Obstetric shock and shock in obstetrics – steady obstetrical syndrome

Obstetric shock (OS) has been defined as a life-threatening cardiovascular collapse syndrome associated with pregnancy, childbirth and puerperium (obstetrics causes), and is the most significant cause of high maternal mortality (MM) throughout human history. Shock in obstetrics (SIO) refers to indirect causes of non-obstetrics causes in pregnancy, childbirth and puerperium (polytrauma, aesthetic incidents, cardiovascular or cerebrovascular incidents, other septic syndromes). The goals of OS treatment are: to quickly detect the location or cause of bleeding / injury / inflammation, prevent the progression of shock, prevent massive transfusions, preserve the uterus (and adnexa), and preserve fertility if possible. Surgical treatment of septic shock includes exploratory laparotomy (laparoscopy), ectomy or resection of the necrotized organ, abdominal lavage with multiple drainages, continuous peritoneal drainage with lavation, extensive triple antibiosis per admission or per antibiogram and thromboprophylaxis. OS seems to remain a permanent miasma in practical clinical obstetrics, which we will not be able to influence, because we have obviously caused today's increase in MM from haemorrhagic OS by iatrogenic increase in the number of caesarean sections, especially elective ones

Balneogynaecology in the 21st century: increasingly recommended primary and complementary treatment of chronic gynaecological diseases

Balneo-gynaecological treatment methods include external bath hydrotherapy, sedentary baths and topical dressings/cataplasm, and internal (intravaginal or intrarectal use of peloids and mineral water). Hyperosmolar thermal spas have been very popular in the treatment of infertility due to the improvement of symptoms of chronic pelvic pain, endometriosis, chronic vascular and inflammatory pelvic diseases. Acute pelvic inflammatory syndrome is a contraindication for balneo-hydrotherapy while hyperthermal hydrotherapy is contraindicated in endometriosis and neurovegetative dystonia due to the stimulation of hyperemia, which worsens the clinical picture. Balneo-hydrotherapy is not recommended in metrorrhagia and malignancies. Balneogynaecological treatment certainly has its own primary but also complementary role in the treatment of chronic gynaecological diseases and is increasingly recommended today

Analysis of improving business processes by implementing the lean concept at the level of tertiary healthcare

Introduction. The success of healthcare organizations depends on the quality and speed of providing services to patients. Synonym for the term success of health care organization is the implementation of modern concepts Synonymous with the success of healthcare organizations is the implementation of modern concepts. In this paper, the emphasis is on the lean concept, affects the quality and speed of providing health services. Subject of research. The subject being researched in this paper is a lean concept which essence is determined by the implementation of methods that affect the speed and quality of providing health services. The aim of the work is to point out the actuality of the lean concept and its application at the tertiary level of health care. Examine the opinion of healthcare workers about the effects that would be achieved by applying the new management system (lean concept). Aim of this paper is to indicate the actuality of the lean concept and its application at the tertiary level of health care system. Examine the opinion of healthcare workers about the effects that would be achieved by applying the new management system (lean concept). More precise possibilities of imple- menting the lean methodology, which can be used to improve clinical processes. Materials and methods. The research was conducted by designing and using research questionnaires. Questionnaire structured by the author for the purposes of research in this paper. The questionnaire was sent to 472 employees’ mail addresses and was filled out by 91 employees. One of the reasons for the lower questionnaire return rate is the lack of familiarity of employees with the lean concept and its effects on the provision of health services. The return rate of referrals indicates the need for prior presentation and familiarization with the concept itself and its impact on business processes. A Likert scale was used to assess the opinions of healthcare services workers about the effects that would be achieved by applying the lean concept at the tertiary level. Medical wastes are shown in the oncology department (case analysis). We statistically processed the data obtained from the questionnaire using the SPSS 20.0 software package. The results are presented tabularly and graphically. The following methods are used in the paper: analysis method, inductive - deductive method, synthesis method, description method and proof method. Results. The results of the research showed that (analysis of health organizations that apply the lean concept) and the opinion of health workers about the possibility of applying the lean concept at the tertiary level of health care has a positive impact on improving the efficiency of the provision of health services. The interpretation of the correlation coefficient from the previous table indicates the exist- ence of a positive relationship between the effectiveness and efficiency of business processes (r=0.846; p<0,05). Based on the literature review and the obtained results, it was determined that there is no formalized concept with instructions on the implementation of clinical process improvement methods. There was a positive impact on improving the efficiency of the provision of health services, through the imple- mentation of modern methods. The review of the literature and the obtained results revealed that there is no formalized concept with instructions on the implementation of clinical process improvement methods. Conclusion The expected positive effects of the implementation of the lean concept at the tertiary lev- el of the health care of are manifested through: faster service delivery to patients, reduction of service waiting time and general improvement of business processes. The implementation of the lean concept would reduce medical waste, which would positively affect the quality of health care services

Analysis of improving business processes by implementing the lean concept at the level of tertiary healthcare

