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Emergency laparotomy is a life-saving intervention for acute abdominal conditions, yet its impact on patients' long-term quality of life (QOL) remains poorly understood. This systematic review synthesizes evidence on QOL outcomes following emergency laparotomy, with a focus on emergency medicine perspectives, including recovery trajectories, influencing factors, and implications for clinical practice. A comprehensive search of PubMed/Medline, Embase, Web of Science, and Scopus was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In total, 11 studies were included, encompassing prospective and retrospective cohorts, cross-sectional surveys, and one randomized controlled trial. The risk of bias was assessed using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. Narrative synthesis was performed due to heterogeneity in QOL measures. Key findings revealed significant variability in QOL recovery. Survivors of peritonitis without malignancy reported acceptable QOL, while cancer and advanced age predicted worse outcomes. Chronic pain affected 19-45% of patients, particularly after small bowel obstruction surgery, and was linked to long-term functional impairment. Laparoscopy improved QOL in elderly patients compared to laparotomy. Frailty and prolonged hospitalization were associated with declines in physical and social functioning. Patient-reported outcome measures were feasible in emergency settings but highlighted unmet needs in psychological and social recovery. Emergency laparotomy significantly impacts QOL, with recovery shaped by surgical approach, comorbidities, and postoperative pain. Standardized QOL assessment, integrated multidisciplinary care, and targeted rehabilitation are needed to optimize long-term outcomes. Future research should prioritize prospective studies with uniform QOL metrics to guide patient-centered interventions.

Uterine fibroids represent a prevalent gynecological condition with significant implications for fertility and quality of life. This systematic review evaluates the efficacy, safety, and fertility outcomes of minimally invasive myomectomy (MIM) techniques, including laparoscopic myomectomy (LM), robot-assisted laparoscopic myomectomy (RALM), and single-port laparoscopic myomectomy (SPLM), and non-invasive approaches such as ultrasound-guided high-intensity focused ultrasound (USgHIFU). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we analyzed 17 studies encompassing diverse surgical methods and reproductive outcomes, with quality assessment performed using the Newcastle-Ottawa scale (NOS). Key findings demonstrate that MIM techniques yield favorable fertility outcomes compared to traditional abdominal myomectomy. Among the included studies, 10 were rated as low risk of bias and 7 as moderate risk on the NOS. Laparoendoscopic single-site myomectomy (LESS-M) and SPLM were associated with higher pregnancy rates (66.7% and 75%, respectively) and shorter time to conception (7.6 vs. 10.1 months for LESS-M vs. conventional LM). RALM showed promise in complex cases, with pregnancy rates of 13-66.7% and no reported uterine ruptures. Non-invasive USgHIFU offered comparable pregnancy rates to LM but was linked to shorter conception times and mixed fetal outcomes, including higher preterm birth rates. Surgical nuances, such as barbed versus nonbarbed sutures, did not significantly impact fertility, while fibroid characteristics and surgeon expertise played pivotal roles. Vaginal birth after LM was deemed safe, with no uterine ruptures reported in large cohorts. However, heterogeneity in study designs, retrospective biases, and limited long-term follow-up data underscore the need for standardized protocols and prospective trials. MIM techniques are a viable option for women seeking fertility preservation, offering reduced morbidity and comparable or superior reproductive outcomes. Future research should prioritize multicenter studies to optimize patient selection and surgical standardization.

 Arterial blood gas (ABG) analysis is a critical diagnostic tool used in emergency and intensive care settings to assess a patient's acid-base balance, ventilation, and oxygenation. Despite its importance, ABG interpretation remains challenging for junior doctors, particularly when dealing with complex cases involving mixed respiratory and metabolic disturbances. This clinical audit was conducted to evaluate the baseline competency of junior doctors in ABG interpretation and to measure the impact of targeted educational interventions.  Aim: This study aims to evaluate the baseline knowledge of junior doctors in ABG interpretation and to assess the impact of targeted educational interventions on improving their interpretation skills.  A prospective, two-cycle clinical audit was conducted at Dongola Teaching Hospital in Northern Sudan, involving 110 questionnaires, 55 in each cycle. The first cycle served as a baseline assessment using structured clinical scenarios based on American Thoracic Society (ATS) guidelines. After identifying deficiencies, educational interventions were implemented over a two-week period. These included focused lectures, visual posters, and small-group case discussions. The second cycle reassessed the same parameters using a revised version of the questionnaire to reduce recall bias. Data were analyzed using SPSS version 25, and statistical significance was evaluated using the chi-square test with p < 0.05 considered significant.  Results: Significant improvements were observed in most key areas of ABG interpretation. The ability to assess compensation improved from 23 (42%) to 40 (72%) (p = 0.002), identifying respiratory vs. metabolic origin increased from 37 (68%) to 50 (90%) (p = 0.005), and detection of mixed acid-base disorders rose from 30 (54%) to 43 (78%) (p = 0.015). The calculation of anion gap improved from 35 (64%) to 47 (86%) (p = 0.009), and basic interpretation of pH disturbances increased from 41 (74%) to 48 (88%) (p = 0.15). Although some gains were not statistically significant, all areas demonstrated clinical relevance and educational benefit.  The findings demonstrate that structured educational interventions can significantly enhance ABG interpretation skills among junior doctors, particularly in resource-limited settings. This audit supports the integration of focused, practical ABG training into routine junior doctor education and highlights the importance of ongoing assessment through audit cycles. Wider adoption of such strategies may contribute to improved diagnostic accuracy, timely interventions, and better patient outcomes.

