoplication (n = 4), and gastric bypass (n = 8). The mean room setup time was 63 +/- 14 minutes, and the mean robotic arm-positioning time was 16 +/- 7 minutes. Conversion to laparoscopy occurred in two (11%) of 18 cases because of equipment difficulty (n = 1) and technical difficulty (n = 1). Estimated blood loss was 91 +/- 71 mL. The mean operative time was 156 +/- 42 minutes, and the robotic operative time was 27% of the total operative time. The mean length of hospital stay was 2.2 +/- 1.5 days. There was one postoperative wound infection and one anastomotic stricture. Robotically assisted laparoscopic abdominal surgery is feasible and safe; however, the theoretical advantages of the da Vinci surgical system were not clinically apparent.

Trans-Obturator-Tape (T.O.T.) "outside-in" approach in surgical treatment of female stress urinary incontinence.

PubMed

Jovanović, M; Džamić, Z; Aćimović, M; Kajmaković, B; Pejčić, T

2014-01-01

The aim of the study was to analyzed the efficacy and safety of a minimally invasive surgical procedure using the Trans- Obturator-Tape with "outside-in" approach for treatment female stress urinary incontinence. 171 women with stress urinary incontinence (SUI) associated with urethral hypermobility, underwent the T.O.T. procedure (March 2010 to January 2014). 27 patients were previously operated for incontinence. Mean age was 59 years (37-80). 6 patients were having mixed incontinence, and 51 had SUI with urgencies. A non-elastic, polypropylene tape was placed under the mid-urethra. The surgical placement technique utilises a trans-obturator percutaneous approach. All patients underwent post-operative clinical examination, cough-stress test (full bladder), uroflowmetry, and post-voiding residual assessment. Mean follow-up was 22 months (4-45). At 12 months follow-up 91,2% of the patients were completely cured. The overall peri-operative complication rate was 6.4% with no vascular, nerve or bowel injury. 5 patients (2.9%) had post-operative urinary retention. The present study confirms the results obtained by the instigator of the technique, E. Delorme, and allows us to consider T.O.T. as an effective and safe technique for the treatment of female stress urinary incontinence.

Trans-septal suturing following septoplasty: an alternative for nasal packing.

PubMed

Ghimire, A; Limbu, T R; Bhandari, R

2012-09-01

Septoplasty is one of the most common otorhinolaryngologic surgical procedure. It is customary to place a pack in the nose as a part of nasal surgery to stop bleeding, enhance apposition of mucosal flaps, and stabilize the operated septal cartilage and bones. But nasal packing is not an innocuous procedure. The most common problem encountered by the patients after septoplasty with nasal pack is the pain and discomfort in post operative period. The study has been performed to compare the complications and outcome of septoplasty with or without nasal packing. Forty four patients were randomly allocated into two groups, Group A (n = 21) and Group B (n = 23). In Group A trans-septal suture and in Group B intranasal pack was used following septoplasty. Both groups were compared for postoperative pain, postoperative complications and surgical outcome. Among 44 patients 31 patients were male and 13 patients were female. Most of the patients ie 79.5% were operated for nasal obstruction. Only one patient had postoperative nasal bleeding requiring nasal pack in Group A. Higher Postoperative pain score, longer hospital stay and more complications were observed in Group B patients. No difference was found in patients' satisfaction after the operation. Septoplasty can be safely performed without postoperative nasal packing and is preferred to avoid postoperative pain, discomfort and other complications.

Usage of a Trans-Obturator-Tape (T.O.T.) "outside-in" approach in surgical treatment of female stress urinary incontinence.

PubMed

Jovanovic, Mirko; Vuksanović, Aleksandar; Dzamić', Zoran; Aćimović, Miodrag; Radovanović, Milan; Djurasić, Ljubomir

2011-01-01

The aim of the study was to analyzed the efficacy and safety of a new minimally invasive surgical procedure using the Trans-Obturator-Tape with"outside-in" approach for treatment female stress urinary incontinence. 31 women with stress urinary incontinence (SUI) associated with urethral hypermobility, underwent the T.O.T. procedure (March 2010 to January 2011). 5 patients were previously operated for incontinence. Mean age was 59 years (37-80). 10 patients were having mixed incontinence. A non-elastic, polypropylene tape was placed under the mid-urethra. The surgical placement technique utilises a trans-obturator percutaneous approach. All patients underwent post-operative clinical examination, cough-stress test (full bladder), uroflowmetry, and post-voiding residual assessment. Mean follow-up was 5 months (1-9). At 6 months follow-up 96.7% of the patients were completely cured. The overall peri-operative complication rate was 6.4% with no vascular, nerve or bowel injury. One patients (3.4%) had post-operative urinary retention. The present study confirms the results obtained by the instigator of the technique, E. Delorme, and allows us to consider T.O.T. as an effective and safe technique for the treatment of female stress urinary incontinence.

32 CFR 700.857 - Safe navigation and regulations governing operation of ships and aircraft.

Code of Federal Regulations, 2013 CFR

2013-07-01

... OFFICIAL RECORDS The Commanding Officer Commanding Officers Afloat § 700.857 Safe navigation and regulations governing operation of ships and aircraft. (a) The commanding officer is responsible for the safe... Operations or the Commandant of the Marine Corps, as appropriate. (d) The Commanding Officer is responsible...

32 CFR 700.857 - Safe navigation and regulations governing operation of ships and aircraft.

Code of Federal Regulations, 2010 CFR

2010-07-01

... OFFICIAL RECORDS The Commanding Officer Commanding Officers Afloat § 700.857 Safe navigation and regulations governing operation of ships and aircraft. (a) The commanding officer is responsible for the safe... Operations or the Commandant of the Marine Corps, as appropriate. (d) The Commanding Officer is responsible...

32 CFR 700.857 - Safe navigation and regulations governing operation of ships and aircraft.

Code of Federal Regulations, 2011 CFR

2011-07-01

... OFFICIAL RECORDS The Commanding Officer Commanding Officers Afloat § 700.857 Safe navigation and regulations governing operation of ships and aircraft. (a) The commanding officer is responsible for the safe... Operations or the Commandant of the Marine Corps, as appropriate. (d) The Commanding Officer is responsible...

32 CFR 700.857 - Safe navigation and regulations governing operation of ships and aircraft.

Code of Federal Regulations, 2014 CFR

2014-07-01

... OFFICIAL RECORDS The Commanding Officer Commanding Officers Afloat § 700.857 Safe navigation and regulations governing operation of ships and aircraft. (a) The commanding officer is responsible for the safe... Operations or the Commandant of the Marine Corps, as appropriate. (d) The Commanding Officer is responsible...

32 CFR 700.857 - Safe navigation and regulations governing operation of ships and aircraft.

Code of Federal Regulations, 2012 CFR

2012-07-01

... OFFICIAL RECORDS The Commanding Officer Commanding Officers Afloat § 700.857 Safe navigation and regulations governing operation of ships and aircraft. (a) The commanding officer is responsible for the safe... Operations or the Commandant of the Marine Corps, as appropriate. (d) The Commanding Officer is responsible...

Standardized Procedure Content And Data Structure Based On Human Factors Requirements For Computer-Based Procedures

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

Bly, Aaron; Oxstrand, Johanna; Le Blanc, Katya L

2015-02-01

Most activities that involve human interaction with systems in a nuclear power plant are guided by procedures. Traditionally, the use of procedures has been a paper-based process that supports safe operation of the nuclear power industry. However, the nuclear industry is constantly trying to find ways to decrease the human error rate, especially the human errors associated with procedure use. Advances in digital technology make computer-based procedures (CBPs) a valid option that provides further enhancement of safety by improving human performance related to procedure use. The transition from paper-based procedures (PBPs) to CBPs creates a need for a computer-based proceduremore » system (CBPS). A CBPS needs to have the ability to perform logical operations in order to adjust to the inputs received from either users or real time data from plant status databases. Without the ability for logical operations the procedure is just an electronic copy of the paper-based procedure. In order to provide the CBPS with the information it needs to display the procedure steps to the user, special care is needed in the format used to deliver all data and instructions to create the steps. The procedure should be broken down into basic elements and formatted in a standard method for the CBPS. One way to build the underlying data architecture is to use an Extensible Markup Language (XML) schema, which utilizes basic elements to build each step in the smart procedure. The attributes of each step will determine the type of functionality that the system will generate for that step. The CBPS will provide the context for the step to deliver referential information, request a decision, or accept input from the user. The XML schema needs to provide all data necessary for the system to accurately perform each step without the need for the procedure writer to reprogram the CBPS. The research team at the Idaho National Laboratory has developed a prototype CBPS for field workers as well as the underlying data structure for such CBPS. The objective of the research effort is to develop guidance on how to design both the user interface and the underlying schema. This paper will describe the result and insights gained from the research activities conducted to date.« less

EMS providers' perceptions of safety climate and adherence to safe work practices.

PubMed

Eliseo, Laura J; Murray, Kate A; White, Laura F; Dyer, Sophia; Mitchell, Patricia A; Fernandez, William G

2012-01-01

Occupational injuries are an important source of morbidity for emergency medical services (EMS) providers. Previous work has shown that employee perceptions of an organization's commitment to safety (i.e., safety climate) correlate with adherence to safe practices. To assess the association between perceived safety climate and compliance with safety procedures in an urban EMS system with >100,000 calls/year. EMS providers were issued a self-administered survey that included questions on demographics, years of experience, perceived safety climate, and adherence to safety procedures. Safety climate was assessed with a 20-item validated instrument. Adherence to safety procedures was assessed with a nine-item list of safety behaviors. Strict adherence to safety procedures was defined as endorsing "agree" or "strongly agree" on 80% of items. The effect of safety climate on compliance with safe practices was estimated using multiple logistic regression. One hundred ninety-six of 221 providers (89%) completed surveys; 74% were male; the median age was 36-40 years; and the median amount of experience was 8 years. One hundred twenty-seven of 196 respondents (65%) reported strict adherence to safe work practice. Factor analysis confirmed the original six-factor grouping of questions; frequent safety-related feedback/training was significantly associated with safe practices (odds ratio [OR] = 2.14, 95% confidence interval [CI] = 1.01-4.51). EMS workers perceiving a high degree of perceived safety climate was associated with twofold greater odds of self-reported level of strict adherence to safe work practices. Frequent safety-related feedback/training was the one dimension of safety climate that had the strongest association with adherence to safe workplace behaviors.

Description of 103 Cases of Hypobaric Sickness from NASA-sponsored Research

NASA Technical Reports Server (NTRS)

Conkin, Johnny; Klein, Jill S.; Acock, Keena E.

2003-01-01

One hundred and three cases of hypobaric decompression sickness (DCS) are documented, with 6 classified as Type II DCS. The presence and grade of venous gas emboli (VGE) are part of the case descriptions. Cases were diagnosed from 731 exposures in 5 different altitude chambers from 4 different laboratories between the years 1982 and 1999. Research was funded by NASA to develop operational prebreathe (PB) procedures that would permit safe extravehicular activity from the Space Shuttle and International Space Station using an extravehicular mobility unit (spacesuit) operated at 4.3 psia. Both vehicles operate at 14.7 psia with an "air" atmosphere, so a PB procedure is required to reduce nitrogen partial pressure in the tissues to an acceptable level prior to depressurization to 4.3 psia. Thirty-two additional descriptions of symptoms that were not diagnosed as DCS together with VGE information are also included. The information for each case resides in logbooks from 32 different tests. Additional information is stored in the NASA Decompression Sickness Database and the Prebreathe Reduction Protocol Database, both maintained by the Environmental Physiology Laboratory at the Johnson Space Center. Both sources were reviewed to provide the narratives that follow.

Surgical treatment of gastroesophageal reflux disease and upside-down stomach using the Da Vinci robotic system. A prospective study.

PubMed

Hartmann, Jens; Jacobi, Christoph A; Menenakos, Charalambos; Ismail, Mahmoud; Braumann, Chris

2008-03-01

So far, the impact of telematic surgical approach in Gastroesophageal Reflux Disease (GERD) is still obscure. In this prospective study, we analyzed the Da Vinci Intuitive Surgical robotic system for antireflux surgery. In April 2003, we set up a pilot study to evaluate the efficacy of laparoscopic telerobotic surgery using the three-arm Da Vinci system. Optimal trocar positions, operating and setup times, conversion rate, intraoperative complications, and perioperative morbidity, as well as mortality rate, were analyzed. The median age was 53 years (range 25-74) in 118 patients (52 female/66 male). In 17 patients, an upside-down stomach- and in 101 GERD was surgical indication. The median operating time has been reduced from 105 min to 91 min after 40 procedures and setup time from 24.5 min to 10.4 min after 10 procedures. The system is safe and it seems to be superior to traditional laparoscopy during dissection in the esophageal hiatus region. This compensates long setup- and operating times. Disadvantages are the high costs, the time to master the setup/system and the necessity of exact trocar positioning.

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

International Society for the Advancement of Cytometry cell sorter biosafety standards.

PubMed

Holmes, Kevin L; Fontes, Benjamin; Hogarth, Philip; Konz, Richard; Monard, Simon; Pletcher, Charles H; Wadley, Robert B; Schmid, Ingrid; Perfetto, Stephen P

2014-05-01

Flow cytometric cell sorting of biological specimens has become prevalent in basic and clinical research laboratories. These specimens may contain known or unknown infectious agents, necessitating precautions to protect instrument operators and the environment from biohazards arising from the use of sorters. To this end the International Society of Analytical Cytology (ISAC) was proactive in establishing biosafety guidelines in 1997 (Schmid et al., Cytometry 1997;28:99-117) and subsequently published revised biosafety standards for cell sorting of unfixed samples in 2007 (Schmid et al., Cytometry Part A J Int Soc Anal Cytol 2007;71A:414-437). Since their publication, these documents have become recognized worldwide as the standard of practice and safety precautions for laboratories performing cell sorting experiments. However, the field of cytometry has progressed since 2007, and the document requires an update. The new Standards provides guidance: (1) for laboratory design for cell sorter laboratories; (2) for the creation of laboratory or instrument specific Standard Operating Procedures (SOP); and (3) on procedures for the safe operation of cell sorters, including personal protective equipment (PPE) and validation of aerosol containment. Published © 2014 Wiley Periodicals Inc.

Cybersonics: Tapping into Technology

NASA Technical Reports Server (NTRS)

2001-01-01

With the assistance of Small Business Innovation Research (SBIR) funding from NASA's Jet Propulsion Laboratory, Cybersonics, Inc., developed an ultrasonic drill with applications ranging from the medical industry to space exploration. The drill, which has the ability to take a core sample of the hardest granite or perform the most delicate diagnostic medical procedure, is a lightweight, ultrasonic device made to fit in the palm of the hand. Piezoelectric actuators, which have only two moving parts and no gears or motors, drive the components of the device, enabling it to operate in a wide range of temperatures. The most remarkable aspect of the drill is its ability to penetrate even the hardest rock with minimal force application. The ultrasonic device requires 20 to 30 times less force than standard rotating drills, allowing it to be safely guided by hand during operation. Also, the drill is operable at a level as low as three watts of power, where conventional drills require more than three times this level. Potential future applications for the ultrasonic drill include rock and soil sampling, medical procedures that involve core sampling or probing, landmine detection, building and construction, and space exploration. Cybersonics, Inc. developed an ultrasonic drill with applications ranging from the medical industry to space exploration.

The University of Pennsylvania curriculum for training otorhinolaryngology residents in transoral robotic surgery.

PubMed

Sperry, Steven M; O'Malley, Bert W; Weinstein, Gregory S

2014-01-01

To define a curriculum for the development of robotic surgical skills in otorhinolaryngology residency training. A systematic review of the current literature on robotic surgery training was performed. Based on prior reports in other specialties, a curriculum for otorhinolaryngology residents was created that progresses through several modules, including didactics, inanimate skills laboratory, and operative experience. The curriculum for residents in otorhinolaryngology was designed as follows: didactics include an overview of the robotic device and instruments, a tutorial in basic controls and function, and a room setup and positioning. The anatomy and steps of transoral procedures are taught through books, videos, operative observations, and cadaver dissections. Skills are developed with a virtual reality robotic simulator and robotics labs. The operative experience progresses from case observation to bedside assistant to console surgeon. The role of the console surgeon progresses in a stepwise fashion, and the procedures of radical tonsillectomy, supraglottic partial laryngectomy, and base of tongue resection have been organized as a series of steps. A structured curriculum for training residents in transoral robotic surgery was developed. This training is important for otorhinolaryngology residents to acquire the knowledge and skills to perform robotic surgery safely. © 2015 S. Karger AG, Basel.

Development of a non-tissue adherent neurosurgical patty and an ex vivo testing system to evaluate adherent characteristics.

PubMed

Kinoshita, Manabu; Taniguchi, Mai; Takagaki, Masatoshi; Seike, Nobuhisa; Hashimoto, Naoya; Yoshimine, Toshiki

2015-05-01

Neurosurgical patties are the most frequently used instruments during neurosurgical procedures, and their high performance is required to ensure safe operations. They must offer cushioning, water-absorbing, water-retaining, and non-tissue adherent characteristics. Here, the authors describe a revised neurosurgical patty that is superior in all respects to the conventional patty available in Japan. Patty characteristics were critically and scientifically evaluated using various in vitro assays. Moreover, a novel ex vivo evaluation system focusing on the adherent characteristics of the neurosurgical patty was developed. The proposed assay could provide benchmark data for comparing different neurosurgical patties, offering neurosurgeons objective data on the performance of patties. The newly developed patty was also evaluated in real neurosurgical settings and showed superb performance during various neurosurgical procedures.

Early complications with the holmium laser

NASA Astrophysics Data System (ADS)

Beaghler, Marc A.; Stewart, Steven C.; Ruckle, Herbert C.; Poon, Michael W.

1997-05-01

The purpose of this study is to report early complications in our initial experience with the holmium laser in 133 patients. A retrospective study of patients undergoing endourological procedures with the holmium laser was performed. Complications included urinary tract infection (3), post-operative bradycardia (1), inverted T-waves (1), intractable flank pain (1), urinary retention (1), inability to access a lower pole calyx with a 365 micron fiber (9), stone migration (5), termination of procedure due to poor visualization (2). No ureteral perforations or strictures occurred. The holmium laser was capable of fragmenting all urinary calculi in this study. In our initial experience, the holmium laser is safe and effective in the treatment of genitourinary pathology. Use of laser fibers larger than 200 microns occasionally limit deflection into a lower pole or dependent calyx.

Case series of 17 modified Weil's osteotomies for Freiberg's and Köhler's II AVN, with AOFAS scoring pre- and post-operatively.

PubMed

Edmondson, M C; Sherry, K R; Afolayan, J; Armitage, A R; Skyrme, A D

2011-03-01

Treatment for metatarsal head avascular necrosis is largely conservative. For severe or refractory cases there are various surgical options. We have performed a 'modified Weil's osteotomy' of the distal metatarsal in order to manage this problem. We present the largest case series, to our knowledge, with 17 such cases. The patients were scored pre- and post-operatively using the AOFAS Forefoot scoring system. We found that this procedure provided a mean score improvement of 36 points, with a complication rate of 5.9%. We would advocate this modified osteotomy as an effective, reliable and safe treatment option. Copyright © 2009 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Orbital Express Mission Operations Planning and Resource Management using ASPEN

NASA Technical Reports Server (NTRS)

Chouinard, Caroline; Knight, Russell; Jones, Grailing; Tran, Danny

2008-01-01

The Orbital Express satellite servicing demonstrator program is a DARPA program aimed at developing "a safe and cost-effective approach to autonomously service satellites in orbit". The system consists of: a) the Autonomous Space Transport Robotic Operations (ASTRO) vehicle, under development by Boeing Integrated Defense Systems, and b) a prototype modular next-generation serviceable satellite, NEXTSat, being developed by Ball Aerospace. Flexibility of ASPEN: a) Accommodate changes to procedures; b) Accommodate changes to daily losses and gains; c) Responsive re-planning; and d) Critical to success of mission planning Auto-Generation of activity models: a) Created plans quickly; b) Repetition/Re-use of models each day; and c) Guarantees the AML syntax. One SRP per day vs. Tactical team

The role of fracture mechanics in the design of fuel tanks in space vehicles

NASA Technical Reports Server (NTRS)

Denton, S. J.; Liu, C. K.

1976-01-01

With special reference to design of fuel tanks in space vehicles, the principles of fracture mechanics are reviewed. An approximate but extremely simple relationship is derived among the operating stress level, the length of crack, and the number of cycles of failure. Any one of the variables can be computed approximately from the knowledge of the other two, if the loading schedule (mission of the tank) is not greatly altered. Two sample examples illustrating the procedures of determining the allowable safe operating stress corresponding to a set of assumed loading schedule are included. The selection of sample examples is limited by the relatively meager available data on the candidate material for various stress ratios in the cycling.

