Implementation of Evidence-Based International Recommendations Reduces Postoperative Delirium Rate in Patients Undergoing Cardiac Surgery or Interventions: A System-Based Quality Improvement Study.

Background: Delirium is a frequent and serious complication of cardiac procedures that can lead to serious long-term health restrictions. As primary prevention is more effective in reducing rate of delirium than the therapy itself, this study aimed to investigate the effect of a multidisciplinary delirium prevention bundle on the postoperative delirium rate in patients undergoing cardiac procedures. Methods: In this system-based quality improvement study, a four-component delirium prevention bundle was implemented in patients undergoing cardiac procedures at a single high-volume center. The program included preoperative delirium risk stratification, multidisciplinary education of consensus guidelines, written memory aids, and post-anesthetic visits with delirium screening until postoperative day three. Results: Overall, 234 patients were included and analyzed during the 6-month study period. The overall delirium incidence rate was 12.4%. After the first 3-month baseline implementation period, the delirium rate was 17.2%, compared with 7.6% (p = 0.026) after implementation of the delirium prevention bundle. Multivariate analysis revealed independent risk factors such as age [adjusted odds ratio (OR): 1.046; 95% confidence interval (CI): 1.002-1.092; p = 0.042], double valve surgery [adjusted OR: 13.1; 95% CI: 3.240-52.974; p < 0.0001], and peripheral artery disease [adjusted OR: 8.131; 95% CI: 2.336-28.306; p < 0.001]. Hospital stay was significantly longer in patients with delirium [median 13 (12-19.5) versus 12 (11-14) days, p = 0.009]. Conclusions: This multidisciplinary system-based quality improvement study demonstrated a beneficial effect on the delirium rate after the implementation of a four-component delirium prevention bundle in patients undergoing cardiac surgery or intervention. Furthermore, multivariate analysis revealed important independent risk factors for delirium development. This might improve early risk stratification and strategies for this high-risk patient collective.

Wearable devices as part of postoperative early warning score systems: a scoping review.

Postoperative deterioration is often preceded by abnormalities in vital parameters, but limited resources prevent their continuous monitoring in patients with no indication to ICU admission. The development of new technologies allowed the introduction of wearable devices (WDs), enabling the possibility of postoperative monitoring in surgical wards. We performed a Scoping Review to determine the current use of wearable devices as part of Continuous Remote Early Warning Score (CREWS) systems and their efficiency during postoperative period. This Scoping Review was conducted according to PRISMA-ScR guidelines. PICO framework was used before the search to define the review protocol. Systematic literature research has been performed on PubMed, MeSH, MEDLINE and Embase, considering a period between 2018 and February 2024. Prospective and retrospective studies involving patients undergoing cardiac and non-cardiac surgery are included. A total of 10 articles were included in the review. 11 different CE/FDA approved wearable devices were used in the studies analyzed. In all studies the WDs were applied the day of the surgery. The use of WDs as part of CREWS systems is feasible and safe. Furthermore, with the aid of other technologies (LoRa and Artificial Intelligence), they shorten Length of Stay (LOS) and reduce the number of ICU admissions with a reduction in healthcare costs. Continuous monitoring in surgical departments can facilitate the correct and timely identification of postoperative complications. This article is a starting point for the development of new protocols and for the application of these monitoring systems in clinical practice.

The effect of preadmission education given to bariatric surgery patients on postoperative recovery: A randomized controlled study.

