Objective: To describe the incidence and anatomical locations of peripheral nerve injuries (PNIs) related to patient positioning during urologic, gynaecologic and colorectal robotic-assisted surgery ...(RAS).
Background: Incorrect positioning of extremities and lack of assistive devices in steep Trendelenburg (up to 45 degrees) positioning during urologic, gynaecologic and colorectal RAS places the patient at potential risk of nerve injury.
Method: A structured search of recent systematic reviews published between January 2019 and August 2021 in the Cochrane Library, PubMed, ProQuest and Google Scholar databases using search terms 'patient positioning', 'roboticassisted surgery', 'Trendelenburg', 'complication' and 'injury' with medical subject headings (MeSH) was conducted.
Results: The overall incidence rates of PNI associated with patient positioning during RAS varied from 0.16 to 10.8 per cent. The most common anatomical positions of nerve injuries in upper extremities related to patient positioning during RAS were identified in brachial plexus, ulnar, median, radial and humeral nerves. For lower extremities, nerve injuries were identified in the sciatic, femoral, obturator, femoral cutaneous and common cutaneous nerves.
Conclusion: Operating room teams should develop institutional policies to support perioperative practice that is based on the best available evidence.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection often causes pneumonia and respiratory failure that may lead to postintensive care syndrome, including critical illness ...neuropathy (CIN) and critical illness myopathy (CIM). The data on the rehabilitation outcomes of post-novel coronavirus disease (COVID) patients with CIN and CIM following respiratory failure and mechanical ventilation are still limited. To address this, we enrolled in our prospective observational study a sample of 50 consecutive COVID-19 patients admitted to our facility between 2 November 2020 and 3 May 2021 with electrophysiologically confirmed or clinically suspected diagnosis of CIN/CIM. The functional abilities were assessed at admission and discharge with the Functional Independence Measure (FIM), The Canadian Occupational Performance Measure, 10-metre walk test, 6-min walk test and the de Morton Mobility Index. The gain in motor FIM and the length of stay were used as an index of rehabilitation efficiency. Nutritional status was also assessed using anthropometric measurements and bioelectrical Impedance analysis. Psychologic evaluation was performed at admission only. At admission, functional limitations and severe malnutrition were present in all patients with psychologic problems in about one third. At discharge (42 ± 16 days later), clinically important and statistically significant improvements were found in all outcome measures, which was also noted by the patients. The gain in motor FIM was larger with the longer length of stay up to 2 months and plateaued thereafter. We conclude that post-COVID-19 patients who develop CIN/CIM following respiratory failure can improve functional and nutritional status during inpatient rehabilitation.
Introduction: There has been little research on systematic training of new employees in perioperative nursing. The aim of the present study was to establish whether the attitude of the employees in ...perioperative nursing towards the training of new employees in the workplace is connected to their education in perioperative nursing, workload, work competence or attitude of new employees in perioperative nursing. Methods: A quantitative exploratory research was performed in March 2017 and data was collected by means of a structured survey questionnaire. Perioperative nursing staff working in a selected Slovenian hospital's operating theatres, who are trained well enough to work independently (n = 69) and have at least one year of working experience, were questioned to obtain a purposive sample. Descriptive statistics, the Pearson correlation coefficient and factor analysis are shown. Results: Employees in perioperative nursing gladly transmit their knowledge and experience (x = 4.79), growing professionally as they do so ( = 4.63). They see the training of new employees as their personal challenge (x = 4.17). The knowledge of the respondents was shown to be a factor that is marginally positively associated (r = 0.278, p = 0.021) with the attitude to training new employees in the workplace. The training that experienced employees in perioperative nursing have received, their competencies, workload, and their opinion of the work of the new employees, are not connected to the attitudes they posses when training these new employees in the workplace. Discussion and conclusion: The study indicates the need to establish definined criteria relating to the employment of candidates, and may contribute toward the future design of a systematic training course in perioperative nursing.
Uvod: V operativni dejavnosti heterogena skupina strokovnjakov z različnimi osebnostmi in vrednostnimi sistemi, značilnimi za vsako profesijo, deli odgovornost do enega pacienta, kar lahko sproži ...napetost v odnosih in se stopnjuje v nasilje. Namen raziskave je bil prikazati razširjenost tega fenomena ter opredeliti z njim povezane dejavnike in posledice.Metode: Izvedena je bila sistematična iskalna strategija v bazah podatkov CINAHL, Medline, Academic Search Elite, ProQuest in COBIB.SI z datumom objave od januarja 2008 do vključno decembra 2017. Uporabljeni so bili iskalni pojmi v angleščini aggressive behavior, disruptive behavior, operating room, perioperative, violence, verbal abuse, bullying, surgeon in v slovenščini zdravstvena nega, nasilje. Podanih je bilo 735 zadetkov, glede na naslov in izvleček smo za ustrezne določili 68 virov, po vsebinskem pregledu smo jih izločili še 47.Rezultati: Zaključki pregleda literature so temeljili na 22 referencah. Oblikovanih je bilo 6 kategorij: (1) povzročitelji in nivoji nasilja, (2) vrste (tipi) nasilja, (3) neposredni vzroki za pojav nasilja v operacijski dvorani, (4) dejavniki, povezani s pojavom in prepoznavnostjo nasilja, (5) posledice nasilja ter (6) individualni in sistemski organizacijski ukrepi za obvladovanje posledic nasilja.Diskusija in zaključek: Najpogostejši izvajalci nasilja v operativni dejavnosti so kirurgi in zaposleni v operacijski zdravstveni negi, najpogostejši vzroki pa hierarhija, nepredvidljive situacije, kadrovski in materialni deficit, medosebni odnosi, delovna obremenitev, organizacijska kultura. Izkazuje se potreba po tovrstni reprezentativni raziskavi v Sloveniji.
