The document discusses recent advances in safer surgery. It defines safer surgery as reducing avoidable harm to surgical patients. Common causes of patient harm include errors by healthcare professionals, a complex healthcare system, and barriers during care. Standards, communication, and learning from incidents can help achieve safer surgery goals. The WHO surgical safety checklist provides a standardized 5-step process of briefing, sign in, time out, sign out, and debriefing to reduce errors and improve outcomes. Implementing changes gradually through repeated testing and feedback cycles allows for safer surgery initiatives to be successfully adopted.
Purpose of the call:
•Review current data and state of the SSCL
•Discuss the role of communications and team work in patient safety
•Discuss and define how we can measure the effectiveness of the SSCL.
Read more and watch the webinar recording: http://bit.ly/1sXDqaZ
1. Safety is everybody’s business. According the Hippocratic oath from 5th century : “ Never do harm to anyone” Safer Surgery can be defined as a reduction in avoidable harm to a surgical patient
2. It is a part of medical specialty that uses operative manual and instrumental technique on a patient to investigate or treat a pathological condition. Surgical team: 1. Surgeon 2. Surgeon’s assistance 3. Anesthetist 4. Scrub nurse 5. Scouting nurse 6. Surgical technologist
3. Time or duration when patient admitted and discharge after completion of surgery. So, surgical safety has broadly included in different phases: 1. Preoperative(Diagnosis, investigation) 2. Per operative 3. Postoperative(Up to discharge)
4. 1. Adverse events: An incident which result in harm to the patient. 2. Near Miss: An incident which could resulted in unwanted harm but did not. 3. No-harm events: An incident that occur and reach to the patient but result in no injury.
5. An article in the Gurdian newspaper UK in March 2013 claimed that “five worst medical” nightmares a Pt faces, three related to surgery: 1. Wrong site surgery 2. Wrong patient surgery 3. Retained instruments and swabs The rate of harm in surgical patient is unknown but probably occur in about 10% surgical patient, though much of this harm will be minor.
6. 1. Patients themselves. 2. Healthcare professional 3. System failure. 4. Medical complexity
7. Patients Themselves 1. A variety of presentation. 2. Differing co-morbidities 3. Differing response to treatment 4. Patients are reluctant to speak up. 5. Refuse to co-operate 6. Hide and seek
8. Healthcare professional 1. Inadequate Pt assessment(delay or error in Diagnosis) 2. Failure to use or interpret appropriate test 3. Error in performance of an operation and test. 4. Inadequate monitoring or follow-up. 5. Deficient training or experience 6. Fatigue, overwork or time pressure. 7. Personal or psychological factor i.e. drug abuse or depression. 8. Lack of recognition of the danger of medical errors.
9. System failure 1. Poor communication between healthcare provider. 2. Inadequate staffing level 3. Overreliance on investigation 4. Lack of coordination at handover 5. Drug similarities. 6. Equipment failure due to lack of skilled operators. 7. Inadequate system to report and review patient safety incident.
10. Medical complexity 1. Advance and new technologies(laparoscopic, robotic surgery) 2. Potent drug and their side effects and interaction. 3. Working environment- Surgical ICU, HDU and Operation theatre
11. Surgery is one of the most complex health intervention to deliver. More than 100 million people worldwide require surgical treatment every year for different reason. Great Professor of Surgery Sir Alfred Cuschieri and other describes surgical errors in different categories that committed by the surgeons during care of the Patients.
12. 1. Diagnosis and management erro
WHO has undertaken a number of global and regional initiatives to address surgical safety. The Global Initiative for Emergency and Essential Surgical Care and the Guidelines for Essential Trauma Care focussed on access and quality. The Second Global Patient Safety Challenge: Safe Surgery Saves Lives addresses the safety of surgical care.
Improving Surgical Safety and Patient OutcomesC Daniel Smith
Keynote talk delivered at New Jersey Hospital Association Seminary on Improving Surgical Safety & Patient Outcomes held on September 25, 2013 at their Conference Center in Princeton New Jersey. Over physicians, administrators, nurses and perioperative services providers in attendance.
