Enhancing Patient Safety in the Operating Room: A Comprehensive Guide from a Nurse’s Perspective

Ensuring patient safety within the operating room is a paramount concern in contemporary healthcare, and this guide aims to provide an in-depth exploration of this crucial aspect from the perspective of nurses. Nurses play a pivotal role in supporting surgeons and maintaining a safe environment for patients undergoing various medical procedures.

Oxidative Stress before and after Operation in Patients with Chronic Cholecystitis Containing Gallstone

To study the relationship of oxidative, antioxidative constituents and antioxidases in blood with chronic cholecystitis containing gallstone, levels of lipoperoxides (LPO), nitric oxide (NO), vitamin C(VC), vitamin E (VE) and β carotene (β CAR) in plasma as well as level of LPO, activities of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH Px) in erythrocytes were investigated by spectrophotometric assay in 107 patients with this condition (PCg) and 100 healthy volunteers (HVs). Compared with HVs group, the average value of LPO and NO in plasma and that of LPO in erythrocytes of PCg group were significantly increased ( P <0.0001), while that of VC, VE and β CAR in plasma and the average activities of SOD, CAT and GSH Px in erythrocytes were significantly decreased ( P <0.0001). Linear regression and correlation analysis for 107 preoperative PCg showed that the value of LPO and NO in plasma and that of LPO in erythrocytes of PCg gradually increased ( P <0.0001), representing a significant linear positive correlation. The value of VC, VE and β CAR in plasma and that of SOD, CAT and GSH Px in erythrocytes of PCg gradually decreased ( P <0.0001), representing a significant linear negative correlation. Stepwise regression and correlation analysis for 107 preoperative PCg suggested that the closest correlation was observed between the course of disease and the value of NO and VC in plasma and that of SOD, GSH Px and LPO in erythrocytes, r =0.7306, F =32.1408, P <0.0001. Compared with the preoperative PCg group, the average value of LPO and NO in plasma and that of LPO in erythrocytes of the postoperative PCg group were significantly decreased ( P <0.0001). Furthermore, the average value of VC in plasma and that of SOD, CAT and GSH Px in erythrocytes of the postoperative PCg group were significantly increased ( P <0.0001), whereas no significant difference was found between their average value of VE and β CAR in plasma. These findings suggested that oxidative stress was an aggravating pathological condition in PCg group. Therefore, we recommend that in treating PCg, antioxidants such as VC, VE, β CAR should be given in order to alleviate their potential oxidative damages.

The Popularization and Application of Cold Storage Red Blood Cells or Whole Blood at -80 ℃ of the Rh(D) Negative Patients in Surgical Operation

Summary: The efficiency of cold storage red blood cells (CSRBC) or whole blood at -80 ℃ used in 27 Rh(D) negative patients during surgical operation was reported. The Rh(D) negative patients received the transfusion of CSRBC or whole blood stored at -80 ℃ for 180 to 360 days. The changes in the indexes, such as blood TB, DB, K +, Na +, BUN, Cr, urine protein (URPO), UOB, Hb, HCT, serum total protein, relative to hemolytic reaction and blood volume before and after transfusion were observed. The results showed that after transfusion of CSRBC or whole blood 27 cases were negative for urine protein and UOB, and the levels of BUN and Cr were normal (P>0.05). Blood TB, DB, Hb, and HCT were increased, while pH, blood K + and blood Na + was normal with the difference being not significant before and after operation (P>0.05). Plasma protein was decreased, but there was no significant difference before and after operation (P>0.05). It was suggested that CSRBC or whole blood at -80 ℃ could be safely infused to the Rh(D) negative patients without side effects during the surgical operation.

