Patient Safety and organizational Safety Culture in Surgery: A Need of an Hour in the developing countries

Every year, more than 200 million surgeries are performed around the world, and recent statistics show that adverse event rates for surgical pathologies remain unacceptably high, despite several national and global patient safety initiatives over the last decade. Patient safety is diverse and highly complicated in nature, with several critical components. Although concern for patient safety is fundamental in health care practice, its transition into knowledge is comparatively recent, and hence patient safety may be deemed a "new" field. Current surgical safety guidelines and checklists are generic and not adapted to specific patient concerns and risk factors in surgical subspecialties. All surgical practitioners and health care organizations must therefore become better aware of the fundamental context of patient safety, actively participate in endeavors to integrate patient safety measures in daily practice, and foster a patient safety culture. The purpose of this review article is to outline patient safety in surgical techniques that should be adopted and implemented

Democratic Middle Ground in Nepal: A Perspective from the North American Nepali Diaspora

The call of our time is to safeguard the accomplishments of the 1990 Peoples Movement, to restore sovereignty to the people, and to work towards the middle ground to resolve the nation\u27s core problems. History teaches us that recognizing, adopting and adhering to the middle path takes much vision and courage. The natural instinct is to stick to one\u27s own interpretation of the world (usually based on narrow self-interest) and to shun ideas and individuals that require a moderation of one\u27s views. However, success in politics and statecraft, more so than in any other area of human affairs, is hinged to the middle ground in a way that ultimately requires friend and foe to migrate sufficiently towards each other so that the peoples\u27 business can move forward and flourish. We urge all political forces in Nepal to recognize that great achievements in the affairs of nations come about when leaders practice the art of compromise. There is no dishonor for Nepal\u27s monarch and political leaders if they follow the path of the likes of Gandhi, Nehru and Mandela.\u2

Subcutaneous Fat Obesity in a High Body Mass Index Donor Is Not a Contraindication to Living Donor Hepatectomy

Background. Living donor liver transplantation (LDLT) has revolutionized the field of transplantation without compromising donor safety. Donor safety is of paramount concern to the transplant team. BMI >35 kg/m2 is mostly considered a contraindication to liver donation. Here, we present a successful right donor hepatectomy from a donor with a BMI of 36.5 kg/m2. Case Summary. A 39-year-old wife donated her right lobe of liver to her 43-year-old husband with nonalcoholic steatohepatitis-related chronic liver disease (CLD). His indications were refractory ascites, hepatic encephalopathy, acute kidney injury, recurrent elbow and urine infections leading to cachexia. She was initially rejected due to a high BMI but failed to lose weight over the next 2 months, and the need for a transplant in her husband was imminent. With no other potential living donors, we decided to proceed with donor evaluation as she had no other comorbidity. We were surprised to find normal liver function tests and a good liver attenuation index (LAI) of +16 on a computed tomography (CT) scan. Magnetic resonance (MR) imaging revealed a fat fraction of 3%. Volumetry confirmed a remnant of 37.9% and a potential graft-to-recipient weight ratio of 1.23. V/S ratio on CT scan (visceral fat area/subcutaneous fat area at L4-level) was 35 kg/m2. A small percentage of healthy individuals will not have visceral fat obesity and may not have steatotic livers. The CT scan and MR fat fraction estimation can confirm the findings. Biopsy may be avoided if MR fat estimation is 35 kg/m2) with pure subcutaneous fat obesity in the absence of other suitable living donors

Patient Safety and organizational Safety Culture in Surgery: A Need of an Hour in the developing countries

Every year, more than 200 million surgeries are performed around the world, and recent statistics show that adverse event rates for surgical pathologies remain unacceptably high, despite several national and global patient safety initiatives over the last decade. Patient safety is diverse and highly complicated in nature, with several critical components. Although concern for patient safety is fundamental in health care practice, its transition into knowledge is comparatively recent, and hence patient safety may be deemed a "new" field. Current surgical safety guidelines and checklists are generic and not adapted to specific patient concerns and risk factors in surgical subspecialties. All surgical practitioners and health care organizations must therefore become better aware of the fundamental context of patient safety, actively participate in endeavors to integrate patient safety measures in daily practice, and foster a patient safety culture. The purpose of this review article is to outline patient safety in surgical techniques that should be adopted and implemented

Democratic Middle Ground in Nepal: A Perspective from the North American Nepali Diaspora

The call of our time is to safeguard the accomplishments of the 1990 People’s Movement, to restore sovereignty to the people, and to work towards the middle ground to resolve the nation’s core problems. History teaches us that recognizing, adopting and adhering to the middle path takes much vision and courage. The natural instinct is to stick to one’s own interpretation of the world (usually based on narrow self-interest) and to shun ideas and individuals that require a moderation of one’s views. However, success in politics and statecraft, more so than in any other area of human affairs, is hinged to the middle ground in a way that ultimately requires friend and foe to migrate sufficiently towards each other so that the peoples’ business can move forward and flourish. We urge all political forces in Nepal to recognize that great achievements in the affairs of nations come about when leaders practice the art of compromise. There is no dishonor for Nepal’s monarch and political leaders if they follow the path of the likes of Gandhi, Nehru and Mandela.Nepal Study Center, University of New Mexic