AIM: To investigate the effect of preadmission education given to laparoscopic sleeve gastrectomy patients on preoperative and postoperative anxiety, postoperative pain, and patient vital signs. METHODS: The study was designed as randomized, controlled, experimental, and single-blind. This study was conducted with 68 patients who met the inclusion criteria and underwent laparoscopic sleeve gastrectomy in the general surgery clinic of a university hospital between December 2022 and October 2023. Data were collected using the 'Perioperative Form,' 'Visual Analog Scale,' and 'State Anxiety Scale I-II.' Intervention group patients were informed and educated about the surgical process in the outpatient clinic. The anxiety levels of all patients were determined with the State Anxiety Scale the day before surgery. In the postoperative period, vital signs (once), anxiety (on the first day after surgery), and pain levels (eight times during 48 h) were measured. RESULTS: In the analysis between the groups, the difference between the duration of postoperative hospital stay (p = 0.007), pain (p = 0.000 for all measured), and anxiety levels (p = 0.000) was statistically significant. There were also significant differences in the diastolic blood pressure (p = 0.007), body temperature (p = 0.000), and saturation values (p = 0.000). Patients' readiness level for surgery was the most influential factor in postoperative pain levels (p = 0.000). CONCLUSION: The education given to the patients before hospitalization decreased preoperative and postoperative anxiety levels, postoperative hospital stay and pain levels, and positively affected diastolic blood pressure, body temperature and saturation levels. One-to-one education given to patients in the outpatient clinic also contributes positively to their readiness for surgery. This study provides valuable evidence to the wider global clinical community by demonstrating the important benefits of preadmission education for patients undergoing bariatric surgery. Implementation of similar educational interventions in diverse healthcare settings worldwide may lead to increased postoperative recovery and improved overall patient well-being after bariatric surgery.

Management of Pathologic Hip Fracture Secondary to Musculoskeletal Echinococcosis: A Case Report.

A 50-year-old female from Uzbekistan presented to our emergency department with severe right hip pain and loss of ambulation. Her history included multiple hepatic echinococcal cyst resections. After a fall, she underwent a proximal femur open reduction and internal fixation (ORIF) and revision in Uzbekistan, which revealed broken screws and cystic lesions. Subsequent treatment included hardware removal, proximal femur replacement, and antiparasitic therapy, leading to significant improvement. This case highlights the need for considering rare pathologies in atypical orthopedic presentations and demonstrates the effectiveness of integrating detailed history, careful diagnostics, and coordinated care to manage challenging conditions.

Methodology for Measuring Intraoperative Blood Loss: Protocol for a Scoping Review.

BACKGROUND: At present, there is no standardized method for measuring intraoperative blood loss. Rather, the current data on existing methods is very broad and opaque. In many cases, blood loss during surgery is estimated visually by the surgeon. However, it is known that this type of method is very prone to error. Therefore, better standardized methods are needed. OBJECTIVE: This study aims to conduct a scoping review to present the currently available methods for measuring intraoperative blood loss. This should help to capture the current status and map and summarize the available evidence for measuring blood loss to identify any gaps. METHODS: We will use a state-of-the-art methodological framework. The databases PubMed (MEDLINE) and Cochrane Library will be searched using a search strategy based on the PICO (Population, Intervention, Comparator, and Outcome) scheme. The search period will be limited to January 01, 2012, to December 31, 2023, and our search will be restricted to clinical trials or clinical studies, randomized controlled trials, and observational studies (in line with PubMed definition of study types). Only publications in English and German will be considered. The intention is to identify clinical studies that define "blood loss" as a target criterion or as a primary or secondary end point. EndNote (version 20.6; Clarivate) will be used for the screening process. The data will be collected and analyzed using Microsoft Excel (version 16.77.1). RESULTS: The included studies will be listed in a database, and the following basic data will be extracted: title, year of publication, country, language, study type, surgical specialty, and type of procedure. The number of participants will be listed and the distribution of the participants will be documented in terms of gender and age. The following results are extracted: the type of measurement method used to measure blood loss in this study and whether the parameter "blood loss" was recorded as a primary or secondary outcome. CONCLUSIONS: Currently, there is no comparable review, resulting in ambiguous data regarding the prevailing measurement methods for intraoperative blood loss. The aim of this study is to provide a comprehensive overview-from methods of measurement to various formulae for calculating blood loss-and to establish a status quo. This could then serve as a foundation for further studies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/58022.

Cost analysis of oncological outpatient neurosurgery under general anesthesia with Hospital-at-Home based postoperative care.