The Impact on the Level of Anxiety and Pain of the Training before Operation Given to Adult Patients

Aim: The aim oh this study was to detrmine the effects of different training programs implemented before inguinal hernia operation on the pre- and post-operation anxiety level of and pain level the patient. Material and method: This quasi experimental study was carried out with inguinal hernia patients 18 - 60 years who were hospitalized in the General Surgery Clinic of Hospital of Atatürk University and Süleyman Demirel Medical Centre in Erzurum for inguinal hernia operation. The study data were collected between November 2007-May 2008 from a total of 90 patients. 30 patients were in the control group, 30 were in the video (VCD) training group, and 30 were in the booklet training group. Data were collected by means of a questionnaire about the patients and the inventory of state anxiety fort he adult. In collecting data, patient introduction form and Spielberger’in State-Trait Anxiety Inventory, and visual analogue scale (VAS) were used. In data assessment, T-test, Pearson correlation test, Mauchly’s variance analysis, Anova for repeated measures tests and Bonferroni Correction Analysisi were used. Results: In control, booklet and VCD groups, In group Situational Constant Anxiety score average was found significant in each three time periods (p < 0.001). When the pain situations of the patients after operation was considered, the distinction in Visual Analogue Scale and Verbal Rating Scala values of two groups in all measurement times was found significant (p<0.001). Conclusion: In the conclusion of the study, it was found out that the given education effective on level of pain and anxiety score for experimental groups of patients.

Influence of different anesthesia methods on stress reaction and hemodynamics for elderly orthopedics patients during operations

Objective:To study the influence of general anesthesia, epidural anesthesia and combined spinal and epidural anesthesia method on stress reaction and hemodynamics for elderly orthopedics patients during operations.Methods: A total of 90 cases of elder patients who received orthopedic operations were randomly divided to group A, B and C, with 30 cases per group. Three groups of patients were separately given by general anesthesia, epidural anesthesia and combined spinal and epidural anesthesia for operations;The variations of adrenocorticotrophic hormone (ACTH), Cortisol (Cor),β-endorphin (β-EP), Angiotensin-Ⅱ(Ang-Ⅱ), heart rate (HR) and blood pressure (SBP, DBP) on patients in three groups before anesthesia (T0), during skin incision (T1), after skin incision (T2) and extubation after operation (T3) were compared and analyzed.Results:During T1, T2, ACTH, Cor,β-EP and Ang-Ⅱlevels in 3 groups of patients were significantly higher than those during T0;SBP and DBP were significantly lower than that during T0;HR during T2 was significantly lower than that during T0;During T3, every index in 3 groups were recovered to levels close to that during T0;During T1, T2, ACTH, Cor,β-EP, Ang-Ⅱlevels in group B and C were significantly lower than that in group A. And levels in C was lower than that in B;SBP and DBP in group B and C were significantly higher than A. No HR statistical significance appeared between each group.Conclusions: During clinical anesthesia, we should choose suitable anesthesia method combined with actual situations of patients. Combined spinal and epidural anesthesia had a slight influence on hemodynamics of elder orthopedics patients during operation, and it could effectively alleviate stress reaction during operation.

Factors That Promote Autonomous and Controlled Motivation in Self-management Behavior of Hemodialysis Patients

This study examined the differences and primary factors from the impact of autonomous motivation and controlled motivation on the self-management behavior of hemodialysis patients.Anonymous,self-describing questionnaires were used for research on nine different dialysis facilities of 413 people who regularly visit.From using the primary factor results of multiple regression analysis,that took autonomous motivation and controlled motivation as the dependent variable,a path diagram was created that led to each motivation.The acknowledgement of autonomy support facilitated whether it was autonomous motivation or controlled motivation(The standardized coefficient was 0.385,0.346,p<0.0001).Positive evaluation coping skills were a primary factor that promoted autonomous motivation,while trait anxiety,disorders of social activities,and lack of motivation were primary factors that promoted controlled motivation.In order to raise the autonomous motivation to promote self-management behavior in patients with hemodialysis treatment,situations that easily cause amotivation and anxiety,as well as tendencies for depression should be assessed.Also the encouragement to attain positive evaluation coping skills to support patient autonomy appears to be effective.

Analysis on Serum Trace Element Levels of Echinococciasis Patients in Garze Tibetan Autonomous Prefecture in Sichuan,China,2011

In Garze Tibetan autonomous prefecture inSichuan province, China, 41 echinococciasis patientswho had received surgical treatment were recruitedin the study, and 82 health persons who had livedin Garze for at least 10 years were selected ascontrols. The serum levels of Zn, Se and Cu of thecases and controls were detected. The resultsshowed that most echinococciasis cases weredistributed in Shiqu county （17.1%, 7/41）, and only1 case was distributed in Yajiang county （2.4%）. Themale to female ratio of the cases was 1：1.56. Theechinococciasis patients were mainly aged 30-39years （36.59%, 15/41）. And, the cases aged 20-49years accounted for 68.29% （28/41）. Comparedwith health controls, the serum levels of Zn and Seof the cases significantly declined. However, theserum level of Cu of the cases had no significantlychange. It was confirmed that the serum levels ofZn and Se were interrelated with the prevalence ofechinococciasis.