Purpose of the call:
•Review current data and state of the SSCL
•Discuss the role of communications and team work in patient safety
•Discuss and define how we can measure the effectiveness of the SSCL.
Read more and watch the webinar recording: http://bit.ly/1sXDqaZ
1. Safety is everybody’s business. According the Hippocratic oath from 5th century : “ Never do harm to anyone” Safer Surgery can be defined as a reduction in avoidable harm to a surgical patient
2. It is a part of medical specialty that uses operative manual and instrumental technique on a patient to investigate or treat a pathological condition. Surgical team: 1. Surgeon 2. Surgeon’s assistance 3. Anesthetist 4. Scrub nurse 5. Scouting nurse 6. Surgical technologist
3. Time or duration when patient admitted and discharge after completion of surgery. So, surgical safety has broadly included in different phases: 1. Preoperative(Diagnosis, investigation) 2. Per operative 3. Postoperative(Up to discharge)
4. 1. Adverse events: An incident which result in harm to the patient. 2. Near Miss: An incident which could resulted in unwanted harm but did not. 3. No-harm events: An incident that occur and reach to the patient but result in no injury.
5. An article in the Gurdian newspaper UK in March 2013 claimed that “five worst medical” nightmares a Pt faces, three related to surgery: 1. Wrong site surgery 2. Wrong patient surgery 3. Retained instruments and swabs The rate of harm in surgical patient is unknown but probably occur in about 10% surgical patient, though much of this harm will be minor.
6. 1. Patients themselves. 2. Healthcare professional 3. System failure. 4. Medical complexity
7. Patients Themselves 1. A variety of presentation. 2. Differing co-morbidities 3. Differing response to treatment 4. Patients are reluctant to speak up. 5. Refuse to co-operate 6. Hide and seek
8. Healthcare professional 1. Inadequate Pt assessment(delay or error in Diagnosis) 2. Failure to use or interpret appropriate test 3. Error in performance of an operation and test. 4. Inadequate monitoring or follow-up. 5. Deficient training or experience 6. Fatigue, overwork or time pressure. 7. Personal or psychological factor i.e. drug abuse or depression. 8. Lack of recognition of the danger of medical errors.
9. System failure 1. Poor communication between healthcare provider. 2. Inadequate staffing level 3. Overreliance on investigation 4. Lack of coordination at handover 5. Drug similarities. 6. Equipment failure due to lack of skilled operators. 7. Inadequate system to report and review patient safety incident.
10. Medical complexity 1. Advance and new technologies(laparoscopic, robotic surgery) 2. Potent drug and their side effects and interaction. 3. Working environment- Surgical ICU, HDU and Operation theatre
11. Surgery is one of the most complex health intervention to deliver. More than 100 million people worldwide require surgical treatment every year for different reason. Great Professor of Surgery Sir Alfred Cuschieri and other describes surgical errors in different categories that committed by the surgeons during care of the Patients.
12. 1. Diagnosis and management erro
WHO has undertaken a number of global and regional initiatives to address surgical safety. The Global Initiative for Emergency and Essential Surgical Care and the Guidelines for Essential Trauma Care focussed on access and quality. The Second Global Patient Safety Challenge: Safe Surgery Saves Lives addresses the safety of surgical care.
Improving Surgical Safety and Patient OutcomesC Daniel Smith
Keynote talk delivered at New Jersey Hospital Association Seminary on Improving Surgical Safety & Patient Outcomes held on September 25, 2013 at their Conference Center in Princeton New Jersey. Over physicians, administrators, nurses and perioperative services providers in attendance.
Principles of Surgical Audit presented by Meeran Earfan, Kurdistan Board Trainee/General Surgery in Sulaimaniyah Teaching Hospital, As Sulaimaniyah, Iraq
This presentation was prepared by RUTAYISIRE François Xavier and ISHIMWE Diane, Medical students in Year 4(Doctorate 2) at University of RWANDA school of medicine and Pharmacy, Department of Medicine and Surgery. we did the work under supervision of Dr Ntakiyiruta Georges,Mmed,FCSECSA
Repair of incisional hernia! A anatomical and technical challenge.KETAN VAGHOLKAR
Incisional hernia is the most challenging problem in abdominal surgery. Open method provides the most sound and longlasting cure to the problem. The recurrence rate with a well done open technique is very low.