OBJECTIVE: This study evaluates the efficiency and cost-effectiveness of an oncological outpatient neurosurgery (OON) protocol using Enhanced Recovery After Surgery (ERAS) principles in a European healthcare setting. Additionally, it assesses the impact of incorporating Hospital at Home (HaH) for perioperative follow-up on program efficiency and costs. METHODS: We analyzed a case cohort of patients who underwent OON with HaH-based postoperative follow-up for tumor removal or biopsy at a tertiary care center since 2019. A control cohort treated under standard inpatient care was also examined. Costs associated with surgery and postoperative care were meticulously calculated for both groups. RESULTS: The case (n=17) and control (n=38) cohorts had comparable demographics and clinical profiles. Surgical costs, including operating room, anesthesia, and surgeon fees, were similar across groups. However, post-operative monitoring was significantly shorter for the outpatient cohort, leading to reduced observation costs (p<0.001). While the duration of follow-up care was similar, outpatient follow-up via HaH was more cost-effective, reducing overall surgery costs by approximately €2958 per patient (p<0.001) compared to inpatient care. No significant differences were observed in costs related to treatment, radiology, or lab tests between groups. CONCLUSIONS: Outpatient neurosurgery with HaH follow-up offers substantial cost savings without compromising care quality in a public health setting. Inpatient care's higher costs are largely due to bed utilization, while the integration of HaH does not add significant costs, making it a viable alternative for postoperative management.

Autocorrelation of daily resting heart rate: A novel metric of postoperative recovery.

PURPOSE: Resting heart rate (RHR) is a sensitive indicator of an individual's physiologic condition. However, its use in clinical practice has been limited due to the wide variation in baseline RHR based on multiple factors, including age, sex, cardiovascular fitness, and comorbidities. The study aims to develop a novel, clinically meaningful metric that is applicable across these conditions, based on day-by-day changes in RHR-the difference in autocorrelation of daily RHR (ACΔ-RHR). We present ACΔ-RHR in the context of monitoring post-discharge recovery for pediatric appendectomy patients. METHODS: Children 3-17 years old who underwent laparoscopic appendectomy for complicated appendicitis from 2019 to 2022 at a tertiary children's hospital wore a Fitbit for twenty-one postoperative days (POD). Patients without complications were included to describe normative recovery. Using RHR on POD 1-3 as the baseline, autocorrelation of daily RHR was calculated (fixed lag = 1) for POD 3-21. Then, daily ACΔ-RHR was determined by subtracting autocorrelation values between the current and previous day. Means and standard deviations were calculated for daily RHR to estimate on which POD ACΔ-RHR stabilized at 0, representing general RHR stability and recovery from surgery for all patients. Subgroup analyses were performed by age (3-10 years old vs 11-17 years old) and sex. RESULTS: Thirty-one patients were included (58.1 % 3-10 years old, 41.9 % female, 67.7 % Hispanic). Whereas the mean daily RHR did not demonstrate clear trends, the mean ACΔ-RHR for the cohort first reached 0 on POD 12 and stabilized on POD 14 (95 % confidence interval: POD [11,17]). Subgroup analysis showed that ACΔ-RHR stabilized on POD 9 for age of 3-10 years, POD 12 for age of 11-17 years, POD 12 for females and POD 10 for males. CONCLUSIONS: The ACΔ-RHR is a promising clinical metric that could enhance post-surgical patient monitoring, such as for children following laparoscopic appendectomy for complicated appendicitis.

Impact of an Adult Congenital Heart Disease Order Set in a Pediatric Cardiac Intensive Care Unit.

Background: Patients with congenital heart disease (CHD) are increasingly surviving to adulthood. Given their age- and condition-specific needs, the optimal postoperative setting for these patients is not yet determined. This study aims to evaluate the utility of an adult-specific order set in improving clinical outcomes for these patients in a pediatric cardiovascular intensive care unit (ICU). Methods: Adults with CHD (ACHD) admitted to the cardiovascular ICU following cardiac surgery at a pediatric tertiary care center were identified for a retrospective cohort study. Health care delivery metrics and clinical outcomes of participants who received the adult-specific order set were compared with control patients admitted prior to the intervention. Categorical outcomes were compared using the χ2 test of independence or Fisher exact test, and continuous outcomes were assessed using the t test. Results: A total of 130 ACHD patients received the intervention, with no significant differences observed in clinical outcomes when compared with 89 controls. While there was additionally no reduction in hospital-related mortality (2.3% vs 7.8%, RR 0.3; P = .1), clinician ordering behaviors were better aligned with best-practices following the intervention. Among patients with moderate or greater anatomic complexity, a post hoc analysis demonstrated reduced in-hospital mortality from those who received the adult order set. Conclusions: The implementation of an adult-specific order set in a pediatric care setting did not improve clinical outcomes for all ACHD patients. Patients with moderate and greater anatomic complexity did see a mortality benefit, suggestive that targeted electronic tools may most benefit those who have the highest risk.

