The three surgical patient safety events, wrong site surgery, retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to stu...The three surgical patient safety events, wrong site surgery, retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to study. The likelihood of occurrence and the magnitude of risk for each of these surgical safety events are undefined. Many providers may never have a personal experience with one of these events and training and education on these topics are sparse. These circumstances lead to faulty thinking that a provider won't ever have an event or if one does occur the provider will intuitively know what to do. Surgeons are not preoccupied with failure and tend to usually consider good outcomes, which leads them to ignore or diminish the importance of implementing and following simple safety practices. These circumstances contribute to the persistent low level occurrence of these three events and to the difficulty in generating sufficient interest to resource solutions. Individual facilities rarely have the time or talent to understand these events and develop lasting solutions. More often than not, even the most well meaning internal review results in a new line to a policy and some rigorous enforcement mandate. This approach routinely fails and is another reason why these problems are so persistent. Vigilance actions alone havebeen unsuccessful so hospitals now have to take a systematic approach to implementing safer processes and providing the resources for surgeons and other stake-holders to optimize the OR environment. This article discusses standardized processes of care for mitigation of injury or outright prevention of wrong site surgery, RSI and surgical fires in an action-oriented framework illustrating the strategic elements important in each event and focusing on the responsibilities for each of the three major OR agents-anesthesiologists, surgeons and nurses. A Surgical Patient Safety Checklist is discussed that incorporates the necessary elements to bring these team members together and influence the emergence of a safer OR.展开更多
Objective：Ocular trauma is a common cause of visual impairment and accounts for 38% to 52% of all patients presenting as ophthalmic accident and emergency cases to the hospital.The purpose of this study is to describ...Objective：Ocular trauma is a common cause of visual impairment and accounts for 38% to 52% of all patients presenting as ophthalmic accident and emergency cases to the hospital.The purpose of this study is to describe the pattern of ocular injuries that leads to hospitalization in the elderly in Kashan,Iran.Methods：In the retrospective consecutive case series,a total of 94 geriatric patients （≥ 65 years） who admitted and underwent management for ocular trauma from April 2001 to March 2011 at Matini Hospital of Kashan,the only center of eye surgery in the region of Kashan,were reviewed.The items include age,sex,injury mechanism,site and extent of damage,presenting and final best corrected visual acuity at least 3 months after trauma,which were reviewed and analyzed with SPSS software.Results：During the 10 years,94 eyes of 94 patients with ocular trauma were included.Mean age of patients was （77.5±5.1） years （range 65 to 102 years）.Male to female ratio was 2.76.The mechanism of ocular injury included sharp trauma in 56 patients （59.6%） and blunt in 38 patients （40.4%）.Trauma occurred mostly in males （69 patients,73.4%） and at the work place （38 patients,40.4%）.On admission the visual acuity in 50 patients （53.2%） with damaged eyes was light perception to hand motion.While the final best corrected visual acuity in 36 patients （38.3%） was better than hand motion.Conclusion：Ocular trauma is a serious cause of visual impairment in the elderly.Appropriate and timely management may improve their visual prognosis.展开更多
文摘The three surgical patient safety events, wrong site surgery, retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to study. The likelihood of occurrence and the magnitude of risk for each of these surgical safety events are undefined. Many providers may never have a personal experience with one of these events and training and education on these topics are sparse. These circumstances lead to faulty thinking that a provider won't ever have an event or if one does occur the provider will intuitively know what to do. Surgeons are not preoccupied with failure and tend to usually consider good outcomes, which leads them to ignore or diminish the importance of implementing and following simple safety practices. These circumstances contribute to the persistent low level occurrence of these three events and to the difficulty in generating sufficient interest to resource solutions. Individual facilities rarely have the time or talent to understand these events and develop lasting solutions. More often than not, even the most well meaning internal review results in a new line to a policy and some rigorous enforcement mandate. This approach routinely fails and is another reason why these problems are so persistent. Vigilance actions alone havebeen unsuccessful so hospitals now have to take a systematic approach to implementing safer processes and providing the resources for surgeons and other stake-holders to optimize the OR environment. This article discusses standardized processes of care for mitigation of injury or outright prevention of wrong site surgery, RSI and surgical fires in an action-oriented framework illustrating the strategic elements important in each event and focusing on the responsibilities for each of the three major OR agents-anesthesiologists, surgeons and nurses. A Surgical Patient Safety Checklist is discussed that incorporates the necessary elements to bring these team members together and influence the emergence of a safer OR.
文摘Objective：Ocular trauma is a common cause of visual impairment and accounts for 38% to 52% of all patients presenting as ophthalmic accident and emergency cases to the hospital.The purpose of this study is to describe the pattern of ocular injuries that leads to hospitalization in the elderly in Kashan,Iran.Methods：In the retrospective consecutive case series,a total of 94 geriatric patients （≥ 65 years） who admitted and underwent management for ocular trauma from April 2001 to March 2011 at Matini Hospital of Kashan,the only center of eye surgery in the region of Kashan,were reviewed.The items include age,sex,injury mechanism,site and extent of damage,presenting and final best corrected visual acuity at least 3 months after trauma,which were reviewed and analyzed with SPSS software.Results：During the 10 years,94 eyes of 94 patients with ocular trauma were included.Mean age of patients was （77.5±5.1） years （range 65 to 102 years）.Male to female ratio was 2.76.The mechanism of ocular injury included sharp trauma in 56 patients （59.6%） and blunt in 38 patients （40.4%）.Trauma occurred mostly in males （69 patients,73.4%） and at the work place （38 patients,40.4%）.On admission the visual acuity in 50 patients （53.2%） with damaged eyes was light perception to hand motion.While the final best corrected visual acuity in 36 patients （38.3%） was better than hand motion.Conclusion：Ocular trauma is a serious cause of visual impairment in the elderly.Appropriate and timely management may improve their visual prognosis.
