Search Results (438)

Background: Hand surgery is increasingly transitioning from hospital operating theatres to outpatient settings, requiring anaesthetic methods that are efficient, cost-effective, and patient-centred. Traditional anaesthesia, such as general anaesthesia, poses challenges including prolonged recovery and physiological stress. Novel strategies, such as Wide-Awake Local Anaesthesia No Tourniquet (WALANT), ultrasound-guided distal nerve blocks, and adjunctive approaches (vapocoolant spray, patient-controlled regional analgesia, cryoanalgesia, jet injectors), have emerged to address these limitations. This narrative review consolidates current evidence regarding the efficacy, applicability, and economic implications of these evolving anaesthesia techniques. Methods: A literature search was conducted across MEDLINE, Embase, CENTRAL, and Scopus databases up to 1 June 2025. Inclusion criteria were English-language original studies on WALANT, vapocoolant sprays, ultrasound-guided distal nerve blocks, or emerging adjunctive anaesthesia methods applicable to hand and upper limb surgery. Exclusion criteria included non-English publications and those without original clinical data. Two independent reviewers screened and selected studies, ensuring relevance and methodological quality. Results: WALANT can provide high patient satisfaction, cost savings of 70–85%, and allow for real-time functional testing during surgery. Ultrasound-guided nerve blocks provided targeted analgesia, preserved elbow function, reduced the need for sedation, and improved perioperative efficiency. Adjuncts such as vapocoolant sprays significantly decreased needle-injection discomfort, offering quick and economical analgesia for superficial procedures. Other emerging adjuncts, including patient-controlled regional anaesthesia (PCRA), cryoanalgesia, and jet injectors, offered additional patient-tailored pain management options, although with higher resource demands. Conclusions: The review highlights the transformative potential of WALANT and adjunctive techniques to enhance efficiency, patient experience, and cost-effectiveness in hand surgery. Despite clear benefits, optimal application requires tailored patient selection, clinician familiarity, and consideration of procedure-specific demands. Full article

Background: Radial shock wave therapy (RSWT) has increasingly been integrated into treatment protocols for adhesive capsulitis. While associations with diabetes and other systemic disorders are well documented, the role of obesity remains underexplored, particularly in relation to RSWT outcomes. Methods: Forty patients with adhesive capsulitis completed a 10-day treatment protocol combining RSWT with conventional physiotherapy. Pain (VAS), disability (SPADI), and range of motion (ROM) were assessed at baseline and immediately after treatment. At one-month follow-up, VAS and SPADI were reassessed alongside the Patient Global Impression of Change (PGIC). Correlations between body mass index (BMI) and clinical outcomes were analyzed, and potential confounding effects of comorbidities and affected-side dominance were examined. Clinical relevance was assessed using minimal clinically important differences (MCID) and effect sizes (Cohen’s d). Results: All clinical outcomes improved significantly post-treatment and at follow-up, with most changes exceeding MCID thresholds and showing large effect sizes. Higher BMI was significantly correlated with greater improvements in SPADI, VAS, shoulder extension, and internal rotation. Most comorbidities were negatively associated with outcomes, except neurologic conditions, which supported mobility improvement. Conclusions: RSWT appears effective in alleviating symptoms of adhesive capsulitis. The observed association between higher BMI and greater mobility improvement suggests potential benefits in overweight and obese patients. These findings warrant further investigation. Full article

Surgical procedures have significantly contributed to the increased life expectancy of the global population. The surgical procedures are carried out in specialised rooms within a healthcare facility normally designated as operating rooms or operating theatres. These rooms require meticulously designed heating, ventilating, and air conditioning systems to ensure optimal thermal comfort, strict sterility, and effective removal of airborne contaminants and anaesthetic gases. The performance of the system directly affects the risk of surgical site infections and associated post-operative complications. This study presents a computational fluid dynamics analysis of disturbance on airflow and particulate distribution within a representative operating room by the surgical staff and lighting fixtures concerning supply air velocity. The removal of the maximum possible particulate matter, precise control of air temperature and humidity, and unidirectional airflow in the surgical field were incorporated as key design strategies. The species transport model simulations revealed that while laminar airflow offers superior protection in terms of surgical site sterility, its performance is sensitive to disruptions caused by surgical lighting configurations and variations in supply air velocity. The findings highlight the complexities involved in maintaining optimal airflow conditions and underscore the need for integrative air conditioning design approaches that account for optimal design of surgical lighting and operational setups. Full article

