The continuous development of medicine in most fields requires physicians to apply the latest methods and technology to ensure patients\' safety. In the field of anesthesiology we are pioneers in the application of measures that guarantee the security of our patients, making possible the greatest reduction in mortality seen among all other specialties. This objective has been achieved thanks to the introduction of changes such as the one presented in this review article. The specific NRFit® connections for neuraxial and other regional anesthesia applications prevent wrong route medication errors to occur. These medication errors have been related to a high morbidity and mortality rate. This article reviews this new technology based in our own two-year experience at Hospital Universitario Príncipe de Asturias (Alcalá de Henares, Madrid) as well as a literature review using PubMed, UpToDate and ClinicalKey.

Implementation of Quality indicators (QIs) plays an imperative role in improving the total testing process, as it provides a quantitative basis for evaluating the laboratory performance. Besides monitoring of analytical quality specifications, several lines of experimental and clinical evidence have alluded a pivotal role of extra-analytical phases in improving the quality of laboratory services and therefore a relevance of pre- and post-analytical steps have been speculated on the overall quality in the total testing process and consequently on clinical decision-making. This was a retrospective study designed to evaluate and review different extra-analytical quality indicators in NABL accredited clinical biochemistry laboratory at BJ Medical College and Civil Hospital, Ahmedabad, Gujarat in an endeavour to ameliorate the performance of the laboratory. All Clinical Chemistry Laboratory test requests with their respective samples from January 2018 to December 2021 were included in the study. A total of 1,439,011samples were processed, and were evaluated for seven QIs [(% of number of suitable samples not received; QI-8), (% of number of samples received in inappropriate container; QI-9), (% of number of samples hemolysed; QI-10), (% of number of samples with inadequate sample volume; QI 12) (% of number of samples received mismatched; QI 15), (% of number of samples reported after turnaround time; QI 21) and (% of number of samples with critical values informed; QI 22)] based on defined criteria of Quality Specification given by International Federation of Clinical Chemistry. Total number of preanalytical errors was 53,669 (3.72%). Among the preanalytical errors, inadequate sample volume (2.37% of total samples; 63.49% of total pre-analytical errors) was the most common anomaly followed by Not received samples (24.18%) hemolysis (8.26%) mismatched (3.91%) and 0.14% samples were received in Inappropriate container; manifesting that the error frequency was unacceptable for QI 21 and QI 8, acceptable for QI 10, minimally acceptable for QI 15 and optimum for QI QI 9. Furthermore, there was year-wise progressive decline in error rate of inadequate sample volume, hemolysed sample received and mismatched samples. Total number of post analytical errors were 19,002 (1.32%). TAT outlier and critical values communicated were the two QIs evaluated for this phase and results of both QI were within acceptable limits. Quality indicators serve as a tool to monitor process performance and consequently derived error rates warrant active intervention to improve the laboratory services and patient health care. Dissemination of certified documents, regular staff training and evaluation needs to be conducted.

Objectives This study aimed to assess the awareness, implementation, and compliance with the infection control policy recommended by the Saudi Ministry of Health (MOH) for the use and reprocessing of endodontic files and to examine the association between compliance and gender, experience, clinical ranks, and workplace sector. Methods This was a cross-sectional study conducted using a validated self-administered electronic questionnaire created and distributed to dentists who perform endodontic treatment in Saudi Arabia. Data were collected between June and July 2023. Descriptive statistics were reported as counts and percentages. Comparisons among the demographic groups were done using the Kruskal-Wallis and Mann-Whitney tests. Results A total of 402 dentists completed the survey. The results showed that 76.1% (n=306) of respondents claimed that they were aware of the infection control policy recommended by the Saudi MOH for the use and reprocessing of endodontic files in dental clinics. Only 13.2% (n=53) of dentists used single-use endodontic files, and 36.6% (n=147) did not use an endodontic box in their dental clinics. The most commonly reported method of tracing the number of uses of endodontic files was to write the ID of the patient or the number of uses on the sterilization pouch as reported by 37.6% of participants (n=151). The average compliance score percentage was 63.5 ± 16.7. Most of the respondents showed moderate to high levels of compliance (51.7% (n=208) and 42.0% (n=169) of dentists, respectively). Dentists with less than 5 years of experience showed significantly less compliance than dentists with more than 10 years of experience (p = 0.005). Gender, clinical rank, and workplace sector were not significantly associated with the extent of adhering to the evaluated infection control policy. Conclusions Our findings indicate a relatively high level of compliance with the Saudi MOH policy of using and reprocessing endodontic files. However, critical measures such as the single-use of endodontic files, sterilizing new endodontic files, and using the sterilized endodontic box for each patient need improvement. Hence, this study recommends enhancing awareness through continuous education and training.

