Explore the vast range of titles available.

Background The need for cosmetic results in our society and the necessity of an early recovery have promoted the development of minimally invasive techniques, including single-port approach. Some studies have tried to demonstrate the advantages of this access compared with conventional laparoscopic approach. This type of approach requires a high-cost multi-port device, so that some surgeons have tried to create a low-cost homemade device. Materials and methods With this video we intend to show how to build a glove port, a low-cost alternative for the approach by a single port. Conclusions A glove port is a cost effective approach that could be use instead of multi-port device.

Introduction: KIRUBIDE system was a pilot project to promote the collaboration between Primary Health Care (PHC) and the Day Surgery Team in Cruces University Hospital. After its implementation, more PHC centres were interested and Health Organization (Osakidetza) has increased its activity area. Description of practice change implemented: Involvement of PHC doctors supposes a new role in simple surgical pathology (such as hernias or sinus) ordering preoperative tests and sending a non-presence-consult (ICTs) to the Day Surgery Team. So a presence-consult with surgeon and anesthesiologist is coordinated the same day to establish the date of surgery in that moment. After the surgery, the follow up is also made by PHC. This simplifies the usual process, also establishing a professional relationship to solve any problem easily. Aim and theory of change: Improve the health care pathway optimizing the process by cooperation with PHC in diagnoses and follow-up in the whole attention and simplifying preoperative activity and surgical scheduling. Targeted population and stakeholders: Patients suffering major ambulatory surgery pathology from the PHC centres. Promote Primary Care selection of patients and follow-up until the end of the process. Timeline: KIRUBIDE system was implemented in 2014, after two years 150 were included in the pilot project from different PHC centres. As a result, more centres were interested and reached 300 patients after recent implantation. Highlights: There was a voluntary participation from PHC doctors of 40%. 150 patients were included in the project and 114 finally were operated. Waiting list was reduced to a mean of 15 days since surgical team consult and to 43 days after PHC consult compared to 73 and 101 days from the usual pathway. A satisfaction survey was made obtaining high level (90%) in both patients and professionals in reduction of waiting list and improvement of communication. Comments on sustainability: KIRUBIDE system may increase the workload per patient of PHC doctors. There is no investment because the communication is established online by electronic health records system. Cost effectiveness was not studied but it's assumed to improve as less appointments are needed. Comments on transferability: KIRUBIDE allows a great integration of PHC in Major Ambulatory Surgery programs and it can be applied to other hospitals that have the same organizational structure as our own increasing the efficiency. Conclusions: KIRUBIDE system simplifies the care model of candidate patients, reducing the steps in the usual assistance circuit and surgery-waiting-lists with people satisfaction. It also favours the integration of medical specialties and improves the patients’ follow-up. This program improves resources’ use and care quality because it optimizes the process by reducing steps. Discussions: KIRUBIDE system is mostly focused in simple pathology but it may be applied in others such as cholecystectomy. It only analyses a limited area with a specific organization structure not available in other places. Lesson learned: Patients need more information than the one given. Primary Health Care doctors think that time needed with each patient increases but agree that a better communication implies benefits for professionals and patients.

Abstract Background Hepatic artery avulsion following politrauma is an extremely rare condition with a very high mortality rate. Management is based on damage control surgery given the precarious situation of these patients. Ligating the artery is one option under such circumstances, despite potential consequences including ischemic cholangiopathy (IC). Ischemic cholangiopathy, which can be caused by an insufficient blood supply to the bile duct, generally results in stricture and recurrent cholangitis, and the need for a liver transplant in extreme cases. Case presentation We present the case of a 37-year-old male with multiple traumas after falling from the third floor of a building. He was hemodynamically unstable upon arrival at the emergencies department, with no improvement on administration of aggressive fluid therapy. A Echo-FAST exam evidenced fluid in all quadrants, so the patient was transferred to the operating room where a 4-litre hemoperitoneum secondary to total avulsion of the proper hepatic artery was observed. The patient required massive transfusion and vasoactive drugs, with instability throughout the intervention; therefore, we decided to ligate the proper hepatic artery. Hepatic dysfunction and diffuse IC with multiple episodes of recurrent cholangitis were observed during the postoperative period. Given the irreversible clinical picture, we opted for a liver transplant 70 days after the patient’s initial admission. The patient died on Day 34 post-transplant due to irreversible ischemic brain damage and a right occipital hemorrhage. Conclusions Hepatic artery avulsion due to trauma is very rare and its management very complex, and in certain situations the artery must be ligated. The main consequence of ligating the hepatic artery is IC, which is more frequently observed secondary to iatrogenic lesions or systemic diseases, while very few cases have been published in which IC is secondary to hepatic artery avulsion caused by hepatic trauma. Treatment depends on the extent of ischemia, and when the damage is diffuse, as in our case, it may involve a liver transplant.

Background To determine whether there is greater employee satisfaction in organisations that have made more progress in implementation of the European Foundation for Quality Management (EFQM) model. Methods A series of cross-sectional studies (one for each assessment cycle) comparing staff satisfaction survey results between groups of healthcare organisations by degree of implementation of the EFQM model (assessed in terms of external recognition of management quality in each organisation). Setting: 30 healthcare organisations including hospitals, primary care and mental health providers in Osakidetza, the Basque public health service. Participants: Employees of 30 Osakidetza organisations. Intervention: Progress in implementation of EFQM model. Main outcome measures: Scores in 9 dimensions of employee satisfaction from questionnaires administered in healthcare organisations in 4 assessment cycles between 2001 and 2010. Results Comparing satisfaction results in organisations granted Gold or Silver Q Awards and those without this type of external recognition, we found statistically significant differences in the dimensions of training and internal communication. Then, comparing recipients of Gold Q Awards with those with no Q Certification, differences in leadership style and in policy and strategy also emerged as significant. Conclusions Progress of healthcare organisations in the implementation of the EFQM Excellence Model is associated with increases in their employee satisfaction in dimensions that can be managed at the level of each organisation, while dimensions in which no statistically significant differences were found represent common organisational elements with little scope for self-management.