It has not changed the nature of disease
The basic principles of good surgery still apply,including appropriate case selection, excellent exposure,adequate retraction and a high level technical expertise
If a procedure makes no sense with conventional access, it will make no sense with a minimal access approach
The cleaner and gentler the act of operation, the less the patient suffers, the smoother and quicker his convalescence,the more exquisite his healed wound.
We actually do not know what is there stored for us, but we believe that laparoscopy is trending towards advancement and nano and robotic technology is going to replace in future.
3D cameras have come into existence and various newer technologies are being invented.
Safe Laparoscopic Cholecystectomy Techniques that are discussed here are based on current literature and Evidence Based Medicine guidelines and reviews.
This presentation was done by RUTAYISIRE François Xavier and ISHIMWE Diane, medical students at University of RWANDA School of Medicine and pharmacy, department of medicine and surgery. They did it while they were in Year 4 (Doctorate2), under supervision of Dr Ntakiyiruta Georges,Mmed,FCSECSA. It tell us about what a surgical safety checklist is, and why is it important in surgical field.
International Patient Safety Goals (IPSG) help accredited organizations address specific areas of concern in some of the most problematic areas of patient safety.
International-Patient-Safety-GoalsGoal 1: Identify patients correctly
Goal 2: Improve effective communication
Goal 3: Improve the safety of high-alert medications
Goal 4: Ensure safe surgery
Goal 5: Reduce the risk of health care-associated infections
Goal 6: Reduce the risk of patient harm resulting from falls
Principles of Surgical Audit presented by Meeran Earfan, Kurdistan Board Trainee/General Surgery in Sulaimaniyah Teaching Hospital, As Sulaimaniyah, Iraq
This presentation was prepared by RUTAYISIRE François Xavier and ISHIMWE Diane, Medical students in Year 4(Doctorate 2) at University of RWANDA school of medicine and Pharmacy, Department of Medicine and Surgery. we did the work under supervision of Dr Ntakiyiruta Georges,Mmed,FCSECSA
Repair of incisional hernia! A anatomical and technical challenge.KETAN VAGHOLKAR
Incisional hernia is the most challenging problem in abdominal surgery. Open method provides the most sound and longlasting cure to the problem. The recurrence rate with a well done open technique is very low.
It has not changed the nature of disease
The basic principles of good surgery still apply,including appropriate case selection, excellent exposure,adequate retraction and a high level technical expertise
If a procedure makes no sense with conventional access, it will make no sense with a minimal access approach
The cleaner and gentler the act of operation, the less the patient suffers, the smoother and quicker his convalescence,the more exquisite his healed wound.
We actually do not know what is there stored for us, but we believe that laparoscopy is trending towards advancement and nano and robotic technology is going to replace in future.
3D cameras have come into existence and various newer technologies are being invented.
Safe Laparoscopic Cholecystectomy Techniques that are discussed here are based on current literature and Evidence Based Medicine guidelines and reviews.
This presentation was done by RUTAYISIRE François Xavier and ISHIMWE Diane, medical students at University of RWANDA School of Medicine and pharmacy, department of medicine and surgery. They did it while they were in Year 4 (Doctorate2), under supervision of Dr Ntakiyiruta Georges,Mmed,FCSECSA. It tell us about what a surgical safety checklist is, and why is it important in surgical field.
International Patient Safety Goals (IPSG) help accredited organizations address specific areas of concern in some of the most problematic areas of patient safety.
International-Patient-Safety-GoalsGoal 1: Identify patients correctly
Goal 2: Improve effective communication
Goal 3: Improve the safety of high-alert medications
Goal 4: Ensure safe surgery
Goal 5: Reduce the risk of health care-associated infections
Goal 6: Reduce the risk of patient harm resulting from falls
Surgical Risk Assessment is an Important Factor in any Surgical TreatmentJohnJulie1
Surgical risk is a form of assessing the clinical conditions and health conditions of a person who will undergo surgery, so that the risks of complications are identified throughout the period before, during and after surgery. It is calculated through a physician’s clinical assessment and the requirement for some tests, but to facilitate the assessment, there are also some protocols which have better directing in medical thinking. Any doctor can make this assessment, but most often it is done by a general practitioner, a cardiologist and an anesthesiologist. In this way, it is possible for each person to receive some attention before the surgery, such as seeking more appropriate tests or performing treatments to reduce the risk.
