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Surgical Centres (surgical + centre)
Selected AbstractsOptimizing patient flow in a large hospital surgical centre by means of discrete-event computer simulation modelsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 6 2008Rodrigo B. Ferreira MSc Abstract Objective, This study used the discrete-events computer simulation methodology to model a large hospital surgical centre (SC), in order to analyse the impact of increases in the number of post-anaesthetic beds (PABs), of changes in surgical room scheduling strategies and of increases in surgery numbers. Methods, The used inputs were: number of surgeries per day, type of surgical room scheduling, anaesthesia and surgery duration, surgical teams' specialty and number of PABs, and the main outputs were: number of surgeries per day, surgical rooms' use rate and blocking rate, surgical teams' use rate, patients' blocking rate, surgery delays (minutes) and the occurrence of postponed surgeries. Two basic strategies were implemented: in the first strategy, the number of PABs was increased under two assumptions: (a) following the scheduling plan actually used by the hospital (the ,rigid' scheduling , surgical rooms were previously assigned and assignments could not be changed) and (b) following a ,flexible' scheduling (surgical rooms, when available, could be freely used by any surgical team). In the second, the same analysis was performed, increasing the number of patients (up to the system ,feasible maximum') but fixing the number of PABs, in order to evaluate the impact of the number of patients over surgery delays. Conclusion, It was observed that the introduction of a flexible scheduling/increase in PABs would lead to a significant improvement in the SC productivity. [source] Patterns in current anaesthesiological peri-operative practice for colonic resections: a survey in five northern-European countriesACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2006P. Hannemann Background:, For colorectal surgery, evidence suggests that optimal management includes: no pre-operative fasting, a thoracic epidural analgesia continued for 2 days post-operatively, and avoidance of fluid overload. In addition, no long-acting benzodiazepines on the day of surgery and use of short-acting anaesthetic medication may be beneficial. We examined whether these strategies have been adopted in five northern-European countries. Methods:, In 2003, a questionnaire concerning peri-operative anaesthetic routines in elective, open colonic cancer resection was sent to the chief anaesthesiologist in 258 digestive surgical centres in Scotland, the Netherlands, Denmark, Sweden and Norway. Results:, The response rate was 74% (n = 191). Although periods of pre-operative fasting up to 48 h were reported, most (> 85%) responders in all countries declared to adhere to guidelines for pre-operative fasting and oral clear liquids were permitted until 2,3 h before anaesthesia. Solid food was permitted up to 6,8 h prior to anaesthesia. In all countries more than 85% of the responders indicated that epidural anaesthesia was routinely used. Except for Denmark, long-acting benzodiazepines were still widely used. Short-acting anaesthetics were used in all countries except Scotland where isoflurane is the anaesthetic of choice. With the exception of Denmark, intravenous fluids were used unrestrictedly. Conclusion:, In northern Europe, most anaesthesiologists adhere to evidence-based optimal management strategies on pre-operative fasting, thoracic epidurals and short-acting anaesthetics. However, premedication with longer-acting agents is still common. Avoidance of fluid overload has not yet found its way into daily practice. This may leave patients undergoing elective colonic surgery at risk of oversedation and excessive fluid administration with potential adverse effects on surgical outcome. [source] Thromboembolic events after carotid endarterectomy are not prevented by aspirin, but are due to the platelet response to adenosine 5,-diphosphateBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2000P. D. Hayes Background: Aspirin therapy fails to prevent a number of postprocedural thrombotic events, yet it still remains the standard antiplatelet regimen in most vascular surgical centres. After carotid endarterectomy (CEA), thrombosis of the endarterectomized vessel is preceded by increasing numbers of microemboli that can be detected with transcranial Doppler (TCD). The number and rate of emboli is highly predictive of thrombotic stroke. It was hypothesized that a preoperative test of platelet function might identify the mechanism(s) underlying post-CEA thrombosis. Methods: Blood was taken from 120 patients using a standardized phlebotomy technique. Platelet fibrinogen binding was measured by whole blood flow cytometry, in unstimulated samples, and in response to adenosine 5,-diphosphate (ADP) (10,5,10,7 mol l,1) and thrombin (0·02,0·16 units ml,1). Platelet aggregation was measured using ADP (4,20 × 10,7 mol l,1). The ability of aspirin to inhibit platelets was assessed by the aggregation induced by arachidonic acid. For the first 3 h after operation, the number of emboli occurring was quantified using TCD. Results: Of the 120 patients studied, 110 were monitored by TCD. These were divided into patients with more than 25 postoperative emboli (n = 22) and those with fewer than 25 emboli (n = 88). The degree of platelet inhibition induced by aspirin was not significantly different between the two groups (P = 0·89). However, platelets from the group with high rates of embolization bound 58 per cent more fibrinogen on flow cytometry in response to stimulation with a physiological dose of ADP (10,7 mol l,1) (P = 0·006). Aggregation of platelets from this group was also increased in response to ADP (35 per cent) relative to the group with few emboli (P = 0·001). ADP also induced more rapid aggregation in the patients with more than 25 emboli (P = 0·04). There was no difference in the activity of resting platelets (P = 0·4) or platelets stimulated by thrombin (P = 0·43), between the two groups of patients. Conclusion: These data suggest that it is the platelet response to ADP which is important in arterial thrombotic complications rather than products of the cyclo-oxygenase pathway. This observation could have significant therapeutic implications for other vascular or interventional procedures in which the endothelium is disrupted. © 2000 British Journal of Surgery Society Ltd [source] How should we quantify the performance of KPro's?ACTA OPHTHALMOLOGICA, Issue 2009Purpose To report a method of standardized data collection and reporting and statistical assessment that can be used for all KPro´s available on the market. The database (will be presented) should be , Usable for different types of KPro´s , Easily adaptable to changes in technique , Allow for complete entry of relevant data Methods Visual Acuity data should be reported in different international surgical centres in a standardized manner: Best spectacle corrected VA, unless BCVA only possible with CL (> useful time of wear). A complete entry of all relevant data is possible in this database. The statistical analysis should be agreed upon by all centres. For Survival Time = Retention of KPro > the Kaplan-Meier method For Visual Acuity over the Course of Time > the Monte-Carlo method Results A database will be demonstrated that can be used free of charge by all KPro centres interested. The VISUAL ACUITY BY TIME- INDEX (VAT- Index) will also be presented, whose theoretical basis published in: Journal of Theoretical Medicine, 2002 / 4, 183-190, W. Hitzl and G. Grabner [bdquo]Application of the Monte Carlo Method for the Assessment of Long-term Success in Keratoprosthesis Surgery". Example of its use will be give, based in data, courtesy Barraquer Eye Clinic, Barcelona. Conclusion With the Kaplan-Meier method: + analysis is done quickly, uses all data available, hypotheses tests are available for comparisons and mean and median survival time can be computed - no information about relation between time and best corrected visual acuity and the definition of terminal event is arbitrary to a certain extent. Monte-Carlo method (VAT-index): + Method is based on a so-called non-parametric longitudinal model + Reliabel estimation of relation between time and best corrected visual acuity at any given time point (patient as well as surgeon is basically interested in this relation). + statistically valid analysis and better comparison of different KPro techniques + easy comparison of defined postoperative periods + comparison of different initial clinical findings and diseases possible + long-time follow-up of BCVA - shorter follow-up time as compared with Kaplan-Meier method (e.g. with strict [bdquo]80%data complete" criteria) [source] | ||||||||||