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Heavner SF, Stuenkel M, Russ Sellers R, McCallus R, Dean KD, Wilson C, Shuffler M, Britt TW, Stark Taylor S, Benedum M, Munk N, Mayo R, Cartmell KB, Griffin S, Kennedy AB. "I Don't Want to Go to Work": A Mixed-Methods Analysis of Healthcare Worker Experiences from the Front- and Side-Lines of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5953. [PMID: 37297557 PMCID: PMC10252235 DOI: 10.3390/ijerph20115953] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/24/2023] [Accepted: 05/10/2023] [Indexed: 06/12/2023]
Abstract
During the COVID-19 pandemic, healthcare workers (HCW) were categorized as "essential" and "non-essential", creating a division where some were "locked-in" a system with little ability to prepare for or control the oncoming crisis. Others were "locked-out" regardless of whether their skills might be useful. The purpose of this study was to systematically gather data over the course of the COVID-19 pandemic from HCW through an interprofessional lens to examine experiences of locked-out HCW. This convergent parallel mixed-methods study captured perspectives representing nearly two dozen professions through a survey, administered via social media, and video blogs. Analysis included logistic regression models of differences in outcome measures by professional category and Rapid Identification of Themes from Audio recordings (RITA) of video blogs. We collected 1299 baseline responses from 15 April 2020 to 16 March 2021. Of those responses, 12.1% reported no signs of burnout, while 21.9% reported four or more signs. Qualitative analysis identified four themes: (1) professional identity, (2) intrinsic stressors, (3) extrinsic factors, and (4) coping strategies. There are some differences in the experiences of locked-in and locked-out HCW. This did not always lead to differing reports of moral distress and burnout, and both groups struggled to cope with the realities of the pandemic.
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Affiliation(s)
- Smith F. Heavner
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA
| | - Mackenzie Stuenkel
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | | | - Rhiannon McCallus
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Kendall D. Dean
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA
| | - Chloe Wilson
- Department of Psychology, Clemson University, Clemson, SC 29634, USA
| | - Marissa Shuffler
- Department of Psychology, Clemson University, Clemson, SC 29634, USA
| | - Thomas W. Britt
- Department of Psychology, Clemson University, Clemson, SC 29634, USA
| | - Shannon Stark Taylor
- Center for Family Medicine, Department of Medicine, Prisma Health, Greenville, SC 29605, USA
| | - Molly Benedum
- AppFamily Medicine, Department of Medicine, Appalachian Regional Healthcare System, Boone, NC 28607, USA
| | - Niki Munk
- Department of Health Sciences, School of Health & Human Sciences, Indiana University, Indianapolis, IN 46202, USA
| | - Rachel Mayo
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | | | - Sarah Griffin
- Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Ann Blair Kennedy
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA
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Edwards K, Cowan D, Brunero S. Perspective: Coping with Covid-19: An isolation risk assessment and management guideline for healthcare staff. Int J Ment Health Nurs 2023; 32:337-347. [PMID: 36385730 DOI: 10.1111/inm.13093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/18/2022]
Abstract
The mental health consequences of pandemic isolation have been well documented extending from psychological conditions such as anxiety and depression to increased falls risk, medication errors and delirium. Whilst risk factors associated with isolation are known, there remains a gap in the guidance for healthcare staff on how to assess for these risks and develop effective management plans. Using a structured professional judgement (SPJ) approach and the author's recent experience providing consultation and leadership to clinical staff working with at-risk patients during the pandemic, an isolation risk assessment and management guideline was developed. SPJ is an evidenced-based analytical method used to understand and mitigate risk that was primarily developed for the assessment and management of aggression and violence. This paper discusses an evidenced-based process used to develop the guideline and the application of its use from the author's clinical experience.
