Objective. This study aims to determine time and motion in the operating room in emergent, urgent and scheduled cesarean section surgeries among pregnant COVID-19 patients. Methodology. A time and motion performance evaluation study was done by computing the following parameters: pre-induction time, pre-incision time, opening time, closing time, for both decision-to-delivery interval (DDI) and overall operative time. Results. During the study period, emergent DDI average was 2 hours and 38 minutes, emergent overall operative time was 1 hour and 31 minutes, urgent DDI average was 3 hours and 51 minutes, and urgent overall operative time of 1 hour and 57 minutes. However, in both urgent and emergent cases, the recommended DDI of 30 minutes, and the average duration of 44.3 minutes for CS were not feasible. Conclusion. The COVID-19 pandemic has negatively affected the provision of surgical obstetric care and OR utilization. Due to the new safety protocol for healthcare workers and patients, there was a significant delay in DDI and overall operative time. The causes were preparation, anesthesia factors or obstetrician factors. Identifying modifiable obstacles may improve the DDI, overall operative time, and the quality of maternal and child birth care during this pandemic.
Pregnancy ; Female ; Cesarean Section ; Time and Motion Studies ; COVID-19 ; Time Perception ; Motion

PURPOSE: Measurement of colon transit time is well-known physiologic study for patients with chronic constipation. But information we get from it is frequently inconsistent with patient's complaint. This study was designed to ascertain the actual significance of that measurement. METHODS: The subjects included two groups of patients with chronic constipation. One group consists of 32 patients(group A), The other group 36 patients(group B). Colon transit time study and defecographic examinations were done using previously described methods. But the former study was a little modified in group A, in which sodium phosphate enema was given at the previous day of oral intake of radio-opaque markers. Findings of colon transit time study and their relations to the defecographic results were compared with each other. RESULTS: As for the 5th day-findings of colon transit time, 6 cases(18.7%) were abnormal in group A and 3 cases(8.4%) in group B(statistically not different). As for the 3rd day-findings, 15 cases(46.9%) were abnormal in group A and 7 cases(19.5%) in group B( statistically different, p=0.0163). Defecographic findings showed 7 cases(21.9%) of outlet obstruction pattern in group A and 9 cases(25%) in group B. Correlations between these findings and those of colonic transit time studies were not proven statistically. CONCLUSION: Colon transit time study with single marker bolus and the 5th day photography technique was considered not to reflect the actual conditions of patients with chronic constipation. But sodium phophate enema, given to patients before starting the study, seemed to enhance the accuracy of study.
Colon* ; Constipation* ; Enema ; Humans ; Photography ; Sodium ; Time and Motion Studies*

PURPOSE: This study undertaken to evaluate the clinical results between the fixation of both bones and the fixation of the only tibia for extra-articular distal tibial and fibular fracture, and to know if the fixation of both bones could be needed. MATERIALS AND METHODS: In a retrospective study from 1994 to 1999, thirty-seven patients who underwent internal fixation with plate and screws for both bones (Group I : 17 cases) and only tibia (Group II : 20 cases) for extra-articular distal 1/3 tibial and distal 1/4 fibular fractures, which were above distal tibio-fibular syndesmosis, were evaluated the period of union, range of motion and operative time. RESULTS: The union period of tibia was 124 days (Group I) and 126 days (Group II) and the cases of full ROM were 16 / 17 cases (94.1%) in Group I and 18 / 20 cases (90.0%) in Group II. The mean score was 94.6 points in Group I and 91.3 points in Group II by Baird scoring system (P>0.05), and the operative time was 147 minutes (Group I) and 106 minutes (Group II) (P<0.05). CONCLUSION: The clinical results in extra-articular distal tibial and fibular fractures, which were distal 1/4 and above distal tibio-fibular syndemosis, treated with internal fixation of the only tibia were as good as internal fixation of both bones. We thought that there is no need to fix distal fibular fracture in these cases.
Humans ; Operative Time ; Range of Motion, Articular ; Retrospective Studies ; Tibia*

BACKGROUND: A retrospective observational time motion study of elective gynecologic surgeries performed from January 2015 to December 2016 was conducted at the Operating Room Complex of a tertiary training hospital. There was a change from three operating suites with standard last stitch time in 2015 to only two with no cutoff times in 2016. This was due to the renovation of the Operating Room Complex.