(1) Background: Virtual Reality (VR) films challenge traditional visual cognition by offering novel perceptual experiences. This study investigates the applicability of Gestalt grouping principles in dynamic VR scenes, the influence of VR environments on grouping efficiency, and the relationship between viewer experience and grouping effects. (2) Methods: Eye-tracking experiments were conducted with 42 participants using the HTC Vive Pro Eye and Tobii Pro Lab. Participants watched a non-narrative VR film with fixed camera positions to eliminate narrative and auditory confounds. Eye-tracking metrics were analyzed using SPSS version 29.0.1, and data were visualized through heat maps and gaze trajectory plots. (3) Results: Viewers tended to focus on spatial nodes and continuous structures. Initial fixations were anchored near the body but shifted rapidly thereafter. Heat maps revealed a consistent concentration of fixations on the dock area. (4) Conclusions: VR reshapes visual organization, where proximity, continuity, and closure outweigh traditional saliency. Dynamic elements draw attention only when linked to user goals. Designers should prioritize spatial logic, using functional nodes as cognitive anchors and continuous paths as embodied guides. Future work should test these mechanisms in narrative VR and explore neural correlates via fNIRS or EEG. Full article

(1) Background: Traditional logistics training faces challenges like high costs, limited scalability, and safety risks. Virtual Reality Movie Training (VRMT) enhances operational accuracy, safety, and accessibility through immersive simulation. However, adoption faces barriers including high equipment costs, immature technology, and coordination challenges among logistics enterprises, design companies, and government entities. This study explores strategic interactions to optimize VRMT adoption. (2) Methods: A tripartite evolutionary game model was used to analyze strategic interactions between logistics enterprises, design companies, and government. (3) Results: System stability occurs when logistics enterprises adopt VRMT, design companies deliver high-quality solutions, and government provides active support. Simulations reveal stronger adoption coefficients through increased employee acceptance and enhanced training quality. Government incentives and brand premiums significantly influence quality design provision, though excessive subsidies may reduce governmental willingness to support initiatives. (4) Conclusions: Cost minimization and accessibility improvement require batch hardware purchasing, optimized training cycles, and shared platforms at logistics enterprises. Design companies should optimize content development for cost-effectiveness while maintaining quality standards to leverage brand benefits. Governments should establish VRMT quality certification, invest in public VR platforms for SMEs, and convert accident savings into fiscal supplements. This tripartite collaboration enables efficient, safe, and sustainable logistics training transformation. Full article

The article examines the role of art in the successful revitalisation of brownfield sites in Nantes. The city’s deindustrialization in the 1960s–80s caused a severe economic and social crisis. Significant areas were left behind by the abandoned factories, which were rapidly degrading, negatively affecting the entire city. Many of these were located on a river island in the city centre. Since the early 1990s, the Nantes authorities initiated a process of revitalising brownfield sites. They implemented several culture-led regeneration strategies. Nantes opened up to temporary events: street theatre shows and art festivals. The flagship project and symbol of renewal became Les Machines de Île, mobile, interactive machines that took over the previously degraded island and hark back to its industrial past. Site-specific art installations filled the city. The municipal authorities also started to implement the concept of a creative cluster, concentrating art colleges, cultural facilities, and creativity-related businesses on former wasteland. The use of a variety of strategies brought success, and the results went beyond the revitalised area. Cultural activities became an accelerator of change and contributed to the regeneration process of the city. Full article

The use of Shakespeare within warzones and at the frontline of conflict centralizes vital questions about the role of the arts during times of profound crisis, when lives and liberties are under direct attack. This article first considers Shakespearean productions linked to Russia’s 2022 invasion of Ukraine, concentrating on the inaugural Ukrainian Shakespeare Festival and two documentaries that reveal how staging Shakespeare can serve humanitarian needs, promote political debate, and help individuals to process their wartime experiences. It then expands to include examples from other conflicts, including the First World War and the ongoing crisis in Gaza, and argues that warzone productions—in addition to embracing what theatre can achieve at times of conflict—also address its limitations. Warzone performances often acknowledge a gulf between representation and lived experience, between tragedy as a dramatic form and reality, which is reinforced when the individuals staging Shakespeare are also ‘actors’ in the war. This article proposes that what unites war and theatre is the power of narrative for shaping action and interpretation, and this recognition underlines the responsibilities of political and theatrical narratives at times of war, as well as the role of the critic. Full article

Music is an elusive phenomenon with sounds that disappear while sounding. This challenges the description of the music and its processing by the listener or performer. A possible answer to this problem lies in the definition of music as flowing sound energy that continuously modifies its substance and shape. Such an approach adheres to the materiality of sound and allows for a description of music in rheological terms. We therefore take as a starting point the analogy of music as a virtual, motional object that follows a trajectory through time, revolving around three major issues: (i) the relation between sound and motion, (ii) the description of motion or movement over time, and (iii) the embodied and enactive character of musical engagement. The paper relies mainly on historical sources—most notably the work of Alexander Truslit on motion perception and Ernst Kurth on energetics—and connects them to modern paradigms of embodied and enactive cognition as applied to music. Full article