Surgical Risk Assessment is an Important Factor in any Surgical Treatmentsuppubs1pubs1
Surgical risk is a form of assessing the clinical conditions and health conditions of a person who will undergo surgery, so that the risks of complications are identified throughout the period before, during and after surgery. It is calculated through a physician’s clinical assessment and the requirement for some tests, but to facilitate the assessment, there are also some protocols which have better directing in medical thinking. Any doctor can make this assessment, but most often it is done by a general practitioner, a cardiologist and an anesthesiologist. In this way, it is possible for each person to receive some attention before the surgery, such as seeking more appropriate tests or performing treatments to reduce the risk.
The correct application of the safety check steps in our routine theatre operations and procedures will greatly reduce surgically related mortality and morbidity.
Patient safety is the absence of preventable harm to a patient during the process of health care and reduction of risk of unnecessary harm associated with health.
The World Health Organisation is a global tool to ensure safety in surgery. The principles and procedures are described for how to implement it in your organisation.
October 27, 2016
Concurrent, or overlapping, surgeries involve the simultaneous scheduling of substantial portions of two or more surgeries under the supervision of a single surgeon, requiring delegation of responsibility to trainees and assistants if necessary. The practice is not uncommon, especially at teaching hospitals, but patients often have no idea that their doctor may also be operating on someone else at the same time. This panel discussion described the practice, its risks and benefits, and recommended approaches to preserve patient trust and safety.
Panelists
- Jonathan Saltzman, Reporter, The Boston Globe Spotlight Team (contributor to “Clash in the Name of Care”) - Setting the Stage: Key issues and concerns raised by concurrent surgeries, patient experiences and outcomes
- Griffith R. Harsh IV, MD, MA, MBA, FACS, Professor of Neurosurgery and Associate Dean, Postgraduate Medical Education, Stanford University - Surgeon’s Perspective: Pros and cons of concurrent scheduling, pressures to schedule this way, potential impact on patients, and the recent statement by the American College of Surgeons
- I. Glenn Cohen, JD, Professor, Harvard Law School; Faculty Director, Petrie-Flom Center - Legal and ethical perspectives: Institutional risk, medical malpractice, informed consent, and applicable regulations
- Moderator: Robert Truog, MD, Frances Glessner Lee Professor of Medical Ethics, Anaesthesia, & Pediatrics and Director, Center for Bioethics, Harvard Medical School; Executive Director, Institute for Professionalism & Ethical Practice and Senior Associate in Critical Care Medicine, Boston Children's Hospital
This event was free and open to the public.
Sponsored by the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School and the Center for Bioethics at Harvard Medical School, with support from the Oswald DeN. Cammann Fund.
Medical errors are ubiquitous and the costs (human and financial) are substantial. The top priority must be to redesign systems geared to prevent, detect and minimise effects of undesirable combinations of design, performance, and circumstance.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. Introduction
The concept of patient safety and avoiding harm
has existed for as long as medicine itself – the
Hippocratic Oath from the 5th century BC states
that doctors should “never do harm to anyone”.
Until studies from 20th century neither the scale
nor causes of such harm were generally
recognised.
3. SAFER SURGERY
Patient safety has been given many definitions.
patient safety can be defined as preventing avoidable
harm and hence safer surgery can be defined as “ a
reduction in avoidable harm to a surgical patient.”
*This definition is still open to interpretation in its
application since harm covers a wide spectrum from
psychological harm to death and whether such harm is
avoidable can also be difficult to determine .
4. Safety in surgery
An article regarding safer surgery in uk , march , 2013 claimed that
3 worst nightmares a patient faces related to surgery –
wrong site/side of surgery ,
Surgery in a wrong patient ,
retained instruments / swabs.
These reports however don’t represent harm rates since they only
deal with specific serious consequences of surgery and also rely on
self reporting .
