This study shows that it is possible to define and develop a whole-procedure VR training curriculum for laparoscopic cholecystectomy using structured scientific methodology.

The aim was to evaluate the effect of caesarean delivery on the neonatal outcome after labour with fetal distress and/or meconium staining (MS). We audited 199 caesarean sections performed for non-reassuring fetal condition (NRFC) and/or MS in a rural regional hospital. The 1 and 5 min Apgar scores were compared with those of 33 vaginal births after labour with MS. There were five neonates out of 232 (2.2%) with an Apgar score <7 at 5 min; one died early, neonatally. In the caesarean section group for NRFC, there were two fresh stillbirths and one early neonatal death, a perinatal mortality of 15.1/1,000 births. The 5 min Apgar score was not statistically significantly affected by the mode of delivery. Caesarean delivery does not improve the neonatal outcome when the amniotic fluid is meconium stained.

Premature infants undergoing laser treatment for retinopathy of prematurity are generally more systemically unstable than the average neonate and are more susceptible to episodes of apnoea and bradycardia [1]. General anaesthesia is associated with an increased risk of complications including ventilatory trauma and complicated extubation. A UK study [2] showed that most units carry out laser treatment for retinopathy of prematurity under general anaesthesia in the operating theatre. We describe an alternative technique using local anaesthetic with sedation, which may be useful in selected cases, and attempt to evaluate pain control during the procedure. MethodsOver a year, three out of 12 consecutive infants undergoing laser for retinopathy of prematurity were prospectively identified as suitable based on their stability with handling and requirement for oxygen supplementation. Half an hour before treatment babies were placed on continuous positive airways pressure (CPAP) ventilation and sub-Tenon's block performed with 1-2 ml lidocaine 0.5%. Chloral hydrate (100 mg.kg ) and paracetamol were given rectally. Laser treatment was performed in an equipped side-room on the neonatal intensive care unit (NICU) with oxygen saturation, ECG monitoring and neonatal nursing support. The Neonatal Pain, Agitation and Sedation Scale (N-PASS; http:// www.n-pass.com) was completed for each baby to assess whether adequate pain relief was achieved during the procedure. The goal of pain management is to keep this score £ 3. Intervention is indicated for a score >3. ResultsThe mean (range) gestational age was 26 (24-29 weeks) and birth weight 657 (542-880) g. The laser procedure lasted 25-30 min per eye. No infant required conversion to general anaesthesia. One baby did not require CPAP after laser treatment and two required CPAP for <8 h each. The mean (range) pain score was 2.8 (0-7) and the mean sedation score was )3 ()4 to 0). Higher pain scores were noted at the beginning of the procedure for each baby and these settled in all cases, after a few minutes. DiscussionOur study suggests that the use of local anaesthesia with sedation is a safe and effective anaesthetic allowing laser treatment for retinopathy of prematurity in selected babies. It prevents treatment delay while waiting for main theatre and the complications associated with transportation are eliminated. It allows application of the laser quickly and accurately. Pain assessment showed that babies suffer minimal distress. An equipped side room on NICU with neonatal nursing support and a neonatologist are essential. Our study has limitations: the numbers are small; follow-up data are limited; and the N-PASS system relies on a degree of subjective assessment.References

BACKGROUND: Surgical site infection is the second most common nosocomial infection after urinary tract infection and contributes to a significant percentage of morbidity and mortality in patients. OBJECTIVES: The objective was to find out SSI rate and determining the factors which are influencing the infection rate. METHODS: A total of 150 samples from surgical site were collected and bacterial isolates identified by standard methods. Antibiotic susceptibility testing was performed by Kirby-Bauer disc diffusion method. RESULTS: Most common bacteria isolated from surgical site infection was Staphylococcus aureus (31.58%) followed by Klebsiella pneumoniae (26.31%), Pseudomonas aeruginosa (15.79%), E.coli (10.53%), Acinetobacter (10.53%) and Proteus mirabilis (5.26%). Percentage of MRSA, ESBL production in E.coli and Klebsiella pneumoniae were 33.33%, 50% and 60% respectively. All the strains of Staphylococcus aureus were sensitive to Vancomycin. Most of the strains of gram negative bacilli were sensitive to Amikacin. CONCLUSION: Surgical site infection prolong the hospital stay, increases the treatment cost, bed occupancy in ward and patient morbidity. Rapid and accurate detection of these pathogens and their antibiotic susceptibility pattern is important for prompt treatment, can prevent the emergence and dissemination of drug resistance. A little modification of determinants can reduce the SSI rate in a hospital to a costeffective way.