Background: Healthcare systems are increasingly strained by limited operating room resources and rising demand, a situation intensified by the COVID-19 pandemic. These pressures have resulted in overcrowded surgical departments, prolonged waiting times for elective procedures, worsened patient health outcomes, and increased hospital expenditure costs. Methods: To address these challenges, this study proposes a multi-objective mathematical optimization model as the analytical core of a decision support approach for OR resource allocation. The model considers multiple constrained resources, including OR time, intensive care units, medium care units, and nursing staff, and aims to minimize both elective patients’ waiting times and total incurred costs over a one-week planning horizon. Developed using real hospital data from a large facility in Thailand, the model was implemented in LINGO version 16.0, and a sensitivity analysis was conducted to assess the impact of surgical department priorities and overtime allowances. Results: Compared to current practices, the optimized OR schedule reduced average waiting times by approximately 7% and total costs by 5%, while balancing resource utilization. Conclusions: This study provides a data-driven tool to support hospital resource planning, improve OR efficiency, and respond effectively to future healthcare crises. Full article

The primary focus of this article is on the deconstruction of language within the context of glossolalia and the Theatre of the Absurd. Following World War II, the expression of absurdity in the literature and theatre gave rise to the Theatre of the Absurd as an anti-literary movement. Glossolalia appears both in the first Christian communities and within the charismatic renewal movement in modern times and refers to the gift of speaking in tongues. The objective of comparing these two occurrences is to identify their similarities and differences in their treatment of the language. Both glossolalia and the Theatre of the Absurd contain destructive aspects as they disintegrate language, but they also contain creative elements; glossolalia is prayer, and the Theatre of the Absurd has artistic merit. To consider the extent to which language deconstruction might serve as a prelude to creative endeavours, this analogy appears to be significant. Full article

Background: The rationale for strict fluid fasting for pediatric and adult patients has been questioned recently. Point-of-care tools for the evaluation of gastric content have evolved over time, often using gastric ultrasound. Usually, the gastric antral cross-sectional area (CSA) is determined. A liberal fluid fasting regimen, that is, ingestion of liquid fluids until the call for theatre, does not delay gastric emptying compared to midnight fasting, as evaluated with gastric ultrasound. Anesthesia is safe, and no adverse events result from a liberal regimen. Methods: The ethics committee of LMU Munich approved the study (21-0903). Liberal fluid fasting in a geriatric orthopedic surgery department (LFFgertrud) is a sub-study within a project investigating perioperative neurocognitive disorders (Study Registration: DRKS00026801). After obtaining informed consent from 134 geriatric patients 70 years or older, we investigated the gastric antral cross-sectional area (CSA) prior to and postimplementation of liberal fluid management, respectively. Results: After the implementation of liberal fluid fasting, fasting times for solid food and liquids decreased from 8.8 (±5.5) to 1.8 (±1.8) hours (p < 0.0001). In 39 patients where CSA was obtained, a slight increase in fluid was encountered. No critical amount of gastric content was observed, and no adverse events occurred. Conclusions: A liberal fluid fasting concept was safe even for comorbid elderly patients in orthopedic surgery. Applying a gastric ultrasound may be helpful to increase safety. According to the incidence of complications encountered in our study, it seems indispensable. Full article

Background: Doppler-guided haemorrhoidal artery ligation with rectoanal repair (HAL-RAR) is a minimally invasive alternative to conventional haemorrhoidectomy. While associated with reduced postoperative pain and quicker recovery, data on its safety, recurrence rates, and applicability across haemorrhoid grades remain limited, particularly in Australian settings. Methods: A retrospective review was conducted on 128 consecutive patients who underwent elective HAL-RAR at a single institution between February 2022 and December 2024. Data on demographics, operative details, postoperative outcomes, and recurrence were collected. Outcomes were stratified by haemorrhoid grade. Multivariate logistic regression was used to identify predictors of recurrence, day-case completion, and conversion to excisional surgery. Results: The median age was 49 years, and 77.3% had Grade II or III haemorrhoids. HAL-RAR was completed as a day case in 76.6% of patients. Postoperative urinary retention occurred in 3.9%, return to theatre in 0.8%, and 30-day readmission in 7.0%. The symptomatic recurrence rate was 17.6%. Grade IV haemorrhoids were independently associated with increased recurrence (aOR 3.64, 95% CI 1.03–12.84), reduced likelihood of day-case management (aOR 0.14, 95% CI 0.03–0.93), and higher conversion to excisional haemorrhoidectomy (aOR 7.23, 95% CI 1.13–46.40). Conclusions: HAL-RAR is a safe, effective, and low-morbidity option for the management of Grade II and III haemorrhoids, suitable for day-case surgery. In selected Grade IV cases, it may offer benefit, although with higher recurrence and conversion risk. Careful patient selection is essential, and longer-term prospective studies are needed to assess durability. Full article