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.

Single-operator cholangioscopy in patients requiring evaluation of bile duct disease or therapy of biliary stones (with videos).

PubMed

Chen, Yang K; Parsi, Mansour A; Binmoeller, Kenneth F; Hawes, Robert H; Pleskow, Douglas K; Slivka, Adam; Haluszka, Oleh; Petersen, Bret T; Sherman, Stuart; Devière, Jacques; Meisner, Søren; Stevens, Peter D; Costamagna, Guido; Ponchon, Thierry; Peetermans, Joyce A; Neuhaus, Horst

2011-10-01

The feasibility of single-operator cholangioscopy (SOC) for biliary diagnostic and therapeutic procedures was previously reported. To confirm the utility of SOC in more widespread clinical use. Prospective clinical cohort study. Fifteen endoscopy referral centers in the United States and Europe. Two hundred ninety-seven patients requiring evaluation of bile duct disease or biliary stone therapy. SOC examination and, as indicated, SOC-directed stone therapy or forceps biopsy. Procedural success defined as ability to (1) visualize target lesions and, if indicated, collect biopsy specimens adequate for histological evaluation or (2) visualize biliary stones and initiate fragmentation and removal. The overall procedure success rate was 89% (95% CI, 84%-92%). Adequate tissue for histological examination was secured in 88% of 140 patients who underwent biopsy. Overall sensitivity in diagnosing malignancy was 78% for SOC visual impression and 49% for SOC-directed biopsy. Sensitivity was higher (84% and 66%, respectively) for intrinsic bile duct malignancies. Diagnostic SOC procedures altered clinical management in 64% of patients. Procedure success was achieved in 92% of 66 patients with stones and complete stone clearance during the study SOC session in 71%. The incidence of serious procedure-related adverse events was 7.5% for diagnostic SOC and 6.1% for SOC-directed stone therapy. The study was observational in design with no control group. Evaluation of bile duct disease and biliary stone therapy can be safely performed with a high success rate by using the SOC system. Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Minimally Invasive Catheter Procedures to Assist Complicated Pacemaker Lead Extraction and Implantation in the Operating Room

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

Kroepil, Patric; Lanzman, Rotem S., E-mail: rotemshlomo@yahoo.de; Miese, Falk R.

2011-04-15

We report on percutaneous catheter procedures in the operating room (OR) to assist complicated manual extraction or insertion of pacemaker (PM) and implantable cardioverter defibrillator leads. We retrospectively reviewed complicated PM revisions and implantations performed between 2004 and 2009 that required percutaneous catheter procedures performed in the OR. The type of interventional procedure, catheter and retrieval system used, venous access, success rates, and procedural complications were analyzed. In 41 (12 female and 29 male [mean age 62 {+-} 17 years]) of 3021 (1.4%) patients, standard manual retrieval of old leads or insertion of new leads was not achievable and thusmore » required percutaneous catheter intervention for retrieval of misplaced leads and/or recanalisation of occluded central veins. Thirteen of 18 (72.2%) catheter-guided retrieval procedures for misplaced (right atrium [RA] or ventricle [RV; n = 3], superior vena cava [n = 2], brachiocephalic vein [n = 5], and subclavian vein [n = 3]) lead fragments in 16 patients were successful. Percutaneous catheter retrieval failed in five patients because there were extremely fixed or adhered lead fragments. Percutaneous transluminal angiography (PTA) of central veins for occlusion or high-grade stenosis was performed in 25 patients. In 22 of 25 patients (88%), recanalization of central veins was successful, thus enabling subsequent lead replacement. Major periprocedural complications were not observed. In the case of complicated manual PM lead implantation or revision, percutaneous catheter-guided extraction of misplaced lead fragments or recanalisation of central veins can be performed safely in the OR, thus enabling subsequent implantation or revision of PM systems in the majority of patients.« less

Percutaneous tracheostomy--special considerations.

PubMed

Ernst, Armin; Critchlow, Jonathan

2003-09-01

Percutaneous tracheostomy is safe and highly effective in well-trained hands in establishing a long-term artificial airway. Most alleged contraindications and some suggestions on how the procedures should be performed likely stem from early trials when only "perfect candidates" were chosen. Most of those contraindications should not be viewed as prohibitions, but as suggestions related to the skill level and training of the operator. We have used this technique in many situations where the small incision and tamponading effect of the tracheostomy tube has been quite beneficial, in selected patients with coagulapathies and severe venous congestion from superior cava syndromes as well as thyroid cancers, and in whom operative approaches would have been difficult. Knowing one's level of expertise and comfort in choosing and rejecting patients and procedures accordingly is the key to keeping PT a procedure with an excellent safety record. As the experience with PT grows, more and more perceived contraindications will disappear. Studies will address the role of PT in children and as a means of establishing emergent airway access. Also, the exact coagulation limits will need to be established. Few contraindications will most likely remain absolute, such as active infections over the proposed entry site, uncontrollable bleeding disorders and excessive ventilatory and oxygenation requirements. In our institution, taking into account these absolute contraindications, fewer than 5% of patients in need of a tracheostomy in the intensive care unit will undergo a primary open procedure.

Overview of the Small Aircraft Transportation System Project Four Enabling Operating Capabilities

NASA Technical Reports Server (NTRS)

Viken, Sally A.; Brooks, Frederick M.; Johnson, Sally C.

2005-01-01

It has become evident that our commercial air transportation system is reaching its peak in terms of capacity, with numerous delays in the system and the demand still steadily increasing. NASA, FAA, and the National Consortium for Aviation Mobility (NCAM) have partnered to aid in increasing the mobility throughout the United States through the Small Aircraft Transportation System (SATS) project. The SATS project has been a five-year effort to provide the technical and economic basis for further national investment and policy decisions to support a small aircraft transportation system. The SATS vision is to enable people and goods to have the convenience of on-demand point-to-point travel, anywhere, anytime for both personal and business travel. This vision can be obtained by expanding near all-weather access to more than 3,400 small community airports that are currently under-utilized throughout the United States. SATS has focused its efforts on four key operating capabilities that have addressed new emerging technologies, procedures, and concepts to pave the way for small aircraft to operate in nearly all weather conditions at virtually any runway in the United States. These four key operating capabilities are: Higher Volume Operations at Non-Towered/Non-Radar Airports, En Route Procedures and Systems for Integrated Fleet Operations, Lower Landing Minimums at Minimally Equipped Landing Facilities, and Increased Single Pilot Performance. The SATS project culminated with the 2005 SATS Public Demonstration in Danville, Virginia on June 5th-7th, by showcasing the accomplishments achieved throughout the project and demonstrating that a small aircraft transportation system could be viable. The technologies, procedures, and concepts were successfully demonstrated to show that they were safe, effective, and affordable for small aircraft in near all weather conditions. The focus of this paper is to provide an overview of the technical and operational feasibility of the four operating capabilities, and explain how they can enable a small aircraft transportation system.

National CPS Certification | A Program of Safe Kids Worldwide

Science.gov Websites

the Tech! ABOUT THE PROGRAM National CPS Certification Training is a program of Safe Kids Worldwide ; E-Vouchers FAQS/HELP FAQs Fees Forms Policies & Procedures Who We Are NHTSA Safe Kids CPS-board State Farm Follow us on Facebook Copyright © 2017 by Safe Kids Worldwide - Child Passenger Safety

A Procedure for Setting Environmentally Safe Total Maximum Daily Loads (TMDLs) for Selenium

Treesearch

A. Dennis Lemly

2002-01-01

This article presents a seven-step procedure for developing environmentally safe total maximum daily loads (TMDLs) for selenium. The need for this information stems from recent actions taken by the U.S. Environmental Protection Agency (EPA) that may require TMDLs for selenium and other contaminants that are impairing water bodies. However, there is no technical...

Venous vascular malformations of the craniofacial region: pre-operative embolisation with direct percutaneous puncture and N-butyl cyanoacrylate.

PubMed

Cil, B E; Vargel, I; Geyik, S; Peynircioglu, B; Cavusoglu, T

2008-12-01

Craniofacial venous vascular malformations cause severe cosmetic problems and yet these lesions are not candidates for transcatheter embolisation owing to the lack of arterial feeders. The purpose of this study was to evaluate the effectiveness of pre-operative embolisation of these lesions with N-butyl 2-cyanoacrylate (NBCA) via direct puncture. Between September 2003 and April 2006, 13 patients (7 female; age range, 6-64 years; mean, 16.7 years) were embolised with direct puncture and injection of NBCA. All of the patients were referred from plastic surgery with an operational plan. Angiography performed in all patients showed no or little arterial staining. NBCA diluted with iodized oil at a ratio of 1:6 (18%) was injected via a percutaneously placed 21 gauge needle. Complete embolisation was achieved in 8 patients and partial embolisation in the remaining 5. A total of 18 sessions of embolisation were performed on 13 patients. Nine patients underwent only one embolisation session, three patients underwent two sessions and only one patient underwent three sessions. The mean volume of NBCA used per session was 5.8 ml, ranging from 1-12 ml. All patients underwent a successful surgical resection to improve cosmetic disfigurement within 10-15 days after the embolisation procedure. Mean follow-up time was 22 months. One patient experienced skin necrosis on her nose after embolisation. No other complications related to the procedure were observed. In conclusion, pre-operative NBCA embolisation with direct puncture is a safe and easy procedure. It can increase the success of the surgical treatment of these lesions.

Starting a robotic program in general thoracic surgery: why, how, and lessons learned.

PubMed

Cerfolio, Robert J; Bryant, Ayesha S; Minnich, Douglas J

2011-06-01

We report our experience in starting a robotic program in thoracic surgery. We retrospectively reviewed our experience in starting a robotic program in general thoracic surgery on a consecutive series of patients. Between February 2009 and September 2010, 150 patients underwent robotic operations. Types of procedures were lobectomy in 62, thymectomy in 30, and benign esophageal procedures in 6. No thymectomy or esophageal procedures required conversion. One conversion was needed for suspected bleeding for a mediastinal mass. Twelve patients were converted for lobectomy (none for bleeding, 1 in the last 24). Median operative time for robotic thymectomy was 119 minutes, and median length of stay was 1 day. The median time for robotic lobectomy was 185 minutes, and median length of stay was 2 days. There were no operative deaths. Morbidity occurred in 23 patients (15%). All patients with cancer had R0 resections and resection of all visible mediastinal and hilar lymph nodes. Robotic surgery is safe and oncologically sound. It requires training of the entire operating room team. The learning curve is steep, involving port placement, availability of the proper instrumentation, use of the correct robotic arms, and proper patient positioning. The robot provides an ideal surgical approach for thymectomy and other mediastinal tumors. Its advantage over thoracoscopy for pulmonary resection is unproven; however, we believe complete thoracic lymph node dissection and teaching is easier. Importantly, defined credentialing for surgeons and cost analysis studies are needed. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Telementoring: use of augmented reality in orthopaedic education: AAOS exhibit selection.

PubMed

Ponce, Brent A; Jennings, Jonathan K; Clay, Terry B; May, Mathew B; Huisingh, Carrie; Sheppard, Evan D

2014-05-21

Virtual interactive presence (VIP) is a new technology that allows an individual to deliver real-time virtual assistance to another geographically remote individual via a standard Internet connection. The objectives of this pilot study were to evaluate the efficiency and performance of a VIP system implemented in an operating room setting, determine the potential utility of the system for guidance of surgical procedures, and assess the safety of the system. Following institutional review board approval, fifteen patients underwent arthroscopic shoulder procedures. Two VIP stations were used, one in the operating room and the other in an adjoining dictation room. The attending surgeon proctored operating resident surgeons from the dictation room until his physical presence was required in the operating room. Following each procedure, the attending surgeon, resident surgeons, and three surgical staff members completed a Likert-scale questionnaire regarding the educational utility, efficiency of use, and safety of the system. The operative time was also compared with historical data. Both attending and resident surgeons assigned a favorable rating to the utility of the VIP to highlight anatomy and provide feedback to the resident (p > 0.05 for the difference). Both groups agreed that the system was easy to use and that safety was not compromised (p > 0.05). The majority of resident and attending surgeon responses indicated no perceptible lag between motions (95% and 100%, respectively; p > 0.99) and no interference of the VIP system with the surgical procedure (85% and 100%, respectively; p = 0.24). The mean operative times with and without VIP use did not differ significantly for rotator cuff repair (p = 0.90) or for treatment of instability (p = 0.57). This pilot study revealed that the VIP technology was efficient, safe, and effective as a teaching tool. The attending and resident surgeons agreed that training was enhanced, and this occurred without increasing operative times. Furthermore, the attending surgeon believed that this technology improved teaching effectiveness. These results are promising, and further objective quantification is warranted.

Outpatient cataract surgery: incident and procedural risk analysis do not support current clinical ophthalmology guidelines.

PubMed

Koolwijk, Jasper; Fick, Mark; Selles, Caroline; Turgut, Gökhan; Noordergraaf, Jeske I M; Tukkers, Floor S; Noordergraaf, Gerrit J

2015-02-01

To evaluate whether an ophthalmologist-led, non-anesthesia-supported, limited monitoring pathway for phacoemulsification/intraocular lens cataract surgery, can be performed safely with only a medical emergency team providing support. Retrospective, observational, cohort study. All patients who underwent elective phacoemulsification/intraocular lens surgery under topical anesthesia in the ophthalmology outpatient unit between January 1, 2011, and December 31, 2012. Cataract surgery was performed by phacoemulsification under topical anesthesia. The intake process mainly embraced ophthalmic evaluation, obtaining a medical history, and proposing the procedure. A staff ophthalmologist performed the procedure assisted by 2 registered nurses in an independent outpatient clinic operating room within the hospital. The clinical pathway was without dedicated presence of or access to anesthesia service. Perioperative monitoring was limited to blood pressure and plethysmography preoperatively and intraoperatively. Patients were offered supportive care and instructed to avoid fasting and continue all their chronic medication. The primary outcome measure was the incidence of adverse events requiring medical emergency team (MET) interventions throughout the pathway. Secondary outcome measures were surgical ocular complication rates, use of oral sedatives, and reported reasons to perform the surgery in the classical operation room complex. Within the cataract pathway, 6961 cases (4347 patients) were eligible for analysis. Three MET interventions related to the phacoemulsification/intraocular lens pathway occurred in the 2-year study period, resulting in an intervention rate of 0.04%. None of the interventions was intraoperative. All 3 patients were diagnosed as vasovagal collapse and recuperated uneventfully. No hospital admittance was required. Eight other incidents occurred within the general ophthalmology outpatient unit population during the study period. Cataract surgery can be safely performed in an outpatient clinic, in the absence of the anesthesia service and with limited workup and monitoring. Basic first aid and basic life support skills seem to be sufficient in case of an adverse event. An MET provides a generous failsafe for this low-risk procedure. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

The world's first obesity surgery performed by a surgeon at a distance.

PubMed

Cadiere, G B; Himpens, J; Vertruyen, M; Favretti, F

1999-04-01

In recent years, laparoscopic procedures have gained popularity. The laparoscopic technique is, however, more difficult than the conventional approach, especially in obese patients. The purpose of this article is to demonstrate a solution to these difficulties. On September 16, 1998, a laparoscopic gastric banding procedure was performed by a surgeon while he was actually sitting at a distance from his patient. The surgeon's assistant was scrubbed and gowned and stood at the patient's side. The surgeon manipulated handles that were connected to a computer in command of robotic arms mounted on the operating table near the patient. The robotic arms contained surgical tools with articulated tips, well inside the abdominal cavity. The system constituted a master-slave construction called Mona (Intuitive Surgical, Mountain View, CA). The entire procedure (adjustable silicone gastric banding) was performed solely by this system without any other intervention. The entire procedure lasted 90 minutes. The blood loss was 25 mL. The patient left the hospital on the second postoperative day. This procedure demonstrates that telesurgical procedures are feasible, can be performed safely even in obese patients, and improve the surgeon's comfort by restoring ergonomically acceptable conditions, by increasing the number of degrees of freedom, and by recreating the eye-hand connection lost in videoendoscopic procedures.

Safety Precautions and Operating Procedures in an (A)BSL-4 Laboratory: 2. General Practices.

PubMed

Mazur, Steven; Holbrook, Michael R; Burdette, Tracey; Joselyn, Nicole; Barr, Jason; Pusl, Daniela; Bollinger, Laura; Coe, Linda; Jahrling, Peter B; Lackemeyer, Matthew G; Wada, Jiro; Kuhn, Jens H; Janosko, Krisztina

2016-10-03

Work in a biosafety level 4 (BSL-4) containment laboratory requires time and great attention to detail. The same work that is done in a BSL-2 laboratory with non-high-consequence pathogens will take significantly longer in a BSL-4 setting. This increased time requirement is due to a multitude of factors that are aimed at protecting the researcher from laboratory-acquired infections, the work environment from potential contamination and the local community from possible release of high-consequence pathogens. Inside the laboratory, movement is restricted due to air hoses attached to the mandatory full-body safety suits. In addition, disinfection of every item that is removed from Class II biosafety cabinets (BSCs) is required. Laboratory specialists must be trained in the practices of the BSL-4 laboratory and must show high proficiency in the skills they are performing. The focus of this article is to outline proper procedures and techniques to ensure laboratory biosafety and experimental accuracy using a standard viral plaque assay as an example procedure. In particular, proper techniques to work safely in a BSL-4 environment when performing an experiment will be visually emphasized. These techniques include: setting up a Class II BSC for experiments, proper cleaning of the Class II BSC when finished working, waste management and safe disposal of waste generated inside a BSL-4 laboratory, and the removal of inactivated samples from inside a BSL-4 laboratory to the BSL-2 laboratory.

A Randomised Trial Comparing Efficacy, Onset and Duration of Action of Pethidine and Tramadol in Abolition of Shivering in the Intra Operative Period

PubMed Central

Kaparti, Lavanya

2014-01-01

Introduction: Regional anaesthesia (spinal anaesthesia) is widely used as a safe anaesthetic technique for both elective and emergency operations. Shivering is known to be a frequent complication, reported in 40 to 70% of patients undergoing surgery under regional anaesthesia. Various methods are available for the control of shivering during anaesthesia. Here we have compared Tramadol, a synthetic opioid with Pethidine, the gold standard drug for the treatment of shivering, in the quest for more safe and efficacious drug. Materials and Methods: Forty patients of ASA 1 and 2 status posted for elective surgical procedures under neuraxial block were selected. Group P (n=20) received Pethidine 0.5mg/kg IV and group T (n=20) received tramadol 1.0 mg/kg IV. Results: Both the drugs were found to be effective in reducing shivering. Nineteen patients in the Group T had control of shivering at end of 5 minutes but there were no patients who had control of shivering Group P (p < 0.0001) which is statistically significant. Conclusion: Tramadol reduced the occurrence of postanesthetic shivering more significantly than pethidine. PMID:25584238

Skill qualifications in pediatric minimally invasive surgery.

PubMed

Iwanaka, Tadashi; Morikawa, Yasuhide; Yamataka, Atsuyuki; Nio, Masaki; Segawa, Osamu; Kawashima, Hiroshi; Sato, Masahito; Terakura, Hirotsugu; Take, Hiroshi; Hirose, Ryuichiro; Yagi, Makoto

2011-07-01

In 2006, The Japanese Society of Pediatric Endoscopic Surgeons devised a plan to develop a pediatric endoscopic surgical skill qualification (ESSQ) system. This system is controlled by The Japan Society for Endoscopic Surgery. The standard requirement for skills qualification is the ability of each applicant to complete common types of laparoscopic surgery. The main goal of the system is to decrease complications of laparoscopic surgery by evaluating the surgical skills of each applicant and subsequently certify surgeons with adequate skills to perform laparoscopic operations safely. A committee of pediatric ESSQ created a checklist to assess the applicant's laparoscopic surgical skills. Skills are assessed in a double-blinded fashion by evaluating an unedited video recording of a fundoplication for pediatric gastroesophageal reflux disease. The initial pediatric ESSQ system was started in 2008. In 2008 and 2009, respectively, 9 out of 17 (53%) and 6 out of 12 (50%) applicants were certified as expert pediatric laparoscopic surgeons. Our ultimate goal is to provide safe and appropriate pediatric minimally invasive procedures and to avoid severe complications. To prove the predictive validity of this system, a survey of the outcomes of operations performed by certified pediatric surgeons is required.

