Healthcare

Background/Objectives: Minimally invasive surgical techniques require precise psychomotor skills distinct from those used in traditional surgery. Simulation-based training is essential for skill acquisition without patient risk. This study compared two prevalent training methodologies: the Origami-Box-Folding Exercise (OBFE) and Outside-the-Box Knot-Tying Exercise (OBTKE). Methods: In this prospective cohort study, 84 surgical residents (34 OBFE, 50 OBTKE) from General Surgery, Obstetrics–Gynecology, and Urology underwent pre- and post-intervention assessments. Performance metrics included completion times for surgical and square knots, out-of-visual-field instrument instances, needle drops, tissue lesions, and self-assessment via 5-point Likert scales. Behavioral Observation Research Interactive Software quantified performance objectively. Data were analyzed using paired Wilcoxon signed-rank tests for within-group comparisons and Wilcoxon rank-sum tests for between-group differences. Results: Both methodologies significantly improved surgical knot-tying performance. Surgical knot completion time decreased by 316.65 s (OBFE) and 360 s (OBTKE) with no significant between-group difference (p = 0.96). For square knots, OBFE exhibited significantly greater improvement with a 278 s reduction versus 169 s for OBTKE (p = 0.02). Technical errors decreased similarly in both groups. OBFE showed greater improvement in self-rated surgical knot knowledge (p = 0.03) and larger effect sizes for self-assessment measures (0.84–0.87 vs. 0.77–0.85). Conclusions: Both OBFE and OBTKE effectively improve laparoscopic skills in surgical residents. OBFE is particularly beneficial for square knot efficiency and self-rated knowledge enhancement, while OBTKE focuses on targeted knot-tying training. These findings support the implementation of both methodologies in surgical education, potentially in sequence—OBFE for foundational skills and OBTKE for advanced refinement.

Introduction: Aesthetic surgery addresses subjective desires for morphological enhancement and differs from reconstructive surgery due to its elective, non-therapeutic nature. This distinction introduces complex medico-legal challenges, particularly concerning informed consent, patient expectations, and the legal evaluation of aesthetic damage. Materials and Methods: A narrative review was conducted using national legislation, Italian and international clinical guidelines, peer-reviewed literature from PubMed, Scopus, and Web of Science, and Italian Supreme Court rulings. Eight commonly litigated aesthetic procedures were analyzed in terms of clinical indications, public reimbursement criteria, and medico-legal risk. Results: Findings revealed significant variability in medico-legal exposure among procedures. Fully elective interventions such as liposuction and breast augmentation carried the highest litigation risk. Common legal claims included inadequate informed consent, poor psychological assessment, and mismatched expectations. The review emphasizes the need for personalized consent processes and comprehensive preoperative evaluations. Discussion: Italian case law increasingly adopts a “mixed obligation” model for aesthetic surgery, requiring not only technical skill but also a prognostic and relational evaluation of the intervention. Informed consent must be detailed, individualized, and well-documented, as it holds greater legal weight than in therapeutic procedures. Predictive medico-legal tools such as psychological profiling and structured consent protocols are essential for risk mitigation. Conclusions: Modern aesthetic surgery requires a redefined approach to damage assessment that incorporates psychological, relational, and identity factors. In both clinical and surgical practice, an approach tailored to the patient’s psychological profile must be increasingly taken into consideration, both when proposing and carrying out treatments and in medical-legal assessments. A legally and ethically sound practice depends on transparency, documentation, and patient-centered care, especially in the absence of therapeutic indications.

Background: Healthcare systems worldwide face growing challenges in anticipating and managing patient surges, particularly in times of public health crises, natural disasters, or seasonal peaks. The ability of healthcare organisations to forecast and respond to such demand fluctuations—referred to as organisational readiness for patient capacity surge—has become a critical determinant of service continuity and patient outcomes. Despite the urgency, there remains a lack of consolidated evidence on how healthcare authorities measure, evaluate, and operationalise this readiness. This systematic review aims to identify and synthesise existing literature that presents case studies, methodologies, and strategic frameworks used to evaluate organisational preparedness for patient surge capacity. It also explores resource allocation mechanisms, hospital capacity planning algorithms, and temporary facility strategies documented in healthcare settings. Methods: The review was conducted across two major scientific repositories, i.e., PubMed and Web of Science (WoS). A set of four structured search queries were formulated to capture the breadth of the topic, focusing on demand forecasting, hospital capacity planning, workforce models, and resource management within the context of healthcare surge demand. The search was limited to publications from the last 10 years (2014–2024) to ensure the inclusion of contemporary practices and technologies. Resutls: A total of 142 articles were selected for detailed analysis. The articles were categorised into six thematic groups: (i) empirical case studies on healthcare surge management; (ii) hospital resources and capacity scaling; (iii) ethical frameworks guiding surge response; (iv) IT-driven algorithms and forecasting tools; (v) policy evaluations and actionable lessons learned; and (vi) existing systematic reviews in related domains. Notably, several articles provided evidence-based frameworks and simulation models supporting predictive planning, while others highlighted real-world implementation of temporary care facilities and staff redeployment protocols. Conclusions: The review underscores the fragmented yet growing body of literature addressing the multidimensional nature of surge preparedness in healthcare. While algorithmic forecasting and capacity modelling are advancing, gaps remain in standardising metrics for organisational readiness and incorporating ethical considerations in surge planning. Limitations of this review include potential selection bias and the subjective categorisation of articles. Future research should aim to develop integrative frameworks that couple technical, operational, and ethical readiness for patient surge scenarios.