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Affiliation(s)
- Kim Edwards
- Integrated Mental Health and Alcohol and Other Drugs Services, Mid North Coast Local Health District, Coffs Harbour, New South Wales, Australia
| | - Darrin Cowan
- Integrated Mental Health and Alcohol and Other Drugs Services, Mid North Coast Local Health District, Port Macquarie, New South Wales, Australia
| | - Scott Brunero
- Mental Health Liaison, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Casual Academic University of Technology, Sydney, New South Wales, Australia
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Matsui Y, Yao S, Kumode T, Tanino K, Mizuno R, Ogoshi Y, Honma S, Murakami T, Kan T, Nakajima S, Harada T, Oh K, Nakamura T, Konishi H, Arii S. Surgeons' involvement in COVID-19 treatment: a practice by a regional core hospital in Japan to avoid physician burnout. BMC Health Serv Res 2023; 23:28. [PMID: 36635725 PMCID: PMC9834681 DOI: 10.1186/s12913-023-09042-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/05/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND To prevent task accumulation on certain divisions, our institution developed a unique system of allocating inpatient treatment of COVID-19 patients to doctors who were not specialized in respiratory infections. The objective of this study was to investigate whether surgeons can be involved in the COVID-19 inpatient treatment without negatively affecting patient outcome, and how such involvement can affect the wellbeing of surgeons. METHODS There were 300 patients diagnosed with COVID-19 and hospitalized from January to June 2021, and 160 of them were treated by the redeployed doctors. They were divided into 3 groups based on the affiliation of the treating doctor. Patient characteristics and outcomes were compared between the groups. In addition, the impact of COVID-19 duty on participating surgeons was investigated from multiple perspectives, and a postduty survey was conducted. RESULTS There were 43 patients assigned to the Department of Surgery. There were no differences in the backgrounds and outcomes of patients compared with other groups. The surgeon's overtime hours were significantly longer during the duty period, despite no change in the number of operations and the complication rate. The questionnaire revealed that there was a certain amount of mental and physical burden from the COVID-19 duty. CONCLUSION Surgeons can take part in inpatient COVID-19 treatment without affecting patient outcome. However, as such duty could negatively affect the surgeons' physical and mental wellbeing, further effort is needed to maintain the balance of fulfilling individual and institutional needs.
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Affiliation(s)
- Yugo Matsui
- grid.415419.c0000 0004 7870 0146Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Hyogo Japan ,grid.415419.c0000 0004 7870 0146COVID-19 Task Force, Kobe City Medical Center West Hospital, Kobe, Hyogo Japan
| | - Siyuan Yao
- grid.415419.c0000 0004 7870 0146Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Hyogo Japan
| | - Takashi Kumode
- grid.415419.c0000 0004 7870 0146Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Hyogo Japan
| | - Keisuke Tanino
- grid.415419.c0000 0004 7870 0146Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Hyogo Japan
| | - Ryosuke Mizuno
- grid.415419.c0000 0004 7870 0146Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Hyogo Japan
| | - Yusuke Ogoshi
- grid.415419.c0000 0004 7870 0146Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Hyogo Japan
| | - Shusaku Honma
- grid.415419.c0000 0004 7870 0146Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Hyogo Japan
| | - Teppei Murakami
- grid.415419.c0000 0004 7870 0146Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Hyogo Japan
| | - Takatsugu Kan
- grid.415419.c0000 0004 7870 0146Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Hyogo Japan
| | - Sanae Nakajima
- grid.415419.c0000 0004 7870 0146Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Hyogo Japan
| | - Takehisa Harada
- grid.415419.c0000 0004 7870 0146Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Hyogo Japan
| | - Koji Oh
- grid.415419.c0000 0004 7870 0146COVID-19 Task Force, Kobe City Medical Center West Hospital, Kobe, Hyogo Japan ,grid.415419.c0000 0004 7870 0146Department of General Internal Medicine, Kobe City Medical Center West Hospital, Kobe, Hyogo Japan
| | - Takehiro Nakamura
