Longer Operative Time for Lower Extremity Bypass Surgery is Associated With Inferior Outcomes.

INTRODUCTION: This study aims to assess the association of operative time with the postoperative length of stay and unplanned return to the operating room in patients undergoing femoral to below knee popliteal bypasses, stratified by autologous vein graft or polytetrafluoroethylene (PTFE). MATERIALS AND METHODS: A retrospective analysis of vascular quality initiative database (2003-2021). The selected patients were grouped into the following: vein bypass (group I) and PTFE (group II) patients. Each group was further stratified by a median split of operative time (i.e., 210 min for autologous vein and 155 min for PTFE) to study the outcomes. The outcomes were assessed by univariate and multivariate approach. RESULTS: Of the 10,902 patients studied, 3570 (32.7%) were in the autologous vein group, while 7332 (67.3%) were in the PTFE group. Univariate analysis revealed autologous vein and PTFE graft recipients that had increased operative times were associated with a longer mean postoperative length of stay and a higher incidence of all-cause return to the operating room. In PTFE group, patients with prolonged operative times were also found to be associated with higher incidence of major amputation, surgical site infection, and cardiovascular events, along with loss of primary patency within a year. CONCLUSIONS: For patients undergoing femoral to below knee popliteal bypasses using an autologous vein or PTFE, longer operative times were associated with inferior outcomes. Mortality was not found to be associated with prolonged operative time.

Impact of Clinical Information on the Turnaround Time in Surgical Histopathology: A Retrospective Study.

Introduction Clinical information (CI) is a key requisite to diagnose and report a specimen in histopathology. A timely dispatched report can help a clinician to confirm a diagnosis and initiate a prompt treatment plan while an unnecessary delay in reporting time can compromise patient's healthcare. The aim of this study was to ascertain the impact of the adequacy of CI provided by clinicians on the turnaround time (TAT) and to investigate factors pertinent to specimens, their handling, and diagnosis. Methods This retrospective study reviewed a total of 803 surgical specimens reported in a duration of four months (from December 2015 till March 2016) by the Department of Histopathology, FMH College of Medicine & Dentistry, Lahore, Pakistan. Frozen section and cytology specimens were excluded. CI was classified into three categories: short and focused, long and detailed, and deficient CI. Deficient CI was designated where the pathologist had to seek more information from the requesting clinicians. Total time taken by the histopathologist to complete a report was calculated after excluding weekends and holidays. Other factors like type of specimen, special staining, diagnosis of malignancy and source of referral were also studied. The data were entered and analyzed on SPSS 22.0 (IBM, Armonk, NY). Shapiro-Wilk test was used to measure the distribution. Results Most of the specimens (46.2%, n = 371) were reported within three days. Of these, most of the specimens (46.9%, n = 174) had a short and focused CI (p < 0.001). Majority of the specimens which were reported within four to five days (42.1%, n = 114) and after five days (62.1%, n = 100) were found to have a long and detailed CI in their requisition forms. Median TAT extended to six (4.00-7.00) days with the use of special stains (p < 0.001). One hundred and sixty-three (20.29%) of the total cases were diagnosed as malignant in which the median TAT significantly prolonged to five days (p < 0.001). Most of the specimens (80%, n = 60) received from the outside laboratories had a long and detailed CI in requisition forms. Endometrial tissue specimen was the predominant type received by the department (24.3%, n = 90). Conclusion Adequate CI is necessary for timely and error-free reporting of a specimen in surgical histopathology. A short, focused and concise CI is associated with a shorter TAT. Long and detailed CI is often seen with a complex surgical specimen that requires a longer time to report. Factors like specimen type, special staining, number of special stains and diagnosis of a malignancy also affect TAT.

Comparison of Knowledge and Attitudes of Medical and Dental Students towards HIV/AIDS in Pakistan.

The number of new human immunodeficiency virus (HIV) cases is increasing in Pakistan while it has seen a decline globally. A survey conducted recently has found that 132,000 people in Pakistan suffer from HIV. This study aims to check the levels of knowledge and attitudes about HIV/acquired immunodeficiency syndrome (AIDS) among medical and dental students. This cross-sectional study was designed and conducted at Combined Military Hospital Lahore Medical College and the Institute of Dentistry (CMH LMC) in Lahore, Pakistan in 2016. Students enrolled in the courses of the MBBS and BDS were included in this study. The questionnaire consisted of three sections: demographics, knowledge and attitude. A total of 414 students completed the questionnaire and out of them, 286 were medical students while the rest were dental students. The mean ± standard deviation score for the students was 10.02 ± 4.37 out of 17 for knowledge related to HIV and AIDS. For acceptable attitude towards AIDS and patients afflicted with the disease, an outcome of 1.93 ± 0.75 out of 4 was observed. The results of this study indicate lack of knowledge about HIV, especially about the modes of transmission and prevention techniques. Therefore, regular interactive workshops and seminars, besides teaching sessions, focused lectures on HIV/AIDS, need to be conducted.

A Survey of Handwashing Knowledge and Attitudes among the Healthcare Professionals in Lahore, Pakistan.

OBJECTIVE: To evaluate the knowledge and attitudes towards handwashing of clinical year medical and dental students and health-care professionals (HCPs) working in the departments of medicine, surgery, dentistry, nursing, and physiotherapy in Lahore, Pakistan. METHODOLOGY: This was a cross-sectional survey conducted during May and June 2016. After approval from the institutional review board, a modified form of the World Health Organization (WHO) Hand Hygiene Knowledge Questionnaire for Healthcare workers that included 18 items was sent to 400 clinical year students and HCPs from six medical colleges and affiliated hospitals of Lahore. The data obtained was entered and analyzed by using IBM SPSS version 20 (IBM, NY, USA). Chi-square was used as the test of significance. A p-value of <0.05 was considered statistically significant for all purposes. RESULTS: The response rate was 79%. Less than half of the respondents (149, 47.9%) were satisfied with their knowledge regarding hand hygiene. Statistically significant associations of various groups of HCPs were observed with their satisfaction regarding knowledge about hand hygiene (p-value = 0.022), their awareness of the proper technique required for handwashing proposed by the WHO (p-value = 0.001), and their awareness about other preventive techniques proposed by the WHO and Centers for Disease Control (CDC) (p-value = 0.021). CONCLUSIONS: The majority of the clinical year students and HCPs were not satisfied with their knowledge regarding hand hygiene. HCPs working in different departments have varying knowledge and attitudes towards hand hygiene. Females were found to be more satisfied with their handwashing practices. Teaching proper technique of handwashing to medical students and starting refresher courses regarding hand hygiene for HCPs are dire needs. The WHO-recommended guidelines should not only be taught but also implemented in the medical field as poor hand hygiene techniques have led to the spread of many diseases around the globe.