Uvod: V operativni dejavnosti heterogena skupina strokovnjakov z različnimi osebnostmi in vrednostnimi sistemi, značilnimi za vsako profesijo, deli odgovornost do enega pacienta, kar lahko sproži ...napetost v odnosih in se stopnjuje v nasilje. Namen raziskave je bil prikazati razširjenost tega fenomena ter opredeliti z njim povezane dejavnike in posledice. Metode: Izvedena je bila sistematična iskalna strategija v bazah podatkov CINAHL, Medline, Academic Search Elite, ProQuest in COBIB.SI z datumom objave od januarja 2008 do vključno decembra 2017. Uporabljeni so bili iskalni pojmi v angleščini aggressive behavior, disruptive behavior, operating room, perioperative, violence, verbal abuse, bullying, surgeon in v slovenščini zdravstvena nega, nasilje. Podanih je bilo 735 zadetkov, glede na naslov in izvleček smo za ustrezne določili 68 virov, po vsebinskem pregledu smo jih izločili še 47. Rezultati: Zaključki pregleda literature so temeljili na 22 referencah. Oblikovanih je bilo 6 kategorij: (1) povzročitelji in nivoji nasilja, (2) vrste (tipi) nasilja, (3) neposredni vzroki za pojav nasilja v operacijski dvorani, (4) dejavniki, povezani s pojavom in prepoznavnostjo nasilja, (5) posledice nasilja ter (6) individualni in sistemski organizacijski ukrepi za obvladovanje posledic nasilja. Diskusija in zaključek: Najpogostejši izvajalci nasilja v operativni dejavnosti so kirurgi in zaposleni v operacijski zdravstveni negi, najpogostejši vzroki pa hierarhija, nepredvidljive situacije, kadrovski in materialni deficit, medosebni odnosi, delovna obremenitev, organizacijska kultura. Izkazuje se potreba po tovrstni reprezentativni raziskavi v Sloveniji.
Electric arc furnace (EAF) steel slag can be used as an alternative high‐quality material in road construction. Although asphalts with slag aggregates have been recognized as environmentally ...acceptable, there is a lack of data concerning the potential leaching of toxic Cr(VI) due to the highly alkaline media of EAF slag. Leaching of selected water extractable metals from slag indicated elevated concentrations of total chromium and Cr(VI). To estimate the environmental impacts of asphalt mixes with slag, leachability tests based on diffusion were performed using pure water and salt water as leaching agents. Compact and ground asphalt composites with natural aggregates, and asphalt composites in which the natural aggregates were completely replaced by slag were prepared. The concentrations of total chromium and Cr(VI) were determined in leachates over a time period of 6 mo. After 1 and 6 mo, the concentrations of some other metals were also determined in the leachates. The results indicated that chromium in leachates from asphalt composites with the addition of slag was present almost solely in its hexavalent form. However, the concentrations were very low (below 25 μg L−1) and did not represent an environmental burden. The leaching of other metals from asphalt composites with the addition of slag was negligible. Therefore, the investigated EAF slag can be considered as environmentally safe substitute for natural aggregates in asphalt mixes.
Leta 2000 je slovenska transplantacijska mreža Slovenijatransplant postala polnovreden del evropske transplantacijske mreže Eurotransplant. Odvzem organov in tkiv za presaditev po vsej državi ...izvajamo mobilne kirurške ekipe iz Kliničnega centra, včasih pa tudi ekipe iz tujine. V vsakem primeru pa so med člani kirurške ekipe tudi tri operacijske medicinske sestre iz Slovenije. Namen raziskave je bil ugotoviti stresne dejavnike pri operacijskih medicinskih sestrah ob odvzemu organov in tkiv za presaditev. Metoda raziskave je bila opisna, raziskovalna tehnika je bil anonimen vprašalnik. Raziskovalno populacijo je sestavljalo 24 operacijskih medicinskih sester. Za obdelavo podatkov smo uporabili deskriptivno statistično metodo in jih grafično prikazali s programom Excel for Windows. Rezultati vprašalnika »Stresni dejavniki pri operacijskih medicinskih sester ob odvzemu organov in tkiv za presaditev« kažejo, da so močno izraženi stresni dejavniki, ki jih operacijske medicinske sestre doživljajo pri odvzemu organov in tkiv za presaditev, naslednji: samo stanje stalne pripravljenosti za transplantacijsko dejavnost, nepravočasno in nezadostno informiranje transplantacijskega koordinatorja, stanje pred operativnim posegom, vožnja z reševalnim vozilom v donorski center, priprava, transport in skrb za opremo in pripomočke, ki jih potrebujemo pri odvzemu organov in tkiv za presaditev v donorskem centru, dejanje, ko anestezist odklopi dajalca od anestezijskih aparatov in posmrtna oskrba dajalca po končanem operativnem posegu.
