BackgroundForeign bodies in rectum and colon is an uncommon problem in surgical practice. Anal eroticism leads amongst etiologic factors. In some patients accidents or forceful application of foreign bodies are causative factors. This study was designed to describe our experience in diagnosis and treatment of this exciting clinical problem.MethodsData were collected prospectively from 1998 to 2013 in 30 patients. Patient demographics, diagnostic findings, location, type, extraction method, and postextraction period were reviewed.ResultsAll the 30 patients were their first admission in emergency service of a hospital. On admission high alcohol intake was determined in 15(50%) patients. All the patients were hospitalized. Most of the rectal foreign bodies (23 of 25) was located distal 2/3 of the rectum. Colorectal perforation was diagnosed in 5 patients who had not any retained foreign body. Under adequate anesthesia transanal extraction was implemented in 23 (92%) patients in the operating room. In the patients with proximal located rectal foreign bodies (2/25), grade III and IV rectal injury or colonic perforation (7/30) laparotomy was carried out.ConclusionA careful physical and rectal examination is essential for correct diagnosis and localization of retained foreign bodies. Forceful and repeated efforts without sphincter relaxation is gives rise to proximal migration of objects and unwanted complications such as rectal perforation. The operating room provides adequate anaesthesia for muscle relaxation and technical advantages in transanal extraction of rectal foreign bodies. Therefore, nonoperative success rate improves. If the objects are large and proximally migrated and if the patients suffer from peritonitis due to rectal or colon perforation or pelvic sepsis, laparatomy is performed witout much delay.
Electronic Health Records (EHR) are the healthcare sector’s core digital strategy meant to improve the quality of care provided to patients. Despite the benefits afforded by this digital transformation initiative, adoption among healthcare organizations has been slower than desired. The sheer volume and sensitive nature of patient records compel these organizations to exercise a healthy amount of caution in implementing EHR. Cyberattacks have also increased the risks associated with non-optimal EHR implementations. An influx of high-profile data breaches has plagued the sector during the COVID-19 pandemic, which put the spotlight on EHR cybersecurity. One objective of this research project is to aid the acceleration of EHR adoption. Another objective is to ensure the robustness of the system to resist malicious attacks. For the former, a systematic review was used to unearth all the possible causes why the adoption of EHR has been anemic. In this paper, sixty-five existing proposed EHR solutions were analyzed and it was found that there are fourteen major challenges that need to be addressed to reduce friction and risk for health organizations. These were privacy, security, confidentiality, interoperability, access control, scalability, authentication, accessibility, availability, data storage, data ownership, data validity, data integrity, and ease of use. We propose EHRChain, a new framework that tackles all the listed challenges simultaneously to address the first objective while also being designed to achieve the second objective. It is enabled by dual-blockchains based on Hyperledger Sawtooth to allow patient data decentralization via a consortium blockchain and IPFS for distributed data storage.
Background Intraoperative near‐infrared imaging (NIFI) of parathyroid glands (PG) by first‐generation technology had limited image quality and depth penetration. Second‐generation NIFI has recently been introduced. Our aim was to compare (1) capability to detect PG and (2) image quality between older and newer technologies. Methods Accurately detecting PG, as well as, quality of autofluorescence (AF) was compared between an older charge‐coupled device (CCD) camera and a newer complementary metal‐oxide semiconductor (CMOS). χ2, t test, and analysis of variance were used for analysis. Results There were 300 patients who underwent parathyroidectomy (PTX) and/or thyroidectomy (THY) with NIFI, 200 with CCD, and 100 with CMOS. Although both NIFI technologies detected >94% of PG, CMOS was superior to CCD. Comparing AF quality, mean pixel intensity of PG compared with the background was higher with CMOS compared with CCD. When comparing PG detected by NIFI before visual identification by a surgeon, both CCD and CMOS had similar results (25% vs. 22%; p = .3). Conclusion Both NIFI cameras were excellent at detecting PG. Second‐generation NIFI (CMOS) displayed higher detection rates and AF intensity. Although surgeons identified majority of PG before NIFI detection, 25% of PG were identified with NIFI first, suggesting future advancements of this technology may expand its applications during parathyroid/thyroid operations.
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