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Introduction Cesarean hysterectomy is a relatively rarely performed, complex, life-saving procedure considered during post-partum hemorrhage and other obstetric complications. This multi-site study aimed at validating a low-cost, low-fidelity cesarean hysterectomy model to support resident proficiency and increase their confidence in performing this critical procedure. Materials and methods We developed a low-fidelity, anatomically representative model for cesarean hysterectomy simulation purposes. Obstetrics and Gynecology residents at two residency programs were offered a simulation experience using the model, with a performance assessment via two validated assessment tools. The clinical case involved a 38 y/o woman with a delivery complicated by postpartum hemorrhage who failed conservative therapy and required a peripartum hysterectomy. Participants included 26 residents, postgraduate year (PGY)1 through PGY4, at two midwestern university-based obstetrics and gynecology residency programs. Results The median resident scores on the Task Specific Checklist (TSC) and Global Rating Scale (GRS) correlated with increasing PGY levels. The combined TSC+GRS score was a median of 40 out of 49 total for the PGY4 class, while the PGY1 class had a median combined TSC+GRS score of 12 of 49. The PGY2 and -3 classes had TSC+GRS scores of 14 and 28, respectively. The simulation model was well-received with a median 4/5 rating for improving comfort level with cesarean hysterectomy and a median 4/5 rating for model realism. Conclusion This study validated a cost-effective, easily reproducible model that highlights the vital anatomy relevant to a cesarean hysterectomy. The model and simulation offer a way to introduce cesarean hysterectomies to residents while in training, particularly at sites that may not perform a substantial number of these procedures., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Boards of Loyola University and University of Toledo issued approval 19-001-PHS. IRB approval was obtained from both institutions. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: Not an external source but the study was grant-funded. York Educational Research Grant from the Stritch School of Medicine (5000 USD). Financial relationships: Dani Zoorob declare(s) Surgical Educator and Travel Support from Applied Medical. Surgical Educator and Travel Support. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Frenn et al.)

Management of type 2 diabetes mellitus (T2DM) largely relies on medication adherence of individuals with diabetes to achieve optimal glycemic control. The economic burden of diabetes could impede adherence, leading to a reduction in treatment efficacy and increased risk of complications. Furthermore, monotherapy in diabetes is losing traction due to its ineffectiveness in achieving early and sustained optimal glycemic control in a significant proportion of the population. Hence, clinicians prefer combination treatment due to their improved efficacy and safety. Considering these factors, the current review highlights the safety and efficacy of the affordable combination therapies, a dual therapy, glipizide + metformin, and a triple-drug combination of glimepiride + metformin + pioglitazone and its applicability in the management of T2DM among individuals with diabetes in India., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2024, Shaikh et al.)

Healthcare facilities in China are facing increasing demands as the country has the fastest aging populations in the world. Day surgery can be utilized to address some of these demands. Benefits of day surgery include shortened hospital stay, decreased risk of hospital-associated infections, and increased cost efficiency. We present a retrospective study of eight years of day surgery data from West China Hospital, one of the largest hospitals in China, with an emphasis on an examination of the growth in day surgeries. We examined patterns of utilization of day surgery versus inpatient surgery (including types of surgeries performed in the Day Surgery Center and the ratio of day surgery versus elective surgery), as well as unplanned readmission and return to inpatient department rates, and a comparison of average costs and length of stay for day surgery versus hospital surgery. Day surgery has a safe and cost-effective way to alleviate the soaring healthcare demands in West China. There is potential opportunity to further address the ever-increasing demands on the healthcare system in this area by performing more complex surgeries as day surgeries. This article presents an effective organizational protocol and proposes a reliable medical quality assurance system, which prioritizes safety of the growing day surgery program; furthermore, it describes the factors and lessons learned from the successful implementation of a day surgery system., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Jiang et al.)

We started a quality improvement project (QIP) with the aim of implementing an antimicrobial stewardship program (AMSP) to optimize antimicrobial use. We implemented this QIP in our tertiary care center with baseline data from July 1, 2017, to December 31, 2017 (pre-AMSP period), and the project period between January 1, 2018, and June 30, 2018. It covered every inpatient with a positive microbiological culture and patients who were initiated on a pre-selected list of 16 restricted antimicrobials. Numerous plan-do-study-act (PDSA) cycles were conducted alongside daily AMSP rounds, consisting of prospective audit and feedback to all stakeholders. The outcome measures used were antibiotic consumption and costs, Clostridium difficile infection (CDI) rates, the average length of stay (LOS), and adverse drug reaction (ADR) reporting rates. We demonstrated a considerable reduction in the consumption of the selected antibiotics, as well as a direct translation to cost-saving. The AMSP directly contributed to collective savings of around half a million US dollars in hospital bills for patients. We also demonstrated reduced average LOS, CDI rates, and increased reporting of ADRs to antibiotics. The reduction in average LOS was also directly beneficial to patients with reduced time spent in the hospital. The reduction in CDI rates proves that there is a reduction in the development of AMR, and in the short term, fewer incidences of healthcare-associated infections. This, in addition to better surveillance of ADRs to antimicrobials, improved patient safety and quality of care., Competing Interests: The authors have declared that no competing interests exist.