Integrated Test and Evaluation Flight Test 3 Flight Test Plan

NASA Technical Reports Server (NTRS)

Marston, Michael Lawrence

2015-01-01

The desire and ability to fly Unmanned Aircraft Systems (UAS) in the National Airspace System (NAS) is of increasing urgency. The application of unmanned aircraft to perform national security, defense, scientific, and emergency management are driving the critical need for less restrictive access by UAS to the NAS. UAS represent a new capability that will provide a variety of services in the government (public) and commercial (civil) aviation sectors. The growth of this potential industry has not yet been realized due to the lack of a common understanding of what is required to safely operate UAS in the NAS. NASA's UAS Integration into the NAS Project is conducting research in the areas of Separation Assurance/Sense and Avoid Interoperability, Human Systems Integration (HSI), and Communication to support reducing the barriers of UAS access to the NAS. This research is broken into two research themes namely, UAS Integration and Test Infrastructure. UAS Integration focuses on airspace integration procedures and performance standards to enable UAS integration in the air transportation system, covering Sense and Avoid (SAA) performance standards, command and control performance standards, and human systems integration. The focus of Test Infrastructure is to enable development and validation of airspace integration procedures and performance standards, including the integrated test and evaluation. In support of the integrated test and evaluation efforts, the Project will develop an adaptable, scalable, and schedulable relevant test environment capable of evaluating concepts and technologies for unmanned aircraft systems to safely operate in the NAS. To accomplish this task, the Project will conduct a series of Human-in-the-Loop and Flight Test activities that integrate key concepts, technologies and/or procedures in a relevant air traffic environment. Each of the integrated events will build on the technical achievements, fidelity and complexity of the previous tests and technical simulations, resulting in research findings that support the development of regulations governing the access of UAS into the NAS.

UAS Integration in the NAS Project: Integrated Test and Evaluation (IT&E) Flight Test 3. Revision E

NASA Technical Reports Server (NTRS)

Marston, Michael

2015-01-01

The desire and ability to fly Unmanned Aircraft Systems (UAS) in the National Airspace System (NAS) is of increasing urgency. The application of unmanned aircraft to perform national security, defense, scientific, and emergency management are driving the critical need for less restrictive access by UAS to the NAS. UAS represent a new capability that will provide a variety of services in the government (public) and commercial (civil) aviation sectors. The growth of this potential industry has not yet been realized due to the lack of a common understanding of what is required to safely operate UAS in the NAS. NASA's UAS Integration into the NAS Project is conducting research in the areas of Separation Assurance/Sense and Avoid Interoperability, Human Systems Integration (HSI), and Communication to support reducing the barriers of UAS access to the NAS. This research is broken into two research themes namely, UAS Integration and Test Infrastructure. UAS Integration focuses on airspace integration procedures and performance standards to enable UAS integration in the air transportation system, covering Sense and Avoid (SAA) performance standards, command and control performance standards, and human systems integration. The focus of Test Infrastructure is to enable development and validation of airspace integration procedures and performance standards, including the integrated test and evaluation. In support of the integrated test and evaluation efforts, the Project will develop an adaptable, scalable, and schedulable relevant test environment capable of evaluating concepts and technologies for unmanned aircraft systems to safely operate in the NAS. To accomplish this task, the Project will conduct a series of Human-in-the-Loop and Flight Test activities that integrate key concepts, technologies and/or procedures in a relevant air traffic environment. Each of the integrated events will build on the technical achievements, fidelity and complexity of the previous tests and technical simulations, resulting in research findings that support the development of regulations governing the access of UAS into the NAS.

The pedicled internal pudendal artery perforator (PIPAP) flap for ischial pressure sore reconstruction: Technique and long-term outcome of a cohort study.

PubMed

Legemate, Catherine M; van der Kwaak, Monique; Gobets, David; Huikeshoven, Menno; van Zuijlen, Paul P M

2018-06-01

The ischial region is the site most affected by pressure sores and has the highest recurrence and complication rates compared to other affected sites. We developed a practical and safe pedicled flap for reconstruction of ischial pressure sores based on the rich available perforators from the internal pudendal artery and the surplus of skin at the infragluteal fold. A retrospective cohort study was conducted in all patients who underwent ischial pressure ulcer reconstruction using the PIPAP flap between March 2010 and March 2017. The skin flap was designed along the gluteal fold. The skin perforators of the pudendal artery were marked with a Doppler probe in the medial region of the gluteal fold. Surgery was performed in the jackknife position, and flaps were elevated in the suprafascial plane. Patients were assessed for minor (requiring no additional surgery) and major complications (requiring additional surgery). Twenty-seven patients (34 flaps) were identified. The median follow-up period was 38 months (IQR 37). Primary closure of the donor-site was achieved in all procedures, only one flap required muscle flap transposition in order to fill the dead space. The mean operating time was 60 ± 21 minutes. In six flaps (9%) wound healing problems were noted that did not require an additional operative procedure. Among the nine flaps (27%) that required a second procedure, 3 (9%) were necessary due to recurrent ulcers. The PIPAP flap is a safe and reliable alternative for ischial pressure sore reconstruction, certainly when compared to available techniques. Moreover, it has significant advantages over other techniques including minimal donor-site morbidity, preservation of posterior thigh skin, buttock-line integrity and reliable vascularity. Copyright © 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Checkout and Standard Use Procedures for the Mark III Space Suit Assembly

NASA Technical Reports Server (NTRS)

Valish, Dana J.

2012-01-01

The operational pressure range is the range to which the suit can be nominally operated for manned testing. The top end of the nominal operational pressure range is equivalent to 1/2 the proof pressure. Structural pressure is 1.5 times the specified test pressure for any given test. Proof pressure is the maximum unmanned pressure to which the suit was tested by the vendor prior to delivery. The maximum allowable working pressure (MAWP) is 90% of the proof pressure. The pressure systems RVs are set to keep components below their MAWPs. If the suit is pressurized over its MAWP, the suit will be taken out of service and an in-depth inspection/review of the suit will be performed before the suit is put back in service. The procedures outlined in this document should be followed as written. However, the suit test engineer (STE) may make redline changes real-time, provided those changes are recorded in the anomaly section of the test data sheet. If technicians supporting suit build-up, check-out, and/or test execution believe that a procedure can be improved, they should notify their lead. If procedures are incorrect to the point of potentially causing hardware damage or affecting safety, bring the problem to the technician lead and/or STE s attention and stop work until a solution (temporary or permanent) is authorized. Certain steps in the procedure are marked with a DV , for Designated Verifier. The Designated Verifier for this procedure is an Advanced Space Suit Technology Development Laboratory technician, not directly involved in performing the procedural steps, who will verify that the step was performed as stated. The steps to be verified by the DV were selected based on one or more of the following criteria: the step was deemed significant in ensuring the safe performance of the test, the data recorded in the step is of specific interest in monitoring the suit system operation, or the step has a strong influence on the successful completion of test objectives. Prior to all manned test activities, Advanced Suit Test Data Sheet (TDS) Parts A-E shall be completed to verify system and team are ready for test. Advanced Suit TDS Parts F-G shall be completed at the end of the suited activity. Appendix B identifies tha appropriate Mark III suit emergency event procedures.

Strategies for Countering Terrorist Safe Havens

DTIC Science & Technology

2014-02-20

within safe havens, tactical containment, pseudo operations, and surrogate security forces. The thesis draws from four historical case studies to...leadership targeting within safe havens, tactical containment, pseudo operations, and surrogate security forces. The thesis draws from four historical case ...surrogate forces and pseudo operations—provide viable potential options for USSOF to counter the complex problem of safe havens. Overall, the case

Safety of elective hand surgery following axillary lymph node dissection for breast cancer.

PubMed

Hershko, Dan D; Stahl, Shalom

2007-01-01

The development of lymphedema is the most feared complication shared by breast cancer survivors undergoing hand surgery after prior axillary lymph node dissection (ALND). Traditionally, these patients are advised to avoid any interventional procedures in the ipsilateral upper extremity. However, the appropriateness of some of these precautions was recently challenged by some surgeons claiming that elective hand operations can be safely performed in these patients. The purpose of this study was to evaluate our experience and determine the safety of elective hand operations in breast cancer survivors. The medical records of patients operated for different hand conditions after prior breast surgery and ALND at our institution between 1983 and 2002 were reviewed. The techniques and preventive measures performed, use of antibiotics, and upper extremity complications associated with the operations were analyzed. Overall, we operated on 27 patients after prior ALND performed for breast cancer. Follow-up was available for 25 patients. Four patients had pre-existing lymphedema. The surgical technique used was similar to that performed in patients without prior ALND and antibiotic prophylaxis was not given. Delayed wound healing was observed in one patient and finger joint stiffness in another. Two patients with pre-existing lymphedema developed temporary worsening of their condition. None of the patients developed new lymphedema. The results of the present study support the few previous studies, suggesting that hand surgery can be safely performed in patients with prior ALND. Based on these findings, the appropriateness of the rigorous precautions and prohibitions regarding the care and use of the ipsilateral upper extremity may need to be reconsidered.

Suction curettage.

PubMed

English, E C

1983-12-01

In the decade after the legalization of elective abortion by a Supreme Court decision in January 1973, suction curettage has been widely used and accepted as a safe outpatient procedure for first-trimester abortion. Evaluation of the patient for feasibility of the procedure requires careful assessment of gestational age and the determination of the absence of an ectopic pregnancy and conditions that might contraindicate local anesthesia. Counseling clarifies the patient's options and ensures her understanding of the implications of abortion so that she can give an informed consent. Suction curettage is performed under local anesthesia using a sterile plastic cannula or curette inserted through a progressively dilated cervix with aspiration of the uterine contents by an electric pump. The procedure is completed by the physician's examination of the aspirate for the presence of placental villi. Postoperative instructions include contraception and monitoring for hemorrhage and infection prior to a return visit in 10 to 14 days. Complications can be reduced by careful selection of patients with appropriate duration of pregnancy, the use of gentle operative technique, antibiotics for prophylaxis of infection, and a continued maintenance of experience and procedural skill by the physician.

Simple Automatic File Exchange (SAFE) to Support Low-Cost Spacecraft Operation via the Internet

NASA Technical Reports Server (NTRS)

Baker, Paul; Repaci, Max; Sames, David

1998-01-01

Various issues associated with Simple Automatic File Exchange (SAFE) are presented in viewgraph form. Specific topics include: 1) Packet telemetry, Internet IP networks and cost reduction; 2) Basic functions and technical features of SAFE; 3) Project goals, including low-cost satellite transmission to data centers to be distributed via an Internet; 4) Operations with a replicated file protocol; 5) File exchange operation; 6) Ground stations as gateways; 7) Lessons learned from demonstrations and tests with SAFE; and 8) Feedback and future initiatives.

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.

Pre-Study Walkthrough with a Commercial Pilot for a Preliminary Single Pilot Operations Experiment

NASA Technical Reports Server (NTRS)

O'Connor-Dreher, Ryan; Roberts, Z.; Ziccardi, J.; Vu, K-P. L.; Strybel, T.; Koteskey, Robert William; Lachter, Joel B.; Vi Dao, Quang; Johnson, Walter W.; Battiste, V.

2013-01-01

The number of crew members in commercial flights has decreased to two members, down from the five-member crew required 50 years ago. One question of interest is whether the crew should be reduced to one pilot. In order to determine the critical factors involved in safely transitioning to a single pilot, research must examine whether any performance deficits arise with the loss of a crew member. With a concrete understanding of the cognitive and behavioral role of a co-pilot, aeronautical technologies and procedures can be developed that make up for the removal of the second aircrew member. The current project describes a pre-study walkthrough process that can be used to help in the development of scenarios for testing future concepts and technologies for single pilot operations. Qualitative information regarding the tasks performed by the pilots can be extracted with this technique and adapted for future investigations of single pilot operations.

Study of safety implications for shuttle launched spacecraft using fluorinated oxidizers. Volume 1: Complete text

NASA Technical Reports Server (NTRS)

1975-01-01

The safety implications of space shuttle launched spacecraft using liquid flourine as the oxidizer for spacecraft propulsion were investigated. Feasibility of safe operation was investigated and the equipment and procedures necessary to maximize the chance of success determined. Hazards to the shuttle were found to be similar in kind if not degree to those encountered in use of nitrogen tetroxide (also toxic oxidizer). It was concluded that residual risks from spacecraft using fluorine and nitrogen tetroxide during ground and flight handling may be reduced by isolation of the oxidizer to only its tank. Operation of planetary spacecraft propulsion in the vicinity of the shuttle in earth orbit is not required. The primary hazard to personnel was identified as propellant loading operations, which should be accomplished in an area reasonably remote from personnel and facilities concentrations. Clearing the pad during spacecraft mating with the shuttle orbiter is recommended.

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.

Direct puncture embolization of the internal iliac artery during cesarean delivery for pernicious placenta previa coexisting with placenta accreta.

PubMed

Chen, Zhenyu; Li, Ju; Shen, Jian; Jin, Jiaxi; Zhang, Wei; Zhong, Wan

2016-12-01

To evaluate direct puncture embolization of the internal iliac artery with hemostatic gelatin sponge particles to treat pernicious placenta previa coexisting with placenta accreta during cesarean delivery. A retrospective study was conducted of data from women with pernicious placenta previa and placenta accreta who underwent direct puncture embolization of the internal iliac artery during cesarean delivery at a center in China between September 1, 2013, and February 28, 2015. Information regarding surgical procedures, operative data, and outcomes during hospitalization were obtained from medical records. The procedure was successful in all 16 cases included. Mean operative time was 78 minutes (range 65-90) and mean estimated blood loss was 1550 mL (range 1000-2500). Complications such as fever, buttock pain, or acute limb ischemia were not observed. The procedure was performed after partial cystectomy for two patients with bladder invasion. Postoperative Doppler imaging indicated uterine recovery and normalized uterine blood flow in all patients. Direct puncture embolization of the internal iliac artery during cesarean delivery was a safe, effective, simple, and rapid method to control hemorrhage among women with pernicious placenta previa and placenta accreta. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Minimally invasive repair of pectus carinatum using a newly designed bar and stabilizer: a single-institution experience.

PubMed

Yüksel, Mustafa; Bostanci, Korkut; Evman, Serdar

2011-08-01

A modified technique of the Nuss procedure for the minimally invasive repair of pectus carinatum was defined by Abramson, and it has been gaining support for the last few years. We have been performing the Abramson procedure in our institutions since 2006. This article describes our recent experience with a novel instrument for pectus carinatum correction. In 2008, we developed a new pectus bar and stabilizing system for this procedure and started using it on our pectus carinatum patients. Between July 2008 and December 2009, 18 patients were operated on with these newly designed implants. Excellent esthetic results obtained regarding the postoperative course, verified with the patients' and parent's answers on a satisfaction questionnaire; all patients except one (94.4%) feeling satisfied with the operation. Two of the bars have been removed during the 18-month follow-up. Three fixating steel wire breakages requiring re-fixing of the stabilizers and two local skin adhesions over the bar were seen as postoperative complications. This article describes a novel instrument and surgical technique that is safely and easily used in minimally invasive correction of pectus carinatum deformities, with minimal complications and high satisfaction rates. Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

75 FR 21151 - Proposed Collection; Comment Request for Revenue Procedure 2004-18

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-22

... Revenue Procedure 2004- 18 AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice and request... comments concerning Revenue Procedure 2004-18, Average Area Purchase Price Safe Harbors and Nationwide.... OMB Number: 1545-1877. Revenue Procedure Number: Revenue Procedure 2004-18. Abstract: Revenue...

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

Endoscopic Evacuation of Subdural Collections.

PubMed

Boyaci, Suat; Gumustas, Oguzhan Guven; Korkmaz, Serdar; Aksoy, Kaya

2016-01-01

Intraoperative use of the endoscope is a hot topic in neurosurgery and it gives broader visualization of critical and hardlyreached areas. Endoscope-assisted surgical approach to chronic subdural haematoma (SDH) is a minimally invasive technique and may give an expansion to the regular method of burr-hole haematoma drainage. Endoscope-assisted haematoma drainage with mini-craniotomy was performed over a 24-month period, and prospectively collected data is reviewed. A total of 10 procedures (8 patients) were performed using the endoscopeassisted technique. Four of them were chronic SDH and six were subacute SDH. Procedures were extended 20 minutes in average because of endoscopic intervention. There was no extra-morbidity through the study as a consequence of endoscopic assessment. Endoscope-assisted techniques can make the operation safe in selected circumstances with improved intraoperative visualization. It may likewise take into consideration the identification and destruction of neo-membranes, septums and solid clots. In addition, the source of bleeding can be easily coagulated. The endoscope-assisted techniques, with all of these features, can alter the pre- and intra-operative decision-making for selected patients.

Robotic right colectomy using the Da Vinci Single-Site® platform: case report.

PubMed

Morelli, Luca; Guadagni, Simone; Caprili, Giovanni; Di Candio, Giulio; Boggi, Ugo; Mosca, Franco

2013-09-01

While single-port laparoscopy for abdominal surgery is technically challenging, the Da Vinci Single-Site® robotic surgery platform may help to overcome some of the difficulties of this rapidly evolving technique. The authors of this article present a case of single-incision, robotic right colectomy using this device. A 74-year-old female with malignant polyp of caecum was operated on with a single-site approach using the Da Vinci Single-Site® robotic surgery device. Resection and anastomosis were performed extra-corporeally after undocking the robot. The procedure was successfully completed in 200 min. No surgical complications occurred during the intervention and the post-operative stay and no conversion to laparotomy or additional trocars were required. To the best of our knowledge, this is the first case of right colectomy using the Da Vinci Single-Site® robotic surgery platform to be reported. The procedure is feasible and safe and its main advantages are restoration of triangulation and reduced instrument clashes. Copyright © 2013 John Wiley & Sons, Ltd.

Laparoscopic inguinal hernia repair.

PubMed

Hussein, M K; Khoury, G S; Taha, A M

1998-01-01

Open hernia repair is associated with significant postoperative pain and disability resulting in delayed return to full activity. Laparoscopic hernia repair has been advocated as the procedure that combines the benefit of tension-free repair with the preservation of the basic anatomy of the inguinal area. We present our experience with 803 laparoscopic hernia repairs in 517 patients over a period of 66 months (August 92 to February 98). The effects of the learning curve and the refinement of the technique had their impact on earlier results and complications. However, with more experience we found that the laparoscopic preperitoneal approach is safe and efficacious. There was no mortality. Most patients (85%) were discharged home within 24 h of the procedure and returned to full activity within 10 days. Patient satisfaction was excellent. The complication rate decreased and operative time was reduced with experience. This procedure is clearly indicated in patients who have recurrent or bilateral hernias. It is associated with shorter convalescence and a quick return to work.

Technical innovation: Intragastric Single Port Sleeve Gastrectomy (IGSG). A feasibility survival study on porcine model.

PubMed

Estupinam, Oscar; Oliveira, André Lacerda de Abreu; Antunes, Fernanda; Galvão, Manoel; Phillips, Henrique; Scheffer, Jussara Peters; Rios, Marcelo; Zorron, Ricardo

2018-01-01

To perform technically the laparoscopic sleeve gastrectomy (LSG) using a unique Intragastric Single Port (IGSG) in animal swine model, evidencing an effective and safe procedure, optimizing the conventional technique. IGSG was performed in 4 minipigs, using a percutaneous intragastric single port located in the pre-pyloric region. The gastric stapling of the greater curvature started from the pre-pyloric region towards the angle of His by Endo GIA™ system and the specimen was removed through the single port. In the postoperative day 30, the animals were sacrificed and submitted to autopsy. All procedures were performed without conversion, and all survived 30 days. The mean operative time was 42 min. During the perioperative period no complications were observed during invagination and stapling. No postoperative complications occurred. Post-mortem examination showed no leaks or infectious complications. Intragastric Single Port is a feasible procedure that may be a suitable alternative technique of sleeve gastrectomy for the treatment of morbid obesity.

Aortic operation after previous coronary artery bypass grafting: management of patent grafts for myocardial protection.

PubMed

Nakajima, Masato; Tsuchiya, Koji; Fukuda, Shoji; Morimoto, Hironobu; Mitsumori, Yoshitaka; Kato, Kaori

2006-04-01

Aortic surgery for progressive aortic valve disease or aortic aneurysm after previous coronary artery bypass grafting (CABG) is a challenging procedure. We report the outcome of aortic reoperation after previous CABG and evaluate our management of patent grafts and our methods for obtaining myocardial protection. From February 2001 to July 2003, 6 patients with progressive aortic valve disease and aneurysm of the thoracic aorta were operated on. The group comprised 3 men and 3 women with a mean age of 67.6 years. There were 4 patients with an aneurysm of the aortic arch, 1 with chronic ascending aortic dissection, and 1 with progressive aortic valve stenosis. The interval between previous CABG and aortic surgery was 74.0 +/- 44.2 months. All reoperations were performed via median resternotomy. Myocardial protection was obtained by hypothermic perfusion of patent in-situ arterial grafts following cold-blood cardioplegia administration via the aortic root under aortic cross clamping. The operative procedure was aortic arch replacement in 4 patients, ascending aortic replacement with double CABG in 1, and aortic valve replacement in 1. All patients survived the reoperation. Postoperative maximum creatine kinase-MB was 49.2 +/- 29.8 and no new Q-waves occurred in the electrocardiogram nor were any new wall motion abnormalities recognized on echocardiography. There were no late deaths during a follow-up of 30.7 months. Reoperative aortic procedures after CABG can be performed safely with myocardial protection via hypothermic perfusion of a patent in-situ arterial graft.