Background Effective discharge documentation is essential for ensuring patient safety, care continuity, and communication among healthcare providers. However, in resource-limited settings like Sudan, documentation quality is often suboptimal, leading to gaps in care and poor patient outcomes. This quality improvement project (QIP) at Dongola Specialized Hospital aimed to address these challenges by implementing a standardized discharge card and providing targeted staff training. Methods  The study was conducted over two cycles, with data collected from 50 discharge cards in each cycle, selected using a simple randomization technique. The first cycle assessed baseline documentation practices, revealing significant inconsistencies. A standardized discharge card was then developed and implemented, accompanied by training sessions for healthcare providers. The second cycle evaluated the intervention's effectiveness, measuring compliance and completeness of patient information (e.g., clinical summaries, discharge plans, and medication lists). Feedback from healthcare providers and patients was also collected to assess the new system's impact. Results The intervention led to significant improvements in discharge documentation quality. Compliance with the new format increased from 66% in the first cycle to 92% in the second cycle. Completeness of patient information reached 100%, while clinical summaries and discharge plans improved by 40% and 30%, respectively. Medication list accuracy also increased to 88%. Preliminary data indicated a 15% reduction in readmission rates, attributed to clearer postdischarge instructions. However, challenges such as incomplete documentation in certain sections and time constraints for healthcare providers remained. Conclusion The implementation of a standardized discharge card significantly improved the quality of discharge documentation at Dongola Specialized Hospital, contributing to better patient outcomes and reduced readmission rates. The findings highlight the importance of structured documentation and regular audits in enhancing patient safety and care continuity, particularly in resource-limited settings. Ongoing efforts are needed to address remaining challenges, such as incomplete documentation and time constraints, to ensure sustained improvements in the discharge process. This study serves as a model for similar healthcare facilities aiming to improve documentation practices and patient care.

Background Thorough and standardized documentation of operative notes is essential for effective communication, patient safety, legal protection, and the continuity of care. However, in many hospitals in Sudan, surgeons often use non-standardized methods, resulting in inconsistent and incomplete records. This study evaluates the quality of operative notes at the Port Sudan Teaching Hospital using the Royal College of Surgeons of England (RCSEng) guidelines, aiming to improve compliance and documentation practices. Methods A clinical audit was conducted in two cycles at the General Surgery Department. The first cycle, a retrospective review of 50 surgical notes, was carried out over one week in July 2024. The second cycle conducted prospectively on another 50 notes throughout September 2024, involved the implementation of an improved proforma and staff training. Data were collected using a standardized checklist aligned with Royal College of Surgeons in Ireland (RCSI) guidelines, covering 18 documentation criteria. Results were analyzed using Microsoft Excel 2016 (Microsoft Corporation, Redmond, Washington, United States) to assess improvements in compliance. Results The compliance with documentation standards increased significantly from 51.9% in the first cycle to 82.1% in the second cycle. Notable improvements were observed in recording operative findings (17, 34%), complications (34, 68%), and deep vein thrombosis (DVT) prophylaxis (47, 94%). Despite the overall progress, modest improvements were noted in documenting the anesthetist's name (2.5, 5%) and the surgeon's signature (3, 6%). These findings underscore the positive impact of structured proformas and targeted staff training. Conclusion The implementation of standardized documentation tools and staff training significantly improved the quality of surgical operative notes at the Port Sudan Teaching Hospital. While notable progress was achieved, continued efforts, including digital solutions and regular audits, are needed to sustain these improvements and promote patient safety.

Background Surgical site infections (SSIs) are a critical concern in healthcare, particularly in developing countries, where they are among the most prevalent and challenging hospital-acquired infections. Adherence to proper hand hygiene practices is essential to prevent SSIs. However, compliance among surgical teams remains suboptimal due to factors such as time constraints, lack of training, and resource limitations. This study evaluates and enhances adherence to surgical hand scrubbing protocols at Osman Degna Teaching Hospital using World Health Organization (WHO) guidelines. Methods An observational cross-sectional audit was conducted in two cycles between August and October 2024, with 54 observations per cycle. Baseline adherence was assessed in the first cycle. Targeted interventions, including video demonstrations, hands-on training, and feedback, were implemented before the second cycle. Data were collected using a structured checklist and analyzed quantitatively to compare compliance rates and qualitatively to identify barriers to adherence. Results Compliance with hand scrubbing protocols improved significantly from 63.1% in the first cycle to 94.3% in the second. The most notable improvement (51.5%) was observed in rotational rubbing with clasped fingers. Other areas, including scrubbing palms and rinsing hands, showed substantial increases (30.3-42%). These findings highlight the effectiveness of structured training and feedback in enhancing adherence. Conclusion Targeted educational interventions significantly improved compliance with surgical hand scrubbing protocols, contributing to better infection control practices. While these improvements demonstrate the potential of training programs, continued efforts and long-term strategies are necessary to sustain progress and further reduce the risk of SSIs.