Shunt-E 4.0—Autonomous Zero Emission Shunting Processes in Port and Hinterland Railway Operations

The port railway operation in Germany and Europe is not least due to its long history of technological and regulatory developments characterized by a high number of players and a lack of comprehensive planning and optimization of all relevant processes.Innovative technologies and business processes are therefore useful and needed to achieve key steps on the way to an overall optimization of rail transport within global supply chains.A substantial part of the European rail freight transport has its origin or its destination in an inland or sea port.Considering the railway system,ports play a more important role for urgently needed innovations than the pure interfaces between sea and land transport.Especially ports with their own railway system have an own responsibility in this matter.Insofar the goal of the Bremen Port Railway—which already now has a leading share of railway in modal split in Europe—is to exploit the opportunities offered by digitalization.Significant steps for this are the optimization and gradually automatization of rail operational processes on the last mile including modern and transparent IT systems and the designing of autonomous shunting processes.Together with research partners ISL(Institute of Shipping Economics and Logistics Bremen),BIBA(Bremen Institute for Production and Logistics)and IVE(Institute for Transport,Railway Construction and Operation in Brunswick)and in connection with associated business partners the project Rang-E has been applied for at the Ministry of Transport in the funding initiative IHATEC(Innovated HArbour TEChnologies)—and had won a grant to perform the proposed work.Basic thoughts are outlined in the following.

Autonomous bus services:current research status and future recommendations

Implementing autonomous bus services in several cities has garnered substantial research attention worldwide.However,the benefits and challenges of this emerging mode remain insufficiently understood.Consequently,VOSviewer was employed for a bibliometric analysis involving 300 publications,investigating the associations among authors,journals,and keywords.Subsequently,we comprehensively reviewed the current state of research on two topics and proposed future recommendations.Results indicate that the first document related to autonomous bus services was published in 2009.Most user attitude-related research data are obtained via questionnaires and analyzed using statistical techniques.Autonomous bus services are expected to benefit passengers regarding travel time,cost,safety,etc.,while passenger preferences are inconsistent.However,integrating the service into existing bus systems requires careful consideration of the schedule sequences.Notably,modular autonomous bus services present a new opportunity for the further optimization of bus services.In future studies,standardized data acquisition procedures should be developed to achieve comparable results.Regarding traveler choice behavior,the effect of specific autonomous bus service policies over time and the heterogeneity due to cultural or social contexts across regions should be assessed.To further promote autonomous bus services,based on fluctuating travel demands,the effects of vehicle capacity,speed,and cost of fleet composition should be evaluated comprehensively to optimize the bus network and schedule sequence.Owing to the protracted nature of the transition from conventional to fully autonomous buses,one should prioritize semi-autonomous bus services.Another essential future research direction is to integrate modular autonomous bus assembly or disassembly strategies with different fine-grained operation optimization techniques in various scenarios.

Autonomic reinnervation and functional regeneration in autologous transplanted submandibular glands in patients with severe keratoconjunctivitis sicca

Autologous submandibular gland（SMG） transplantation has been proved to ameliorate the discomforts in patients with severe keratoconjunctivitis sicca. The transplanted glands underwent a hypofunctional period and then restored secretion spontaneously.This study aims to investigate whether autonomic nerves reinnervate the grafts and contribute to the functional recovery, and further determine the origin of these nerves. Parts of the transplanted SMGs were collected from the epiphora patients, and a rabbit SMG transplantation model was established to fulfill the serial observation on the transplanted glands with time. The results showed that autonomic nerves distributed in the transplanted SMGs and parasympathetic ganglionic cells were observed in the stroma of the glands. Low-dense and unevenly distributed cholinergic axons, severe acinar atrophy and fibrosis were visible in the patients＇ glands 4–6 months post-transplantation, whereas the cholinergic axon density and acinar area were increased with time. The acinar area or the secretory flow rate of the transplanted glands was statistically correlated with the cholinergic axon density in the rabbit model, respectively. Meanwhile, large cholinergic nerve trunks were found to locate in the temporal fascia lower to the gland, and sympathetic plexus concomitant with the arteries was observed both in the adjacent fascia and in the stroma of the glands. In summary, the transplanted SMGs are reinnervated by autonomic nerves and the cholinergic nerves play a role in the morphological and functional restoration of the glands. Moreover, these autonomic nerves might originate from the auriculotemporal nerve and the sympathetic plexus around the supplying arteries.