A Flexible Evolvable Architecture for Constellation Mission Systems User Applications

NASA Technical Reports Server (NTRS)

Trimble, Jay P.; Crocker, Alan R.

2008-01-01

While simulating a complex set of repair tasks to be performed by EVA crewmembers on an upcoming mission, flight controllers and astronauts determine that the repair will take much longer than originally anticipated. All equipment in the vicinity of the worksite must be powered off to maintain a safe environment for the astronauts. Because heater power will be unavailable, several critical components will now be at risk of freezing and permanent damage. If an impending thermal violation is detected, Mission Control will have very limited time to react. Therefore, flight controllers must not only modify their procedures to account for these risks, they must also incorporate into their displays outputs from thermal models, alternate temperature measurements, new alarm limits, and emergency power-on commands to enable the detection and response to freezing conditions. Current software for mission control systems makes scenarios like this difficult to address. Given the time frame for modifying software, operations teams are left with labor-intensive operational workarounds as their only options. NASA Ames Research Center (ARC) and NASA Johnson Space Center (JSC) are collaborating on the development of a flexible software system for mission operations that will enable greater user flexibility than has been available to date. Using composable software, end users in the scenario described above could recompose procedures and command and control displays to allow flight controllers to monitor temperature measurements, identify time-critical conditions, and execute the procedures required to respond to these conditions before flight hardware is permanently damaged.

Ureterovaginal fistula--etiological factors and outcome.

PubMed

Murtaza, Badar; Mahmood, Arshad; Niaz, Waqar Azim; Akmal, Muhammad; Ahmad, Hussain; Saeed, Saira

2012-10-01

To assess the etiological factors and the outcome of ureterovaginal fistula in an urban setting. The observational study was conducted at the Armed Forces Institute of Urology, Military Hospital, Rawalpindi, from January 2009 to January 2011. All the patients of uretero-vaginal fistula at the centre were included on the basis of non-probability purposive sampling. The etiology, clinical presentation and the investigative procedures were recorded. The operative modality contemplated was noted and post-operative results were evaluated. The data was entered in a structured proforma and analysed for descriptive statistics using SPSS version 14.0. Seventeen cases of ureterovaginal fistula were recorded. Amongst these 10 (58.8%) were post-hysterectomy, while 7 (41.1%) cases post-caesarean section. The emergency procedures performed by the residents/junior registrars contributed 12 (70.2%) of the cases. All these patients were treated surgically; 14 (82.3%) were managed with ureteroneocystostomy, 2 (11.7%) required Boari Flap reconstruction, and in psoas hitch was performed in 1 (5.8%) case. The time of intervention was 4 - 12 weeks (9.76 +/- 2.223). Post-operatively, only 1 (5.8%) case had superficial wound infection and 1 (5.8%) urinary tract infection. All the patients remained dry with a follow-up period of 3 - 24 months (mean 12.24 +/- 6.879). Ureterovaginal fistula is one of the complications of emergency procedures, especially in the hands of inexperienced surgeons. Prompt diagnosis and surgical intervention produce excellent results. Intervention can be done safely as early as 4 weeks after the initiation of the condition.

The role of lasers in modern urology

PubMed Central

Dołowy, Łukasz; Dembowski, Janusz; Zdrojowy, Romuald; Kołodziej, Anna

2015-01-01

Introduction The functioning of modern urological departments and the high level of service they provide is possible through, among other things, the use of modern laser techniques. Material and methods Open operations have been replaced by minimally invasive procedures, and classical surgical tools by advanced lasers. The search for new applications with lasers began as technology developed. Among many devices available, holmium, diode and thulium lasers are currently the most popular. Results Depending on the wavelength, the absorption by water and hemoglobin and the depth of penetration, lasers can be used for coagulation, vaporization and enucleation. In many centres, after all the possibilities of pharmacological treatment have been exhausted, lasers are used as the primary treatment for patients with benign prostatic hyperplasia, with therapeutic results that are better than those obtained through open or endoscopic operations. The use of lasers in the treatment of urolithiasis, urinary strictures and bladder tumours has made treatment of older patients with multiple comorbidities safe, without further necessity to modify the anticoagulant drug treatment. Laser procedures are additionally less invasive, reduce hospitalization time and enable a shorter bladder catheterization time, sometimes even eliminating the need for bladder catherterization completely. Such procedures are also characterized by more stable outcomes and a lower number of reoperations. Conclusions There are also indications that with the increased competition among laser manufacturers, decreased purchase and maintenance costs, and increased operational safety, laser equipment will become mandatory and indispensable asset in all urology wards. PMID:26251737

Two-micron (thulium) laser resection of the prostate-tangerine technique: a new method for BPH treatment.

PubMed

Xia, Shu-Jie

2009-05-01

Two-micron (thulium) laser resection of the prostate-tangerine technique (TmLRP-TT) is a transurethral procedure that uses a thulium laser fiber to dissect whole prostatic lobes off the surgical capsule, similar to peeling a tangerine. We recently reported the primary results. Here we introduce this procedure in detail. A 70-W, 2-microm (thulium) laser was used in continuous-wave mode. We joined the incision by making a transverse cut from the level of the verumontanum to the bladder neck, making the resection sufficiently deep to reach the surgical capsule, and resected the prostate into small pieces, just like peeling a tangerine. As we resected the prostate, the pieces were vaporized, sufficiently small to be evacuated through the resectoscope sheath, and the use of the mechanical tissue morcellator was not required. The excellent hemostasis of the thulium laser ensured the safety of TmLRP-TT. No patient required blood transfusion. Saline irrigation was used intraoperatively, and no case of transurethral resection syndrome was observed. The bladder outlet obstruction had clearly resolved after catheter removal in all cases. We designed the tangerine technique and proved it to be the most suitable procedure for the use of thulium laser in the treatment of benign prostatic hyperplasia (BPH). This procedure, which takes less operative time than standard techniques, is safe and combines efficient cutting and rapid organic vaporization, thereby showing the great superiority of the thulium fiber laser in the treatment of BPH. It has been proven to be as safe and efficient as transurethral resection of the prostate (TURP) during the 1-year follow-up.

Awake intubation creates feelings of being in a vulnerable situation but cared for in safe hands: a qualitative study.

PubMed

Knudsen, Kati; Nilsson, Ulrica; Högman, Marieann; Pöder, Ulrika

2016-08-30

Awake fiberoptic intubation is an alternative procedure for securing the airway and is a recommended option when a difficult airway is expected. The aim of the present study was to describe patient experiences with this procedure. A qualitative, descriptive design was used and patients were recruited from three county hospitals and one university hospital in Sweden. Data was collected by semi-structured interviews with 13 patients who underwent awake fiberoptic intubation. A qualitative content analysis extracted theme, categories, and subcategories. From the patient statements, one main theme emerged, feelings of being in a vulnerable situation but cared for in safe hands, which were described in five categories with 15 subcategories. The categories were: a need for tailored information, distress and fear of the intubation, acceptance and trust of the staff's competence, professional caring and support, and no hesitation about new awake intubation. The patients felt they lacked information about what to expect and relied on the professionals' expertise. Some patients felt overwhelmed by the information they were given and wanted less specific information about the equipment used but more information about how they would be cared for in the operating room. Undergoing awake intubation was an acceptable experience for most patients, whereas others experienced it as being painful and terrifying because they felt they could not breathe or communicate during the procedure itself. Tailored information about what to expect, ensuring eye contact and breathing instruction during the procedure seems to reduce patient distress when undergoing awake fiberoptic intubation. Most of the patients would not hesitate to undergo awake intubation again in the future if needed.

Safe Hazmat Storage Tips.

ERIC Educational Resources Information Center

Neville, Angela

1996-01-01

Provides a list of recommendations for safely managing hazardous waste containers. Encourages training of employees on the hazards of the wastes they handle and the correct procedures for managing containers. (DDR)

Protocol for Removal of Third Molar Root Tips from the Inferior Alveolar Canal-Crossing the line.

PubMed

Punga, Rohit; Keswani, Kiran

2014-12-01

The safe removal of third molars involved with the inferior alveolar canal (IAC) has been an area of concern since long. Many times we hesitate for the removal of third molars, fearing injury to the inferior alveolar nerve. The authors here describe a simple technique which can be used to remove third molars showing evidence of proximity to IAC on presurgical radiographic evaluation, as well as those root tips which, during removal, accidentally enter the IAC space. A step-by-step protocol is presented along with necessary precautions during the operative procedure.

Reduction corporoplasty.

PubMed

Hakky, Tariq S; Martinez, Daniel; Yang, Christopher; Carrion, Rafael E

2015-01-01

Here we present the first video demonstration of reduction corporoplasty in the management of phallic disfigurement in a 17 year old man with a history sickle cell disease and priapism. Surgical management of aneurysmal dilation of the corpora has yet to be defined in the literature. We preformed bilateral elliptical incisions over the lateral corpora as management of aneurysmal dilation of the corpora to correct phallic disfigurement. The patient tolerated the procedure well and has resolution of his corporal disfigurement. Reduction corporoplasty using bilateral lateral elliptical incisions in the management of aneurysmal dilation of the corpora is a safe an feasible operation in the management of phallic disfigurement.

[Association of biliary calculosis and portal cavernomatosis].

PubMed

Crespi, C; De Giorgio, A M

1992-08-01

This paper reports the case of a woman, who underwent surgery because of cholelithiasis, with intraoperative finding of prehepatic portal hypertension from portal vein thrombosis ("portal cavernoma") with healthy liver, later confirmed by angiographic studies. This rare pathologic association carries a higher risk of major operative complications; therefore the Authors agree with the general belief that, for these cases, biliary tract surgery should be as simple and safe as possible. In the case of preoperative diagnosis of biliary disease associated with portal cavernoma, should a surgical approach on the biliary tract be required, we agree on the advisability of performing a shunting procedure before any kind of biliary surgery. In case of variceal bleeding endoscopic sclerotherapy will be the first choice; surgical procedures (shunting) should be seen as a second choice in case of rebleeding after sclerotherapy.

Laparoscopic implantation of an artificial urinary sphincter around the prostatic urethra

PubMed Central

Chłosta, Piotr; Aboumarzouk, Omar; Bondad, Jasper; Szopiński, Tomasz; Korzelik, Ignacy; Borówka, Andrzej

2015-01-01

Objective To report the first laparoscopic periprostatic implantation of an artificial urinary sphincter (AUS) after a transurethral resection of the prostate. Background The implantation of an AUS is a standard procedure for severe urinary incontinence. In men it is usually implanted through a perineal approach, with the cuff placed around the bulbous urethra, bladder neck, or even around the prostate. Method We report a laparoscopic periprostatic implantation of an AUS after a transurethral resection of a prostate in a 72-year-old-man with incontinence. Results The operative duration was 180 min and the blood loss was 150 mL. There were no complications. After activating the AUS the patient was totally continent. Conclusion The laparoscopic periprostatic implantation of an AUS is a safe, effective and considerably less invasive procedure. PMID:26413345

Field Telemetry of Blade-rotor Coupled Torsional Vibration at Matuura Power Station Number 1 Unit

NASA Technical Reports Server (NTRS)

Isii, Kuniyoshi; Murakami, Hideaki; Otawara, Yasuhiko; Okabe, Akira

1991-01-01

The quasi-modal reduction technique and finite element model (FEM) were used to construct an analytical model for the blade-rotor coupled torsional vibration of a steam turbine generator of the Matuura Power Station. A single rotor test was executed in order to evaluate umbrella vibration characteristics. Based on the single rotor test results and the quasi-modal procedure, the total rotor system was analyzed to predict coupled torsional frequencies. Finally, field measurement of the vibration of the last stage buckets was made, which confirmed that the double synchronous resonance was 124.2 Hz, meaning that the machine can be safely operated. The measured eigen values are very close to the predicted value. The single rotor test and this analytical procedure thus proved to be a valid technique to estimate coupled torsional vibration.

Minilaparotomy salvage of malfunctioning catheters in peritoneal dialysis.

PubMed

Li, Jian-Ri; Cheng, Chi-Hung; Chiu, Kun-Yuan; Cheng, Chen-Li; Yang, Chi-Rei; Ho, Hao-Chung; Ko, Jiunn-Liang; Ou, Yen-Chuan

2013-01-01

Catheter malfunction is a common and significant complication during peritoneal dialysis (PD). We developed a minilaparotomy procedure to rescue malfunctioning catheters and to prevent recurrence of malfunction. From 2006 to 2011, 11 patients receiving PD had a malfunctioning catheter. In all patients, a 2-cm incision, 5 cm caudally to the previous peritoneal entry site was used to correct the malfunctioning catheter, with concomitant fixation of the catheter to the peritoneum. Catheter tip migration occurred in 7 patients, omental wrapping in 3, and blood clot obstruction in 1. The mean onset time to catheter malfunction was 197.5 days (range: 4 - 1270 days), and the mean operating time was 41 minutes (range: 35 - 56 minutes). There was no recurrence of catheter malfunction and no surgery-related peritonitis. Our minilaparotomy procedure is safe and feasible for the salvage of malfunctioning PD catheters.

[Dynamic compression brace for pectus carinatum].

PubMed

de Beer, Sjoerd A; de Jong, Justin R; Heij, Hugo A

2013-01-01

Pectus carinatum occurs in one of 1500-1700 people and may lead to physical, cosmetic and psychosocial problems. Surgical treatment of pectus carinatum is performed using the 'Ravitch procedure'. An alternative and less invasive treatment consists of external compression with a brace. Results are often disappointing because of skin complications, a low level of comfort of the brace and low compliance. Nowadays a new brace (dynamic compression brace) exists with which the comfort and thus the compliance can be increased by measuring and regulating the pressure of correction during the treatment. This leads to better results and fewer complications. In 80-90% of patients the results are good to excellent and an operation can be avoided. This new brace is therefore a less invasive, cheap and safe alternative to the Ravitch procedure in the treatment of pectus carinatum in children.

Ambulatory surgery centers--current legal issues 2004 (Part 2).

PubMed

Becker, Scott; Szabad, Melissa; Foltushansky, Sofia

2004-05-01

This article covers several of the emerging issues related to ASCs, the anti-kickback statute and safe harbors, other regulations and relevant court decisions. The ASC Safe Harbors raise several concerns either because they are vague, silent, or provide little guidance as to their requirements. Perhaps the most challenging question under the ASC safe harbor relates to the handling of physicians who do not comply with the various safe harbor tests. As discussed, an ASC should address early on whether physicians who fail to meet or comply with the safe harbor will be redeemed from the venture. In redeeming such physicians, it is important to consider whether the company's operating agreement or shareholder agreement provides for redemption upon such event and whether the redemption will lead to litigation or compliance risks. Along the same lines, since it is illegal to provide any form of value in exchange for referrals under the anti-kickback statute, share sales at below fair market value may be viewed as an illegal kickback in exchange for referrals. Thus, in terms of adding physician owners, a number of guidelines should be followed. An ASC should also carefully consider situations in which it waives or discounts co-payments or deductibles. The safest course for a provider remains to collect the entire co-payment and deductible amounts from patients. Moreover, in the case of Medicare and Medicaid patients, an ASC should never waive or discount co-payments and deductibles unless the patient demonstrates financial hardship. Either way, such a waiver or discount should only be in accord with an applicable charity care or discount policy. A new issue involving the anti-kickback statue, state and federal self referral laws, and Medicare regulations, has gained attention as ASCs are increasingly finding themselves approached by third party vendors to enter into an arrangement, where the vendor owns the equipment and bills a third-party payor for the technical component of the procedure performed with the equipment, and the vendor then pays the ASC a fee for its lease of ASC space to house the equipment. These types of relationships can raise several legal compliance concerns. An ASC should understand that the arrangement could jeopardize its state ASC license and its Medicare certification even though the arrangement does not involve Medicare certified procedures or Medicare patients. Furthermore, this type of business venture might not comply with state and federal self referral laws. ASCs are also increasingly facing situations where a provider performs a procedure for which there is no facility charge for the ASC, but the physician is receiving a professional fee from Medicare. In this situation, ASCs should implement a policy, similar to the example provided in this article, to avoid even the appearance of providing an inducement or reward for referrals of Medicare or Medicaid business by requiring physicians to pay the Center a fee, consistent with fair market value, for the use of the Center for non-Covered Procedures or for performing multiple procedures within the same operative session. Lastly, as touched upon by this article, in the joint venture context, ASCs must take into account several guidelines in order to steer clear from risks associated with tax-exempt entities as an investor and antitrust price fixing issues. Whether a joint venture, of which a tax exempt entity is an investor, is deemed organized and operated in furtherance of the charitable purposes of a tax-exempt partner as set forth in Section 501(c)(3) of the Code depends on the facts and circumstances of each case. Generally, a joint venture will satisfy the guidelines if the tax-exempt investor in the joint venture retains sufficient control over the joint venture to ensure that the joint venture furthers the charitable purposes of the tax-exempt investor and adequately serves the community. In the ASC physician hospital joint venture arena, the principal antitrust concern relates to potential claims of price fixing. Where a hospital is a partner in a joint venture, the hospital and joint venture must take action to assure that the pricing and negotiations of the hospital and the ASC are handled separately. In all of these situations, ASCs and their investors must pay close attention and stay current of the safe harbor concepts, as well as the other regulations, guidelines, and court decisions discussed in this article in order to avoid potential regulatory and litigation risks.

Simple circumcision device: proof of concept for a single-visit, adjustable device to facilitate safe adult male circumcision.

PubMed

Hotaling, James M; Leddy, Laura S; Haider, Mahum A; Mossanen, Matthew; Bailey, Michael R; MacConaghy, Brian; Olson, Francis; Krieger, John N

2014-05-01

To conduct a proof-of-concept study to determine the potential utility of a novel, adjustable single-visit, disposable device to facilitate rapid adult circumcision. Prospective pilot trial of a novel surgical device. Tertiary care Veterans Administration medical center. Five adult males. Circumcisions performed by junior trainees using an adjustable, single-size surgical-assist device constructed by the University of Washington Applied Physics Laboratory. The attending surgeon and trainees completed standardized forms after each procedure to assess technical problems and ease of use. Follow-up visits were scheduled to evaluate adverse events, postoperative pain, cosmetic outcomes, and participant satisfaction at 3, 8, 30, and 90 days postoperatively. The average operative time was 16.4 minutes. All cases were performed with local anesthesia, and no case required electrocautery or conversion to standard surgery. At the postoperative day 3 visit, all subjects were happy with their results and would recommend the procedure to another patient. One participant had a minor wound separation noted at the 30-day visit that resolved during follow-up. There were no wound infections, hematomas, or other adverse events. This proof-of-study suggests that the Simple Circumcision Device may facilitate delivery of safe adult male circumcision services. Copyright © 2014 American Society for Reproductive Medicine. All rights reserved.

Flight Deck Technologies to Enable NextGen Low Visibility Surface Operations

NASA Technical Reports Server (NTRS)

Prinzel, Lawrence (Lance) J., III; Arthur, Jarvis (Trey) J.; Kramer, Lynda J.; Norman, Robert M.; Bailey, Randall E.; Jones, Denise R.; Karwac, Jerry R., Jr.; Shelton, Kevin J.; Ellis, Kyle K. E.

2013-01-01

Many key capabilities are being identified to enable Next Generation Air Transportation System (NextGen), including the concept of Equivalent Visual Operations (EVO) . replicating the capacity and safety of today.s visual flight rules (VFR) in all-weather conditions. NASA is striving to develop the technologies and knowledge to enable EVO and to extend EVO towards a Better-Than-Visual operational concept. This operational concept envisions an .equivalent visual. paradigm where an electronic means provides sufficient visual references of the external world and other required flight references on flight deck displays that enable Visual Flight Rules (VFR)-like operational tempos while maintaining and improving safety of VFR while using VFR-like procedures in all-weather conditions. The Langley Research Center (LaRC) has recently completed preliminary research on flight deck technologies for low visibility surface operations. The work assessed the potential of enhanced vision and airport moving map displays to achieve equivalent levels of safety and performance to existing low visibility operational requirements. The work has the potential to better enable NextGen by perhaps providing an operational credit for conducting safe low visibility surface operations by use of the flight deck technologies.

A review of the International Atomic Energy Agency (IAEA) international standards for tissue banks.

PubMed

Morales Pedraza, Jorge; Lobo Gajiwala, Astrid; Martinez Pardo, María Esther

2012-03-01

The IAEA International Standards for Tissue Banks published in 2003 were based on the Standards then currently in use in the USA and the European Union, among others, and reflect the best practices associated with the operation of a tissue bank. They cover legal, ethical and regulatory controls as well as requirements and procedures from donor selection and tissue retrieval to processing and distribution of finished tissue for clinical use. The application of these standards allows tissue banks to operate with the current good tissue practice, thereby providing grafts of high quality that satisfy the national and international demand for safe and biologically useful grafts. The objective of this article is to review the IAEA Standards and recommend new topics that could improve the current version.