Incidence reporting systems In which adverse incidents are
reported to a central system , are mandated in many hospitals but
they only capture a small number of incidents which actually occur .
5. Reporting systems are designed to allow improvements in practice
and are intended as markers of patient safety rates.
Retrospective notes analysis can also be used locally to identify
harm events , both to produce harm event rates and acts as a basis
for improvement.
Global trigger tool has been developed , which consists of quick
screening of patient notes looking for trigger factors . For example –
low haemoglobin levels, admission in critical care , returns to
operation Theatre,etc (trigger factors)which if present indicate
increased probability of an adverse event .
Major disadvantage of this method is that ,it mainly depends on
documentation.
6. How do patients suffer avoidable harm
?
1) Patient themselves: Patients have a variety of
presentations of disease , differing comorbidities , and
differing response to treatment.
An important approach in reducing these errors is
standardisation of procedures and establishing specific
guidelines which are acceptable all over the world.
7. 2) Complex disease management: There is a
spectrum of complexity in surgical management
according to diagnosis. The development of
laparoscopic surgery and use of robotics are best
examples of actual and potential changes in surgical
management.
*Many advances in surgical care involve a learning
curve for surgeons ,during this time patients may be at
increased risk of unintended harm.
8. 3) Health care professionals :
Errors by healthcare professionals
are one of the common causes for
patient harm.
Attempting to do more than one thing
at a time leads to errors. Distractions
in operation theatre may detoriate
mental and physical performance due
to stress ,fatigue and time pressures.
9. 4) Health care system: Health care is delivered by teams –
however it is not always clear who is in the team and what role
they play. On occasions the strong hierarchical structure
prevents teams members from intervening when a patient is
about to be harmed .
Trainee surgeons usually follow rotation during which they learn
different processes of health care which in turn may not always
overcome issues related to patient harm.
A combination of reduced length of training and reduced hours
per week might lead to inadequately trained surgeons .
Health care costs a considerable amount and efficiency and cost
reduction can impact patient safety.
10. BARRIERS TO HARM: Important
element of prevention of harm is the use
of defences or barriers .
Barriers can be of various forms for
example- defences or barriers for
surgeons may be “STOP” or” TIMEOUT “
moment in operation theatre , red wrist
bands for patients with history of drug
allergies etc.
11. Surgery made safer
Right surgeon ; right place and right time.
The right surgeon requires adequate training and
experience .Further, trained surgeons require updating in
current techniques .
Right time of surgery is applicable to emergency surgery.
Patient has to be operated as soon as clinically
appropriate , this has often been difficult to achieve and
has always been a high priority for healthcare
organisation.
12. Indicators of patient Safety
Adverse event: An incident that results in harm to the patient.
A near miss: An incident that could have resulted in unwanted
consequences but did not , either by chance or through a timely
intervention preventing the event from reaching the patient .
A no harm event: an incident that occurs and reaches the patient
but results in no injury to the patient. Harm is avoided by chance
or due to mitigating circumstances.
13. Goals of safer surgery can be achieved by:
A. Standardisation ;
B. communication and
C. learning from incidents.
14. A. Standardisation :
Standardisation of health care can be produced nationally
or locally, but national guidance with appropriate local
adaptation has proved to be helpful.
Standardisation should be based on research evidence or
best practice .
standardisation is particularly useful where healthcare is
delivered by different professionals in ever changing teams.
15. Various examples of standardisation effecting surgical patients
are:
1) Preoperative Investigations.
2) Preoperative care if diabetes patients .
3) Preventing thromboembolism perioperatively.
4) Surgical site infection prevention.
5) Preoperative starvation time.
6) Early or clinically appropriate time of operation in critically ill
patients.
7) five steps of patient safety –Incorporating the WHO surgical
checklist.
16. B. Communication:
Poor communication between patients and health care
professionals contributes to majority of patient adverse
incidents.
Fair communication is needed in hand over , briefing , ward
rounds and in discussions about individual patients .
Such communications needs to be structured , understood and
documented.
The form of communication should be considered (face to face
or over telephone ).
Training in and implementation of adequate communication
methods is not universal yet.