Introduction. The success of healthcare organizations depends on the quality and speed of providing services to patients. Synonym for the term success of health care organization is the implementation of modern concepts Synonymous with the success of healthcare organizations is the implementation of modern concepts. In this paper, the emphasis is on the lean concept, affects the quality and speed of providing health services. Subject of research. The subject being researched in this paper is a lean concept which essence is determined by the implementation of methods that affect the speed and quality of providing health services. The aim of the work is to point out the actuality of the lean concept and its application at the tertiary level of health care. Examine the opinion of healthcare workers about the effects that would be achieved by applying the new management system (lean concept). Aim of this paper is to indicate the actuality of the lean concept and its application at the tertiary level of health care system. Examine the opinion of healthcare workers about the effects that would be achieved by applying the new management system (lean concept). More precise possibilities of imple- menting the lean methodology, which can be used to improve clinical processes. Materials and methods. The research was conducted by designing and using research questionnaires. Questionnaire structured by the author for the purposes of research in this paper. The questionnaire was sent to 472 employees’ mail addresses and was filled out by 91 employees. One of the reasons for the lower questionnaire return rate is the lack of familiarity of employees with the lean concept and its effects on the provision of health services. The return rate of referrals indicates the need for prior presentation and familiarization with the concept itself and its impact on business processes. A Likert scale was used to assess the opinions of healthcare services workers about the effects that would be achieved by applying the lean concept at the tertiary level. Medical wastes are shown in the oncology department (case analysis). We statistically processed the data obtained from the questionnaire using the SPSS 20.0 software package. The results are presented tabularly and graphically. The following methods are used in the paper: analysis method, inductive - deductive method, synthesis method, description method and proof method. Results. The results of the research showed that (analysis of health organizations that apply the lean concept) and the opinion of health workers about the possibility of applying the lean concept at the tertiary level of health care has a positive impact on improving the efficiency of the provision of health services. The interpretation of the correlation coefficient from the previous table indicates the exist- ence of a positive relationship between the effectiveness and efficiency of business processes (r=0.846; p<0,05). Based on the literature review and the obtained results, it was determined that there is no formalized concept with instructions on the implementation of clinical process improvement methods. There was a positive impact on improving the efficiency of the provision of health services, through the imple- mentation of modern methods. The review of the literature and the obtained results revealed that there is no formalized concept with instructions on the implementation of clinical process improvement methods. Conclusion The expected positive effects of the implementation of the lean concept at the tertiary lev- el of the health care of are manifested through: faster service delivery to patients, reduction of service waiting time and general improvement of business processes. The implementation of the lean concept would reduce medical waste, which would positively affect the quality of health care services

Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study.

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Acute Abdomen in Gynecology — Single University Centre Experiences

Background: Acute abdomen (AA) is a synonym for a condition caused by an acute disease of an intra-abdominal organ that requires urgent surgical intervention. The gynecological-obstetrical etiopathogenesis of AA is based on pathological events on the genital organs due to hemorrhagic, inflammatory, and ischemic/obstructive genesis, and is a significant reason for admission to emergency gynecological departments, and emergency surgery. Methods: A retrospective clinical research was performed from 2005 to 2021, from the surgical protocol of the University Department for Gynecology and Obstetrics, Clinical Hospital “Sveti Duh” in Zagreb. In the examined sixteen-year period, 703 patients (4.06%) had surgery with a diagnosis of AA. Results: The largest number of surgeries due to AA was performed in the age group of 21–45 years (74.40%), i.e., in the reproductive age, followed by 106 patients aged 46–52 years (15.07%), then 46 (6.54%) patients in children and adolescent age up to 20 years of age, then from 53–60 years 23 (3.27%) patients, and in the elderly >60 years old, with 5 (0.71%) patients. The etiopathogenetic factors of AA were: the most common intra-abdominal hemorrhage in 68.14%, followed by inflammation and the most common complications of pelvic inflammatory disease in 25.60%, ischemic-obstructive causes in 2.56% and other causes in 3.7%. Out of the total number of surgeries, 450 (64.01%) were due to ectopic tubal pregnancy. Out of the total number of surgeries, 549 (78.09%) were performed (completed) by laparoscopy procedures, and by laparotomy and/or relaparotomy in 154 cases (21.90%). Regarding laparoscopy, 93.48% was performed in the age group up to 20 years, 83.56% in the age group of 21–45 years, and 62.26% was performed in the age group of 46–52 years. Regarding laparotomy, 69.57% was performed in patients aged 53–60 years, and 100% in the age group of patients >60 years. A pathological substrate was found for all operated patients, which they undergo for surgery, and we had no cases in which we did not prove a perioperative or pathohistological reason for AA. There were no patients’ deaths in the current study, which had to undergo for surgery for AA. Conclusions: We emphasize the urgent need for proper and continuous education of hospital teams, as well as extra-hospital emergency teams in recognizing AA symptoms of gynecological genesis based on history, clinical palpation examination, and ultrasound examination as a fundamental triad in the diagnosis of this life-threatening condition that requires only surgical treatment

Ultrasound Characteristics of Myometrial Invasion in Endometrial Carcinoma: A Prospective Cohort Study

Background: Both objective and subjective transvaginal sonography (TVS) methods are used to assess the degree of myometrial invasion (MI). Subjective TVS assessment of MI (50%) may be as good or better than any objective measurement technique. The aim of this study is to examine the ultrasound characteristics of endometrial cancer (EC) in two groups of patients; with myometrial invasion less and greater than 50%. Methods: This is a prospective cohort study included 60 female patients with pathohistologically (PHD) proven endometrial cancer. Patients were divided into two groups, after surgery and PHD assessment of MI degree, into those with less and more than 50% MI. The degree of MI was performed by subjective assessment (50%). Results: The frequency of anteroposterior (AP) diameter of EC greater than 2 cm was statistically significantly higher in the group of subjects with MI >50% (p 50% is statistically significantly higher, with a difference of 10.48 milliliters compared to the group of subjects with MI 50% has a good diagnostic value: accuracy = 0.87; sensitivity = 0.77; specificity = 0.94; positive predictive value = 0.91; negative predictive value = 0.84; positive likelihood ratio = 13.08; negative likelihood ratio = 0.25. According to the subjective method of TVS, the degree of MI was overestimated in 5.9% of respondents, underestimated in 23.1%. Conclusions: The three dimensions, as well as the volume of endometrial cancer, obtained by TVS, are significantly higher in subjects with >50% myometrial invasion; there is also a significantly higher frequency of EC diameter greater than 2 cm in the group of subjects with >50% myometrial invasion