"Lull pgm System" for Autologous Fat Grafting: A Simple Closed System with Minimal Equipment and No Extra Cost.

PubMed

Morselli, Paolo Giovanni; Micai, Alessandro; Giorgini, Federico Armando

2016-08-01

The "Lull pgm system" is a closed system for purifying harvested fat. It processes the collected tissue safely without any additional cost. The system was conceived by referring to the targets described in the literature with the aim of creating a simple system that guarantees a high standard of purification and requires minimal equipment that is available in every operating room. Cost must be always considered: even the most prosperous hospitals must keep within tight annual budgets. "Lull" can be used instead of expensive devices or disposable kits, without substantially increasing the operating time. The system has been used in clinical practice for many plastic reconstructive procedures and has obtained positive results and patient satisfaction, and no contraindications or disadvantages have been observed.

Antegrade scrotal sclerotherapy for the treatment of varicocele in childhood and adolescence.

PubMed

Mottrie, A M; Matani, Y; Baert, J; Voges, G E; Hohenfellner, R

1995-07-01

To test the efficacy of antegrade scrotal sclerotherapy (ASS) for the treatment of varicocele in teenagers. The study included 38 patients (mean age 14.9 years, range 12-18) with left-sided varicocele. Three patients had a grade 1 varicocele, 22 were grade 2 and 13 were grade 3. ASS was performed under local anaesthesia on an out-patient basis. ASS was accepted by all patients except one. There were no peri-operative problems and only one patient developed post-operative epididymitis. During 9 to 15 months of follow-up (mean 11 months), only two patients developed persistence of a lower grade of varicocele. This study illustrates that ASS is a safe and successful out-patient procedure for the treatment of varicocele in teenagers.

KSC-2013-2344

NASA Image and Video Library

2013-05-13

CAPE CANAVERAL, Fla. -- At NASA’s Kennedy Space Center in Florida, Lockheed Martin crews begin uncovering the Orion ground test vehicle in the Launch Equipment Test Facility, or LETF. The GTA was moved from the Operations and Checkout Facility to the LETF for a series of pyrotechnic bolt tests. The GTA is being used for path finding operations in the O&C, including simulated manufacturing and assembly procedures. Launching atop NASA's heavy-lift Space Launch System SLS, which also is under development, the Orion Multi-Purpose Crew Vehicle MPCV will serve as the exploration vehicle that will carry astronaut crews beyond low Earth orbit. It also will provide emergency abort capabilities, sustain the crew during space travel and provide safe re-entry from deep space return velocities. For more information, visit www.nasa.gov/orion. Photo credit: Jim Grossman

KSC-2013-2345

NASA Image and Video Library

2013-05-13

CAPE CANAVERAL, Fla. -- At NASA’s Kennedy Space Center in Florida, Lockheed Martin crews uncover the Orion ground test vehicle in the Launch Equipment Test Facility, or LETF. The GTA was moved from the Operations and Checkout Facility to the LETF for a series of pyrotechnic bolt tests. The GTA is being used for path finding operations in the O&C, including simulated manufacturing and assembly procedures. Launching atop NASA's heavy-lift Space Launch System SLS, which also is under development, the Orion Multi-Purpose Crew Vehicle MPCV will serve as the exploration vehicle that will carry astronaut crews beyond low Earth orbit. It also will provide emergency abort capabilities, sustain the crew during space travel and provide safe re-entry from deep space return velocities. For more information, visit www.nasa.gov/orion. Photo credit: Jim Grossman

An overview of safety assessment, regulation, and control of hazardous material use at NREL

NASA Astrophysics Data System (ADS)

Nelson, B. P.; Crandall, R. S.; Moskowitz, P. D.; Fthenakis, V. M.

1992-12-01

This paper summarizes the methodology we use to ensure the safe use of hazardous materials at the National Renewable Energy Laboratory (NREL). First, we analyze the processes and the materials used in those processes to identify the hazards presented. Then we study federal, state, and local regulations and apply the relevant requirements to our operations. When necessary, we generate internal safety documents to consolidate this information. We design research operations and support systems to conform to these requirements. Before we construct the systems, we perform a semiquantitative risk analysis on likely accident scenarios. All scenarios presenting an unacceptable risk require system or procedural modifications to reduce the risk. Following these modifications, we repeat the risk analysis to ensure that the respective accident scenarios present an acceptable risk. Once all risks are acceptable, we conduct an operational readiness review (ORR). A management-appointed panel performs the ORR ensuring compliance with all relevant requirements. After successful completion of the ORR, operations can begin.

50 CFR 218.124 - Mitigation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... safe speed. Release of ordinance through cloud cover is prohibited: Aircraft must be able to see... m) or lower, if safe to do so, and at the slowest safe speed. Firing or range clearance aircraft... speed, if operationally feasible and weather conditions permit. In dual aircraft operations, crews are...

50 CFR 218.124 - Mitigation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... safe speed. Release of ordinance through cloud cover is prohibited: Aircraft must be able to see... m) or lower, if safe to do so, and at the slowest safe speed. Firing or range clearance aircraft... speed, if operationally feasible and weather conditions permit. In dual aircraft operations, crews are...

50 CFR 218.124 - Mitigation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... safe speed. Release of ordinance through cloud cover is prohibited: Aircraft must be able to see... m) or lower, if safe to do so, and at the slowest safe speed. Firing or range clearance aircraft... speed, if operationally feasible and weather conditions permit. In dual aircraft operations, crews are...

50 CFR 218.124 - Mitigation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... safe speed. Release of ordinance through cloud cover is prohibited: Aircraft must be able to see... m) or lower, if safe to do so, and at the slowest safe speed. Firing or range clearance aircraft... speed, if operationally feasible and weather conditions permit. In dual aircraft operations, crews are...

An XML Representation for Crew Procedures

NASA Technical Reports Server (NTRS)

Simpson, Richard C.

2005-01-01

NASA ensures safe operation of complex systems through the use of formally-documented procedures, which encode the operational knowledge of the system as derived from system experts. Crew members use procedure documentation on the ground for training purposes and on-board space shuttle and space station to guide their activities. Investigators at JSC are developing a new representation for procedures that is content-based (as opposed to display-based). Instead of specifying how a procedure should look on the printed page, the content-based representation will identify the components of a procedure and (more importantly) how the components are related (e.g., how the activities within a procedure are sequenced; what resources need to be available for each activity). This approach will allow different sets of rules to be created for displaying procedures on a computer screen, on a hand-held personal digital assistant (PDA), verbally, or on a printed page, and will also allow intelligent reasoning processes to automatically interpret and use procedure definitions. During his NASA fellowship, Dr. Simpson examined how various industries represent procedures (also called business processes or workflows), in areas such as manufacturing, accounting, shipping, or customer service. A useful method for designing and evaluating workflow representation languages is by determining their ability to encode various workflow patterns, which depict abstract relationships between the components of a procedure removed from the context of a specific procedure or industry. Investigators have used this type of analysis to evaluate how well-suited existing workflow representation languages are for various industries based on the workflow patterns that commonly arise across industry-specific procedures. Based on this type of analysis, it is already clear that existing workflow representations capture discrete flow of control (i.e., when one activity should start and stop based on when other activities start and stop), but do not capture the flow of data, materials, resources or priorities. Existing workflow representation languages are also limited to representing sequences of discrete activities, and cannot encode procedures involving continuous flow of information or materials between activities.

[Implementation of a robotic video-assisted thoracic surgical program].

PubMed

Baste, J-M; Riviera, C; Nouhaud, F-X; Rinieri, P; Melki, J; Peillon, C

2016-03-01

Recent publications from North America have shown the benefits of robot-assisted thoracic surgery. We report here the process of setting up such a program in a French university centre and early results in a unit with an average treatment volume. Retrospective review of a single institution database. The program was launched after a 6-month preparation period. From January 2012 to January 2013, totally endoscopic, full robot-assisted procedures were performed on 30 patients (17 males). Median age was 54 [Q1-Q3, 48-63] years and ASA score 2 [1,2]. Operative procedures included thymectomy (9 ; 30%), lobectomy with nodes resection (11 ; 38%), segmentectomy (4 ; 14%), lymphadenectomy (3 ; 10%), Bronchogenic cyst (2, 5%) and posterior mediastinal mass resection (1 ; 3%). No conversion was required. Median blood loss was 50mL [10-100]. Median operating time was 135 min (105-165) including 30 min [20-40] for docking, 90min for robot-assisted operating [70-120] and 15 min [10-15] for lesion extraction. CO2 insufflation was used in 28 cases (93%). Hospital stay was 4 days [4-6] with 6 minor complications (20%) (Grade 1 according to the Clavien-Dindo classification). After a median 4 months follow-up [2-7], all patients were alive and demonstrated a good quality of life. This series suggests that full robotic thoracic procedures are safe and effective treatment for various pathologies, with low morbidity and without a significant learning curve, even in a lower volume centre. This technology should accompany the development of minimally invasive thoracic surgery. The importance of robotic training should be emphasized to optimize procedures and costs. Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Endodontic flare-ups: comparison of incidence between single and multiple visits procedures in patients attending a Nigerian teaching hospital.

PubMed

Oginni, Ao; Udoye, C I

2004-12-01

The present study was performed to compare the incidence of endodontic flare ups in single with multiple visits treatment procedures, to establish the relationship between pre-operative and post obturation pain in patients attending for endodontic therapy in a Nigerian teaching Hospital. Patients were randomly assigned to either single visit or multiple visits group. Data collected at root canal treatment appointment and recall visits (1st, 7th and 30th day post obturation) include pulp vitality status, the presence or absence of pre-operative pain, presence and degree of post obturation pain. Presence of endodontic flare-ups (defined as either patient's report of pain not controlled with over the counter medication and or increasing swelling). The compiled data were analyzed using chi-square where applicable. P level < 0.05 was taken as significant. Ten endodontic flare-ups (8.1 %) were recorded in the multiple visits group compared to 19 (18,3%) flare-ups for the single visit group, P = 0.02. For both single and multiple visits procedures, there were statistically significant correlations between pre operative and post obturation pain (P = 0.002 and P = 0.0004 respectively). Teeth with vital pulps reported the lowest frequency of post obturation pain (48.8%), while those with non vital pulps were found to have the highest frequency oh post obturation pain (50,3%), P = 0.9. Although the present study reported higher incidences for post obturation pain and flare-ups following the single visit procedures, single visit endodontic therapy has been shown to be a safe and effective alternative to multiple visits treatment.

Safely Enabling UAS Operations in Low-Altitude Airspace

NASA Technical Reports Server (NTRS)

Kopardekar, Parimal H.

2016-01-01

Flexibility where possible, and structure where necessary. Consider the needs of national security, safe airspace operations, economic opportunities, and emerging technologies. Risk-based approach based on population density, assets on the ground, density of operations, etc. Digital, virtual, dynamic, and as needed UTM services to manage operations.

Influence of two different surgical techniques on the difficulty of impacted lower third molar extraction and their post-operative complications.

PubMed

Mavrodi, Alexandra; Ohanyan, Ani; Kechagias, Nikos; Tsekos, Antonis; Vahtsevanos, Konstantinos

2015-09-01

Post-operative complications of various degrees of severity are commonly observed in third molar impaction surgery. For this reason, a surgical procedure that decreases the trauma of bone and soft tissues should be a priority for surgeons. In the present study, we compare the efficacy and the post-operative complications of patients to whom two different surgical techniques were applied for impacted lower third molar extraction. Patients of the first group underwent the classical bur technique, while patients of the second group underwent another technique, in which an elevator was placed on the buccal surface of the impacted molar in order to luxate the alveolar socket more easily. Comparing the two techniques, we observed a statistically significant decrease in the duration of the procedure and in the need for tooth sectioning when applying the second surgical technique, while the post-operative complications were similar in the two groups. We also found a statistically significant lower incidence of lingual nerve lesions and only a slightly higher frequency of sharp mandibular bone irregularities in the second group, which however was not statistically significant. The results of our study indicate that the surgical technique using an elevator on the buccal surface of the tooth seems to be a reliable method to extract impacted third molars safely, easily, quickly and with the minimum trauma to the surrounding tissues.

[Cox/maze III procedure combined with mitral valve replacement in treatment of rheumatic mitral valve disease with atrial fibrilation].

PubMed

Chen, Rukun; Wang, Yongqing; Chen, Yongbing; Chen, Suocheng

2002-06-25

To compare the curative effect of Cox/maze III procedure combined with mitral replacement and that of mitral valve replacement (MVR). Fifty-six patients suffering from rheumatic heart disease with atrial fibrillation (AF) were treated by Cox/maze III procedure combined with MVR (maze group). Another 56 age, sex, and heart function-matched patients with the same diagnosis underwent MVR alone during the same period. Warfarin was administered after operation in both groups. Comparison of operative complication and curative effects was made. The aortic cross-clamp time and cardio pulmonary bypass time (CPB) were longer in maze group than in MVT group (75 +/- 22 min vs 41 +/- 11 min, P < 0.05 and 124 +/- 40 min VS 68 +/- 19 min, P < 0.05). Bleeding happened after the heart reatored beating in 2 patients in maze group and in one patient in MVT group, all these 3 patients responding satisfactorily to hemostasis. The early post-operative mortality was 1.79% (1/56) in both groups. In maze group, AF disappeared in all patients but one who had node rhythm. Normal sinus rhythm was restored in 98.18% of the patients (54/55). Atrial contractility was restored in all patients with sinus rhythm. One year after operation, 98.18% patients' cardiac function changed to grade and 1.82% changed to grade II. In MVR group AF disappeared after operation temporarily for 24 hours in 7 patients and re-appeared, and AF disappeared in one patients for 2 years so far. One year after operation, the cardiac function of 94.6% patients in MVR group changed to grade I, of 3.6% patients to grade II, and of 1.8% patients to grade III. No serious hemorrhage relate d to anticoagulant therapy happened. One patient in MVR group suffered from hemiplegia due to cerebral embolism. The late mortality was 1.8% on maze group amd 3.6% in MVR group. Cox/maze III procedure combined with NVR is safe and effective in treating rheumatic heart disease with AF.

Ontogeny of a surgical technique: Robotic kidney transplantation with regional hypothermia.

PubMed

Sood, Akshay; McCulloch, Peter; Dahm, Philipp; Ahlawat, Rajesh; Jeong, Wooju; Bhandari, Mahendra; Menon, Mani

2016-01-01

Innovation is a hallmark of surgical practice. It is generally accepted that a new procedure will undergo technical changes during its evolution; however, quantitative accounts of the process are limited. Multiple groups, including our own, have recently described a minimally-invasive approach to conventional kidney transplantation (KT) operation. Unique to our experience is a structured development of the technique within the confines of a safe surgical innovation framework - the IDEAL framework (idea, development, exploration, assessment, long-term monitoring; stages 0-4). We here provide a first-hand narrative of the progress of robotic KT operation from preclinical trial to clinical application. Overall, 54 patients underwent robotic KT with regional hypothermia successfully. Major technical changes including selection of optimal patient position (flank vs. lithotomy), robotic instrumentation, vascular occlusion method (bulldog vs. tourniquet) and suture material (prolene vs. GoreTex) occurred early during the procedure development (IDEAL stage 0, preclinical). Minor technical changes such as utilization of the aortic punch for arteriotomy (case 3), use of barbed suture during ureteroneocystostomy (case 6) and extraperitonealization of the graft kidney (case 6) that increased the efficiency and safety of the procedure continued throughout procedure development (IDEAL stages 1-2, clinical stages). We demonstrate that a surgical technique evolves continually; although, the majority of technical alterations occur early in the life-cycle of the procedure. Development of a new technique within the confines a structured surgical innovation framework allows for evidence based progression of the technique and may minimize the risk of harm to the patient. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

After-hour Versus Daytime Shifts in Non-Operating Room Anesthesia Environments: National Distribution of Case Volume, Patient Characteristics, and Procedures.

PubMed

Gabriel, Rodney A; Burton, Brittany N; Tsai, Mitchell H; Ehrenfeld, Jesse M; Dutton, Richard P; Urman, Richard D

2017-09-01

The objective of this study was to characterize workload during all hours of the day in the non-operating room anesthesia (NORA) environment and identify what type of patients and procedures were more likely to occur during after-hours. By investigating data from the National Anesthesia Clinical Outcomes Registry, we characterized the total number of ongoing NORA cases per hour of the day (0 - 23 h). Results were presented as the mean hour and standard error (SE). Multivariable logistic regression was applied to assess the association of various patient, procedural, and facility characteristics with time of day (after-hours = 17:01-06:59 local time versus day-time). Included in this analysis, there were a total of 4,948,634 cases performed on non-holiday weekdays. The mean hour for ongoing cases for gastroenterology, cardiac, radiology and "other" were: 10.8 with standard error (SE) of 0.002, 11.5 (SE of 0.005), 11.2 (SE of 0.005), and 10.8 (SE of 0.002), respectively. Pairwise differences between means for each NORA specialty were all statistically significant (p < 0.0001). During after-hour shifts (4.3% of cases), patients with higher American Society of Anesthesiologists physical status classification scores had increased odds for undergoing a NORA procedure, while procedures that were more physiologically complex had decreased odds. With the increasing demand for NORA services, it is prudent that we fully understand the challenges of providing safe and efficient anesthetic services particularly in locations where fewer resources are available.

Mayo Clinic experience with modified Vecchietti procedure for vaginal agenesis: it is easy, safe, and effective.

PubMed

Nahas, Samar; Yi, Johnny; Magrina, Javier

2013-01-01

To evaluate the surgical outcome and the anatomic and sexual function in 10 women with Rokitansky syndrome who underwent the laparoscopic Vecchietti procedure at our center. Retrospective analysis. Data were analyzed on the basis of short-term and long-term surgical outcome and sexual function. All patients underwent clinical follow-up at 1, 2, and 6 months after surgery. In all 10 patients, the procedure produced anatomic and functional success. The laparoscopic Vecchietti technique is safe, simple, and effective for treatment of vaginal agenesis. Results are comparable to those of all European studies, and the procedure should gain more popularity in North America. Copyright © 2013 AAGL. All rights reserved.

One-Year Surgical Outcomes and Quality of Life after Minimally Invasive Sling Procedures for the Treatment of Female Stress Urinary Incontinence: TVT SECUR® vs. CureMesh®

PubMed Central

Joo, Young Min; Choe, Jin Ho

2010-01-01

Purpose We compared the efficacy and safety of two minimally invasive sling procedures used to treat female stress urinary incontinence (SUI), tension-free vaginal tape (TVT) SECUR® and CureMesh®, and assessed the 1-year surgical outcomes. Materials and Methods Sixty women with SUI were assigned to undergo either the TVT SECUR (n=38) or CureMesh (n=22) procedures between April 2007 and June 2008. Patients were monitored via outpatient visits at 1 month, 3 months, and 1 year after surgery. The efficacy of these procedures was evaluated by the cough test or by a urodynamic study. At these postoperative visits, the patients also completed several questionnaires, including incontinence quality of life, patient's perception of urgency severity, the scored form of the Bristol Female Lower Urinary Tract Symptoms, visual analog scale, and questions about perceived benefit, satisfaction, and willingness to undergo the same operation again. The objective cure rate was defined as no leakage during the cough test with a full bladder. The subjective cure rate was evaluated by self-assessment of goal achievement performed 1 year postoperatively. Results The two groups were similar in preoperative characteristics and urodynamic parameters. The objective cure rates were similar between TVT SECUR and CureMesh (68.4% vs. 77.3%). All respondents reported improvement after surgery. There were no intra-operative complications. Conclusions Our results showed that the TVT SECUR and CureMesh procedures are both safe and simple to perform and have no significant differences in efficacy. Comparative studies with long-term follow-up are warranted to determine the true efficacy of these procedures. PMID:20495697

The risk of shorter fasting time for pediatric deep sedation.