Regional anesthesia in a patient with primary ciliary dyskinesia:A case report

BACKGROUND Primary ciliary dyskinesia(PCD)is an inherited autosomal-recessive disorder of impaired mucociliary clearance characterized by chronic respiratory diseases,otolaryngological diseases,central nervous system abnormalities,reproductive system abnormalities,and cardiac function abnormalities.General anesthesia in these patients is associated with a higher incidence of respiratory complications than in patients without the disease.CASE SUMMARY A 16-year-old male patient was referred to the emergency room complaining of right ankle pain due to distal tibiofibular fracture.Three years prior,he had been diagnosed with PCD.At that time,he had experienced several episodes of pneumonia,sinusitis,and chronic middle ear infections,for which he underwent surgical interventions.At the current admission,he presented with cough and sputum but no other respiratory symptoms.A chest computed tomography scan revealed centrilobular ground-glass opacities in both lower lobes and a calcified nodule in the left lower lobe.For the surgical procedure and postoperative pain management,combined spinal-epidural anesthesia was employed.The patient’s postoperative pain score was measured by the numerical rating scale(NRS).On the day of surgery,his NRS was 5 points.By the second postoperative day,the NRS score had decreased to 2–3 points.The epidural catheter was removed on the fourth day following the operation.The patient was subsequently discharged no respiratory complications.CONCLUSION We performed combined spinal-epidural anesthesia in a patient with PCD.The patient experienced no additional respiratory complications and was discharged with a low NRS score for pain.

Critical values of monitoring indexes for perioperative major adverse cardiac events in elderly patients with biliary diseases

BACKGROUND Major adverse cardiac events(MACE) in elderly patients with biliary diseases are the main cause of perioperative accidental death, but no widely recognized quantitative monitoring index of perioperative cardiac function so far.AIM To investigate the critical values of monitoring indexes for perioperative MACE in elderly patients with biliary diseases.METHODS The clinical data of 208 elderly patients with biliary diseases in our hospital from May 2016 to April 2021 were retrospectively analysed. According to whether MACE occurred during the perioperative period, they were divided into the MACE group and the non-MACE group.RESULTS In the MACE compared with the non-MACE group, postoperative complications, mortality, hospital stay, high sensitivity troponin-Ⅰ(Hs-TnI), creatine kinase isoenzyme(CK-MB), myoglobin(MYO), B-type natriuretic peptide(BNP), and Ddimer(D-D) levels were significantly increased(P < 0.05). Multivariate logistic regression showed that postoperative BNP and D-D were independent risk factors for perioperative MACE, and their cut-off values in the receiver operating characteristic(ROC) curve were 382.65 pg/mL and 0.965 mg/L, respectively.CONCLUSION The postoperative BNP and D-D were independent risk factors for perioperative MACE, with the critical values of 382.65 pg/mL and 0.965 mg/L respectively. Consequently, timely monitoring and effective maintenance of perioperative cardiac function stability are of great clinical significance to further improve the perioperative safety of elderly patients with biliary diseases.

