An analysis of time utilization and cancellations of scheduled cases in the main operation theater complex of a tertiary care teaching institute of North India

Context:

Operation theater (OT) utilization.

Aims:

To analyze the time utilization and to assess the stated causes of cancellations of scheduled cases in the OT complex of a tertiary care teaching institute.

Settings and Design:

This prospective study was carried out from December 2010 to April 2011.

Materials and Methods:

each of the 16 OT tables was observed for 6 days (total 96 days). The available resource hours were taken as 0800-1600 hrs. (480 min/day; 46,080 min in 96 days). The following parameters were recorded — time spent on supportive services, time spent on actual surgery, room turn over time, time spent for total procedure and time between entry and exit of patient.

Statistical Analysis:

Data were analyzed using the SPSS software version 15.

Results:

Of the total 325 scheduled cases, 252 were operated and 73 (22.5%) were cancelled. There were delays on 15 days (15.63%) in starting the OT table at the scheduled time. Of the total resource hours (46,080 min), the mean “Raw utilization” was 37,573 min (81.54%) and the “Adjusted utilization” was 39,668 min (86.09%). The mean time spent on “supportive services” was 5539 min (12.02%) and on “actual surgery”’ was 28,277 min (61.37%), and the “room turn over time” was 2095 min (5.39%). Among the stated reasons for cancellations, lack of operating time — 57 cases (78.1%) — was the most common.

Conclusion:

Study of time utilization and cancellation are important tools in assessing the optimal utilization of available resource hours in an OT.

Agreement and variability in the interpretation of early CT changes in stroke patients qualifying for intravenous rtPA therapy

BACKGROUND AND PURPOSE

Ischemic changes identified on CT scans performed in the first few hours after stroke onset, which are thought to possibly represent early cytotoxic edema and development of irreversible injury, may have important implications for subsequent treatment. However, insecurity and conflicting data exist over the ability of clinicians to correctly recognize and interpret these changes. We performed a detailed review of selected baseline CT scans from the NINDS rt-PA Stroke Trial to test agreement among experienced stroke specialists and other physicians on the presence of early CT ischemic changes.

METHODS

Seventy baseline CT scans from the NINDS Stroke Trial were read and classified for the presence or absence of various early findings of ischemia by 16 individuals, including NINDS trial investigators, other neurologists, other emergency medicine physicians, and radiology or stroke fellows. CT scans included normal scans and scans from patients who later developed symptomatic intracranial hemorrhage, as well as scans on which the NINDS rt-PA Stroke Trial neuroradiologist identified clear-cut early CT changes. For each CT finding, kappa-statistics were used to assess the proportion of agreement beyond chance.

RESULTS

kappa-Values (95% confidence interval [CI]) ranged from 0.20 (-0.20, 0.61) (fair agreement) to 0.41 (0.37, 0.45) (moderate agreement) among the 16 viewers, and the kappa-value was only 0.39 (0.29, 0.49) (fair) in answer to the question "do early CT changes involve more than one third of the MCA [middle cerebral artery] territory?" There was substantial variability within each specialty group and between groups. kappa-Values were only fair to moderate even among physicians experienced in selecting and treating acute stroke patients with rtPA. Observed agreement ranged from 68% to 85%. Physicians agreed on the finding of early CT changes involving >33% of the MCA territory 77% of the time, although the kappa-value of 0.39 suggested only moderate agreement beyond chance.

CONCLUSIONS

There is considerable lack of agreement, even among experienced clinicians, in recognizing and quantifying early CT changes. Improved methods of recognizing and quantifying early ischemic brain damage are needed.

Duropleural fistula manifested as a large pleural transudate: an unusual complication of transthoracic diskectomy

A 52-year-old patient presented with large symptomatic transudative pleural effusion 4 months following T8 to T9 transthoracic diskectomy. Anterior approach diskectomy has replaced the traditional laminectomy for treating symptomatic centrally herniated and calcified thoracic disks. We describe in this report the first case of a large cerebrospinal fluid collection in the pleural cavity caused by persistent postoperative duropleural fistula. The possibility of a duropleural fistula should be entertained in patients who present with a pleural effusion following transthoracic diskectomy.

Lipase activity in Mycobacterium leprae--an indicator of metabolic function

Presence of lipase, in Mycobacterium leprae obtained from human nodules and infected armadillo tissues, has been detected by demonstrating the ability of the bacteria to hydrolyze tributyrin. This capacity is expressed during incubation of the bacteria with the substrate and needs a source of carbon and other energy metabolites. The activity is blocked by anti M. leprae drug rifampicin. It is concluded that expression of lipase activity is a metabolic event of M. leprae, while they are maintained in an energy providing medium.