The rate of electrosurgery complications is 0.1-2.1%. More than 10 years ago, SAGES pioneered a well-structured educational program (FUSE) aimed to teach about the safe use of electrosurgery. This inspired the development of similar training programs around the globe. Still, the knowledge gap persists among surgeons, possibly due to the lack of judgment.
To investigate factors affecting the level of expertise in electrosurgical safety and their correlation with self-assessment scores among surgeons and surgical residents.
We conducted an online survey consisting of 15 questions that could be thematically broken down into 5 blocks. We analyzed how the objective scores were correlated with the self-assessment scores, professional experience, past participation in training programs, and work at a teaching hospital.
A total of 145 specialists took part in the survey, including 111 general surgeons and 34 s-year surgical residents from Russia, Belarus, Ukraine, and Kirgizia. Only 9 (8.1%) surgeons scored \"excellent,\" 32 (28.8%) scored \"good,\" and 56 (50.4%) scored \"fair.\" Of all surgical residents participating in the study, only 1 (2.9%) scored \"excellent,\" 9 (26.5%) scored \"good,\" and 11 (32.4%) scored \"fair.\" The test was failed by 14 surgeons (12.6%) and 13 (38.2%) residents. The difference between the trainees and the surgeons was statistically significant. Our multivariate logistic model identified 3 significant factors predisposing to successful performance on the test: past training in the safe use of electrosurgery, professional experience, and work at a teaching hospital. Of all study participants, those with no past training in the safe use of electrosurgery, and non-teaching surgeons were the most realistic about their competencies.
We have identified alarming gaps in the knowledge of electrosurgical safety among surgeons. Faculty staff and experienced surgeons scored higher, but past training was the most influential factor in improving knowledge of electrosurgical safety.

Vestibular disorders may generate complex signs and symptoms, which may alter patients\' balance and the quality of life. Dizziness and vertigo can strongly affect daily activities and relations. Despite the presence of conventional drugs, maneuvers, and surgery, another interesting therapeutic opportunity is offered by nutraceuticals. These molecules are often used in the treatment of dizziness and vertigo, but the rationale of their application is not always solidly demonstrated by the scientific evidence. Several substances have shown a variable level of efficacy/usefulness in this field, but there is lack of important evidence for most of them. From a medico-legal point of view, specific information must be provided to the patient regarding the efficacy and possibilities that the use of these preparations can allow. Administering the right nutraceutical to the proper patient is a fundamental clinical skill. Integrating conventional drug treatment with nutraceutical administration seems to be easy, but it may be difficult considering the (in part unexplored) pharmacodynamics and pharmacokinetics of nutraceuticals. The aim of the scientific community should be to elevate nutraceuticals to the same law and technical dignity of conventional drugs.

The importance of telemedicine technologies around the world has been growing for many years, and it turned out to be a particularly important issue for conducting some medical procedures during the SARS-CoV-2 pandemic. It is necessary to create interdisciplinary teams to design and implement improved procedures using telemedicine tools. The aim of the article is to develop original, improved posthospital patient care process after total hip arthroplasty (THA) with the use of telemedicine technologies. In the study, a literature review and empirical research were used. The conducted research resulted in the designing an original posthospital patient care process after THA that uses telematics technologies. Due to the use of analyzed telemedicine technologies, the designed patient care process brings a possibility to increase the patient\'s safety by monitoring life parameters, allowing for regular, remote contact with specialists and to be supervised remotely. All this may contribute to shortening the convalescence time, reducing the risk of complications, as well as reducing treatment costs. The designed model is ready for further clinical research with the participation of medical staff, patients after THA and patient caregivers.

Since the odontoid fractures become increasingly common in the aging population, technical improvements are even more needed. The odontoid screwing has been progressively preferred by many surgeons in type II fractures according to the Anderson-D\'Alonzo classification system. However, X-ray exposure remains an issue for surgeons and OR staff members. The aim of the present study was to investigate the feasibility of using the O-Arm for odontoid screwing comparing the radiation exposure to the standard C-Arm.
Patients consequently referred to our center for odontoid type II fractures, from January 2018 to April 2019, eligible for odontoid screwing were enrolled in the present study. They were operated on using either C-Arm or O-Arm-assisted procedures. The surgical duration, number of acquisitions, global X-ray exposure for the OR staff and patients, and screw placement accuracy were evaluated.
No differences in terms of patients\' demographical characteristics and surgical duration were reported. The number of acquisitions, intraoperative and global X-ray dose, for the OR staff and patients, was lower in O-Arm-assisted procedures (p < 0.05). The screws were all well positioned.
Since the surgical outcomes seem to be similar using the O-Arm for odontoid screwing, the lower X-ray exposure and the possibility for checking the instrumentation positioning with 3D reconstructions before leaving the OR should be considered.