17. C. Learning from incidents:
Incidents in which patients have or potentially could have
been harmed should be reported locally and a system in place
whereby these are analysed and appropriate action decided
and implemented , in order to reduce the risk of the same
event happening again.
Improvement in patient safety as a result of previous incidents
is important since , because of the complexity of healthcare
and human nature, its not possible to anticipate in advance
patient harm.
18. Unfortunately, learning from incidents is not as effective as it could be
for many reasons-
1)many incidents are not reported ,
2)the number reported is so great that it can be difficult to prioritise
appropriately ,
3)analysis is not always correct and there can be difficulty in
implementing action.
All doctors should be trained in analysis of incidents since this will
improve their ability to learn individually from incident.
Complaints from patient are another potential source of patient safety
incidents to be analysed and actioned as appropriate .
Consideration should be given to the most appropriate way to
introduce patient Safety initiative.
19. Implementation of safer surgery
initiatives
Implementing changes in healthcare can be difficult- the
system is complex and has many people involved in each
pathway, getting agreement can be difficult and time
consuming.
The model for improvement method for implementing change
has been particularly associated with patient safety work –it
was the recommended method for implementation of the
WHO Checklist .
20. This model suggests introducing small tests of change – a
small, change in a limited area and time and observing this
change .
If successful it can be tried in a larger group or different areas-
with constant feedback.
This is referred to as repeated plan do study act (PDSA)
cycle.
The method requires a structured approach to change but is
less time consuming and requires less initial buy in from
everyone .
21.
22. Five steps of safer surgery (by who checklist) :
1. Briefing
2. Sign in
3. Time out
4. Sign out
5. Debriefing
23. 1)Briefing:
It Is carried out at the start of the operation before the patient is
anaesthetised.
Role of briefing:
A. To ‘walk through’ the list and anticipate any problems that might
occur, such as equipment, test results, patients not ready, ICU bed
availability etc and resolve them so that the operation runs more
efficiently – to develop contingency plans.
B. 2. To come together as a team for that list.
C. 3. To open communication between different team members to
ensure everyone is on ‘the same page’.
D. 4. To flatten hierarchy & allow anyone with concerns to speak out.
24. 2) Sign in : (before induction of Anaesthesia)
This includes
A) Confirming : identity of patient , site of surgery ,procedure,
consent.
B) Marking the site of surgery.
C) Completion of anaesthesia safety Checklist.
D) Checking equipment functional status.
E) Allergic history of patient.
F) Difficult airway/ risk of aspiration.
G) Blood loss anticipation.
25. 3)Time out: (before skin incision)
It includes:
A)Introduction of all members(names of operating surgeon,
anaesthetist, scrub nurse, technician)
B)Surgeon, anaesthetist and nurse verbally confirm patient ,
site of surgery and procedure.
C)Anticipated critical events:
I. Surgeon reviews: critical steps of the procedure, duration,
and anticipated blood loss
II. Anaesthesia team reviews: Any patient specific concerns.
III. Nursing team reviews: Confirm count and sterility of
instruments, functioning of equipment, etc.
26. D) Preoperative antibiotic (60min
prior to incision)
E) Essential imaging being displayed
( xray films, ct/mri scan films etc)
27. 4)Sign out: (before patient leaves
operating room)
Nurse verbally confirms:
a. Name of procedure recorded
b. Counts- instruments, sponge,
needles
c. Labelling of specimen if any.
d. Any equipment problems to be
addressed
e. Key concerns for recovery and
management post operatively.
28. Debriefing: Carried out at the end of the operation.
Aim:
a) To learn what went well and what went wrong, so that
problems can be addressed and avoided in future
procedures.
b) To thank team members for what went well.
29. References
RECENT ADVANCES IN SURGERY BY
IRVING TAYLOR – 36th edition.
PATIENT SAFETY CURRICULUM
GUIDE – MULTI-PROFESSIONAL
EDITION – WHO 2011.
Ten years of surgical safety checklist – a
study by DR.T.GWEISER AND DR.A.B
HAYNES , BRITISH JOURNAL OF
SURGERY, MAY,2018.
Safer surgery – analysing behaviour in
operating theatre by Flin and Mitchel.