OBJECTIVE: To determine the factors and problems affecting operating room processes

MATERIALS AND METHODS: Different time motion parameters such as induction time, length of induction, cutting time, last stitch time, total operation time, turnover time, and number of cases performed were collected from the nurses' documentation records. Average values from two different time periods were compared and analyzed.

RESULTS: Results showed no improvement with the revised policies implemented in 2016. With only two rooms, surgeons were able to cope with the number of patients by extending operating hours later through the day. Recurring problems on manpower and lack of resources were noted.

CONCLUSION: There is a need to identify hindrance to efficient operating room utilization with the goal to decrease patient queue, improve patient as well as staff satisfaction, and increase hospital revenue. Multi-disciplinary changes in practices, processes, and attitudes are timely for improvements in operating room utilization and consequently better patient centric outcomes.

PURPOSE: Currently, various tools are used for the diagnosis of nonrelaxing puborectalis syndrome (NRPRS), one of major causes of chronic constipation. Defecography, electromyography (EMG), balloon expulsion test, and a colon transit time study one examples of such tools, but none can be said to be the most accurate and effective one. A diagnosis is only made when two or more examinations show positive findings simultaneously. The aim of this study is to assess the correlation between EMG and the manometric defecation index (DI), which is a relatively new parameter, for the diagnosis of NRPRS. METHODS: Forty-two chronically cornstipated patients without any history of anal or abdominal surgery underwent both anorectal manometric and EMG tests. The manometric defecation index (DI) was defined as the ratio between the peak rectal pressure and the peak anal pressure when the pressures were measured simultaneously during push by the catheter with longitudinally arranged side holes. The ratio of EMG activity was defined as the ratio between the peak amplitude during push and the peak amplitude during rest when EMG activities were measured by using an anal plug electrode. The two variables were compared prospectively, and their correlation was analyzed. RESULTS: The manometric DI and the ratio of EMG activit in 42 patients were 0.80+/-0.75 and 1.50+/-0.65, respectively. The correlation coefficient between the two variables was -0.50 (P= 0.001). CONCLUSIONS: The manometric DI and the ratio of EMG activit were correlated significantly. Therefore, it can be said that the anorectal manometric test can replace the EMG test for diagnosis of NRPRS, which has less convenient access for most colorectal surgeons.
Catheters ; Colon ; Constipation ; Defecation* ; Defecography ; Diagnosis* ; Electrodes ; Electromyography ; Humans ; Prospective Studies ; Time and Motion Studies

BACKGROUND: Constipation occurs frequently in diabetes mellitus (DM). However, there are few reports that investigated the characteristics of constipation associated with DM. The purpose of this study was to evaluate the clinical features of constipation associated with DM. METHODS: Among constipated patients who visited Asan Medical Center from January 2000 to December 2004, 45 patients with DM (DM group) and 104 patients without DM (non-DM group) were included in this study. We reviewed the clinical presentation, results of anorectal manometry, colon transit time study, and defecogram. We also analyzed the response to biofeedback therapy. RESULTS: The severity of constipation symptoms before treatment was not different between DM and non-DM group. Patients with colon transit time over 56 hours were more frequent in DM group than in non-DM group (21/45, 46.7% vs. 31/104, 29.8% ; p=0.047). Among DM group, colon transit time and the duration of DM showed positive correlation (r=0.431, p=0.003). The resting anal sphincter pressure was significantly lower in DM group than in non-DM group (43.5+/-21.5 mmHg vs. 51.7+/-22.6 mmHg ; p=0.048). The results of defecography were similar between DM and non-DM group. Successful responses to biofeedback therapy were not different between DM and non-DM group (19/34, 55.9% vs. 43/79, 54.4% ; p=0.887). CONCLUSIONS: Slow transit constipation was more frequent in DM group than in non-DM group. The successful responses to biofeedback therapy appear to be similar between DM and non-DM group.
Anal Canal ; Biofeedback, Psychology ; Chungcheongnam-do ; Colon ; Constipation* ; Defecography ; Diabetes Mellitus* ; Humans ; Manometry ; Time and Motion Studies