Dermatosurgery is a growing subspeciality due to increasing numbers of skin cancer and aesthetic procedures. Patient safety is a major issue in dermatosurgery. Quality management, education, and organization are the backbone of patient safety. A simple measure to support patient\'s safety and to avoid wrong site surgery is preoperative skin marking. Permanent skin markers offer a painless and cost-effective option. To ensure optimal results, the following problems need careful consideration: good viability after disinfection, sterility of the operation field, no sensitization, or toxic effects of the ink. These issues are discussed in detail to allow a safe and successful procedure.

Currently available simulators are supposed to allow young neurosurgeons to hone their technical skills in a safe environment, without causing any unnecessary harm to their patients caused by their inexperience. For this training method to be largely accepted in neurosurgery, it is necessary to prove simulation efficacy by means of large-scale clinical validation studies.
We correlated and analysed the performance at a simulator and the actual operative skills of different neurosurgeons (construct validity). We conducted a study involving 92 residents and attending neurosurgeons from different European Centres; each participant had to perform a virtual task, namely the placement of an external ventricular drain (EVD) at a neurosurgical simulator (ImmersiveTouch). The number of attempts needed to reach the ventricles and the accuracy in positioning the catheter were assessed.
Data suggests a positive correlation between subjects who placed more EVDs in the previous year and those who get better scores at the simulator (p = .008) (fewer attempts and better surgical accuracy). The number of attempts to reach the ventricle was also analysed; senior residents needed fewer attempts (mean = 2.26; SD = 1.11) than junior residents (mean = 3.12; SD = 1.05) (p = .007) and staff neurosurgeons (mean = 2.89, SD = 1.23). Scoring results were compared by using the Fisher\'s test, for the analysis of the variances, and the Student\'s T test. Surprisingly, having a wider surgical experience overall does not correlate with the best performance at the simulator.
The performance of an EVD placement on a simulator correlates with the density of the neurosurgical experience for that specific task performed in the OR, suggesting that simulators are able to differentiate neurosurgeons according to their surgical ability. Namely this suggests that the simulation performance reflects the surgeons\' consistency in placing EVDs in the last year.

OBJECTIVE: To evaluate law and educational components of patient\'s safety (PS) in surgery.
METHODS: In order to analyze complex causes of adverse outcomes in surgery we performed an interviewing of 110 surgeons, 42 emergency physicians and 25 health care managers. The main keynote consisted in assessing law and educational components of PS.
RESULTS: The study revealed significant professional shortcomings in law PS level and low educational and motivational activity of physicians of all specialties.
CONCLUSIONS: Multi-faceted nature of PS problem requires multidisciplinary training of modern surgeons not only in the knowledge of key risk factors for adverse outcomes, but also in satisfaction of non-medical expectations of patients. Due to numerous objective reasons Russian surgical school should have the opportunity not to blindly copy the experience of our foreign colleagues, but to scientifically substantiate the development of own national security system both for surgical patients and medical workers themselves.
Цель исследования - оценка правового и образовательно-мотивационного компонентов безопасности пациентов в хирургии. Материал и методы. В рамках изучения комплексных причин неблагоприятных исходов лечения в хирургии было проведено анкетирование 110 хирургов, 42 врачей скорой помощи и 25 организаторов здравоохранения, основной лейтмотив которого заключался в оценке правового и образовательно-мотивационного компонентов безопасности пациентов. Результаты. Исследование выявило значительные профессиональные недостатки в уровне правовой безопасности пациентов и низкую образовательно-мотивационную активность врачей всех специальностей. Вывод. Многогранность проблемы безопасности пациентов требует от современных хирургов мультидисциплинарной подготовки не только в области знаний о ключевых факторах риска неблагоприятных исходов лечения, но и в области удовлетворения немедицинских ожиданий пациентов. В силу целого ряда объективных причин для российской хирургической школы должна оставаться возможность не для слепого копирования опыта наших зарубежных коллег, а для научно-обоснованного развития своей национальной системы обеспечения безопасности как хирургических пациентов, так и самих медицинских работников.