METHODS: Patient positioned semi-supine with left sided propped up and the ipsilateral arm placed naturally and secured by the side and below the chest wall. Cleaned and draped as for sterile procedure. General anaesthesia and lung isolation achieved with a double lumen endotracheal intubation. A 2.5 cm incision was made at 4(th) intercostal space, anterior axillary line (lateral to nipple line). Extra small size wound protector was used and CO2 insufflation was not needed. Instruments utilised in this case were "not new" and used for laparoscopic surgery 2 decades ago. This video demonstrates the simple technique of left uniportal approach to total thymectomy. Safe en bloc resection of thymus and thymic tumour with surrounding fatty tissue were performed, by combination of careful pleura dissection using diathermy, traction and blunt dissection of thymus. Extra caution when dividing thymic vein branches from innominate vein is prudent in order to prevent intra-operative haemorrhage and subsequent conversion to sternotomy or thoracotomy.
RESULTS: In this video, total thymectomy was performed without complication. The specimen was removed through the port and a single chest tube was placed at end of procedure for 1 day. Patient went home uneventfully on day 2.
CONCLUSIONS: Left uniportal VATS thymectomy is feasible, and preferred for left sided thymoma. This simple approach should be encouraged and performed by all enthusiastic VATS thoracic surgeons.
METHODS: Patient positioned semi-supine with right sided propped up and the ipsilateral arm placed naturally and secured by the side and below the chest wall. Cleaned and draped as for sterile procedure. General anaesthesia and lung isolation achieved with a double lumen endotracheal intubation. A 2.5 cm incision was made at 5(th) intercostal space, anterior axillary line (lateral to nipple line). Extra small size wound protector was used and CO2 insufflation was not needed. Instruments utilised in this case were "not new" and used for laparoscopic surgery 2 decades ago. This video demonstrates the simple technique of right uniportal approach to total thymectomy. Safe en bloc dissection of thymus and thymic tumour with surrounding fatty tissue were performed by combination of careful pleura dissection using diathermy, traction and blunt dissection of thymus. Extra caution when dividing thymic vein branches from innominate vein is prudent in all thymic dissection and prevent intra-operative haemorrhage and subsequent conversion to sternotomy or thoracotomy.
RESULTS: In this video, total thymectomy was performed without complication. The specimen was removed through the port and a single chest tube was placed at end of procedure for 1 day. Patient went home uneventfully on day 2.
CONCLUSIONS: Right uniportal VATS thymectomy is feasible, and this simple approach should be encouraged and performed by all enthusiastic VATS thoracic surgeons.
METHODS: This video demonstrated the uniportal procedure for bullectomy and double pleurodesis for PSP. A 2.5 cm incision was made at 4th intercostal space, anterior axillary line. Extra small size wound protector was used and CO2 insufflation was not needed. Adhesion divided with diathermy and visible apical bullae was resected using endoscopic stapler. Abrasive pleurodesis performed by using scratch patch mounted on Robert clamp, gently running along the parietal pleura within the chest wall. In addition, 5 grams of pure talc was delivered into pleural space. Single drain inserted via the port and lung fully inflated upon resuming ventilation by anaesthetist. Drain remained for 48 hours under negative pressure of -20 mmHg and patient usually went home on day 3 post-operatively.
RESULTS: During the period from 2009 to 2015, over 160 cases of PSP were treated using this method by the author. To date, there is no recurrence reported upon follow up at outpatient clinic. There was no mortality and patients resumed active physical activity 8 weeks after the procedure.
CONCLUSIONS: Uniportal VATS bullectomy and double pleurodesis is a safe procedure for treating PSP and effective in preventing future recurrence of lung collapse. This simple approach should be encouraged and performed by all enthusiastic VATS thoracic surgeons.