Surgery remains a healthcare intervention with significant risks for patients. Novel technologies can now enhance the peri-operative workflow, with artificial intelligence (AI) and extended reality (XR) to assist with pre-operative planning. This review focuses on innovation in AI, XR and imaging for hepato-biliary surgery planning. The clinical challenges in hepato-biliary surgery arise from heterogeneity of clinical presentations, the need for multiple imaging modalities and highly variable local anatomy. AI-based models have been developed for risk prediction and multi-disciplinary tumor (MDT) board meetings. The future could involve an on-demand and highly accurate AI-powered decision tool for hepato-biliary surgery, assisting the surgeon to make the most informed decision on the treatment plan, conferring the best possible outcome for individual patients. Advances in AI can also be used to automate image interpretation and 3D modelling, enabling fast and accurate 3D reconstructions of patient anatomy. Surgical navigation systems utilizing XR are already in development, showing an early signal towards improved patient outcomes when used for hepato-biliary surgery. Live visualization of hepato-biliary anatomy in the operating theatre is likely to improve operative safety and performance. The technological advances in AI and XR provide new applications in pre-operative planning with potential for patient benefit. Their use in surgical simulation could accelerate learning curves for surgeons in training. Future research must focus on standardization of AI and XR study reporting, robust databases that are ethically and data protection-compliant, and development of inter-disciplinary tools for various healthcare applications and systems. Full article

Microbiological contamination of healthcare workers’ gowns represents a critical risk for the transmission of healthcare-associated infections (HAIs). Despite their use as protective equipment, gowns can act as reservoirs of antibiotic-resistant bacteria, favouring the spread of pathogens between healthcare workers and patients. The presence of these resistant bacteria on healthcare workers’ gowns highlights the urgent need to address this risk as part of infection control strategies. The aim of this work was to assess the microbiological risks associated with the contamination of healthcare staff gowns with Gram-negative bacteria, including the ESKAPE group, and their relationship with antimicrobial resistance. An observational, cross-sectional, prospective study was conducted in 321 hospital workers. The imprinting technique was used to quantify the bacterial load on the gowns, followed by bacterial identification by MALDI-TOF mass spectrometry. In addition, antimicrobial resistance profiles were analysed, and tests for carbapenemases and BLEE production were performed. The ERIC-PCR technique was also used for molecular analysis of Pantoea eucrina clones. Several Gram-negative bacteria were identified, including bacteria of the ESKAPE group. The rate of microbiological contamination of the gowns was 61.05% with no association with the sex of the healthcare personnel. It was observed that critical areas of the hospital, such as intensive care units and operating theatres, showed contamination by medically important bacteria. In addition, some strains of P. eucrina showed resistance to carbapenemics and cephalosporins. ERIC-PCR analysis of P. eucrina isolates showed genetic heterogeneity, indicating absence of clonal dissemination. Healthcare personnel gowns are a significant reservoir of pathogenic bacteria, especially in critical areas of Hospital Juárez de México. It is essential to implement infection control strategies that include improving the cleaning and laundering of gowns and ideally eliminating them from clothing to reduce the risk of transmission of nosocomial infections. Full article

Ninety-five-year-old Doris Held, a great niece of Sigmund Freud, has been convening the Shakespeare Reading Group in Northampton, Massachusetts, my hometown, since she moved here in 2016. In the following essay, which is a personal response to my experience of this group of Shakespearean readers, to Doris Held, and to the work of Shakespeare in general, I attempt to chart the full impact of the Bard’s work on my life and on the world around me. I am neither a scholar nor a historian. In a true sense, I am a bystander Shakespearean, who has received deep reward and benefit from the experience, but it is Doris Held and her group who opened my eyes to the precise nature of this unexamined reward. Doris brought the spirit of the group from Cambridge, Massachusetts, where she had been a dues-paying member for decades of something called the Old Cambridge Shakespeare Association, which itself dates to 1880. My wife Debra and I attended the first meeting in Northampton more than a decade ago, and we have been receiving emails from Doris four times a year ever since. While these communications often induce guilt, they invariably lead to pleasures that I would never want to relinquish. That is a complicated dynamic in my routine, and I try to grapple with its ebb and flow in the pages that follow. Each time I get one, I have a version of the same conversation in my head. Is Doris still doing this? Haven’t they done all the plays by now? All things considered, wouldn’t they—and I—rather be home watching a true crime documentary about Gaby Petito on Netflix? What the hell is William Shakespeare to me anyway? At this point, if I’m honest, Shakespeare is Doris. The experience with this group led me in two directions. One took me back to my now long-ago history with Shakespeare’s work as an actor in college. The other took me via historical research into the prehistory of Doris Held’s previous Shakespeare group in Cambridge, Massachusetts. The two paths gave me a deeper grasp of the influence of his work across the world and on my own life. Full article