Effective role of aromatherapy in reducing big little problem-postoperative nausea and vomiting: A systematic review.

Postoperative nausea and vomiting (PONV) are common and distressing side effects after surgery and anesthesia. Pharmacological treatment is not sufficient to manage these two symptoms. Although the use of certain anesthetic agents is considered the main basis for this phenomenon, the exact factors are unknown. Aromatherapy is effective in reducing PONV in adults. The aim of this review is to scan the studies evaluating the effect of aromatherapy on the management of nausea and vomiting in the postoperative. A literature search was performed by scanning Cochrane Reviews, PubMed, OVID, Sciences Direct, and Google Scholar. Keywords "aromatherapy," "use of aromatherapy," "aromatherapy oils," "nausea," "vomiting," "postoperative nausea and vomiting," and "PONV" combined with Boolean operators, including AND, OR, and NOT. Data gathered from studies published from 2013 to 2023 were reviewed for the effect of aromatherapy on PONV. As a result of the screening, 12 studies out of a total of 706 studies were examined based on the inclusion criteria. In the studies, aromatherapy was used either by inhalation or orally. The plants that were used the most in these studies were ginger and mint. When the literature was reviewed, it was found that aromatherapy reduced the rate of nausea and vomiting and the need for antiemetics, especially in the first minutes after surgery. Using aromatherapy in surgical patients may relieve common postoperative symptoms. The limitations of drug therapy have led to an increase in the use of alternative drugs for the management of nausea and vomiting. Aromatherapy was favored by most patients and is an effective treatment option for PONV.

Prospective Evaluation of Extubation Failure in Neonates and Infants After Cardiac Surgery.

Background: Extubation failure and its associated complications are not uncommon after pediatric cardiac surgery, especially in neonates and young infants. We aimed to identify the frequency, etiologies, and clinical characteristics associated with extubation failure after cardiac surgery in neonates and young infants. Methods: We conducted a single center prospective observational study of patients ≤180 days undergoing cardiac surgery between June 2022 and May 2023 with at least one extubation attempt. Patients who failed extubation, defined as reintubation within 72 h of first extubation attempt, were compared with patients extubated successfully using χ2, Fisher exact, or Wilcoxon rank-sum tests as appropriate. Results: We prospectively enrolled 132 patients who met inclusion criteria, of which 11 (8.3%) failed extubation. Median time to reintubation was 25.5 h (range 0.4-55.8). Extubation failures occurring within 12 h (n = 4) were attributed to upper airway obstruction or apnea, whereas extubation failures occurring between 12 and 72 h (n = 7) were more likely to be due to intrinsic lung disease or cardiac dysfunction. Underlying genetic anomalies, greater weight relative to baseline at extubation, or receiving positive end expiratory pressure (PEEP) > 5 cmH2O at extubation were significantly associated with extubation failure. Conclusions: In this study of neonates and young infants recovering from cardiac surgery, etiologies of early versus later extubation failure involved different pathophysiology. We also identified weight relative to baseline and PEEP at extubation as possible modifiable targets for future investigations of extubation failure in this patient population.

Optimizing postsurgical recovery for elderly patients with gastric cancer.

Based on a recent study by Li et al, this editorial examines the significance of enhanced recovery after surgery (ERAS) protocols for elderly patients with gastric cancer. Cancer-related mortality, which is overwhelmingly caused by gastric cancer, calls for effective treatment strategies. Despite advances in the field of oncology, conventional postoperative care often results in prolonged hospital stays and increased complications. The aim of ERAS is to expedite recovery, reduce surgical stress, and improve patient satisfaction. The study of Li et al showed that, compared to traditional care, ERAS significantly reduces mortality risk, shortens hospital stays, and decreases postoperative complications. These findings support the widespread implementation of ERAS protocols in surgical practice to enhance patient outcomes and healthcare value.