Rhegmatogenous Retinal Detachment in One-Eyed Patients: Therapeutic and Prognostic Challenges

Background: Retinal detachment is a major ophthalmologic emergency. The rhegmatogenous form is the most common and its management is exclusively surgical as soon as possible. This urgency becomes major and absolute when it occurs in a particular monocular vision. Purpose: To analyze the clinical forms of rhegmatogenous retinal detachment (RRD), the results and the complications of their management in monophthalmic patients. Methodology: This was a retrospective and analytical study from June 2007 to December 2019. We included all patients who received a consultation for rhegmatogenous retinal detachment. All patients were seen by at least two posterior segment specialists and all were operated on by the same surgeon. Results: 57 files (57 eyes) were collected with an average age of 44.71 years and a sex ratio of 7.14. The average consultation time is 40.80 days. Patients complained of decreased visual acuity in 96.49% of cases. We had myopia in 49.12% of cases and 91.23% of patients were phakic. Retinal holes were found in 31.58% of our patients and giant tears in 17.54%. The mean retinal detachment extension was 2.52 quadrants and the macula was raised in 32 cases. The average time taken to take charge was 10 days. Detachment surgery was performed in 42 patients with 100% anatomical recovery. Conclusion: Retinal detachment in one-eyed patient is a major ophthalmic emergency. Its management must not suffer from any delay. Post-operative outcomes are relatively similar between the internal and external pathways. In one-eyed patient, silicone can be left alone in the absence of complications.

Conceptual Architecture for Remotely Piloted Operation Mode in Commercial Aircraft

With the increasing civil aviation passengers and the rapid development of aviation logistics,the study on remotely piloted operation(RPO)mode has received extensive attention.RPO mode constructs the piloting decisionmaking mode which involves the tripartite collaboration among airborne automatic/autonomous system,remote ground-based crews and air traffic control.In this paper,we describe the organizing architecture for commercial remotely piloted aircraft(CRPA)system and its components.Compared with the current operation mode,the new air-ground collaborative decision-making mode has been established with six different situations based on the type of the flight and the condition of the remote pilot.Taking airport surface operation as an experimental example,we model the airport surface operation process and compare the advantages and disadvantages between RPO mode and the current dual-pilot mode from the perspectives of time and operation coverage,and draw conclusions that RPO mode can basically cover the flight operations of the dual-pilot,improve the accuracy of pilot operations and greatly reduce response time by 48%in pre-flight inspection.The above research would be the foundation for the RPO development of commercial aircraft in China.

A SURVEY OF ELECTIVE SURGICAL PATIENTS' ATTITUDES TOWARD ANESTHESIA IN PUMC HOSPITAL

Objective.To assess patients’ knowledge,attitudes,and concerns regarding anesthetic management.Method.A survey of 55items was developed and administered preoperatively to 500patients including 190men and 310women in our hospital.Patients were interviewed on their know ledge of the role of anesthesiolo-gists,their preferences regarding anesthetic management,and also their concernaboutpotential anesthetic complica-tions.Results.Patients’ perceptions ofanesthesiologists’ training androle have reacheda certainlevel.Mostsignifi-cant preoperative concerns regardi ng the anesthesiologists focused on experience,qualifications,and pr esence or absence during the anesthesia.Patients’ concerns also included the possibility of not being waken up following anesthesia,experiencing postoperative pain,and becoming paralyzed.The variations of concerns depended partial-ly on patients’ sex,type of anesthesia,and propose d surgical procedure,partially on t heir education and living environments.Conclusion.It is suggested that anesthesiologists address significant patient con cerns during the preopera-tive visit to enhance their effectiv eness in patient care.Efforts to educate the public on the anesthesiologists’ role in preoperative care would improve p atients’ confidence.

Intraoperative Care of the Conscious Patient from the Perspective of the Operating Theatre Nurse:A Grounded Theory

Introduction: Intraoperative care includes a unique knowledge of how to perform a safe and effective surgery procedure. Surgery performed under regional or local anaesthesia allows the patient to remain conscious during the procedure and is rather common in Swedish healthcare today. Aim: The aim was to obtain a deeper understanding of the main concerns of operating theatre nurses (OTN) when caring for conscious patients during the intraoperative phase. Methods: Interviews were conducted with 23 OTNs from five different hospitals in Sweden and analysed according to grounded theory. Findings: The main concern among the OTNs was to take the patient in consideration. The core category “achieve and maintain ethical treatment of patients” in the operating theatre (OT) was a strategy used throughout the intraoperative process. Ethical treatment was described as moral behaviour at different levels and included the team’s behaviour, respectful and individualised patientcare, and the working-morale of the professionals. Being vigilant and being flexible were the categories related to the core category. The OTNs constantly assessed where to pay most attention as they balanced between the needs of the patient, the team, and the surgery procedure. Conclusion: It is important that every patient is taken into consideration and that ethical principles are held to the highest standards in the OT. A familiar team can facilitate that. The complex skills that operating theatre nurses develop can be added to explain important competencies within the profession.