PubMed

Clark, Mathew; Birisci, Esma; Anderson, Jordan E; Anliker, Christina M; Bryant, Micheal A; Downs, Craig; Dalabih, Abdallah

2016-01-01

Current guidelines adopted by the American Academy of Pediatrics calls for prolonged fasting times before performing pediatric procedural sedation and analgesia (PSA). PSA is increasingly provided to children outside of the operating theater by sedation trained pediatric providers and does not require airway manipulation. We investigated the safety of a shorter fasting time compared to a longer and guideline compliant fasting time. We tried to identify the association between fasting time and sedation-related complications. This is a prospective observational study that included children 2 months to 18 years of age and had an American Society of Anesthesiologists physical status classification of I or II, who underwent deep sedation for elective procedures, performed by pediatric critical care providers. Procedures included radiologic imaging studies, electroencephalograms, auditory brainstem response, echocardiograms, Botox injections, and other minor surgical procedures. Subjects were divided into two groups depending on the length of their fasting time (4-6 h and >6 h). Complication rates were calculated and compared between the three groups. In the studied group of 2487 subjects, 1007 (40.5%) had fasting time of 4-6 h and the remaining 1480 (59.5%) subjects had fasted for >6 h. There were no statistically significant differences in any of the studied complications between the two groups. This study found no difference in complication rate in regard to the fasting time among our subjects cohort, which included only healthy children receiving elective procedures performed by sedation trained pediatric critical care providers. This suggests that using shorter fasting time may be safe for procedures performed outside of the operating theater that does not involve high-risk patients or airway manipulation.

[Classification and choice of surgical procedures for chronic pancreatitis].

PubMed

Yang, Yin-Mo; Wan, Yuan-Lian; Zhuang, Yan; Wang, Wei-Min; Yan, Zhong-Yu; Huang, Yan-Ting

2005-02-01

To explore the classification, choice of surgical procedures and the clinical outcome of surgical management for chronic pancreatitis. 54 patients with chronic pancreatitis undergoing operation in our hospital from 1983 to 2004 were analyzed retrospectively, who were divided into chronic calcifying pancreatitis and chronic obstructive pancreatitis according to the clinical manifestations. There were 41 men (76%) and 13 women (24%) with a mean age of 54 years. The cause of chronic pancreatitis was alcohol related in 25 cases (46%), cholelithiasis in 21 (39%), and previous episodes of acute pancreatitis in 18 (33%). Clinical manifestations included abdominal pain in 38 cases (70%), obstructive jaundice in 27 cases (50%). There existed a significant difference in some clinical materials between the two groups of chronic calcifying pancreatitis and chronic obstructive pancreatitis, which might mean the different pathologic basis in the two kinds of chronic pancreatitis. A total of 34 patients underwent nine different operations without perioperative deaths. Both the Puestow procedure and the pancreatoduodenectomy was safe and achieved pain relief in a large percentage of patients, which could also improve the exocrine function whereas the endocrine function remained unchanged. Addition of biliary bypass to the Puestow procedure was suitable for the patients with stenosis of common bile duct. Jaundice was the main manifestation in the patients with the inflammatory mass in the head of the pancreas and Whipple's procedure or other resectional procedures should be performed for them. Only drainage of bile duct had a better outcome for the relief of jaundice, but its effect to pancreas need to be further evaluated. The clinicopathologic characteristics of obstructive chronic pancreatitis was more variable and the surgical management should be also different for individuals.

Minilaparotomy with a gasless laparoscopic-assisted procedure by abdominal wall lifting for ileorectal anastomosis in patients with slow transit constipation.

PubMed

Tomita, Ryouichi; Fujisak, Shigeru

2009-01-01

Total colectomy with ileorectal anastomosis (IRA) is the most widely adopted procedure. The aim of this study was to introduce a minimally invasive procedure, i.e., minilaparotomy with laparoscopic-assisted procedure, by abdominal wall lifting for IRA in patients with slow transit constipation (STC). Six STC patients (6 women, aged 40-69 years, mean age 56.3 years) underwent minilaparotomy with gasless laparoscopic-assisted approach by abdominal wall lifting for IRA. The present procedure involved a 7-cm lower abdominal median incision made at the beginning of the operation. 12 mm ports were also placed in the right and left upper abdominal quadrant positions. The upper abdominal wall was lifted by a subcutaneous Kirshner wire. The small wound was pulled upward and/or laterally by retractors (abdominal lifting) and conventional surgical instruments were used through the wound. Occasionally laparoscopic assistance was employed. The terminal ileum with total colon was brought out through the small wound and transected, approximately 5 cm from the ileocecal valve. The colon was also resected at the level of promontrium. Then, IRA was performed in the instruments. The total surgical time was 197.7 +/- 33.9 min and the mean estimated blood loss was 176.8 +/- 42.2 ml. There was no surgical mortality. Post-operative hospitalization was 8.1 +/- 2.1 days. Six months after surgery, they defecated 1.8 +/- 2.1 times daily, have no abdominal distension, pain, and incontinence. The patients also take no laxatives. All subjects were satisfied with this procedure. Minilaparotomy with gasless laparoscopic-assisted IRA by abdominal wall lifting could be a safe and efficient technique in the treatment of STC.

A comperative study for short-term surgical outcomes of midurethral sling procedures in obese and non-obese women with stress urinary incontinence.

PubMed

Kokanalı, Mahmut Kuntay; Cavkaytar, Sabri; Kokanalı, Demet; Aksakal, Orhan; Doganay, Melike

2016-11-01

There is little data comparing the surgical outcomes of tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures in obese women. Therefore, we aimed to compare the surgical outcomes of TOT and TVT procedures among obese women with a diagnosis of stress urinary incontinence (SUI). One hundred and eighty-nine women who underwent TVT or TOT procedures due to pure SUI were included. Women in whom the body mass index (BMI) was ≥30 kg/m 2 were considered as obese, while <30 kg/m 2 were non-obese. And women with BMI ≥35 kg/m 2 was defined as morbidly obese. At sixth month postoperative follow-up, neither the comparison of TVT and TOT results in obese women nor the comparison of TVT or TOT results between obese and non-obese women showed any significant differences in terms of objective and subjective cure rates, quality of life improvements, or intra/postoperative complications. TVT and TOT procedures also have similar effectiveness among morbidly obese women. We have concluded that TVT and TOT operations seem to be equally effective and safe surgical treatment procedures for female SUI regardless of BMI.

Pylorus preserving loop duodeno-enterostomy with sleeve gastrectomy - preliminary results

PubMed Central

2014-01-01

Background Bariatric operations mostly combine a restrictive gastric component with a rerouting of the intestinal passage. The pylorus can thereby be alternatively preserved or excluded. With the aim of performing a “pylorus-preserving gastric bypass”, we present early results of a proximal postpyloric loop duodeno-jejunostomy associated with a sleeve gastrectomy (LSG) compared to results of a parallel, but distal LSG with a loop duodeno-ileostomy as a two-step procedure. Methods 16 patients underwent either a two-step LSG with a distal loop duodeno-ileostomy (DIOS) as revisional bariatric surgery or a combined single step operation with a proximal duodeno-jejunostomy (DJOS). Total small intestinal length was determined to account for inter-individual differences. Results Mean operative time for the second-step of the DIOS operation was 121 min and 147 min for the combined DJOS operation. The overall intestinal length was 750.8 cm (range 600-900 cm) with a bypassed limb length of 235.7 cm in DJOS patients. The mean length of the common channel in DIOS patients measured 245.6 cm. Overall excess weight loss (%EWL) of the two-step DIOS procedure came to 38.31% and 49.60%, DJOS patients experienced an %EWL of 19.75% and 46.53% at 1 and 6 months, resp. No complication related to the duodeno-enterostomy occurred. Conclusions Loop duodeno-enterosomies with sleeve gastrectomy can be safely performed and may open new alternatives in bariatric surgery with the possibility for inter-individual adaptation. PMID:24725654

Surgical treatment of female stress urinary incontinence with a trans-obturator-tape (T.O.T.) Uratape: short term results of a prospective multicentric study.

PubMed

Costa, P; Grise, P; Droupy, S; Monneins, F; Assenmacher, C; Ballanger, P; Hermieu, J F; Delmas, V; Boccon-Gibod, L; Ortuno, C

2004-07-01

The aim of the study was to assess the efficacy and safety of a new minimally invasive surgical procedure using the Trans-Obturator-Tape Uratape to treat female stress urinary incontinence. 183 women with stress urinary incontinence (SUI) associated with urethral hypermobility, underwent the T.O.T. procedure (October 2001 to March 2003). 26 patients were previously operated for incontinence. 26 patients were operated at the same time for their genital prolapse. Mean age was 56 years (29-87). 50/183 patients were having mixed incontinence. A non-elastic, polypropylene tape (UraTape, Mentor-Porgès) with a silicon coated central part was placed under the mid-urethra. The surgical placement technique utilises a trans-obturator percutaneous approach. All patients underwent post-operative clinical examination, cough-stress test (full bladder), uroflowmetry, and post-voiding residual assessment. Mean follow-up was 7 months (1-21). At 1 year follow-up 80.5% of the patients were completely cured and 7.5% were improved. The overall peri-operative complication rate was 2.2% with no vascular, nerve or bowel injury. 6 patients (3.3%) had post-operative urinary retention. The present multicentric study confirms the results obtained by the instigator of the technique, E. Delorme, and allows us to consider T.O.T. as an effective and safe technique for the treatment of female stress urinary incontinence, alone or in combination with prolapse repair. Copyright 2004 Elsevier B.V.

Safely Enabling Civilian Unmanned Aerial System (UAS) Operations in Low-Altitude Airspace by Unmanned Aerial System Traffic Management (UTM)

NASA Technical Reports Server (NTRS)

Kopardekar, Parimal Hemchandra

2015-01-01

Many UAS will operate at lower altitude (Class G, below 2000 feet). There is an urgent need for a system for civilian low-altitude airspace and UAS operations. Stakeholders want to work with NASA to enable safe operations.

Safely Enabling Civilian Unmanned Aerial System (UAS) Operations In Low-Altitude Airspace By Unmanned Aerial System Traffic Management (UTM)

NASA Technical Reports Server (NTRS)

Kopardekar, Parimal H.

2015-01-01

Many UAS will operate at lower altitude (Class G, below 2000 feet)There is urgent need for a system for civilian low-altitude airspace and UAS operations. Stakeholders want to work with NASA to enable safe operations.

45 CFR 1310.17 - Driver and bus monitor training.

Code of Federal Regulations, 2010 CFR

2010-10-01

... safe and efficient manner; (2) safely run a fixed route, including loading and unloading children... first aid in case of injury; (4) handle emergency situations, including vehicle evacuation procedures...

Safe and accurate midcervical pedicle screw insertion procedure with the patient-specific screw guide template system.

PubMed

Kaneyama, Shuichi; Sugawara, Taku; Sumi, Masatoshi

2015-03-15

Clinical trial for midcervical pedicle screw insertion using a novel patient-specific intraoperative screw guiding device. To evaluate the availability of the "Screw Guide Template" (SGT) system for insertion of midcervical pedicle screws. Despite many efforts for accurate midcervical pedicle screw insertion, there still remain unacceptable rate of screw malpositioning that might cause neurovascular injuries. We developed patient-specific SGT system for safe and accurate intraoperative screw navigation tool and have reported its availability for the screw insertion to C2 vertebra and thoracic spine. Preoperatively, the bone image on computed tomography was analyzed and the trajectories of the screws were designed in 3-dimensional format. Three types of templates were created for each lamina: location template, drill guide template, and screw guide template. During the operations, after engaging the templates directly with the laminae, drilling, tapping, and screwing were performed with each template. We placed 80 midcervical pedicle screws for 20 patients. The accuracy and safety of the screw insertion by SGT system were evaluated using postoperative computed tomographic scan by calculation of screw deviation from the preplanned trajectory and evaluation of screw breach of pedicle wall. All templates fitted the laminae and screw navigation procedures proceeded uneventfully. All screws were inserted accurately with the mean screw deviation from planned trajectory of 0.29 ± 0.31 mm and no neurovascular complication was experienced. We demonstrated that our SGT system could support the precise screw insertion in midcervical pedicle. SGT prescribes the safe screw trajectory in a 3-dimensional manner and the templates fit and lock directly to the target laminae, which prevents screwing error along with the change of spinal alignment during the surgery. These advantages of the SGT system guarantee the high accuracy in screw insertion, which allowed surgeons to insert cervical pedicle screws safely. 3.

Reconstruction of the gastric passage by a side-to-side gastrogastrostomy after failed vertical-banded gastroplasty: a case report

PubMed Central

Soll, Christopher; Müller, Markus K; Wildi, Stefan; Clavien, Pierre-Alain; Weber, Markus

2008-01-01

Introduction Vertical-banded gastroplasty, a technique that is commonly performed in the treatment of morbid obesity, represents a nonadjustable restrictive procedure which reduces the volume of the upper stomach by a vertical stapler line. In addition, a textile or silicone band restricts food passage through the stomach. Case presentation A 71-year-old woman presented with a severe gastric stenosis 11 years after vertical gastroplasty. We describe a side-to-side gastrogastrostomy as a safe surgical procedure to restore the physiological gastric passage after failed vertical-banded gastroplasty. Conclusion Occasionally, restrictive procedures for morbid obesity cannot be converted into an alternative bariatric procedure to maintain weight control. This report demonstrates that a side-to-side gastrogastrostomy is a feasible and safe procedure. PMID:18513454

Initial experience with custom-fit total knee replacement: intra-operative events and long-leg coronal alignment.

PubMed

Spencer, Brian A; Mont, Michael A; McGrath, Mike S; Boyd, Bradley; Mitrick, Michael F

2009-12-01

New technology using magnetic resonance imaging (MRI) allows the surgeon to place total knee replacement components into each patient's pre-arthritic natural alignment. This study evaluated the initial intra-operative experience using this technique. Twenty-one patients had a sagittal MRI of their arthritic knee to determine component placement for a total knee replacement. Cutting guides were machined to control all intra-operative cuts. Intra-operative events were recorded and these knees were compared to a matching cohort of the senior surgeon's previous 30 conventional total knee replacements. Post-operative scanograms were obtained from each patient and coronal alignment was compared to previous studies using conventional and computer-assisted techniques. There were no intra-operative or acute post-operative complications. There were no differences in blood loss and there was a mean decrease in operative time of 14% compared to a cohort of patients with conventional knee replacements. The average deviation from the mechanical axis was 1.2 degrees of varus, which was comparable to previously reported conventional and computer-assisted techniques. Custom-fit total knee replacement appeared to be a safe procedure for uncomplicated cases of osteoarthritis.

78 FR 57319 - Children's Online Privacy Protection Rule Safe Harbor Proposed Self-Regulatory Guidelines...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-18

...-AB20 Children's Online Privacy Protection Rule Safe Harbor Proposed Self-Regulatory Guidelines; kidSAFE... proposed self-regulatory guidelines submitted by the kidSAFE Seal Program (``kidSAFE''), owned and operated... part of the SUPPLEMENTARY INFORMATION section below. Write ``kidSAFE Application for Safe Harbor...

The power of simplification: Operator interface with the AP1000{sup R} during design-basis and beyond design-basis events

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

Williams, M. G.; Mouser, M. R.; Simon, J. B.

2012-07-01

The AP1000{sup R} plant is an 1100-MWe pressurized water reactor with passive safety features and extensive plant simplifications that enhance construction, operation, maintenance, safety and cost. The passive safety features are designed to function without safety-grade support systems such as component cooling water, service water, compressed air or HVAC. The AP1000 passive safety features achieve and maintain safe shutdown in case of a design-basis accident for 72 hours without need for operator action, meeting the expectations provided in the European Utility Requirements and the Utility Requirement Document for passive plants. Limited operator actions may be required to maintain safe conditionsmore » in the spent fuel pool (SFP) via passive means. This safety approach therefore minimizes the reliance on operator action for accident mitigation, and this paper examines the operator interaction with the Human-System Interface (HSI) as the severity of an accident increases from an anticipated transient to a design basis accident and finally, to a beyond-design-basis event. The AP1000 Control Room design provides an extremely effective environment for addressing the first 72 hours of design-basis events and transients, providing ease of information dissemination and minimal reliance upon operator actions. Symptom-based procedures including Emergency Operating Procedures (EOPs), Abnormal Operating Procedures (AOPs) and Alarm Response Procedures (ARPs) are used to mitigate design basis transients and accidents. Use of the Computerized Procedure System (CPS) aids the operators during mitigation of the event. The CPS provides cues and direction to the operators as the event progresses. If the event becomes progressively worse or lasts longer than 72 hours, and depending upon the nature of failures that may have occurred, minimal operator actions may be required outside of the control room in areas that have been designed to be accessible using components that have been designed to be reliable in these conditions. The primary goal of any such actions is to maintain or refill the passive inventory available to cool the core, containment and spent fuel pool in the safety-related and seismically qualified Passive Containment Cooling Water Storage Tank (PCCWST). The seismically-qualified, ground-mounted Passive Containment Cooling Ancillary Water Storage Tank (PCCAWST) is also available for this function as appropriate. The primary effect of these actions would be to increase the coping time for the AP1000 during design basis events, as well as events such as those described above, from 72 hours without operator intervention to 7 days with minimal operator actions. These Operator actions necessary to protect the health and safety of the public are addressed in the Post-72 Hour procedures, as well as some EOPs, AOPs, ARPs and the Severe Accident Management Guidelines (SAMGs). Should the event continue to become more severe and plant conditions degrade further with indications of inadequate core cooling, the SAMGs provide guidance for strategies to address these hypothetical severe accident conditions. The AP1000 SAMG diagnoses and actions are prioritized to first utilize the AP1000 features that are expected to retain a damaged core inside the reactor vessel. Only one strategy is undertaken at any time. This strategy will be followed and its effectiveness evaluated before other strategies are undertaken. This is a key feature of both the symptom-oriented AP1000 EOPs and the AP1000 SAMGs which maximizes the probability of retaining a damaged core inside the reactor vessel and containment while minimizing the chances for confusion and human errors during implementation. The AP1000 SAMGs are simple and straight-forward and have been developed with considerable input from human factors and plant operations experts. Most importantly, and different from severe accident management strategies for other plants, the AP1000 SAMGs do not require diagnosis of the location of the core (i.e., whether reactor vessel failure has occurred). This is a fundamental consequence of the AP1000 In-Vessel Retention approach, which allows severe accident management to be based on fundamental principles (e.g. provide coolant as close as possible to the core) that do not change during a specific event. This eliminates the need for one of the more difficult diagnostic requirements, since reactor vessel failure does not directly relate to any measurable plant parameter, and differs from other designs in that an engineered failure of the pressure vessel' (e.g. core catcher) is never required. (authors)« less

Laparoscopy is safe among patients with congestive heart failure undergoing general surgery procedures.

PubMed

Speicher, Paul J; Ganapathi, Asvin M; Englum, Brian R; Vaslef, Steven N

2014-08-01

Over the past 2 decades, laparoscopy has been established as a superior technique in many general surgery procedures. Few studies, however, have examined the impact of the use of a laparoscopic approach in patients with symptomatic congestive heart failure (CHF). Because pneumoperitoneum has known effects on cardiopulmonary physiology, patients with CHF may be at increased risk. This study examines current trends in approaches to patients with CHF and effects on perioperative outcomes. The 2005-2011 National Surgical Quality Improvement Program Participant User File was used to identify patients who underwent the following general surgery procedures: Appendectomy, segmental colectomy, small bowel resection, ventral hernia repair, and splenectomy. Included for analysis were those with newly diagnosed CHF or chronic CHF with new signs or symptoms. Trends of use of laparoscopy were assessed across procedure types. The primary endpoint was 30-day mortality. The independent effect of laparoscopy in CHF was estimated with a multiple logistic regression model. A total of 265,198 patients were included for analysis, of whom 2,219 were identified as having new or recently worsened CHF. Of these patients, there were 1,300 (58.6%) colectomies, 486 (21.9%) small bowel resections, 216 (9.7%) ventral hernia repairs, 141 (6.4%) appendectomies, and 76 (3.4%) splenectomies. Laparoscopy was used less frequently in patients with CHF compared with their non-CHF counterparts, particularly for nonelective procedures. Baseline characteristics were similar for laparoscopy versus open procedures with the notable exception of urgent/emergent case status (36.4% vs 71.3%; P < .001). After multivariable adjustment, laparoscopy seemed to have a protective effect against mortality (adjusted odds ratio, 0.45; P = .04), but no differences in other secondary endpoints. For patients with CHF, an open operative approach seems to be utilized more frequently in general surgery procedures, particularly in urgent/emergent cases. Despite these patterns and apparent preferences, laparoscopy seems to offer a safe alternative in appropriately selected patients. Because morbidity and mortality were considerable regardless of approach, further understanding of appropriate management in this population is necessary. Copyright © 2014 Mosby, Inc. All rights reserved.

Laparoscopy is safe among patients with congestive heart failure undergoing general surgery procedures

PubMed Central

Speicher, Paul J.; Ganapathi, Asvin M.; Englum, Brian R.; Vaslef, Steven N.