- grid.415419.c0000 0004 7870 0146COVID-19 Task Force, Kobe City Medical Center West Hospital, Kobe, Hyogo Japan ,grid.415419.c0000 0004 7870 0146Department of Diabetes and Endocrinology, Kobe City Medical Center West Hospital, Kobe, Hyogo Japan
| | - Hiroki Konishi
- grid.415419.c0000 0004 7870 0146COVID-19 Task Force, Kobe City Medical Center West Hospital, Kobe, Hyogo Japan ,grid.415419.c0000 0004 7870 0146Department of General Internal Medicine, Kobe City Medical Center West Hospital, Kobe, Hyogo Japan
| | - Shigeki Arii
- grid.415419.c0000 0004 7870 0146Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Hyogo Japan
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Burnout in Trauma Surgeons During the COVID-19 Pandemic: a Long-standing Problem Worsens. CURRENT TRAUMA REPORTS 2023; 9:1-9. [PMID: 36591542 PMCID: PMC9793372 DOI: 10.1007/s40719-022-00247-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/29/2022]
Abstract
Purpose of Review Physician burnout is well-described in the literature. We analyze the effects of the COVID-19 pandemic on burnout in trauma and acute care surgeons (TACS). Recent Findings Along with other healthcare workers and trainees, TACS faced unprecedented clinical, personal, and professional challenges in treating a novel pathogen and were uniquely affected due to their skillset as surgeons, intensivists, and leaders. The pandemic and its consequences have increased burnout and are suspected to have worsened PTSD and moral injury among TACS. The healthcare system is just beginning to grapple with these problems. Summary COVID-19 significantly added to the pre-existing burden of burnout among TACS. We offer prevention and mitigation strategies. Furthermore, to build upon the work done by individuals and organizations, we urge that national institutions address burnout from a regulatory standpoint.
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Zeeshan S, Rajab Ali M, Khan RN, Allana AR, Zahid N, Najjad MK, Abro AA, Nadeem MA, Mughal Z, Ahmed I, Ali A. The Impact of COVID-19 on the Psychological Well-Being of Surgeons in Pakistan: A Multicenter Cross-Sectional Study. Cureus 2022; 14:e26997. [PMID: 35989806 PMCID: PMC9386303 DOI: 10.7759/cureus.26997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/05/2022] Open
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Olorunfemi O, Nwozichi C. Hermeneutic phenomenology of lived experience of family caregivers of critically-ill patients sustained by healthcare technologies in Benin City, Nigeria. MGM JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4103/mgmj.mgmj_185_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Abbass K, Niazi AAK, Qazi TF, Basit A, Song H. The aftermath of COVID-19 pandemic period: barriers in implementation of social distancing at workplace. LIBRARY HI TECH 2021. [DOI: 10.1108/lht-03-2021-0113] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe study aims to investigate the barriers in implementing social distancing at the workplace as an aftermath of the COVID-19 pandemic period.Design/methodology/approachStudy design consists of a review of literature, data collection and analysis. It encompasses identification, verification and analysis of the relationships among the barriers. Data have been collected from a panel of experts on matrix-type questionnaires from workplaces. Interpretive structural modeling (ISM) augmented with “Matrice d' Impacts Croise's Multiplication Appliquée a UN Classement (Cross Impact Matrix Multiplication Applied to Classification)” (MICMAC) for structural analysis.FindingsThe literature has identified twenty major barriers to implementing social distancing at the workplace. The research findings reveal/show that the barrier “matter of disrespect” occupies the bottom level in the ISM model. Therefore, it is the most critical barrier; whereas, employees with disabilities and “herding culture” are crucial as they occupy the next lowest level, therefore, are crucial. Moreover, there are ten barriers positioned in the middle of the model having moderate-severe effects, and seven falls on the top level of the model having relatively less severe effects. Results of MICMAC affirm and avow the results of ISM.Research limitations/implicationsThe study will have profound theoretical and practical implications for stakeholders since it provides lot of new useful and valuable information, gives relational insights and determines priorities subject to usual limitations of survey research.Originality/valueIt is an original attempt to make some sense of practicability of social distancing for stakeholders including policymakers, frontline health workers and public at large.