Non-Operating Room Anesthesia and the COVID-19 Patient: Evidence Based Strategies

As non-operating room anesthesia (NORA) vastly increases, so does the complexity of both the patients and the procedures. Unfamiliar environment, remote locations, and limited access to resources are some of the many challenges faced by the anesthesiologist in this environment. Understanding the environmental factors such as the room layout, machine placement and patient positioning needs advanced planning in the COVID-19 patient to determine airway management, intravenous access and overall patient safety. Communication with the proceduralist and healthcare workers (HCW) is of essence as both the procedure and anesthetic requirements may need to be altered as the case progresses. Standard monitoring guidelines should apply to all patients regardless of depth of anesthesia. The COVID-19 patient adds to these challenges. Aerosol generating medical procedures (AGMP’s) need to be identified ahead of time in order to ensure the safety of both the staff and patients. This allows for planning and preparation required for transportation of the patient to the room. HCWs may need to be identified and be available to assist with the procedure. Time should be allocated for transportation, briefing, room preparation, personal protective equipment needs of the staff and donning and doffing procedures as per institutional protocol. Communication means with staff outside of the room should be discussed in advance should an emergent situation arise during the procedure. Debriefing should be performed at the end of every procedure to improve patient safety and outcomes.

煤矿智能快速掘进关键技术研究现状及展望

针对煤矿巷道掘进智能化建设情况,探讨了现阶段分别以连采机、掘锚一体机、全断面掘进系统、掘锚机为核心的四大类智能快速掘进成套装备发展现状,分析了四大类智能快掘装备与地质条件适用性,提出了实现煤矿智能化掘进需要解决的关键技术的问题,探讨了以信息传输与智能分析技术、智能感知技术、精确定位导航技术,自主定型定向截割技术、掘进机远程自主截割控制技术以及多级多工序智能协同控制技术为基础的智能化掘进实现途径;基于复杂地质条件下煤矿巷道掘进亟待解决的关键问题,提出了以掘进作业功能需求、掘进工艺要求为依据的系统化分析、模块化设计、功能优化组合的设计方法;研究了以虚控实、虚实结合的多级数字孪生构架,基于掘进巷道设备、环境、地质构造多维信息再现实现掘进机远程控制;提出了单机智能化、系统协同化、井下智控与地面远程监控相协同的控制方法。开发了新型的无重复碾压柔性超前支护技术、截割部多级伸缩截割技术、智能锚固机组多钻机并行作业等技术,研制了具有掘、支、锚、运、探多工序并行作业的新型快速掘进作业联合机组,提出了掘进机器人、超前支护机器人、锚固机器人、辅助运输机器人组柔性并行作业技术;提出了基于数据驱动的多机多工序协同控制行为规划决策方法。提出构建完整的煤矿井下跨系统全时空信息数字感知体系,构建集井下现场生产状态、掘进巷道空间信息、掘进装备状态、风险信息等多参量、多尺度、全时空特性的数据感知智能化监控平台,实现虚拟系统与实际掘进系统实时通信,通过数据驱动规划分析实现智能化、少人化掘进。

深空探测自主运行的一种可信性技术体系

未认知与不确定性是深空探测任务的基本特征.本文基于战略导向的体系化基础研究,建立了一种面向科学价值最大化的探测场景和以可靠性为核心技术基础的深空探测自主运行可信性技术体系.分析研究了深空探测场景下的可靠性概念;面向精确感知、最优计算、准确决策、快精准执行的目标要素,提出了深空探测自主运行的可信性体系框架以及“需求-认知-工程”总体技术架构;针对自主运行可信性的关键技术难点,开展了可靠性导向的多物理场、强耦合白盒建模,复杂网络故障传播机制分析,COTS元器件深空探测应用的高可靠保证,以及“模型+数据+知识”一体的融合机制分析等研究.对该技术体系的关键技术验证策略及其最小系统在卫星星座中的应用进行了验证,结果表明,所提出的技术体系具有较高的工程价值.