METHODS: This study used a survey to collect data from 200 nursing staff, i.e., nurses and medical assistants, employed by a large private hospital and a public hospital in Malaysia. Respondents were asked to answer 5-point Likert scale questions regarding transformational leadership, employee empowerment, and job satisfaction. Partial least squares-structural equation modeling (PLS-SEM) was used to analyze the measurement models and to estimate parameters in a path model. Statistical analysis was performed to examine whether empowerment mediated the relationship between transformational leadership and job satisfaction.
RESULTS: This analysis showed that empowerment mediated the effect of transformational leadership on the job satisfaction in nursing staff. Employee empowerment not only is indispensable for enhancing job satisfaction but also mediates the relationship between transformational leadership and job satisfaction among nursing staff.
CONCLUSIONS: The results of this research contribute to the literature on job satisfaction in healthcare industries by enhancing the understanding of the influences of empowerment and transformational leadership on job satisfaction among nursing staff. This study offers important policy insight for healthcare managers who seek to increase job satisfaction among their nursing staff.
METHODS: A cross-section of 163,397 adults aged 35 to 70 years were recruited from 661 urban and rural communities in selected low-, middle- and high-income countries (complete data for this analysis from 151,619 participants). Using blood pressure measurements, self-reported health and household data, concentration indices adjusted for age, sex and urban-rural location, we estimate the magnitude of wealth-related inequalities in the levels of hypertension awareness, treatment, and control in each of the 21 country samples.
RESULTS: Overall, the magnitude of wealth-related inequalities in hypertension awareness, treatment, and control was observed to be higher in poorer than in richer countries. In poorer countries, levels of hypertension awareness and treatment tended to be higher among wealthier households; while a similar pro-rich distribution was observed for hypertension control in countries at all levels of economic development. In some countries, hypertension awareness was greater among the poor (Sweden, Argentina, Poland), as was treatment (Sweden, Poland) and control (Sweden).
CONCLUSION: Inequality in hypertension management outcomes decreased as countries became richer, but the considerable variation in patterns of wealth-related inequality - even among countries at similar levels of economic development - underscores the importance of health systems in improving hypertension management for all. These findings show that some, but not all, countries, including those with limited resources, have been able to achieve more equitable management of hypertension; and strategies must be tailored to national contexts to achieve optimal impact at population level.
PATIENT AND METHODS: This was a prospective, double blinded randomized study conducted in a tertiary hospital in Malaysia. Patients (n = 64) were randomly allocated to receive 2 Hertz EA and compared to a control group. EA was started intraoperatively till the end of the surgery (mean duration of surgery was 149.06 ± 42.64 minutes) under general anaesthesia. Postoperative numerical rating scale (NRS), the incidence of nausea, vomiting and usage of rescue antiemetics were recorded at 30 minutes, 2, 4, and 24 hours, respectively. The total morphine demand and usage from the patient-controlled analgesia Morphine (PCAM) were also recorded in the first 24 hours postoperatively.
RESULTS: The mean NRS was 2.75 (SD = 2.34) at 30 minutes and 2.25 (SD = 1.80) at 2 hours postoperatively in the EA group that was significantly lower than the mean NRS in the control group as 4.50 (SD = 2.37) at 30 minutes and 3.88 (SD = 2.21) at 2 hours. The mean PCA morphine demand was 27.28 (SD = 21.61) times pressed in the EA group and 55.25 (SD = 46.85) times pressed in the control group within 24 hours postoperatively, which showed a significant reduction in the EA group than the control group. Similarly, total morphine requirement was significantly lower in the EA group with the value of 21.38 (SD = 14.38) mg compared to the control group with the value of 33.94 (SD = 20.24) mg within 24 hours postoperatively. Incidence of postoperative nausea also significantly reduced in the EA group at 30 minutes (15.6%) compared to the control group (46.9%).
CONCLUSIONS: It can be concluded that subjects receiving EA intraoperatively experienced less pain and PONV. Hence, it is plausible that EA has an opioid-sparing effect and can reduce PONV.