Can Paediatric Femoral Fracture Hip Spica Application be Done in the Outpatient Setting?

@#children with femur fractures. This study compares the outcomes of spica cast application, in terms of quality of fracture reduction and hospital charges when performed in operating theatre versus outpatient clinics at a local institution. Materials and Methods: A total of 93 paediatric patients, aged between 2 months to 8 years, who underwent spica casting for an isolated femur fracture between January 2008 and March 2019, were identified retrospectively. They were separated into inpatient or outpatient cohort based on the location of spica cast application. Five patients with metaphyseal fractures and four with un-displaced fractures were excluded. There were 13 and 71 patients in the outpatient and inpatient cohort respectively who underwent spica casting for their diaphyseal and displaced femur fractures. Variables between cohorts were compared. Results: There were no significant differences in gender, fracture pattern, and mechanism of injury between cohorts. Spica casting as inpatients delayed the time from assessment to casting (23.55 ± 29.67h vs. 6.75 ± 4.27h, p<0.05), increased average hospital stay (41.2 ± 31.1h vs. 19.2 ± 15.0h, p<0.05) and average hospital charges (US$1857.14 vs US$775.49, p<0.05). Excluding the un-displaced fractures, there were no significant differences in the period of cast immobilisation and median follow-up length. Both cohorts had a similar proportion of unacceptable reduction and revision casting rate. Conclusion: Both cohorts presented similar spica casting outcomes of fracture reduction and follow-up period. With spica cast application in operating theatre reporting higher hospital charges and prolonged hospital stay, the outpatient clinic should always be considered for hip spica application.

Perceived needs of patients undergoing coronary artery bypass graft surgery during perioperative period

Introduction: Perioperative care is nursing care provided by perioperative nurses to surgical patients during the perioperative period. Its role is important as patients especially those who had undergone coronary artery bypass graft (CABG) surgery encounter high levels of psychological and physical stress. Objective: To determine the needs of CABG patients throughout the perioperative period and how well those needs were met. Methods: This is a cross sectional descriptive survey. A total of 88 patients who had undergone coronary artery bypass graft were recruited through census sampling. The instrument which was adapted and used with permission for this study was “Survey of Patient Needs and Experiences during the Perioperative Period’ questionnaire (Davis et al., 2014). Results: The patients perceived the perioperative needs in the post-anaesthesia care unit area to be the most important (M = 2.89, SD = 0.06). Perioperative needs which were rated the highest for each of the four time periods were “Having information about the surgical procedure itself”, “Having your family member or significant other with you in the pre-surgical area complications”, “Being treated with respect and with dignity by hospital personnel” and “Having your family member or significant other visit you in the recovery room”. Overall, patients perceived their needs during perioperative period to be partly met (M = 2.73, SD = 0.07) with post-anaesthesia care unit area being rated the highest (M = 2.81, SD = 0.06). Conclusion: The results of this study highlighted the perceived needs of patients undergoing coronary artery bypass graft surgery throughout their perioperative period. In order to improve the quality of perioperative care for patients, nurses need to take into consideration the important needs identified by the patients and address the items which were not meeting the needs of the patients.

A Research and Discuss on the Training Style of Professional Core Competence in the Operating Theatre / 中国实用护理杂志

Objective To research and discuss the scientificalness and effectiveness of professional core competence training in the operating theatre so as to seek for a way for the professional growth of operating room nurses.Methods Under the guidance of Guideline on Core Competence Building of Professional Nurses compiled by Department of Health of Guangdong Province in 2009,in accordance with the theory of core competence training and taking into account of different yearly salaries and levels of 21 nurses,we made respective plans and carried them out.Results After implementing professional core competence training,the rate of operating nurses' mastering basic knowledge and techniques reaches 92.50％,the rate of mastering professional knowledge and techniques reaches 86.25％,the ability of clinical thinking increases by 85％,the ability of education and research development increases by 78.50％,the ability of self-training raises by 98.20％,safe management raises by 91.50％,and the emergency ability raises by 93.60％.The analysis and compare are based on seven aspects,therefore are of statistical significance.Conclusion The training of the core competence in the operating theatre is practical,scientific and feasible in-service education which not only improves operating room nurses' abilities of clinical thinking and solving clinical nursing problems,but also provides career progress for operating room nurses.