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An evaluation of clinical and quality of life outcomes after ventral hernia repair with poly-4-hydroxybutyrate mesh. Hernia 2021; 25:717-726. [PMID: 33907919 DOI: 10.1007/s10029-021-02394-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/08/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Despite continued efforts, recurrence after ventral hernia repair (VHR) remains a common problem. Biosynthetic Phasix™ (Poly-4-Hydroxybutyrate, P4HB) mesh combines the durability of synthetic mesh with the bio-resistance of biologics. P4HB has shown promising early outcomes, but long-term data are lacking. We examine patients following VHR with P4HB with at least 3 years of follow-up to assess clinical and patient reported outcomes (PROs). METHODS Adult patients (≥ 18 years old) undergoing VHR with P4HB mesh between 10/2015 and 01/2018 by a single surgeon were retrospectively identified. Patients with < 36 months of follow-up were excluded unless they had a documented recurrence. Clinical outcomes and quality of life using the Hernia-Related Quality of Life Survey (HerQLes) were assessed. RESULTS Seventy-one patients were included with a median age and body mass index of 61.2 and 31 kg/m2, respectively. Mesh was placed in the retromuscular (79%) and onlay (21%) planes with 1/3 of patients having hernias repaired in contaminated fields. There were no mesh infections, enterocutaneous fistulas, or mesh explantations. Nine patients (12.7%) developed recurrence at a median follow-up of 43.1 months [38.2-49.1]. Mesh plane, fixation technique, and Ventral Hernia Working Group were not associated with recurrence. Significant improvement in disease-specific PROs was observed and maintained at 3-year follow-up. CONCLUSION Longitudinal clinical and quality of life outcomes after clean and contaminated VHR with P4HB are limited. Here, we conclude that P4HB is an effective and versatile mesh option for use in abdominal wall reinforcement.
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Charleux-Muller D, Hurel R, Fabacher T, Brigand C, Rohr S, Manfredelli S, Passot G, Ortega-Deballon P, Dubuisson V, Renard Y, Romain B. Slowly absorbable mesh in contaminated incisional hernia repair: results of a French multicenter study. Hernia 2021; 25:1051-1059. [PMID: 33492554 DOI: 10.1007/s10029-020-02366-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/29/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To analyze the postoperative morbidity and 1-year recurrence rate of incisional hernia repair using a biosynthetic long-term absorbable mesh in patients at higher risk of surgical infection in a contaminated surgical field. METHODS All patients undergoing incisional hernia repair in a contaminated surgical field with the use of a biosynthetic long-term absorbable mesh (Phasix®) between May 2016 and September 2018 at six participating university centers were included in this retrospective cohort and were followed-up until September 2019. Regarding the risk of surgical infection, patients were classified according to the modified Ventral Hernia Working Group classification. Preoperative, operative and postoperative data were collected. All patients' surgical site infections (SSIs) and occurrences (SSOs) and recurrence rates were the endpoints of the study. RESULTS Two hundred and fifteen patients were included: 170 with mVHWG grade 3 (79%) and 45 with mVHWG grade 2 (21%). The SSI and SSO rates at 12 months were 22.3% and 39.5%, respectively. According to the Dindo-Clavien classification, 43 patients (20.0%) had at least one minor complication, and 57 patients (26.5%) had at least one major complication. Among the 121 patients (56.3%) having at least 1 year of follow-up, the clinical recurrence rate was 12.4%. Multivariate analysis showed that a concomitant gastrointestinal procedure was an independent risk factor for surgical infection (OR = 2.61), and an emergency setting was an independent risk factor for major complications (OR = 11.9). CONCLUSION The use of a biosynthetic absorbable mesh (Phasix®) is safe in a contaminated surgical field, with satisfying immediate postoperative and 1-year results. TRIAL REGISTRATION The study is registered on Clinical Trial ID: NCT04132986.