2015-01-01

Background Over the past 2 decades, laparoscopy has been established as a superior technique in many general surgery procedures. Few studies, however, have examined the impact of the use of a laparoscopic approach in patients with symptomatic congestive heart failure (CHF). Because pneumoperitoneum has known effects on cardiopulmonary physiology, patients with CHF may be at increased risk. This study examines current trends in approaches to patients with CHF and effects on perioperative outcomes. Methods The 2005–2011 National Surgical Quality Improvement Program Participant User File was used to identify patients who underwent the following general surgery procedures: Appendectomy, segmental colectomy, small bowel resection, ventral hernia repair, and splenectomy. Included for analysis were those with newly diagnosed CHF or chronic CHF with new signs or symptoms. Trends of use of laparoscopy were assessed across procedure types. The primary endpoint was 30-day mortality. The independent effect of laparoscopy in CHF was estimated with a multiple logistic regression model. Results A total of 265,198 patients were included for analysis, of whom 2,219 were identified as having new or recently worsened CHF. Of these patients, there were 1,300 (58.6%) colectomies, 486 (21.9%) small bowel resections, 216 (9.7%) ventral hernia repairs, 141 (6.4%) appendectomies, and 76 (3.4%) splenectomies. Laparoscopy was used less frequently in patients with CHF compared with their non-CHF counterparts, particularly for nonelective procedures. Baseline characteristics were similar for laparoscopy versus open procedures with the notable exception of urgent/emergent case status (36.4% vs 71.3%; P < .001). After multivariable adjustment, laparoscopy seemed to have a protective effect against mortality (adjusted odds ratio, 0.45; P = .04), but no differences in other secondary endpoints. Conclusion For patients with CHF, an open operative approach seems to be utilized more frequently in general surgery procedures, particularly in urgent/emergent cases. Despite these patterns and apparent preferences, laparoscopy seems to offer a safe alternative in appropriately selected patients. Because morbidity and mortality were considerable regardless of approach, further understanding of appropriate management in this population is necessary. PMID:24947641

Ultrasound-guided intrasphincteric botulinum toxin injection relieves obstructive defecation due to Hirschsprung's disease and internal anal sphincter achalasia.

PubMed

Church, Joseph T; Gadepalli, Samir K; Talishinsky, Toghrul; Teitelbaum, Daniel H; Jarboe, Marcus D

2017-01-01

Chronic obstructive defecation can occur in patients with Hirschsprung Disease (HD) and internal anal sphincter (IAS) achalasia. Injection of Botulinum Toxin (BoTox) into the IAS can temporarily relieve obstructive defecation, but can be challenging when performed by tactile sense alone. We compared results of BoTox injections with and without ultrasound (US) guidance. We retrospectively reviewed BoTox injections into the IAS for obstructive defecation over 5years. Analyzed outcomes included short-term improvement, defined as resolution of enterocolitis, new ability to spontaneously defecate, and/or normalization of bowel movement frequency 2weeks post-operatively, as well as requirement of more definitive surgical therapy (myotomy/myomectomy, colectomy, colostomy, cecostomy/appendicostomy, and/or sacral nerve stimulator implantation). Outcomes were compared using t-test and Fisher's Exact test, with significance defined as p<0.05. Twelve patients who underwent BoTox injection were included, including 5 patients who underwent injections both with and without ultrasound. Ten underwent an ultrasound-guided injection (13 injection procedures), 5 of whom had HD. Seven underwent an injection without ultrasound guidance (17 injection procedures), 5 of whom had HD. Procedures performed with US resulted in greater short-term improvement (76% versus 65% without ultrasound) and less requirement of a definitive procedure for obstructive defecation (p<0.05). US-guided BoTox injection is safe and effective for obstructive defecation, and may decrease the need for a definitive operation. III. Copyright © 2017 Elsevier Inc. All rights reserved.

Teaching single-incision laparoscopic appendectomy in pediatric patients.

PubMed

Burjonrappa, Sathyaprasad C; Nerkar, Hrishikesh

2012-01-01

Laparoscopic appendectomy is accepted as the gold standard technique for the treatment of acute appendicitis. Recently single-incision laparoscopic surgery (SILS) was tried in the pediatric population and was shown to be both feasible and safe. We describe our early experience in teaching the SILS procedure for appendicitis in a large community hospital center surgical residency program. SILS appendectomy was performed in 40 consecutive patients with acute appendicitis who were admitted by a single surgeon from May 2011 to August 2011. All patients over the age of 4 y presenting with noncomplicated and complicated appendicitis (perforated) were offered SILS appendectomy. Execution of the technical aspects of 20 SILS operations done by 3 PGY III residents was evaluated. The average age of the patient was 11.1 y (range, 7 to 15). SILS was performed successfully in 19 out of 20 patients. Nineteen patients underwent emergent or urgent appendectomy, while 1 patient underwent an interval procedure. Nine patients were found to have perforated appendicitis, while the other 11 had noncomplicated acute appendicitis. One patient was converted to conventional 3-port laparoscopy due to difficulties during the procedure. The mean operative time was 73 min (range, 47 to 112). A significant learning curve to successfully execute the critical steps of the SILS procedure was noted in all residents evaluated. SILS technology appears promising for the treatment of acute appendicitis. However, its successful incorporation into surgical training programs will depend on the development of innovative simulation strategies.

First Tarsometatarsal Arthrodesis: An Anatomic Evaluation of Dorsomedial Versus Plantar Plating.

PubMed

Simons, Paul; Fröber, Rosemarie; Loracher, Clemens; Knobe, Matthias; Gras, Florian; Hofmann, Gunther O; Klos, Kajetan

2015-01-01

Fusion of the first tarsometatarsal joint is a widely used procedure for the correction of hallux valgus deformity. Although dorsomedial H-shaped plating systems are being increasingly used, fusion can also be achieved by plantar plating. The goal of the present study was to compare these 2 operative techniques based on the anatomic considerations and show the potential pitfalls of both procedures. Six pairs of deep-frozen human lower legs were used in the present cadaveric study. In a randomized manner, either dorsomedial arthrodesis or plantar plating through a medial incision was performed. With regard to arterial injury, the plantar technique resulted in fewer lesions (plantar, 4 injuries [66.7%] to the terminal branches of the first digital branch of the medial plantar artery; dorsomedial, 3 injuries [50%] to the main trunks of the plantar metatarsal arteries and the first dorsal metatarsal artery). With respect to injury to the veins, the plantar procedure affected significantly fewer high-caliber subcutaneous trunk veins. The nerves coursing through the operative field, such as the saphenous and superficial fibular nerves, were compromised more often by the dorsal approach. Neither the plantar plating nor the dorsomedial plating technique was associated with injury to the insertion of the tibialis anterior muscle. Both studied techniques are safe, well-established procedures. Arthrodesis with plantar plating, however, offers additional advantages and is a reliable tool in the foot and ankle surgeon's repertoire. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

How Safe Are Kid-Safe Search Engines?

ERIC Educational Resources Information Center

Masterson-Krum, Hope

2001-01-01

Examines search tools available to elementary and secondary school students, both human-compiled and crawler-based, to help direct them to age-appropriate Web sites; analyzes the procedures of search engines labeled family-friendly or kid safe that use filters; and tests the effectiveness of these services to students in school libraries. (LRW)

From Barrier Free to Safe Environments: The New Zealand Experience. Monograph #44.

ERIC Educational Resources Information Center

Wrightson, William; Pope, Campbell

Intrinsically safe design is presented as a logical extension of the principles of barrier free design, and as a higher level design strategy for effecting widespread implementation of the basic accessibility requirements for people with disabilities. Two fundamental planning procedures are proposed: including principles of safe and accessible…

Cost analysis and outcomes of a second-look tympanoplasty-mastoidectomy strategy for cholesteatoma.

PubMed

Crowson, Matthew G; Ramprasad, Vaibhav H; Chapurin, Nikita; Cunningham, Calhoun D; Kaylie, David M

2016-11-01

To analyze cost and compare cholesteatoma recidivism and hearing outcomes with single-stage and second-look operative strategies. Retrospective review and cost analysis. Adult and pediatric patients who underwent a tympanoplasty with mastoidectomy for cholesteatoma with a single-stage or second-look operative strategy were identified. Variables included procedure approach, residual or recurrent cholesteatoma, ossicular chain reconstruction frequency, and operative complications. Audiologic outcomes included pre-/postoperative air bone gap (ABG) and word recognition score (WRS). Cost analysis included charges for consultation and follow-up visits, surgical procedures, computed tomography temporal bone scans, and audiology visits. One hundred and six patients had a tympanoplasty with mastoidectomy for cholesteatoma, with 80 canal wall-up procedures (CWU) as initial approach. Of these, 46 (57.5%) CWU patients had a planned second look. Two (4.3%) CWU patients had recurrent cholesteatoma and 20 (43.4%) had residual identified at second look. Four (11.7%) single-stage CWU strategy patients developed recurrent cholesteatoma. There was no significant difference in pre-/postoperative ABG and WRS between second look and single stage (P > 0.05). Compared to second-look patients, single-stage patients had significantly fewer postoperative visits (6.32 vs. 10.4; P = 0.007), and significantly lower overall charges for care ($23,529. vs. $41.411; P < 0.0001). The goal of cholesteatoma surgery is to produce a safe ear, and a second-look strategy after CWU has historically been used to evaluate for recurrent or residual disease. The cholesteatoma recurrence rate at a second look after a CWU tympanoplasty-mastoidectomy is low. Costs of operative procedures are a significant proportion of healthcare resource expenditures. Considering the low rate of cholesteatoma recurrence and relatively high cost of care, implementation of a second-look strategy should be individually tailored and not universally performed. 4. Laryngoscope, 126:2574-2579, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Laparoscopic sleeve gastrectomy in patients over 59 years: early recovery and 12-month follow-up.

PubMed

Leivonen, Marja Kaarina; Juuti, Anne; Jaser, Nabil; Mustonen, Harri

2011-08-01

Bariatric surgery has shown to be safe for patients over 60 years with good results especially considering resolving of comorbidities. Sleeve gastrectomy is considered to be safer than gastric bypass (GBP) and more effective than gastric banding with less adverse symptoms. Weight loss may be more modest than after GBP, but the effect on vitamins may also be milder. Since 2007, we collected prospectively 12-month follow-up data from 55 sleeve gastrectomy patients of whom 12 were over 59 years of age. Vitamin and calcium supplements were used postoperatively. The recovery from the operation was recorded during hospital stay, at 1- and 12-month follow-up visits using a standard protocol including laboratory tests. The results between patients over and under 59 years were compared. The preoperative weight and weight loss were comparable between the groups. Operation time was shorter and hospital stay was longer for older patients, p = ns. There was no operative mortality. Early major complications were seen more often in the older age group, 42% vs 9% (p = 0.02), but late complications were more common in younger patients, 17% vs 44%, p = ns. Early complications were mostly bleedings, which did not lengthen the hospital stay, neither were re-operations nor endoscopic procedures needed. Excess weight loss and resolving of comorbidities after 12 months was comparable between the groups. However, vitamin deficiencies and hypoalbuminemia were more common in the older age group, 42% and 23% for vitamins and 44% and 29% for proteins, p = ns. The older patients had more adverse effects related to surgery, 25% vs 9%, and younger had more adverse psychiatric effects, p = ns. Sleeve gastrectomy is effective and safe for older bariatric patients. Weight loss is comparable to younger patients and enough to resolve the comorbidities in most of the patients. With standardized nutritional supplementation, the older patients had more often vitamin deficiencies and hypoalbuminemia. Although operative treatment of older bariatric patients is safe, their postoperative care is demanding considering vitamins and protein.

Oxygen Handling and Cooling Options in High Temperature Electrolysis Plants

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

Manohar S. Sohal; J. Stephen Herring

2008-07-01

Idaho National Laboratory is working on a project to generate hydrogen by high temperature electrolysis (HTE). In such an HTE system, safety precautions need to be taken to handle high temperature oxygen at ~830°C. This report is aimed at addressing oxygen handling in a HTE plant.. Though oxygen itself is not flammable, most engineering material, including many gases and liquids, will burn in the presence of oxygen under some favorable physicochemical conditions. At present, an absolute set of rules does not exist that can cover all aspects of oxygen system design, material selection, and operating practices to avoid subtle hazardsmore » related to oxygen. Because most materials, including metals, will burn in an oxygen-enriched environment, hazards are always present when using oxygen. Most materials will ignite in an oxygen-enriched environment at a temperature lower than that in air, and once ignited, combustion rates are greater in the oxygen-enriched environment. Even many metals, if ignited, burn violently in an oxygen-enriched environment. However, these hazards do not preclude the operations and systems involving oxygen. Oxygen can be safely handled and used if all the materials in a system are not flammable in the end-use environment or if ignition sources are identified and controlled. In fact, the incidence of oxygen system fires is reported to be low with a probability of about one in a million. This report is a practical guideline and tutorial for the safe operation and handling of gaseous oxygen in high temperature electrolysis system. The intent is to provide safe, practical guidance that permits the accomplishment of experimental operations at INL, while being restrictive enough to prevent personnel endangerment and to provide reasonable facility protection. Adequate guidelines are provided to govern various aspects of oxygen handling associated with high temperature electrolysis system to generate hydrogen. The intent here is to present acceptable oxygen standards and practices for minimum safety requirements. A summary of operational hazards, along with oxygen safety and emergency procedures, are provided.« less

Laparoendoscopic single-site Heller myotomy with anterior fundoplication for achalasia.

PubMed

Barry, Linda; Ross, Sharona; Dahal, Sujat; Morton, Connor; Okpaleke, Chinyere; Rosas, Melissa; Rosemurgy, Alexander S

2011-06-01

Laparoendoscopic single-site (LESS) surgery is beginning to include advanced laparoscopic operations such as Heller myotomy with anterior fundoplication. However, the efficacy of LESS Heller myotomy has not been established. This study aimed to evaluate the authors' initial experience with LESS Heller myotomy for achalasia. Transumbilical LESS Heller myotomy with concomitant anterior fundoplication for achalasia was undertaken for 66 patients after October 2007. Outcomes including operative time, complications, and length of hospital stay were recorded and compared with those for an earlier contiguous group of 66 consecutive patients undergoing conventional multi-incision laparoscopic Heller myotomy with anterior fundoplication. Symptoms before and after myotomy were scored by the patients using a Likert scale ranging from 0 (never/not severe) to 10 (always/very severe). Data were analyzed using the Mann-Whitney U test, the Wilcoxon matched-pairs test, and Fisher's exact test where appropriate. Patients undergoing LESS Heller myotomy were similar to those undergoing conventional laparoscopic Heller myotomy in gender, age, body mass index (BMI), blood loss, and length of hospital stay. However, the patients undergoing LESS Heller myotomies had operations of significantly longer duration (median, 117 vs. 93 min with the conventional laparoscopic approach) (p<0.003). For 11 patients (16%) undergoing LESS Heller myotomy, additional ports/incisions were required. No patients were converted to "open" operations, and no patients had procedure-specific complications. Symptom reduction was dramatic and satisfying after both LESS and conventional laparoscopic myotomy with fundoplication. The symptom reduction was similar with the two procedures. The LESS approach left no apparent umbilical scar. Heller myotomy with anterior fundoplication effectively treats achalasia. The findings showed LESS Heller myotomy with anterior fundoplication to be feasible, safe, and efficacious. Although the LESS approach increases operative time, it does not increase procedure-related morbidity or hospital length of stay and avoids apparent umbilical scarring. Laparoendoscopic single-site surgery represents a paradigm shift to more minimally invasive surgery and is applicable to advanced laparoscopic operations such as Heller myotomy and anterior fundoplication.

28 CFR 42.530 - Procedures.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Judicial Administration DEPARTMENT OF JUSTICE NONDISCRIMINATION; EQUAL EMPLOYMENT OPPORTUNITY; POLICIES AND... Section 504 of the Rehabilitation Act of 1973 Procedures § 42.530 Procedures. (a) The procedural... section 803(a) of title I of the Omnibus Crime Control and Safe Streets Act, as amended by the Justice...

28 CFR 42.530 - Procedures.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Judicial Administration DEPARTMENT OF JUSTICE NONDISCRIMINATION; EQUAL EMPLOYMENT OPPORTUNITY; POLICIES AND... Section 504 of the Rehabilitation Act of 1973 Procedures § 42.530 Procedures. (a) The procedural... section 803(a) of title I of the Omnibus Crime Control and Safe Streets Act, as amended by the Justice...

28 CFR 42.530 - Procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Judicial Administration DEPARTMENT OF JUSTICE NONDISCRIMINATION; EQUAL EMPLOYMENT OPPORTUNITY; POLICIES AND... Section 504 of the Rehabilitation Act of 1973 Procedures § 42.530 Procedures. (a) The procedural... section 803(a) of title I of the Omnibus Crime Control and Safe Streets Act, as amended by the Justice...

28 CFR 42.530 - Procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Judicial Administration DEPARTMENT OF JUSTICE NONDISCRIMINATION; EQUAL EMPLOYMENT OPPORTUNITY; POLICIES AND... Section 504 of the Rehabilitation Act of 1973 Procedures § 42.530 Procedures. (a) The procedural... section 803(a) of title I of the Omnibus Crime Control and Safe Streets Act, as amended by the Justice...

28 CFR 42.530 - Procedures.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Judicial Administration DEPARTMENT OF JUSTICE NONDISCRIMINATION; EQUAL EMPLOYMENT OPPORTUNITY; POLICIES AND... Section 504 of the Rehabilitation Act of 1973 Procedures § 42.530 Procedures. (a) The procedural... section 803(a) of title I of the Omnibus Crime Control and Safe Streets Act, as amended by the Justice...

Impact of Anatomical, Procedural, and Operator Skill Factors on the Success and Duration of Fluoroscopy-Guided Transjugular Intrahepatic Portosystemic Shunt

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

Marquardt, Steffen, E-mail: marquardt.steffen@mh-hannover.de; Rodt, Thomas, E-mail: rodt.thomas@mh-hannover.de; Rosenthal, Herbert, E-mail: rosenthal.herbert@mh-hannover.de

PurposeTo assess the impact of anatomical, procedural, and operator skill factors on the success and duration of fluoroscopy-guided transjugular intrahepatic portoystemic shunt following standard operating procedure (SOP).Material and MethodsDuring a 32-month period, 102 patients underwent transjugular intrahepatic portosystemic shunt creation (TIPS) by two interventional radiologists (IR) following our institutional SOP based on fluoroscopy guidance. Both demographic and procedural data were assessed. The duration of the intervention (D{sub Int}) and of the portal vein puncture (D{sub Punct}) was analyzed depending on the skill level of the IR as well as the anatomic or procedural factors.ResultsIn 99 of the 102 patients, successfulmore » TIPS without peri-procedural complications was performed. The mean D{sub Int} (IR1: 77 min; IR2: 51 min, P < 0.005) and the mean D{sub Punct} (IR1: 19 min; IR2: 13 min, P < 0.005) were significantly higher in TIPS performed by IR1 (with 2 years of clinical experience performing TIPS, n = 38) than by IR2 (>10 years of clinical experience performing TIPS, n = 61), (P < 0.005 both, Mann–Whitney U test). D{sub Int} showed a higher correlation with D{sub Punct} for IR2 (R{sup 2} = 0.63) than for IR1 (R{sup 2} = 0.13). There was no significant difference in the D{sub Punct} for both IRs with regard to the success of the wedged portography (P = 0.90), diameter of the portal vein (P = 0.60), central right portal vein length (P = 0.49), or liver function (MELD-Score before the TIPS procedure; P = 0.14).ConclusionTIPS following SOP is safe, fast, and reliable. The only significant factor for shorter D{sub Punct} and D{sub Int} was the clinical experience of the IR. Anatomic variability, successful portography, or liver function did not alter the duration or technical success of TIPS.« less

Prior Surgery Determines Islet Yield and Insulin Requirement in Patients with Chronic Pancreatitis

PubMed Central

Wang, Hongjun; Desai, Krupa D; Dong, Huansheng; Owzarski, Stefanie; Romagnuolo, Joseph; Morgan, Katherine A; Adams, David B

2013-01-01

Background Total pancreatectomy with islet autotransplantation (TP-IAT) is safe and effective in the management of intractable pain associated with chronic pancreatitis (CP). Prevention of pancreatogenic diabetes after TP-IAT is related to islet yield from the diseased pancreas. The purpose of this study is to compare islet yield and insulin requirement in the 76 patients who underwent different surgical procedures prior to TP-IAT at the Medical University of South Carolina between the years 2009 to 2011. Methods Patients were grouped into four categories based on the operation they had before TP-IAT: transduodenal sphincteroplasty or no prior surgery (TDS/NPS, n=50), Whipple or Beger procedure (WB, n=14), distal pancreatectomy (DP, n=8) or lateral pancreaticojejunostomy (LPJ, n=4). Islets were harvested from pancreases of those patients at our cGMP facility. Total unpurified islets were transplanted into patients via portal vein infusion. Pancreatic fibrosis, islet yield, cell viability and insulin requirement were measured. Results The pancreases of TDS/NPS and WB patients were less fibrotic, and had higher islet yield compared to those who had DP or LPJ. Higher islet yield also correlated with a greater diabetes free rate and a lesser insulin requirement at the following intervals: pre-operative, post-operative and 6 months after TP-IAT. Conclusions Prior surgery is strongly correlated with the extent of pancreatic fibrosis, islet yield and insulin requirements in CP patients undergoing TP-IAT. The history of prior pancreatic resection and drainage procedures may be used to predict post-operative islet function and help to determine the optimal timing for TP-IAT in CP patients. PMID:23411743

Emergency management of epidural haematoma through burr hole evacuation and drainage. A preliminary report.