Direct oral anticoagulants (DOACs) for postoperative venous thromboembolism prophylaxis in patients with gynecologic malignancies: A quality mini-review.

Venous thromboembolism (VTE) is a common cause of morbidity and mortality in gynecologic oncology patients with an increased risk in the postoperative period. Historically, international guidelines have recommended 28 days of low molecular weight heparin (LMWH) or unfractionated heparin (UFH) for extended VTE prophylaxis after major abdominal and pelvic surgery for gynecologic malignancies. Direct oral anticoagulants (DOACs) have emerged as an attractive alternative to injectable anticoagulants. This quality mini-review evaluated the literature around the use of DOACs for postoperative VTE prophylaxis after surgery for gynecologic cancer. Overall, the reviewed literature supports the use of DOACs in select patients within this population which may lead to an improved patient experience, higher rates of treatment compliance, and increased cost savings.

Managing the Bariatric Surgery Patient: Presurgery and Postsurgery Considerations.

Obesity has extensive health repercussions, and bariatric surgery remains a viable solution to address this issue. This article focuses on the preoperative and postoperative management strategies required to achieve successful and durable outcomes in bariatric surgery patients. Preoperative assessment includes appropriate patient selection, psychosocial evaluation, nutritional analysis, and behavioral/medical counseling. Postoperative assessment includes immediate perioperative care, diet transition, nutritional needs management, and handling of complications associated with bariatric surgery.

Enhanced Recovery After Surgery (ERAS) Practices in Minimally Invasive Gynaecologic Surgery: A National Survey.

OBJECTIVES: Enhanced recovery after surgery (ERAS) pathways are evidence-based practices that minimize perioperative physiologic stress, reducing postoperative complications and recovery time. This study assessed the Canadian application of, and adherence to, ERAS recommendations during minimally invasive gynaecologic surgery, and identified barriers to ERAS uptake. METHODS: A self-administered cross-sectional survey was distributed to obstetrics and gynaecology residents, fellows, and attendings through 3 national listservs from February 2021 to January 2022. The survey assessed 14 perioperative components per the American Association of Gynecologic Laparoscopists ERAS consensus guidelines. Two study groups were defined-participants with versus without an established ERAS program-and comparison analyses as well as inferential statistical tests were performed. RESULTS: Overall, 158 responses were analyzed. A total of 41.9% of respondents work in a centre with an ERAS program. Adherence to ERAS recommendations was high with engaging patients in the operative processes, changing equipment after a contaminated procedure, discontinuing urinary catheters, and initiating early postoperative mobilization. ERAS programming enhanced adherence to preoperative carbohydrate loading, intraoperative fluid management, normothermia, and bowel-regimen adjuncts (P < 0.05). Despite ERAS programming, adherence to some recommendations-preoperative fasting, and comorbidity optimization-remained low. Most respondents felt that ERAS is safe (98%) and improves outcomes (82%). CONCLUSIONS: While the implementation of formal ERAS pathways differs between provinces and hospitals, practitioners across Canada engage in various ERAS components. ERAS program sites had higher adherence to some perioperative recommendations; however, some high-level evidence recommendations still have national adherence gaps. Targeted research around low-adherence components would help identify and address barriers to optimizing surgical care.

Investigating clinical decision-making in bleeding complications among nursing students: A longitudinal mixed-methods study.

AIM: To describe undergraduate nursing students' clinical decision-making in post-procedural bleeding scenarios and explore the changes from the first to the final year of their program. BACKGROUND: Bleeding is a common complication following invasive procedures and its effective management requires nurses to develop strong clinical decision-making competencies. Although nursing education programs typically address bleeding complications, there is a gap in understanding how nursing students make clinical decisions regarding these scenarios. Additionally, little is known about how their approach to bleeding management evolves over the course of their education. DESIGN: Longitudinal mixed-methods study based on the Recognition-Primed Decision Model. METHODS: A total of 59 undergraduate students recorded their responses to two clinical decision-making vignettes depicting patients with signs of bleeding post-hip surgery (first year) and cardiac catheterization (final year). Their responses were analyzed using content analysis. The resulting categories capture the cues students noticed, the goals they aimed to achieve, the actions they proposed and their expectations for how the bleeding situations might unfold. Code frequencies showing the most variation between the first and final years were analyzed to explore changes in students' clinical decision-making. RESULTS: Nearly all students focused on two primary categories: 'Bleeding' and 'Instability and Shock.' Fewer students addressed six secondary categories: 'Stress and Concern,' 'Pain,' 'Lifestyle and Social History,' 'Wound Infection,' 'Arrhythmia,' and 'Generalities in Surgery.' Students often concentrated on actions to manage bleeding without further assessing its causes. Changes from the first to the final year included a more focused assessment of instability and shifts in preferred actions. CONCLUSIONS: This study reveals that nursing students often prioritize immediate actions to stop bleeding while sometimes overlooking the assessment of underlying causes or broader care goals. It suggests that concept-based learning and reflection on long-term outcomes could improve clinical decision-making in post-procedural care.