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Affiliation(s)
- D Charleux-Muller
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France.
| | - R Hurel
- Department of General and Digestive Surgery, Robert Debre University Hospital, University of Reims Champagne Ardenne, Reims, France
| | - T Fabacher
- Department of Public Health, Biostatistic Laboratory, Strasbourg University Hospital, 1 place de l'Hôpital BP426, 67091, Strasbourg, France
| | - C Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France
| | - S Rohr
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France
| | - S Manfredelli
- Department of Digestive and Oncologic Surgery, Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
| | - G Passot
- Department of General, Digestive and Endocrine Surgery, Hospital Lyon Sud, Hospices Civils de Lyon, 165, Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,EMR 3738, University Hospital, Claude Bernard Lyon 1, Lyon, France
| | - P Ortega-Deballon
- Department of General and Digestive Surgery, University Hospital of Dijon, Dijon, France
| | - V Dubuisson
- Department of Vascular and General Surgery, Bordeaux University Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Y Renard
- Department of General and Digestive Surgery, Robert Debre University Hospital, University of Reims Champagne Ardenne, Reims, France
| | - B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 avenue Molière, 67200, Strasbourg, France
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Romanelli J, Gee D, Mellinger JD, Alseidi A, Bittner JG, Auyang E, Asbun H, Feldman LS. The COVID-19 reset: lessons from the pandemic on Burnout and the Practice of Surgery. Surg Endosc 2020; 34:5201-5207. [PMID: 33051763 PMCID: PMC7552950 DOI: 10.1007/s00464-020-08072-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/30/2020] [Indexed: 11/26/2022]
Abstract
Background Burnout among physicians is an increasing concern, and surgeons are not immune to this threat. The ongoing COVID-19 pandemic has caused dramatic changes to surgeon workflow, often leading to redeployment to other clinical areas, slowdown and shutdown of elective surgery practices, and an uncertain future of surgical practice in the post-pandemic setting. Paradoxically, for many surgeons who had to prepare for but not immediately care for a major surge, the crisis did allow for reflective opportunities and a resetting of priorities that could serve to mitigate chronic patterns contributory to Burnout. Methods SAGES Reimagining the Practice of Surgery task force convened a webinar to discuss lessons learned from the COVID pandemic that may address burnout. Results Burnout is multifactorial and may vary in cause among different generation/experience groups. Those that report burnout symptoms often complain of lacking purpose or meaning in their work. Although many mechanisms to address Burnout are from a defensive standpoint—including coping mechanisms, problem solving, and identification of a physician having wellness difficulties—offensive mechanisms such as pursuing purpose and meaning and finding joy in one's work can serve as reset points that promote thriving and fulfillment. Understanding what motivates physicians will help physician leaders to develop and sustain effective teams. Reinvigorating the surgical workforce around themes of meaning and joy in the service rendered via our surgical skills may diminish Burnout through generative and aspirational strategies, as opposed to merely reactive ones. Fostering an educational environment free of discriminatory or demeaning behavior may produce a new workforce conducive to enhanced and resilient wellbeing at the start of careers. Conclusion Surgeon wellness and self-care must be considered an important factor in the future of all healthcare delivery systems, a need reaffirmed by the COVID-19 pandemic.
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Affiliation(s)
- John Romanelli
- University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA, USA
| | - Denise Gee
- Massachusetts General Hospital, Boston, MA, USA
| | - John D Mellinger
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Adnan Alseidi
- San Francisco School of Medicine, University of California, San Francisco, CA, USA
| | - James G Bittner
- University of Connecticut School of Medicine and Quinnipiac University Frank H Netter MD School of Medicine, Saint Francis Hospital, Hartford, CT, USA
| | - Edward Auyang
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Horacio Asbun
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Liane S Feldman
- McGill University Health Centre, 1650 Cedar Avenue D6-156, Montreal, QC, H3G 1A4, Canada.
