Background:

Inguinal hernia surgery is one of the most common surgeries within general surgery, with approximately 20 000 surgeries per year in Sweden. There are three places in Östergötland County where inguinal hernias are executed within outpatient surgery; at Aleris Specialistvård in Motala (ASM), Närsjukvården in Finspång (NiF) and at Medicinskt Centrum in Linköping (MCL).

There is a theory that private health care providers are more time-efficient than public health care providers. The private health care providers are considered to perform more operations over a given time though no studies has been done on time efficiency.

This study was performed to detect if there is a difference in time in the various steps during the surgery between the clinics, what causes these differences and if the patients differ.

Methods:

The study includes 70 patients distributed on three outpatient surgery clinics; ASM, MCL and NiF. The inguinal hernia operations were divided into shorter steps measured with a digital watch.  Furthermore, data were noted about the patients’ age, ASA-score, BMI and who were present in the operating room. Statistical analyses were performed with the Kruskal-Wallis one-way analysis of variance. The software used was SPSS version 22.

Results:

The study found no significant difference in BMI, ASA-score and age between the health care providers (p > 0,05). However, regarding the time efficiency, there were significant differences between the clinics.

Conclusions:

The study concludes that there are big differences in time, within the various steps in the inguinal hernia surgeries, between the clinics. The private health care providers were always faster than the public health care provider. Since no earlier studies have been made in this area, it would be interesting to see if there are similar differences in other types of surgeries.

This paper presents preliminary analysis from a validation study of a novel emergency medicine command and control training and evaluation simulator: DIGEMERGO®. The simulated emergency scenario was a surge capacity event at a generic emergency department, in which the participants took on a management role as the emergency department’s coordinating head nurse. A between group validation design with medical expert and novice participants was used. Initial analysis examined three triage measures associated with surge capacity management performance: time to triage, amount of patients triaged, and triage accuracy. The results show that experts were significantly more accurate at triaging in-hospital patients, but not incoming trauma patients. No significant differences in time or number of patients triaged was found. These initial results partially indicate simulator validity, but trauma patient triage accuracy suffered from a confounding variable in the triage system used. Analysis of additional measures is undergoing to further investigate validity claims.

Introduction: In a double-blind randomized clinical trial (GLUTAMICS-ClinicalTrials.gov Identifier: NCT00489827), intravenous glutamate was associated with a risk reduction exceeding 50% for developing severe circulatory failure after isolated coronary artery bypass graft (CABG) for acute coronary syndrome (ACS). Here our aim was to investigate if glutamate also influenced the need or use of inotropes.

Methods: Post hoc analysis of 824 patients in the GLUTAMICS-trial operated with isolated CABG for ACS. ICU-records were retrospectively scrutinized including hourly registration of inotropic drug infusion, dosage and total duration during the operation and postoperatively.

Results: ICU-records were available for 171 out of 177 patients who received inotropes preoperatively. Only 26% of the patients treated with inotropes fulfilled study criteria for postoperative heart failure at weaning from CPB or later in the ICU. Inotropes were mainly given preemptively to facilitate weaning from CPB or to treat postoperative circulatory instability (bleeding, hypovolemia). With the exception of significantly lower need of epinephrine there were only trends towards lower need of other inotropes overall in favour of glutamate. In patients treated with inotropes (glutamate n=17; placebo n=13) who fulfilled criteria for left ventricular failure at weaning from CPB the average duration of inotropic treatment (34±20 v 80±77 hours; p= 0.014) and the number of inotropes used (1.35 ±0.6 v1.85±0.7; p=0.047) were lower in the glutamate group.

Discussion: Intravenous glutamate had a limited effect on inotrope use overall in patients undergoing CABG for ACS whereas a substantial and significant effect was observed in patients with left ventricular failure at weaning from CPB. Glutamate treatment may therefore help patients predicted postoperative ventricular failure.