Background The COVID-19 pandemic has disrupted the provision and use of healthcare services throughout the world. In Slovenia, an epidemic was officially declared between mid-March and mid-May 2020. ...Although all non-essential health care services were put on hold by government decree, oncological services were listed as an exception. Nevertheless, as cancer control depends also on other health services and additionally major changes in people's behaviour likely occurred, we aimed to analyse whether cancer diagnosis and management were affected during the COVID-19 epidemic in Slovenia. Methods We analysed routine data for the period November 2019 through May 2020 from three sources: (1) from the Slovenian Cancer Registry we analysed data on pathohistological and clinical practice cancer notifications from two major cancer centres in Ljubljana and Maribor; (2) from the e-referral system we analysed data on all referrals in Slovenia issued for oncological services, stratified by type of referral; and (3) from the administrative data of the Institute of Oncology Ljubljana we analysed data on outpatient visits by type as well as on diagnostic imaging performed. Results Compared to the November 2019 - February 2020 average, the decrease in April 2020 was about 43% and 29% for pathohistological and clinical cancer notifications; 33%, 46% and 85% for first, control and genetic counselling referrals; 19% (53%), 43% (72%) and 20% (21%) for first (and control) outpatient visits at the radiotherapy, surgery and medical oncology sectors at the Institute of Oncology Ljubljana, and 48%, 76%, and 42% for X-rays, mammograms and ultrasounds performed at the Institute, respectively. The number of CT and MRI scans performed was not affected. Conclusions Significant drops in first referrals for oncological services, first visits and imaging studies performed at the Institute, as well as cancer notifications in April 2020 point to a possibility of a delayed cancer diagnosis for some patients during the first surge of SARS-CoV-2 cases in Slovenia. The reasons for the delay cannot be ascertained with certainty and could be linked to health-seeking behaviour of the patients, the beliefs and practices of doctors and/ or the health system management during the epidemic. Drops in control referrals and control visits were expected and are most likely due to the Institute of Oncology Ljubljana postponing non-essential follow-ups through May 2020.
Work-related musculoskeletal (MS) disorders are considered one of the most frequent occupational diseases among dental workers. Dental work consists of static, demanding tasks that involve repeated ...gripping of small-sized instruments. The purpose of this study was to investigate the prevalence of MS pain, the areas of pain, and the risk factors for MS pain in dental workers. A self-administrated questionnaire was used as a data collection instrument for dental workers who voluntarily responded to the invitation. To determine the prevalence and severity location of MS pain, the Cornell Musculoskeletal Discomfort Questionnaire was administered among 87 dental workers, with a total of 79.8%, who reported at least one MS complaint. MS pain occurred in 82.6% of general dentists, 75.0% of dental specialists, 66.7% of dental assistants, and 33.3% of dental technicians. Pain most frequently occurred in the neck (60.7%), upper back (52.4%), right shoulder (44.0%), lower back (41.7%), hips/buttocks (29.8%), and the right wrist (23.8%). The prevalence of pain among dental workers could be reduced by ergonomic working environment, regular breaks, maintenance of health, and performing specific exercises designed to dental workers.
Background
In the absence of an automated software analysis, the role of computed tomography perfusion (CTP) in a real time clinical practice is not well established. We evaluated the clinical ...significance of a widely accessible and simple visual grading scale of CTP in the anterior circulation of acute ischemic stroke (AIS) patients treated with mechanical thrombectomy (MT).
Methods
The single center consecutive CT investigations of AIS patients treated with MT in the anterior circulation have been evaluated retrospectively. ASPECT score and collateral circulation evaluation based on the Maas score were determined. Time to peak parametric maps, derived from CTP, were graded into four categories, from least to most favorable. The primary endpoint was functional outcome evaluated as modified Rankin Scale (mRS) ≤ 2 at 90 days after MT.
Results
We included 318 patients in the analysis; 142 (45%) patients had mRS ≤ 2 after 90 days, mortality rate was 24%. Higher CTP and Maas score were significantly correlated with better clinical outcome (Pearson χ
2
25.0 and 37.7, respectively;
p
< 0.01). Collateral circulation and CTP grades were strongly interrelated (Pearson χ
2
78.6;
p
< 0.01). The CTP grade demonstrated statistically significant independent correlation with the clinical outcome irrespective of the collateral circulation grade, ASPECT score and age (OR 2.5;
p
= 0.011). The correlation was more pronounced in patients with normal collateral circulation (OR 3.27;
p
= 0.029).
Conclusion
We demonstrated that both visually graded CTP and collateral circulation grade strongly correlated with the clinical outcome of MT in the anterior circulation of AIS patients. Importantly, CTP correlated with the clinical outcome independent of the collateral circulation.
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