Information Transfer and Communication in Surgical Care

Effective Information transfer and Communication is one of the key aspects of good medical practice and essential for surgical safety. High reliability organisations such as aviation have highlighted the importance of communication for safety and regularly provide communication skills training to their team members via Crew resource management (CRM) module. This report discusses important aspects of communication research in high-risk environments and confers its application in surgery. It analyses the nature and scope of communication failures in surgical field. The thesis has taken bottom-up approach unlike other research in this field, which has taken a top-down approach. First we have mapped and analysed the communication failures across the entire surgical pathway. Analysis of full pathway is critical as communication failures are not discrete events; information loss in one phase of care can potentially compromise safety in a subsequent phase. After the analysis, user-centred interventions were developed and implemented to enhance the information transfer and communication in the postoperative handover phase. Results show that information transfer and communication failures are ubiquitous and distributed across the continuum of surgical care. These findings indicate that there is a room for improvement for enhancing ITC in surgical care. There is an imminent need for standardizing and structuring communication through use of checklists, proformas, care pathways and information technology. Subsequently we have demonstrated that standardization of ITC process through the implementation of postoperative handover proforma has improved the information transfer and decreased the ITC errors. It is hoped that this thesis provides a first step towards understanding, assessing and improving information transfer and communication through entire surgical care pathway, which in a long run will improve surgical safety

Macular Hole Progression after Intravitreal Bevacizumab for Hemicentral Retinal Vein Occlusion

Macular edema secondary to retinal vein occlusion is commonly being treated with off-label intravitreal bevacizumab with good outcomes. A significant reduction in macular edema and improvement in visual acuity is seen following such a treatment with no serious adverse effects. In the reported case, a full-thickness macular hole was noticed one month after intravitreal bevacizumab for macular edema secondary to hemicentral retinal vein occlusion. On a detailed review of the pre- and postoptical coherence tomography scans, it was realized that there was a preexisting stage 2-3 macular hole which was masked by the hemorrhages and edema at the fovea and the macular hole had progressed following the injection

Trip Planner: A Big Data Analytics Based Recommendation System for Tourism Planning

Foreign tourism has gained immense popularity in the recent past. To make a rational decision about the destination to be visited one has to go through variety of social media sources with very large number of reviews, which is a tedious task. Automated analysis of these reviews is quite complex as it involves non structured text data having slang terms also. Moreover, these reviews are pouring in continuously. To overcome this problem, this paper provides a Big Data analytics-based framework to make appropriate selection of the destination on the basis of automated analysis of social media contents based upon the adaptation and augmentation of various tools and technologies. The framework has been implemented using Apache Spark and Bidirectional Encoder Representation Transformers (BERT) deep learning models through which raw text review are analysed and a final score based on five metrics is obtained to recommend destination for visit

Current status of cesarean section myomectomy-prospective ongoing study

Background: The aim of the study was to assess the feasibility, safety and efficacy of performing myomectomy during cesarean section.Methods: It was prospective study conducted in Sri Guru Ram Das University of Health and sciences which is a tertiary care referral centre. Myomectomy was conducted in 34 pregnant women during elective or emergency cesarean section. Analysis was done with reference to age, parity, character of myomas, intraoperative and post-operative morbidity, duration of surgery and duration of stay in hospital.Results: In this study 34-58 fibroid of various size (2-14 cm) were removed in 34 patients during cesarean section. Majority of fibroids were located in body of uterus (65.5%) and in anterior wall (55.2%) and all them were sub serosal. No significant difference was found in mean preoperative hemoglobin (11.8±0.7) and postoperative hemoglobin (10.9±0.8). No patient had postpartum hemorrhage requiring cesarean hysterectomy. Only two patient needed blood transfusion postoperatively. Mean time taken for surgery was 58.4±8.94 minute and average duration of hospital stay was 6.7±1.6.Conclusions: With the advent of better anesthesia, easy availability of blood and blood component, cesarean myomectomy is safe surgical procedure when performed by experienced obstetrician in carefully selected patients

Adenomyosis: correlating clinical suspicion with histopathological diagnosis in a retrospective study

Background: Adenomyosis and leiomyoma are the common causes of abnormal uterine bleeding (AUB). In this study it is aimed to evaluate the correlation of clinical and histopathological examination (HPE) of these entities leading to abnormal uterine bleeding.Methods: This retrospective study was carried out on hysterectomy specimens of subjects who presented themselves in the department of obstetrics and gynaecology of Sri Guru Ram Das Institute of medical sciences and research, Amritsar with chief complaints of AUB not responding to conservative treatment.Results: A total of 100 women with clinical diagnosis of AUB in which hysterectomies were performed, leiomyoma was found in 42% cases, adenomyosis in 22% cases. The most frequent combination of diagnosis was leiomyoma and adenomyosis i.e. 26%. In 9% cases chronic cervicitis and ovarian cyst were detected. In one case endometrial malignancy was found.Conclusions: Though adenomyosis and leiomyoma are clinically diagnosed along with other pathological conditions of the reproductive organs but their confirmation is still to be relied upon HPE; a most important investigation

Non-haemorrhagic causes of obstetrical intensive care unit admissions in tertiary care setting

Background: Management of critically ill obstetric patients involve intensive monitoring in intensive care unit. In present scenario there are significant number of obstetric patients with sepsis, tropical diseases and medical illness that require ICU care. The aim of this study was to evaluate in more detail the non-haemorrhagic causes of obstetric ICU admissions and to identify and adopt high risk strategies as prime learning objective.Methods: It is a prospective ongoing study conducted in 50 patients in SGRDUHS, Amritsar from December 2016 to October 2019, who were admitted in obstetric ICU, out of them 30 cases were attributed to non-haemorrhagic obstetric causes. All demographic parameters along with gestational age, diagnosis on admission, intervention done prior to shift to ICU and details of treatment given in ICU were evaluated. Patient outcome, review of mortality and area of improvement were also noted.Results: Majority of the patient (70.1%) were admitted in 3rd trimester. Obstetric sepsis (13.33%), infective diseases (16.66%), tropical conditions (16.66%), medical disorders (26.66%) and hypertensive disorders (26.66%) were the major causes of admission to obstetric ICU. There were 33.3% mortalities observed in present study and 40% were due to respiratory failure. In ICU mechanical ventilation was done in 63.3% cases and blood products were given in 33.3% of patients.Conclusions: A multidisciplinary approach is ideal to handle non-haemorrhagic situations especially related to medical disorders and tropical diseases. Review of the ICU admissions and periodic audit can improve management of morbidities as well as reduce maternal mortalities

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

A comparative debate on the various anti-vascular endothelial growth factor drugs: Pegaptanib sodium (Macugen), ranibizumab (Lucentis) and bevacizumab (Avastin)

Wet age-related macular degeneration and diabetic retinopathy are pathological consequences of vascular endothelial growth factor (VEGF) release as a reaction to deficiency of oxygen and nutrients in the macular cells. Conventional treatment modalities have been constrained by limited success. Convincing evidence exists that targeting VEGF signaling is a significant approach for the therapy of these ocular angiogenesis-dependent disorders. We have come a long way since the approval of the first angiogenesis inhibitors in medicine. The clinical use of these drugs has provided enormous tempo to clinical and pharmacological research. It has also significantly altered patient outcome and expectations. In the following brief, we will discuss the development and emergence of these drugs as well as the anticipated future course based on evidence