The incidence of biliary injury after laparoscopic cholecystectomy(LC) has shown a declining trend though it may still be twice that as with open cholecystectomy. Major biliary or vasculobiliary injury is associated w...The incidence of biliary injury after laparoscopic cholecystectomy(LC) has shown a declining trend though it may still be twice that as with open cholecystectomy. Major biliary or vasculobiliary injury is associated with significant morbidity. As prevention is the best strategy, the concept of a culture of safe cholecystectomy has been recently introduced to educate surgeons and apprise them of basic tenets of safe performance of LC. Various aspects of safe cholecystectomy include:(1) thorough knowledge of relevant anatomy, various anatomical landmarks, and anatomical variations;(2) an understanding of the mechanisms involved in biliary/vascular injury, the most important being the misidentification injury;(3) identification of various preoperative and intraoperative predictors of difficult cholecystectomy;(4) proper gallbladder retraction;(5) safe use of various energy devices;(6) understanding the critical view of safety, including its doublet view and documentation;(7) awareness of various error traps(e.g., fundus first technique);(8) use of various bailout strategies(e.g., subtotal cholecystectomy) in difficult gallbladder cases;(9) use of intraoperative imaging techniques(e.g., intraoperative cholangiogram) to ascertain correct anatomy; and(10) understanding the concept of time-out.Surgeons should be facile with these aspects of this culture of safety in cholecystectomy in an attempt to reduce the incidence of biliary/vascular injury during LC.展开更多
BACKGROUND Nursing officers are an integral component of any medical team.They participate in taking care of basic airway management and assist in advanced airway management,specifically amidst the current coronavirus...BACKGROUND Nursing officers are an integral component of any medical team.They participate in taking care of basic airway management and assist in advanced airway management,specifically amidst the current coronavirus disease 2019(COVID-19)pandemic.AIM To assess the efficacy of a standardized web-based training module for nurses in preparedness to fight against COVID-19.METHODS The training was held in three sessions of 1 h each,consisting of live audio-visual lectures,case scenarios,and skill demonstrations.The sequence of airway equipment,drug preparation,airway examination,and plans of airway management was demonstrated through mannequin-based video-clips.RESULTS Pre-and post-test scores as well as objective structured clinical examination scores were analyzed using Student’s t-test and the Likert scale was used for feedback assessment.It was found that the mean score out of the total score of 20 was 8.47±4.2 in the pre-test,while in the post-test it was 17.4±1.8(P value<0.001).The participants also felt self-reliant in executing the roles of airway assistant(63.3%)and drug assistant(74.3%).Fear of self-infection with COVID-19 was also high,as 66%of participants feared working with the patient’s airway.CONCLUSION Amidst this COVID-19 emergency,when the health care systems are being persistently challenged,training of nursing staff in the safe conduct of airway management can ensure delivery of life-saving treatment.展开更多
文摘The incidence of biliary injury after laparoscopic cholecystectomy(LC) has shown a declining trend though it may still be twice that as with open cholecystectomy. Major biliary or vasculobiliary injury is associated with significant morbidity. As prevention is the best strategy, the concept of a culture of safe cholecystectomy has been recently introduced to educate surgeons and apprise them of basic tenets of safe performance of LC. Various aspects of safe cholecystectomy include:(1) thorough knowledge of relevant anatomy, various anatomical landmarks, and anatomical variations;(2) an understanding of the mechanisms involved in biliary/vascular injury, the most important being the misidentification injury;(3) identification of various preoperative and intraoperative predictors of difficult cholecystectomy;(4) proper gallbladder retraction;(5) safe use of various energy devices;(6) understanding the critical view of safety, including its doublet view and documentation;(7) awareness of various error traps(e.g., fundus first technique);(8) use of various bailout strategies(e.g., subtotal cholecystectomy) in difficult gallbladder cases;(9) use of intraoperative imaging techniques(e.g., intraoperative cholangiogram) to ascertain correct anatomy; and(10) understanding the concept of time-out.Surgeons should be facile with these aspects of this culture of safety in cholecystectomy in an attempt to reduce the incidence of biliary/vascular injury during LC.
文摘BACKGROUND Nursing officers are an integral component of any medical team.They participate in taking care of basic airway management and assist in advanced airway management,specifically amidst the current coronavirus disease 2019(COVID-19)pandemic.AIM To assess the efficacy of a standardized web-based training module for nurses in preparedness to fight against COVID-19.METHODS The training was held in three sessions of 1 h each,consisting of live audio-visual lectures,case scenarios,and skill demonstrations.The sequence of airway equipment,drug preparation,airway examination,and plans of airway management was demonstrated through mannequin-based video-clips.RESULTS Pre-and post-test scores as well as objective structured clinical examination scores were analyzed using Student’s t-test and the Likert scale was used for feedback assessment.It was found that the mean score out of the total score of 20 was 8.47±4.2 in the pre-test,while in the post-test it was 17.4±1.8(P value<0.001).The participants also felt self-reliant in executing the roles of airway assistant(63.3%)and drug assistant(74.3%).Fear of self-infection with COVID-19 was also high,as 66%of participants feared working with the patient’s airway.CONCLUSION Amidst this COVID-19 emergency,when the health care systems are being persistently challenged,training of nursing staff in the safe conduct of airway management can ensure delivery of life-saving treatment.