Colorectal surgery carries substantial risks of postoperative morbidity, extended hospital stays, and increased healthcare costs. While the overall benefits of enhanced recovery after surgery (ERAS) protocols are well established, recent studies have expanded their scope to include immunological outcomes, telemedicine integration, and patient-centered recovery metrics. This systematic review synthesizes the latest evidence from randomized controlled trials (RCTs) evaluating ERAS protocols in colorectal surgery, with particular attention to these emerging dimensions. A comprehensive search of PubMed, Scopus, Web of Science, Embase, and ClinicalTrials up to July 2025 identified 10 eligible RCTs from 414 screened records. Risk of bias was assessed using the Cochrane RoB 2 tool. Narrative synthesis was performed due to heterogeneity in ERAS components and outcome definitions. Consistent with prior literature, ERAS accelerated the return of bowel function, reduced the length of hospital stay, and lowered complication rates. Notably, recent trials demonstrated immunological benefits, including reductions in inflammatory markers (IL-6, CRP [C-reactive protein]) and preservation of immune function. Telemedicine-enhanced ERAS pathways, such as remote postoperative monitoring, further shortened recovery times while maintaining high patient satisfaction. Patient-centered outcomes, including functional independence, quality of life, and readiness for home discharge, were significantly improved. Most studies exhibited low risk of bias, although variability in ERAS implementation and reporting persisted. These findings confirm that contemporary ERAS protocols not only optimize physiological recovery but also address immune resilience, leverage digital health tools, and prioritize patient experience. Future research should standardize implementation and assess the long-term effects of these innovations.

Background Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), is a leading cause of avoidable hospital-acquired morbidity and mortality. Despite clear international guidelines from bodies such as the American College of Chest Physicians (ACCP) and the National Institute for Health and Care Excellence (NICE), compliance in surgical settings remains suboptimal. This clinical audit aimed to evaluate and improve the documentation and implementation of VTE risk assessment and prophylaxis among surgical patients. Methods A closed-loop clinical audit was conducted at Prince Osman Digna Referral Hospital, Port Sudan, Sudan. The study included retrospective and prospective data collection across two audit cycles, the first involving 50, and the second cycle, 47 randomly selected surgical inpatient records. Data were gathered using a standardized tool aligned with international guidelines. Interventions between the cycles included educational workshops, implementation of standardized assessment forms, visual aids, and feedback sessions. Data were analyzed using descriptive statistics and the Chi-square test to determine changes in compliance. Results In the first cycle (N = 50), compliance was poor: zero (0%) had Caprini scores documented, and 49 (98%) received no prophylaxis. Following targeted interventions, the second cycle (N = 47) showed significant improvement. Caprini score documentation increased to 39 (83%), early mobilization to 30 (63.8%), and LMWH administration to nine (19.1%). Use of TED stockings rose to eight (17%), while those receiving no prophylaxis dropped to seven (14.9%). Documentation of prophylaxis duration improved to 37 (78.7%), compared to one (2%) in the first cycle. Guideline-consistent management plans increased from one (2%) to 30 (65.2%), and education on VTE risk and prophylaxis rose from one (2%) to 20 (42.6%). All improvements were statistically significant (p < 0.05). Conclusion Targeted interventions led to substantial improvements in VTE risk assessment and prophylaxis practices. Standardized tools, clinician education, and systematic feedback proved effective in promoting adherence to evidence-based guidelines. Sustained efforts are essential to maintain compliance and enhance patient safety.

Inadequate discharge documentation at Almanagil Teaching Hospital posed significant risks to patient safety and continuity of care, consistent with challenges seen in similar healthcare settings. The hospital aimed to address these gaps by enhancing the completeness, accuracy, and clarity of surgical discharge documentation through the development and implementation of a standardized discharge card, coupled with targeted staff training. A prospective quality improvement project was conducted in two cycles (May-June 2025), involving audits of 44 (First Cycle) and 51 (Second Cycle) surgical discharge cards. Following baseline assessments, a structured discharge card was developed and implemented, along with targeted clinical staff training. Post-intervention audits revealed substantial improvements. Documentation of telephone number and address rose from 0 (0%) to 47 (92.2%) and 49 (96.1%), respectively. The number of hospital file entries increased from 29 (65.9%) to 49 (96.1%). Referrers' names, roles, organizations, and contact details improved from less than three (6.8%) to 51 (100%). Clinical elements, such as documentation of intraoperative and postoperative complications, rose from nine (20.5%) and eight (18.2%) to 51 (100%). Overall compliance increased from 52.9% to 94.6%, marking a 41.7% gain. The intervention significantly enhanced discharge documentation quality, reinforcing standardization, patient safety, and accountability. The model is scalable to similar resource-limited settings and warrants sustained auditing and ongoing training for long-term impact.