Glove failure in elective thyroid surgery: A prospective randomized study

Objectives: To analyze perforation rate in sterile gloves used by surgeons in the operating theatre of the Department of Endocrinological and General Surgery of Medical University of Lodz. Material and Methods: Randomized and controlled trial. This study analyses the incidents of tears in sterile surgical gloves used by surgeons during operations on 3 types of thyroid diseases according to the 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes. Nine hundred seventy-two pairs (sets) of gloves were collected from 321 surgical procedures. All gloves were tested immediately following surgery using the water leak test (EN455-1) to detect leakage. Results: Glove perforation was detected in 89 of 972 glove sets (9.2%). Statistically relevant more often glove tears occurred in operator than the 1st assistant (p < 0.001). The sites of perforation were localized mostly on the middle finger of the non-dominant hand (22.5%), and the non-dominant ring finger (17.9%). Conclusions: This study has proved that the role performed by the surgeon during the procedure (operator, 1st assistant) has significant influence on the risk of glove perforations. Nearly 90% of glove perforations are unnoticed during surgery

Clinical Characteristics, Treatment, and Short-Term Outcome in Patients with Heart Failure and Cancer.

(1) Our study aimed to look at the clinical characteristics, treatment and short-term outcomes of patients hospitalized due to heart failure with coexisting cancer. (2) Methods: Seventy one cancer (Ca) patients and a randomly selected 70 patients without Ca, hospitalized due to heart failure exacerbation in the same time period constituted the study group (Ca patient group) and controls (non-Ca group), respectively. Data on clinical characteristics were collected retrospectively for both groups. (3) Results: Cancer patients presented with a less advanced NYHA class, had more frequent HFpEF, a higher peak troponin T level, and smaller left atrium size, as compared with controls. The in-hospital deaths of Ca patients were associated with: a higher New York Heart Association (NYHA) class, lower HgB level, worse renal function, higher K and AST levels, presence of diabetes mellitus, and HFpEF. By multivariate logistic regression analysis, impaired renal function was the only independent predictor of in-hospital death in Ca patients (OR-1.15; CI 1.05; 1.27); p = 0.017). The following covariates entered the regression: NYHA class, HgB, GFR, K+, AST, diabetes mellitus t.2, and HFpEF. (4) Conclusions: The clinical picture and the course of heart failure in patients with and without cancer are different

Lateral or Medial Parapatellar Surgical Approach to the Valgus Osteoarthritic Knee? A Retrospective Single-Center Study

Aims: Total knee arthroplasty in patients with fixed valgus deformity is a demanding procedure. The aim of this study was to compare the clinical results of using the lateral approach [LA] versus the medial approach [MA] in the treatment of fixed valgus knee deformities. Methods: This single-center study compared the results of 143 consecutive patients with fixed valgus deformity (mean 21.55° valgus, mean age 68.2 years) undergoing LA Total Knee Arthroplasty [TKA] to 50 patients (mean 16.58° valgus, mean age 67.2 years) undergoing MA TKA. The mean follow-up period was 5.1 years (2–10 years). Data was collected from operative notes, routine postoperative visits, and radiological findings. Apart from a radiological evaluation, patients were clinically assessed both pre- and postoperatively using the Knee Society Score [KSS]. Descriptive statistics together with the Kolmogorov-Smirnov test, the Student’s t-test for independent samples, and the Mann-Whitney U test were used. The level of significance in this study was α = 0.05. Results: In the LA group, the KSS Knee was significantly higher than in the MA group [85.31 vs. 77.42, respectively, p-value p-value 0.087]. The surgery time in the LA group was shorter than in the MA group [81 vs. 91 min, respectively, p-value—0.002]. The complication rate after surgery was higher in the MA group than in the LA group (14% vs. 9%, respectively). Conclusions: The lateral approach is a good alternative to the standard medial parapatellar approach in the treatment of fixed valgus knee deformities. A higher postoperative KSS Knee, shorter surgery time, and similar complication rate make the lateral approach a valuable option for treating patients with osteoarthritis and fixed valgus knee deformity