Current study was designed to assess the functional etiology of patients with pelvic outlet obstruction. Moreover, physiologic characteristics and theirs clinical significances were evaluated in the patients with ramified diagnosis. METHODS: 172 patients with pelvic outlet obstruction were performed 328 numbers of physiologic studies. These included cinedefecography (n=172), anal manometry (n=87), colonic transit time study (n=38), and anal EMG/PNTML (n=31). On the basis of physiologic findings, patient groups were categorized as rectocele (group I), nonrelaxing puborectalis syndrome (group II), anal dyschezia (group III), and rectoanal intussusception (group IV). The physiologic findings were compared between subgroup patients. RESULTS: Incidence of categorized patients was 51.7% (group I, n=89), 22.7% (group II, n=39), 12.2% (group III, n=21), and 8.7% (group IV, n=15), respectively. The mean age of patients with group III were lower (p<0.05) than that of overall patients. The incidence of female patients was higher in group I and the incidence of male patients was higher in group II (p<0.0001). In cinedefecography, patients with group II showed smaller anorectal angle at strain (p<0.001), at dynamic change between rest and strain (p=0.002). In anal manometry, patients with group III showed higher mean resting pressures (p=0.001), higher maximum resting pressures (p<0.001), higher mean squeeze pressures, and higher maximal voluntary contraction (p=0.003) than those of patients with other group. In neurologic study, mean value of PNTML was 2.32 +/- 0.34 (range, 1.60~3.66) msec in overall patients. The size of rectocele was increased in proportion to patient's age (r=0.229, p<0.05), number of delivery (r=0.393, p=0.001), and degree of perineal descent (r=0.231, p<0.05). The degree of perineal descent was increased in proportion to patient's age (r=0.249, p<0.05). CONCLUSIONS: Present series provided the diagnostic ramification of pelvic outlet obstruction by using the anorectal physiologic investigations. In addition to the function of puborectalis muscle, evacuation dynamics of anorectum should be emphasized. These findings could provide the fundamental information for guideline of future therapy in the patients with obstructed defecation.
Colon ; Constipation ; Defecation ; Diagnosis ; Female ; Humans ; Incidence ; Intussusception ; Male ; Manometry ; Rectocele ; Time and Motion Studies

BACKGROUND: Isepamicin, a new aminoglycoside antibiotic, was usually administered to patients for prophylactic use. Mivacurium has a short duration of action. The current study was undertaken to evaluate the neuromuscular blockade of mivacurium following the duration of an intramuscular injection of isepamicin 20 mg/kg/d in rabbits. METHODS: In the first study, the dose-response relations of mivacurium were studied in forty rabbits during thiopental anesthesia. Rabbits were randomly assigned to four groups; group 1: normal saline 2 ml/d IM for 7 days; group 2: isepamicin 20 mg/kg/d IM for 1 day; group 3: isepamicin 20 mg/kg/d IM for 3 days; group 4: isepamicin 20 mg/kg/d IM for 7 days. They received mivacurium 10, 20 and 30ng/kg in groups 1, 2 and 3; mivacurium 20, 30 and 40ng/kg in group 4, respectively. In the second study, time courses of action of mivacurium 0.18 mg/kg in forty rabbits were evaluated in each group. RESULTS: The calculated ED50 for mivacurium in groups 1, 2, 3 and 4 were 19.2 +/- 3.1ng/kg, 15.4 +/- 3.7ng/kg, 20.1 +/- 3.5ng/kg and 31.2 +/- 4.4ng/kg, respectively and corresponding ED95 was 29.9 +/- 3.7ng/kg, 22.1 +/- 4.5ng/kg, 30.1 +/- 5.9ng/kg and 43.4 +/- 5.1ng/kg, respectively. There were significant differences between group 4 and the others (P < 0.05). In the second study, the times after mivacurium 0.18 mg/kg until 95% twitch recovery in groups 1, 2, 3 and 4 were 35.1 +/- 5.1 min, 42.2 +/- 6.2 min, 32.8 +/- 4.9 min and 24.9 +/- 3.6 min, respectively. There were significant differences between group 2 and others, and between group 4 and group 1 or 3, respectively (P < 0.05). CONCLUSIONS: Mivacurium when used as a bolus isepamicin therapy, has both an increased potency and a longer duration of action, but when used during concurrent isepamicin therapy, has both a decreased potency and a shorter duration of action.
Anesthesia ; Drug Interactions ; Humans ; Injections, Intramuscular* ; Neuromuscular Blockade* ; Rabbits* ; Thiopental ; Time and Motion Studies