Flap Monitoring Techniques: A Review.

Postoperative tissue flap vitality monitoring enables early detection of clinical complications, allowing for intervention. Timely re-operation can prevent the need for extensive correction procedures, thus reducing healthcare costs and hospitalization time. Statistics show that monitoring can increase the success rate of flap survival to 95% or higher. However, despite the significant progress in monitoring techniques, major and minor complications, leading to the loss of the flap, still occur. This clinical application review aims to provide a comprehensive overview of the recent advancements and findings in flap surgery reconstructions, transplants, and systems for their postoperative assessment. The literature from the years 1925 to 2024 has been reviewed to capture previous and current solutions for monitoring flap vitality. Clinically acclaimed methods and experimental techniques were classified and reviewed from a technical and clinical standpoint. Physical examination, metabolism change, ultrasound method, and electromagnetic (EM) radiation-based measurement methods were carefully evaluated from the perspective of their considered applications. Guidelines aiding engineers in the future design and development process of monitoring systems were proposed. This paper provides a comprehensive overview of the monitoring techniques used in postoperative flap vitality monitoring. It also gives an overview of each approach and potential ways for future development.

The Evolution of Patient Satisfaction in Postoperative Care: The Impact of Investments and the Algorithm for Assessing Significant Growth over the Last 5 Years.

An analysis of patient satisfaction in the context of healthcare reflects the patient's perception of actual care through the prism of their expectations of ideal care. A study was conducted to investigate patient satisfaction with postoperative care in the context of improvements in hospital medical services (renovations and modernization of operating rooms and wards with beds, endowments in medical equipment for investigation and treatment, new work procedures, and revisions of existing procedures). Statistical analysis was performed based on the questionnaires distributed to patients hospitalized in the surgical wards of the Bihor County Emergency Clinical Hospital, between 2019 and 2023. A total of 4018 questionnaires were collected, and after the elimination of questionnaires with incomplete or incorrect data, 3985 remained in the analysis. Of the total of 2994 people who reported having undergone surgery, a total of 2090 responded to the questions that focused on postoperative care and overall impression of the hospital. No statistically significant differences in patient satisfaction by sociodemographic factors were found. A statistically significant increase in patient satisfaction with postoperative care and overall impression of the hospital was observed over the last 5 years. Correlation testing between postoperative care responses and overall impression, using the Sperman method, shows a directly proportional relationship between the two variables. In the future, it is necessary to extend the patient satisfaction questionnaire to comprehensively analyze the surgical component in order to identify gaps in postoperative care, helping decision makers to improve the medical services provided to patients.

Randomized Controlled Trial: Does the Use of Occlusive Hydrocolloid Silver-Containing Wound Dressing after Sternotomy Reduce Surgical Site Infection after Cardiac Surgery?

(1) Background: To reduce the incidence of surgical site infections (SSIs) following median sternotomy in cardiac surgery, we compared an occlusive hydrocolloid silver-containing wound dressing (OHSCWD) with a standard wound dressing. (2) Methods: This study was designed as a single-center randomized controlled trial. The primary endpoint was the overall rate of incidence of any kind of SSI. Secondary endpoints were the number of dressing changes, the severity of SSIs, and whether there was a need for treatment. Wounds were monitored daily until the seventh and on the 30th postoperative day. (3) Results: Of the 423 patients included, 352 were analyzed. No differences in demographics, cardiovascular risk factors, intraoperative processes, and postoperative care were found between both groups. Additionally, the incidence or extent of SSI showed no significant differences between the two groups. (4) Conclusions: In summary, out of all pre-, intra-, and postoperative factors, the contribution of postoperative wound care to the development of SSIs appears to play a subordinate role. However, by offering equivalent wound protection and a reduced number of dressing changes, OHSCWD after median sternotomy in cardiac surgery patients could be a good alternative to standard dressings from the point of view of the patient, the staff, and the clinic.