PubMed

Liu, J T; Tyan, Y S; Lee, Y K; Wang, J T

2006-03-01

Blood clot evacuation through an osteoplastic craniotomy, a procedure requiring neurosurgical expertise and modern medical facilities, is the accepted method for treatment of a pure traumatic epidural haematoma following closed head injury. In certain emergency situations and/or in less sophisticated settings, however, use of this procedure may not be feasible. The present study was undertaken to ascertain whether placement of a burr hole and drainage under negative pressure constituted a rapid, effective and safe approach to manage patients with simple epidural haematomas. Thirteen patients suffering from a traumatic epidural haematoma were treated from January, 1999 to October, 2002. Twelve patients presented with skull fracture but no fracture was depressed. Placement of flexible tubes through a burr hole, followed by continuous suction under negative pressure, enabled aspiration of the clot and drainage of the cavity. In 8 cases, the procedure was performed under local anaesthesia with 2% Xylocaine and with intravenous sedation with propofol as needed. The operative procedure was accomplished within 30 min, and the drainage tube was left in place for 3-5 days. CT scans were performed daily from days 1 to 5. In 11 of 13 cases, clots were evacuated successfully and patients regained consciousness within 2 hours. Recoveries occurred without significant sequelae. In the remaining 2 cases, the drainage tube was found to be obstructed by a blood clot such that the haematoma was unaffected. A traditional craniotomy was performed within 8-12 hours, and these 2 patients recovered consciousness within the subsequent 6 hours. Burr hole evacuation followed by drainage under negative pressure is a safe and effective method for emergency management of a pure traumatic epidural haematoma. To assure safety patients given this procedure should be monitored by daily CT scans. Decompressive craniotomy should be performed if consciousness does not improve within several hours.

Procedures for making gaseous industrial waste safe

NASA Astrophysics Data System (ADS)

Matros, Yu Sh; Noskov, Aleksandr S.

1990-10-01

The application of various methods (adsorption, absorption, thermal afterburning, catalytic purification, and others) for the removal of sulphur and nitrogen oxides, toxic organic compounds, hydrogen sulphide, and carbon monoxide from industrial waste gases is described. Much attention is devoted to the catalytic procedure for making the gases safe using an energy collecting non-stationary method (reversible process). The advantages and limitations of various gas purification methods are considered. The bibliography includes 279 references.

12 CFR 238.8 - Safe and sound operations.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 4 2013-01-01 2013-01-01 false Safe and sound operations. 238.8 Section 238.8... (CONTINUED) SAVINGS AND LOAN HOLDING COMPANIES (REGULATION LL) General Provisions § 238.8 Safe and sound... inconsistent with sound banking principles or the purposes of HOLA or the Financial Institutions Supervisory...

12 CFR 238.8 - Safe and sound operations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 4 2014-01-01 2014-01-01 false Safe and sound operations. 238.8 Section 238.8... (CONTINUED) SAVINGS AND LOAN HOLDING COMPANIES (REGULATION LL) General Provisions § 238.8 Safe and sound... inconsistent with sound banking principles or the purposes of HOLA or the Financial Institutions Supervisory...

12 CFR 238.8 - Safe and sound operations.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 4 2012-01-01 2012-01-01 false Safe and sound operations. 238.8 Section 238.8... (CONTINUED) SAVINGS AND LOAN HOLDING COMPANIES (REGULATION LL) General Provisions § 238.8 Safe and sound... inconsistent with sound banking principles or the purposes of HOLA or the Financial Institutions Supervisory...

Nerve-sparing abdominal radical trachelectomy: a novel concept to preserve uterine branches of pelvic nerves.

PubMed

Kyo, Satoru; Mizumoto, Yasunari; Takakura, Masahiro; Nakamura, Mitsuhiro; Sato, Emi; Katagiri, Hiroshi; Ishikawa, Masako; Nakayama, Kentaro; Fujiwara, Hiroshi

2015-10-01

Nerve-sparing techniques to avoid bladder dysfunction in abdominal radical hysterectomy have been established during the past two decades, and they have been applied to radical trachelectomy. Although trachelectomy retains the uterine corpus, no report mentions the preservation of uterine branches of pelvic nerves. The aim of the present study was to introduce and discuss our unique concept for preserving them. Four cases with FIGO stage Ia2-Ib1 cervical cancer, in which preservation of uterine branches of the pelvic nerves was attempted, are presented. Operative procedures basically followed the previously reported standard approaches for nerve-sparing radical hysterectomy or trachelectomy, except for some points. Before resection of the sacrouterine ligament, the hypogastric nerve was first identified and translocated laterally. Subsequently, the uterine branches of the pelvic nerve were identified as a continuation of the hypogastric nerve and could be scooped with forceps by detachment of the surrounding connective tissues. Further detachment toward the uterine corpus enabled them to be completely separated from the cervix. This separation was extended up to the level of the junction of the upper and lower branches of the uterine artery. Thereafter, standard resection of the parametrium and paracolpium was performed, followed by cervical resection when it was confirmed that the isolated uterine branches of the pelvic nerves were safely translocated and preserved. There were no recurrences of cancer in these patients. Uterine branches of autonomic nerves can be safely preserved, and the procedure may be considered one of the nerve-sparing techniques for radical abdominal trachelectomy, which may hopefully improve the reproductive outcomes of this operation, although it needs to be evaluated with more patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

When Is Safe, Safe Enough?

ERIC Educational Resources Information Center

Neil, Kirk

2002-01-01

Discusses events affecting parental school-safety concerns and what school districts can do to alleviate those concerns. Addresses post-September 11 crisis-management procedures, preventing sports-related student deaths, maintaining healthy indoor air quality. (PKP)

Laparoscopic heller myotomy for achalasia cardia-initial experience in a teaching institute.

PubMed

Kaman, Lileswar; Iqbal, Javid; Kochhar, Rakesh; Sinha, Saroj

2013-10-01

Laparoscopic Heller cardiomyotomy and Dor fundoplication is the surgical procedure of choice for esophageal achalasia. The aim of our study was to investigate the clinical outcome and safety of laparoscopic Heller-Dor procedure performed by using Hook electrocautery and as a teaching module for advanced laparoscopic surgery. Between January 2005 and December 2010, 25 consecutive patients with achalasia underwent laparoscopic Heller-Dor operation by a single surgeon. All the patients received upper gastrointestinal series (barium swallow), esophagogastroscopy, and esophageal manometry to exclude esophageal carcinoma and to confirm the diagnosis. All the patients were operated by laparoscopic modified Heller myotomy with Dor fundoplication by using hook electrocautery. Among 25 operated patients, 14 were male and 11 were female with a median age of 43 years (range 18-72 years). The mean operative time was 93.3 min (range 50-50 min), the mean operative blood loss was 90 ml (range 40-200 ml), the median time to oral feeding was 2 days (2-4 days), and the median hospital stay was 4 days (4-7 days). There was no conversion to open surgery. Intraoperative mucosal perforation was encountered in three patients and was repaired in all of them by laparoscopic suture. All the patients had an uneventful recovery without postoperative complication and had excellent clinical response (96 %) during follow-up. Laparoscopic Heller-Dor operation using hook electrocautery is safe, inexpensive, and effective treatment for achalasia which is useful for teaching and training surgical residents in advanced laparoscopic surgery.

Unmanned Aerial Systems Traffic Management (UTM): Safely Enabling UAS Operations in Low-Altitude Airspace

NASA Technical Reports Server (NTRS)

Jung, Jaewoo; Kopardekar, Parimal H.

2016-01-01

Flexibility where possible, and structure where necessary. Consider the needs of national security, safe airspace operations, economic opportunities, and emerging technologies. Risk-based approach based on population density, assets on the ground, density of operations, etc. Digital, virtual, dynamic, and as needed UTM services to manage operations.

Unmanned Aerial Systems Traffic Management (UTM): Safely Enabling UAS Operations in Low-Altitude Airspace

NASA Technical Reports Server (NTRS)

Kopardekar, Parimal H.; Cavolowsky, John

2015-01-01

Flexibility where possible, and structure where necessary. Consider the needs of national security, safe airspace operations, economic opportunities, and emerging technologies. Risk-based approach based on population density, assets on the ground, density of operations, etc. Digital, virtual, dynamic, and as needed UTM services to manage operations.

Resident involvement in laparoscopic procedures does not worsen clinical outcomes but may increase operative times and length of hospital stay.

PubMed

Jolley, Jennifer; Lomelin, Daniel; Simorov, Anton; Tadaki, Carl; Oleynikov, Dmitry

2016-09-01

Surgical procedures have a learning curve regarding the number of cases required for proficiency. Consequently, involvement of less experienced resident surgeons may impact patients and the healthcare system. This study examines basic and advanced laparoscopic procedures performed between 2010 and 2011 and evaluates the resident surgeon participation effect. Basic laparoscopic procedures (BL), appendectomy (LA), cholecystectomy (LC), and advanced Nissen fundoplication (LN) were queried from the American College of Surgeons National Surgical Quality Improvement Program database. Cases were identified using Current Procedural Terminology codes. Analyses were performed using IBM SPSS Statistics v.22, α-level = 0.05. Multiple logistic regression was used, accounting for age, race, gender, admission status, wound classification, and ASA classification. In total, 71,819 surgeries were reviewed, 66,327 BL (37,636 LC and 28,691 LA) and 5492 LN. Median age was 48 years for LC and 37 years for LA. In sum, 72.2 % of LC and 49.5 % of LA patients were female. LN median age was 59 years, and 67.7 % of patients were female. For BL, resident involvement was not significantly associated with mortality, morbidity, and return to the OR. Readmission was not related to resident involvement in LC. In LA, resident-involved surgeries had increased readmission and longer OR time, but decreased LOS. In LC, resident involvement was associated with longer LOS and OR time. Resident involvement was not a significant factor in the odds of mortality, morbidity, return to OR, or readmission in LN. Surgeries involving residents had increased odds of having longer LOS, and of lengthier surgery time. We demonstrate resident involvement is safe and does not result in poorer patient outcomes. Readmissions and LOS were higher in BL, and operative times were longer in all surgeries. Resident operations do appear to have real consequences for patients and may impact the healthcare system financially.

Laparoscopy assisted percutaneous stone surgery can be performed in multiple ways for pelvic ectopic kidneys.

PubMed

Soylemez, Haluk; Penbegül, Necmettin; Utangac, Mehmet Mazhar; Dede, Onur; Çakmakçı, Süleyman; Hatipoglu, Namık Kemal

2016-08-01

Pelvic kidney stones remain a unique challenge to the endourologists. Treatment options include open surgery, extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy (PNL), retrograde intrarenal surgery, and laparoscopy assisted PNL (LA-PNL). As a minimal invasive option, LA-PNL can decrease the risk for bowel and major vessel injury. Here, we describe our experience using the LA-PNL procedures with different combinations, to treat kidney stones in multiple patients with a pelvic ectopic kidney (PEK). Eight patients, with PEK, kidney stones, and no other treatment choice, but open surgery, were included in the study. Two different laparoscopic techniques such as mesocolon dissection and transmesocolic, and four different percutaneous procedures such as standard-PNL, mini-PNL, micro-PNL, and a PNL through the renal pelvis were used for stone extraction in these patients. The mean age of patients was 25.6 ± 12.9 years and mean stone size was 524.1 ± 430.3 mm(2). Mean operation time was 150.5 ± 40.0 (77-210) min which was composed of retrograde catheterization (14.8 ± 2.9 min), laparoscopic procedure (48.7 ± 20.6 min) and PNL procedure (86.8 ± 31.1 min). Residual stones were seen in two patients (no additional treatment was need), while a 'stone-free' procedure was achieved in six patients (75.0 %). On the post-operative first month visit, a stone was observed on radiological examinations in only one patient (87.5 % stone-free). Mean hospitalization time was 2.8 ± 0.9 days. No perioperative or post-operative complication was observed in all patients. LA-PNL surgery is a safe and effective option for treatment of PEK stones, and has several alternative approaches.

Therapeutic Efficacy of a New Procedure for Male Urinary Incontinence Combining a Suburethral Polypropylene Mesh and Cardiovascular Patch

PubMed Central

Jiang, Yuan-Hong

2017-01-01

Purpose Stress urinary incontinence (SUI) in men is a complication secondary to prostatectomy or resulting from neurological lesions. This study presents our experiences with male suburethral slings over the past decade. Methods In this study, we considered patients who presented with SUI and were diagnosed with an intrinsic sphincteric deficiency due to postprostatectomy incontinence (PPI) or other causes (non-PPI). Patients who underwent the suburethral sling procedure using a polypropylene mesh and a cardiovascular patch were retrospectively included. An urodynamic study was performed before and after the operation. Global response assessment (GRA) and SUI grading were used for surgical outcome. The revision rate and the infection rate were also evaluated. Results A total 31 patients were enrolled in this study; the mean patient age was 59.5±18.9 years, and the mean follow-up period was 36.9±29.4 months. Fourteen patients comprised the non-PPI group and 17 were in the PPI group. The preoperative SUI of all patients were categorized as a moderate to severe problem according to the SUI grade, with a mean score of 2.32±0.48 before the operation and 0.48±0.57 after the operation. With a mean score of 2.35±0.71, GRA showed that the patients were satisfied with the treatment. After the sling procedure, 4 patients (13%) reported a mild improvement, 12 (38.7%) a moderate improvement, while 15 (48.4%) reported an excellent improvement. Six patients (19.4%), including 5 from the non-PPI group (35.7%) and 1 (5.9%) from the PPI group (P=0.037), underwent sling removal because of infection. Conclusions The male suburethral sling procedure using a polypropylene mesh and a cardiovascular patch is a safe, efficacious, and inexpensive surgical procedure for PPI. In cases of neurological incontinence, however, the higher infection rate in non-PPI patients means that they should be carefully managed. PMID:28361511

Qualitative assessment of the commodity risk for spread of foot-and-mouth disease associated with international trade in deboned beef.

PubMed

Paton, D J; Sinclair, M; Rodríguez, R

2010-06-01

The risk of importing foot-and-mouth disease virus (FMDV) restricts trade in livestock and their products from parts of the world where the virus is present. This reduces trade opportunities and investment in the livestock sector of many developing countries and constrains global food supply. This review focuses on the risks associated with trade in deboned beef (DB) from foot-and-mouth disease (FMD)-infected cattle, countries or zones. A definition of DB is provided along with a description of the procedures for its preparation within beef slaughtering operations. Evidence is reviewed for circumstances under which DB can be contaminated with FMDV, and a commodity risk factor approach is used to consider the mitigating efficacy of slaughterhouse procedures. A combination of pre-slaughter and slaughterhouse measures has enabled DB to be safely imported into FMD-free countries from countries that were not nationally or zonally FMD-free. Nevertheless, current evidence does not provide absolute assurance that abattoir procedures for producing DB can result, by themselves, in a commodity with a negligible risk of transmitting FMDV without complementary measures to reduce the likelihood of slaughtering infected cattle. The main areas of uncertainty are the amounts of residual FMDV-harbouring tissues within DB, and our understanding of what constitutes a safe level of contamination. More detailed guidance should be developed to specify the mitigating measures needed in support of the export of DB from regions that are not officially FMD-free. This will help to avoid differences in interpretation of what is needed that give rise to obstacles to trade.

Knowledge, Attitude and Practice of Healthcare Managers to Medical Waste Management and Occupational Safety Practices: Findings from Southeast Nigeria.

PubMed

Anozie, Okechukwu Bonaventure; Lawani, Lucky Osaheni; Eze, Justus Ndulue; Mamah, Emmanuel Johnbosco; Onoh, Robinson Chukwudi; Ogah, Emeka Onwe; Umezurike, Daniel Akuma; Anozie, Rita Onyinyechi

2017-03-01

Awareness of appropriate waste management procedures and occupational safety measures is fundamental to achieving a safe work environment, and ensuring patient and staff safety. This study was conducted to assess the attitude of healthcare managers to medical waste management and occupational safety practices. This was a cross-sectional study conducted among 54 hospital administrators in Ebonyi state. Semi-structured questionnaires were used for qualitative data collection and analyzed with SPSS statistics for windows (2011), version 20.0 statistical software (Armonk, NY: IBM Corp). Two-fifth (40%) of healthcare managers had received training on medical waste management and occupational safety. Standard operating procedure of waste disposal was practiced by only one hospital (1.9%), while 98.1% (53/54) practiced indiscriminate waste disposal. Injection safety boxes were widely available in all health facilities, nevertheless, the use of incinerators and waste treatment was practiced by 1.9% (1/54) facility. However, 40.7% (22/54) and 59.3% (32/54) of respondents trained their staff and organize safety orientation courses respectively. Staff insurance cover was offered by just one hospital (1.9%), while none of the hospitals had compensation package for occupational hazard victims. Over half (55.6%; 30/54) of the respondents provided both personal protective equipment and post exposure prophylaxis for HIV. There was high level of non-compliance to standard medical waste management procedures, and lack of training on occupational safety measures. Relevant regulating agencies should step up efforts at monitoring and regulation of healthcare activities and ensure staff training on safe handling and disposal of hospital waste.

Intelligent Pilot Aids for Flight Re-Planning in Emergencies

NASA Technical Reports Server (NTRS)

Pritchett, Amy R.

2002-01-01

Experimental studies were conducted with pilots to investigate the attributes of automation that would be appropriate for aiding pilots in emergencies. The specific focus of this year was on methods of mitigating automation brittleness. Brittleness occurs when the automatic system is used in circumstances it was not designed for, causing it to choose an incorrect action or make an inaccurate decision for the situation. Brittleness is impossible to avoid since it is impossible to predict every potential situation the automatic system will be exposed to over its life. However, operators are always ultimately responsible for the actions and decisions of the automation they are monitoring or using, which means they must evaluate the automation's decisions and actions for accuracy. As has been pointed out, this is a difficult thing for human operators to do. There have been various suggestions as to how to aid operators with this evaluation. In the study described in this report we studied how presentation of contextual information about an automatic system's decision might impact the ability of the human operators to evaluate that decision. This study focused on the planning of emergency descents. Fortunately, emergencies (e.g., mechanical or electrical malfunction, on-board fire, and medical emergency) happen quite rarely. However, they can be catastrophic when they do. For all predictable or conceivable emergencies, pilots have emergency procedures that they are trained on, but those procedures often end with 'determine suitable airport and land as quickly as possible.' Planning an emergency descent to an unplanned airport is a difficult task, particularly under the time pressures of an emergency. Automatic decision aids could be very efficient at the task of determining an appropriate airport and calculating an optimal trajectory to that airport. This information could be conveyed to the pilot through an emergency descent procedure listing all of the actions necessary to safely land the plane. However, there is still the potential problem of brittleness. This study examined the impact of contextual information in presentations of emergency descent procedures to see if they might impact the pilot's evaluation of the feasibility of the presented procedure. The study and its results are described in detail.

Songbird - AN Innovative Uas Combining the Advantages of Fixed Wing and Multi Rotor Uas

NASA Astrophysics Data System (ADS)

Thamm, F.-P.; Brieger, N.; Neitzke, K.-P.; Meyer, M.; Jansen, R.; Mönninghof, M.

2015-08-01

This paper describes a family of innovative fixed wing UAS with can vertical take off and land - the SONGBIRD family. With nominal payloads starting from 0.5 kg they can take off and land safely like a multi-rotor UAV, removing the need for an airstrip for the critical phases of operation. A specially designed flight controller allows stable flight at every point of the transition phase between VTOL and fixed wing mode. Because of this smooth process with a all time stable flight, very expensive payload like hyperspectral sensors or advanced optical cameras can be used. Due to their design all airplanes of the SONGBIRD family have excellent horizontal flight properties, a maximum speed of over 110 km/h, good gliding properties and long flight times of up to 1 h. Missions were flown in wind speeds up to 18 m/s. At every time of the flight it is possible to interrupt the mission and hover over a point of interest for detail investigations. The complete flight, including take-off and landing can be performed by autopilot. Designed for daily use in professional environments, SONGBIRDs are built out of glass-fibre and carbon composites for a long service life. For safe operations comprehensive security features are implemented, for example redundant flight controllers and sensors, advanced power management system and mature fail safe procedures. The aircraft can be dismantled into small parts for transportation. SONGBIRDS are available for different pay loads, from 500 g to 2 kg. The SONGBIRD family are interesting tools combining the advantages of multi-copter and fixed wing UAS.