BACKGROUND/AIMS: Technetium-99m ((99m)Tc)-pertechnetate single photon emission computed tomography (SPECT) allows non-invasive measurement of gastric accommodation (GA) and has been reported to provide the results comparable to the gold standard barostat. The reproducibility of the test when it is performed at different time of the day is not known. The aim of this study was to assess the reproducibility of GA measurement by (99m)Tc-pertechnetate SPECT at the same and different time of the day. METHODS: Three GA studies were performed in each of 20 healthy volunteers (9 males, age 35 +/- 9 years), 2 studies in the morning and 1 study in the afternoon. Each study was performed on separate days at least 3 days apart, in random order. The fasting gastric scintigraphy images were acquired using SPECT at 30 minutes after iv (99m)Tc-pertechnetate. Then, the scintigraphic images were acquired 50 minutes after liquid meal (250 mL, Ensure(R)) ingestions. Gastric volumes were calculated from transaxial gastric images using Image J software. The GA was defined as the maximum postprandial gastric volume minus fasting gastric volume. RESULTS: GA measurement by SPECT show good reproducibility at both the same and different time of the day. The intraclass correlation coefficients of GA results for the same time, the first different time and the second different time studies were 0.681, 0.630 and 0.774, respectively, and the intra-subject coefficients of variation were 13.9%, 14.1% and 8.7%, respectively. CONCLUSIONS: GA measurement by (99m)Tc-pertechnetate SPECT shows good reproducibility at both the same and different time of the day. This result suggests that the schedule time does not appear to extremely affect the gastric accommodation value.
Appointments and Schedules ; Fasting ; Humans ; Male ; Meals ; Time and Motion Studies ; Tomography, Emission-Computed, Single-Photon

PURPOSE: The robotic system for surgery was introduced to gastric cancer surgery in the early 2000s to overcome the shortcomings of laparoscopic surgery. The more recently introduced da Vinci Xi® system offers benefits allowing four-quadrant access, greater range of motion, and easier docking through an overhead boom rotation with laser targeting. We aimed to identify whether the Xi® system provides actual advantages over the Si® system in gastrectomy for gastric cancer by comparing the operative outcomes. MATERIALS AND METHODS: We retrospectively reviewed all patients who underwent robotic gastrectomy as treatment for gastric cancer from March 2016 to March 2017. Patients' demographic data, perioperative information, and operative and pathological outcomes were collected and analyzed. RESULTS: A total of 109 patients were included in the Xi® group and 179 in the Si® group. Demographic characteristics were similar in both groups. The mean operative time was 229.9 minutes in the Xi® group and 223.7 minutes in the Si® group. The mean estimated blood loss was 72.7 mL in the Xi® group and 62.1 mL in the Si® group. No patient in the Xi® group was converted to open or laparoscopy, while 3 patients in the Si® group were converted, 2 to open surgery and 1 to laparoscopy, this difference was not statistically significant. Bowel function was resumed 3 days after surgery, while soft diet was initiated 4 days after surgery. CONCLUSIONS: We found no difference in surgical outcomes after robotic gastrectomy for gastric cancer between the da Vinci Xi® and da Vinci Si® procedures.
Diet ; Gastrectomy ; Humans ; Laparoscopy ; Operative Time ; Range of Motion, Articular ; Retrospective Studies ; Stomach Neoplasms