Knowledge, attitudes, and practices toward femtosecond laser small incision lenticule extraction surgery and postoperative care among recipients.

BACKGROUND: To investigate the knowledge, attitudes, and practices (KAP) of individuals who underwent small incision lenticule extraction (SMILE) surgery and explore the influencing factors. METHODS: This cross-sectional study was conducted from June 21, 2023, to August 13, 2023, at Xiangyang Central Hospital. The participants were patients who had undergone SMILE surgery. The self-designed questionnaire had a Cronbach's α = 0.849. Multivariable analyses were performed to determine the factors influencing the KAP scores. RESULTS: Finally, 485 valid questionnaires were analyzed. The median knowledge score was 14 (/17, 82.4%; IQR: 12-15). The median attitude score was 15 (/20, 75.0%; IQR: 14-16). The median practice score was 48 (/60, 80.0%; IQR: 42-54). The knowledge scores correlated to the attitude (r = 0.323, P < 0.001) and practice (r = 0.202, P < 0.001) scores, while the attitude scores correlated to the practice scores (r = 0.065, P < 0.001). College diploma (OR = 0.299, 95%CI: 0.110-0.812, P = 0.018), myopia for < 2 years (OR = 0.177, 95%CI: 0.060-0.526), and not receiving proper eye training (OR = 0.588, 95%CI: 0.402-0.862) were independently associated with knowledge. Being 19-30 years old (OR = 0.421, 95%CI: 0.235-0.756), being ≥ 31 years old (OR = 0.259, 95%CI: 0.111-0.601), myopia for 2-5 years (OR = 0.476, 95%CI: 0.232-0.978), myopia for 5-10 years (OR = 0.480, 95%CI: 0.263-0.875), and moderate myopia in the right eye (OR = 1.745, 95%CI: 1.024-2.974) were independently associated with attitude. Female gender (OR = 1.826, 95%CI: 1.196-2.787), being ≥ 31 years (OR = 2.587, 95%CI: 1.113-6.014), college diploma (OR = 3.436, 95%CI: 1.366-8.641), bachelor's degree (OR = 2.826, 95%CI: 1.214-6.581), and not having proper eye training (OR = 0.458, 95%CI: 0.310-0.677) were independently associated with practice. CONCLUSIONS: Patients who underwent SMILE had high KAP regarding SMILE. This study identified KAP items that would warrant education.

Assessing the quality and standards of operative notes in general surgery; A teaching institute's experience in Pakistan.

Objective: To evaluate the quality and standard of hand-written operative notes in a teaching institute. Methods: This prospective study was carried out in the department of surgery, Fatima Hospital, Baqai Medical University, from January 2023 till May 2023. One hundred fifty operative notes from general surgery domain were considered. These notes were evaluated according to the guidelines of Royal College of Surgeons, with added-on a few variables by the author. Results: All 150 notes were handwritten. Resident surgeon wrote the operative notes under the supervision of primary surgeon. There was a deficiency in mentioning medical record number, procedure starting time and duration of surgery. An important statement about the hemostasis is that it is secured-per-operatively was not documented. The residents were reluctant to explain the surgical procedures diagrammatically. The operative room number was missing in all notes. Post operative instructions lacked the information for nothing per oral, blood pressure, temperature, pulse rate, and input and output charting. Conclusion: It is observed that the operative surgical notes were however explainable about the procedure, but quality and standard was not matchable with that of Royal College of Surgeons notes. Hence, a lack of formal training for the resident surgeons in operative notes writing was observed. This study is a thought provoker to the surgeons and a guide to resident trainees, and hospital management to provide a handful operative notes writing theme in the form of performa provided in the department.