A key avoidable expense in the surgical setting is the wastage of disposable surgical items, which are discarded after cases even if they go unused. A major contributor to wastage of these items is the inaccuracy of surgeon preference cards, which are rarely examined or updated. The authors report the application of a novel technique called cost heatmapping to facilitate standardization of preference cards for microvascular breast reconstruction. Preference card data were obtained for all surgeons performing microvascular breast reconstruction at the authors' institution. These data were visualized using the heatmap.2 function in the gplot package for R. The resulting cost heatmaps were shown to all surgeons performing microvascular breast reconstruction at our institution; each surgeon was asked to classify the items on the heatmap as "always needed," "sometimes needed," or "never needed." This feedback was used to generate a lean standardized preference card for all surgeons. This card was validated by all surgeons performing the case and by nursing leadership familiar with the supply needs of microvascular breast reconstruction before implementation. Cost savings associated with implementation were calculated. Implementation of the preference card changes will lead to an estimated per annum savings of $17,981.20 and a per annum reduction in individual items listed on preference cards of 1,693 items. Cost heatmapping is a powerful tool for increasing surgeon awareness of cost and for facilitating comparison and standardization of surgeon preference cards.
The study of the operating room (OR) began over a century ago and has continued to advance. However, for nonmedical researchers, unique challenges present themselves that must be carefully addressed. We present an overview of the OR aimed at nonmedical researchers interested in studying the OR environment. Based on our extensive experience, we identify several key challenges and describe ways to circumvent them. With a respectable understanding of the OR environment, we can prepare a researcher to gather useful data. Such investigations have the potential to yield great insights about cost savings, efficiency, methods, processes, and general human interaction, among others.
In‐line probing (Regulski, E.E. and Breaker, R.R., (2008) Methods Mol. Biol. 419, 53) provides a straightforward method for probing RNA structure. We have used this technique to characterize the human mitochondrial tRNAAla and four tRNA mutants associated with mitochondrial pathologies, including MERFF (myoclonic epilepsy with ragged red fibers), ophthalmoplegia, and mitochondrial myopathy. Our data suggests that two of these mutants, C5650T and A5628G, adopt abnormal secondary structures at room temperature, which may lead to reduced aminoacylation levels. This work was supported by Carleton College and the Howard Hughes Medical Institute.
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