Contaminação do ar em salas cirúrgicas durante cirurgias de artroplastias total de quadril e joelho, hemiartroplastias e osteossínteses no centro cirúrgico de um hospital Brasileiro / Air contamination levels in operating rooms during surgery of total hip and total knee arthroplasty, hemiarthroplasty and osteosynthesis in the surgical center of a Brazilian hospital

INTRODUÇÃO: Avaliou-se o nível da contaminação do ar em cirurgias ortopédicas. MÉTODOS: O ar das salas cirúrgicas foi analisado microbiologicamente através da exposição de placas próximas à mesa cirúrgica por uma hora. RESULTADOS: Foram evidenciados valores acima do recomendado (369 UFC/m³) nas salas convencionais, assim como naquelas com ar ultralimpo. A contaminação foi predominantemente por Staphylococcus sp (86,9 por cento). verificou-se um número alto de pessoas presentes no interior das salas cirúrgicas, assim como de abertura da porta. CONCLUSÕES: Os níveis de contaminação se apresentaram acima dos valores aceitos por agências reguladoras, representando risco para os pacientes.

INTRODUCTION: The air contamination levels during orthopedic surgeries were evaluated. METHODS: The air of operating rooms (ORs) was examined through exposure to microbiological plates placed near the surgical table for an hour. RESULTS: values above that recommended (369 CFU/m³) for conventional ORs and ORs with ultraclean air were determined. Contamination was predominantly by Staphylococcus sp (86.9 percent). In all surgeries a high number of people were present inside the ORs and the doors were opened frequently. CONCLUSIONS: The contamination levels are above the values accepted by regulatory agencies, representing risk for patients.

Estressores e sintomas de estresse vivenciados por profissionais em um centro cirúrgico / Estressors and symptoms of stress lived by health workers in a surgical center / Estressors y síntomas de tensión vividos por los profesionales en un centro quirúrgico

Nesta pesquisa identificam-se estressores e sintomas de estresse vivenciados por profissionais em um centro cirúrgico. Consiste em um estudo qualitativo, descritivo, exploratório, do qual participaram 29 profissionais. Para a coleta de dados, foram utilizados diário de campo e entrevista semi-estruturada. A análise dos depoimentos resultou na categoria de análise: "Re-conhecendo estressores e sintomas de estresse em profissionais de um centro cirúrgico". Os estressores originam-se das relações interpessoais, falta/insuficiência de materiais, equipamentos, pessoal, aliados a aspectos administrativo-gerenciais, qualificação da equipe, demanda cirúrgica e condição do paciente. Os sintomas físicos incluem dor no corpo, enxaqueca, taquicardia, diarréia, cansaço, hipertensão, sudorese; os sintomas psicológicos referidos foram: impotência, raiva, ódio, mau humor, nervosismo, ansiedade, irritabilidade, desconforto, medo da morte do paciente, cansaço mental, angústia, dentre outros. Os resultados podem desencadear reflexões e ações para reduzir estressores e/ou elencar estratégias eficazes para lidar com o estresse no ambiente de trabalho.

The research identifies stressors and stress symptoms lived by health workers in a surgical center. It is a qualitative study, descriptive, exploratory, with the participation of twenty-nine workers. For the collection of data we used semi-structured interviews and field diaries. The analysis of the statements resulted in an analysis category: "Recognizing stressors and stress symptoms in workers at a surgical center". The stressors result from relationships, the lack of or insufficient materials, equipment, personnel, allied to administrative-managerial aspects, qualification of the team, surgical demands and the patient's condition. The physical symptoms include pain, headache, high cardiac frequencies, diarrhea, fatigue, hypertension, perspiration; the psychological symptoms reported were: impotence, rage, hate, bad mood, nervousness, anxiety, irritability, and discomfort, fear of patient's death, mental fatigue, and anguish, among others. The results can bring about reflections and actions to reduce stressors and effective strategies to deal with stress in the workplace.

La presente investigación identifica estresores y síntomas de estrés padecidos por profesionales en un centro quirúrgico. Se trata de un estudio cualitativo, exploratorio descriptivo llevado a cabo con veintinueve profesionales. La recogida de datos se realizó mediante entrevista semiestructurada y registro de campo. El análisis de los testimonios resultó en la siguiente categoría de análisis: "Reconocimiento de estresores y síntomas de estrés en profesionales de un centro quirúrgico". Los estresores provienen de las relaciones interpersonales, falta de material, equipos, personal y están vinculados a aspectos administrativos, calificación del equipo, demanda laboral y condición del paciente. Los síntomas físicos incluyen dolor en el cuerpo, jaqueca, taquicardia, diarrea, cansancio, hipertensión, hiperhidrosis y los psicológicos impotencia, rabia, odio, malhumor, nerviosismo, ansiedad, irritabilidad y malestar, miedo a la muerte del paciente, cansancio mental y angustia, entre otros. Los resultados podrían suscitar reflexiones y acciones para reducir el nivel de estrés y/o listar estrategias eficaces para lidiar con el estrés en el ambiente laboral.