Sytuacja finansowa szpitala po wejściu w życie sieci szpitali

Purpose: Changes in the health care system introduced in the fourth quarter of 2017 with the entry into force of the so-called “Hospital networks” constituted a huge challenge for managers of medical entities. The assumption of this work is to present, based on the example of the provincial hospital in Łódź, how the changes in legal regulations introduced over the last few years have influenced the financial condition of the institution and its organization. Design/methodology/approach: The financial results of the audited entity were analysed from 2014 to 2019. The most important legal changes (mainly the implementation of the hospital network) as well as their impact on the income from the National Health Fund (NFZ) are presented. The probable (expected) financial result for 2019 is estimated. Findings: From 2014 to 2016, there was a systematic increase in revenues from the NFZ and a positive financial result (about 10 million a year). From 2017, along with the Act on basic hospital security, there was a reduction in profits. Medical staff strikes (payroll claims) in the second half of 2018 additionally contributed to the reduction of revenues from the NFZ. As a consequence, it was necessary to implement, from 2019, a series of corrective actions aimed at reducing costs and increasing savings (employment reduction, organizational changes). Research limitations/implications: Implementation of cost-reducing measures. Originality/value: Original work. JEL: D81 Acknowledgements This research received no funds. Suggested Citation: Sierocka, A., Kostrzewa, D., Leśniak, T. & Marczak, M. (2020). The Financial Situation of the Hospital After the Introduction of the Law on the Hospital Network. Problemy Zarządzania (Management Issues), 18(3), 67–83.Cel: zmiany w systemie ochrony zdrowia wprowadzone w IV kwartale 2017 roku wraz z wejściem w życie tzw. sieci szpitali stanowiły ogromne wyzwanie dla menedżerów podmiotów leczniczych. Założeniem niniejszej pracy jest przedstawienie na przykładzie szpitala wojewódzkiego w Łodzi, jak istotnie wprowadzone na przestrzeni kilku ostatnich lat zmiany przepisów prawnych wpłynęły na stan finansowy placówki i jej organizację. Metodologia: przeanalizowano wyniki finansowe badanej jednostki od 2014 do 2019 roku. Przedstawiono najważniejsze zmiany prawne (przede wszystkim wdrożenie sieci szpitali), jak również ich wpływ na wielkość przychodów z NFZ. Oszacowano prawdopodobny (zakładany) wynik finansowy na rok 2019. Wyniki: od 2014 do 2016 roku widoczny był systematyczny wzrost przychodów z NFZ i dodatni wynik finansowy (ok.10 mln rocznie). Od 2017 roku wraz z ustawą o podstawowym zabezpieczeniu szpitalnym nastąpiło ograniczenie zysków. Strajki (roszczenia płacowe) personelu medycznego w II połowie 2018 roku dodatkowo przyczyniły się do obniżenia przychodów z NFZ. W konsekwencji konieczne było wdrożenie od 2019 roku szeregu działań naprawczych mających na celu redukcję ponoszonych kosztów i zwiększenie oszczędności (redukcja zatrudnienia, zmiany organizacyjne). Ograniczenia/implikacje badawcze: wdrożenie działań redukujących koszty. Oryginalność/wartość: praca oryginalna. JEL: D81 Acknowledgements This research received no funds. Suggested Citation: Sierocka, A., Kostrzewa, D., Leśniak, T. & Marczak, M. (2020). The Financial Situation of the Hospital After the Introduction of the Law on the Hospital Network. Problemy Zarządzania (Management Issues), 18(3), 67–83

Financial Expenses and &ldquo;Losses&rdquo; of the Polish Healthcare System Resulting from the Occurrence of Adverse Events

Background: The globally increasing healthcare expenditures related to the need to treat the consequences of adverse events, as well as the number of claims filed by patients (or their families) and remuneration paid as their result mean that the interest in the subject of adverse event cost management is increasing. An increase in the number of cases concerning medical errors has also occurred in Poland in recent years. The newest statistics from the Ministry of Justice demonstrate that the courts are awarding increasingly higher amounts. The goal of this work was an attempt to approximate, based on our own experiences, the impact of adverse events on the expenditures of the healthcare system in Poland, including the costs of treatment of the consequences of such events, described by the authors as &ldquo;secondary harm&rdquo;. Methods: Based on the analysis of 100 cases for compensation for the occurrence of a medical event, an initial estimate of the costs of primary (initial) treatment, which resulted in the occurrence of the adverse event, and the costs of subsequent hospitalisations/stays, which were its consequences. The study was conducted in the period from October 2020 to November of 2021. Results: The statistical analysis of the examined cases enabled establishing that in 62% they concerned women. Only 38% were events which applied to men. The highest number of cases concerned events which occurred in the last years, that is 2018 (35%), 2019 (23%), and 2017 (17%). The most frequent events included those related to incorrect diagnosis (the lack of correct diagnosis), which resulted in appropriate activities not being undertaken and a lack of appropriate treatment, e.g., lack of diagnosis of cancer, myocardial infarction, appendicitis, or fracture (26%). The next one was incorrect surgical treatment (17%)&mdash;the consequence of which was most frequently a need for repeated surgery and an incorrect conservative treatment of injuries. The obtained results demonstrate that significantly higher funds are spent by medical entities for &ldquo;restorative&rdquo; actions (on average EUR 1433, which attempt to mitigate against the negative consequences of incorrect decisions or actions in the original treatment (average cost of EUR 814)). Conclusions: The consequences of adverse events include not only health-related harm for the patient, but also long-term social, familial, or professional results. The authors of the article are of an opinion that all the conducted analyses and conclusions drawn from them should serve the improvement of patient safety. They also form an initial point for establishing recommendations and advice for the improvement of safety and quality of medical services and the reduction of healthcare-related costs. The authors propose covering the parties injured by an adverse event (subjected to &ldquo;secondary harm&rdquo;) with a unique, innovative programme of post-accident health care, &ldquo;Health Reconstruction&rdquo;

Shaft Fractures in Patients Requiring Primary or Revision Total Knee Arthroplasty Can Be Successfully Treated with Long-Stemmed Implants without Additional Fixation

The aim of this study was to evaluate the bone union, complication rate, clinical and functional outcomes of long-stemmed total knee arthroplasty (TKA) in patients with periprosthetic femoral or tibial shaft fractures and in patients with femoral or tibial shaft fractures with coexisting advanced knee osteoarthritis (OA). This retrospective study comprised 25 patients who underwent surgery due to tibial or femoral shaft fractures: (1) with coexisting severe knee OA or (2) with a periprosthetic fracture requiring implant exchange. In all cases, fracture stabilization was performed intramedullary with the use of long-stemmed implants without the use of additional fixation material (plates, screws, or cerclage). Bone union was achieved in 22/25 patients (88%). One patient required revision with additional plate stabilization due to non-union, and asymptomatic partial bone union was observed in two cases. The group with periprosthetic fractures demonstrated good clinical (mean 73.1 ± 13.3) and moderate functional (mean 59.2 ± 18.8) outcomes in the Knee Society Scoring system (KSS). In the group with shaft fracture and coexisting OA significantly higher clinical (excellent results, mean 84.1 ± 11; p = 0.03) and functional (good results, mean 76.2 ± 20.6; p = 0.04) results were noted. There were no statistically significant differences in terms of range of motion (ROM) or complication rate between these two groups. One-stage TKA with a long-stemmed implant without the use of additional fixation material is an effective method for the treatment of femoral or tibial shaft fractures in patients who require joint replacement. Despite being technically demanding, the approach yields bone union and moderate to excellent clinical and functional outcomes with a relatively low complication rate

Developing a model of information transfer practice between institutions targeted at primary health care patients who are asymptomatic carriers of carbapenemase producing <i>Enterobacteriacae</i>

Background Drug-resistant bacteria are one of the main reasons of deaths worldwide. A significant group of these bacteria are carbapenemase producing Enterobacteriaceae (CPE). The goal of this study was to develop a diagnostic and therapeutic model targeted at asymptomatic carriers of CPE. Material and Methods A team of experts from different branches connected to health care, discussing the topic based on the data collected from previous research. Working sessions were dispersed between June and December 2022. The consensus has been reached via repeated discussion and literature search. Results The facility where CPE are detected is required to create an alert pathogen note and to notify sanitary-epidemiological station and National Reference Centre for Antimicrobial Susceptibility of Microorganisms – neither these institutions, nor the patient are required to notify the primary care physician. In primary care clinics, it is possible to work towards breaking the transmission of CPE by educating patients with CPE and persons who were in contact with them, and to undertake actions in order to look for patients with risk factors for CPE colonisation. In order to improve communication between individual levels of the health care system, standardised information could be introduced to the discharge note about a case of CPE, which will be electronically transmitted to the primary care facility. It might contribute to effective combating of the spread of CPE, by serving as a source of knowledge and education for patients and by checking the patient’s risk factors, which will improve the performance of tests for CPE colonisation. Conclusions The established model of good practice requires a change of legal regulations and its implementation, which will reduce the spread of CPE in health care facilities and will enable its future improvement

Glove failure in elective thyroid surgery: A prospective randomized study

Objectives: To analyze perforation rate in sterile gloves used by surgeons in the operating theatre of the Department of Endocrinological and General Surgery of Medical University of Lodz. Material and Methods: Randomized and controlled trial. This study analyses the incidents of tears in sterile surgical gloves used by surgeons during operations on 3 types of thyroid diseases according to the 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes. Nine hundred seventy-two pairs (sets) of gloves were collected from 321 surgical procedures. All gloves were tested immediately following surgery using the water leak test (EN455-1) to detect leakage. Results: Glove perforation was detected in 89 of 972 glove sets (9.2%). Statistically relevant more often glove tears occurred in operator than the 1st assistant (p < 0.001). The sites of perforation were localized mostly on the middle finger of the non-dominant hand (22.5%), and the non-dominant ring finger (17.9%). Conclusions: This study has proved that the role performed by the surgeon during the procedure (operator, 1st assistant) has significant influence on the risk of glove perforations. Nearly 90% of glove perforations are unnoticed during surgery