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Biosynthetic Resorbable Prosthesis is Useful in Single-Stage Management of Chronic Mesh Infection After Abdominal Wall Hernia Repair. World J Surg 2020; 45:443-450. [PMID: 33025154 DOI: 10.1007/s00268-020-05808-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The goal of this article was to report the results about the efficacy of treatment of chronic mesh infection (CMI) after abdominal wall hernia repair (AWHR) in one-stage management, with complete mesh explantation of infected prosthesis and simultaneous reinforcement with a biosynthetic poly-4-hydroxybutyrate absorbable (P4HB) mesh. METHODS This is a retrospective analysis of all patients that needed mesh removal for CMI between September 2016 and January 2019 at a tertiary center. Epidemiological data, hernia characteristics, surgical, and postoperative variables (Clavien-Dindo classification) of these patients were analyzed. RESULTS Of the 32 patients who required mesh explantation, 30 received one-stage management of CMI. In 60% of the patients, abdominal wall reconstruction was necessary after the infected mesh removal: 8 cases (26.6%) were treated with Rives-Stoppa repair, 4 (13.3%) with a fascial plication, 1 (3.3%) with anterior component separation, and 1 (3.3%) with transversus abdominis release to repair hernia defects. Three Lichtenstein (10%) and 1 Nyhus repairs (3.3%) were performed in patients with groin hernias. The most frequent postoperative complications were surgical site occurrences: seroma in 5 (20%) patients, hematoma in 2 (6.6%) patients, and wound infection in 1 (3.3%) patient. During the mean follow-up of 34.5 months (range 23-46 months), the overall recurrence rate was 3.3%. Persistent, recurrent, or new CMIs were not observed. CONCLUSIONS In our experience, single-stage management of CMI with complete removal of infected prosthesis and replacement with a P4HB mesh is feasible with acceptable results in terms of mesh reinfection and hernia recurrence.
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Bueno-Lledó J, Ceno M, Pérez-Alonso C, Martinez-Hoed J, Pous-Serrano S. Abdominal wall reconstruction with biosynthetic absorbable mesh after infected prosthesis explantation: single stage is better than two-stage approach of chronic mesh infection. Hernia 2020; 25:1005-1012. [PMID: 33001317 DOI: 10.1007/s10029-020-02309-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the efficacy of surgical management of chronic mesh infection (CMI) after abdominal wall hernia repair (AWHR) in single-stage approach (complete removal of infected prosthesis and simultaneous replacement with poly-4-hydroxybutyrate mesh or BAM group), comparing results with two-stage treatment (complete mesh excision and abdominal wall repair with synthetic mesh after several months or SPM group). METHODS Retrospective comparative study of all patients who underwent surgery for CMI between January 2006 and January 2019 at a tertiary center. We compared results in terms of epidemiological data, hernia and prosthesis characteristics, surgical and postoperative variables of both two groups. RESULTS Over the 13-year study period, 2791 AWHR was performed at our hospital; the overall CMI rate was 2.5%. Of 71 patients, 30 (42.2%) were in BAM group and 41 (57.8%) in SPM group. The median cumulative operative time (252 min versus 132 min) and length of stay (16.6 days versus 6.2 days) were significatively longer in SPM group compared with BAM group, due to the need of two surgical procedures. There were a higher number of postoperative complications in SPM group (p = 0.002), some of them grade III. With mean follow-up of 36.5 months (range 21-59), there were no significant differences in terms of overall hernia recurrence and mesh reinfection in both groups. CONCLUSION The use of a poly-4-hydroxybutyrate resorbable mesh in single-stage management of CMI may be a safe and better option than two-stage approach, although more studies are needed to confirm our results.
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Affiliation(s)
- J Bueno-Lledó
- Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari i Politecnic "La Fe", University of Valencia, Calle Gabriel Miró 28, puerta 12, 46008, Valencia, Spain.
| | - M Ceno
- Klinikum Mittelbaden, Balger Strasse 50, 76530, Baden-Baden, Germany
| | - C Pérez-Alonso
- Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari i Politecnic "La Fe", University of Valencia, Calle Gabriel Miró 28, puerta 12, 46008, Valencia, Spain
| | - J Martinez-Hoed
- Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari i Politecnic "La Fe", University of Valencia, Calle Gabriel Miró 28, puerta 12, 46008, Valencia, Spain
| | - S Pous-Serrano
- Unit of Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitari i Politecnic "La Fe", University of Valencia, Calle Gabriel Miró 28, puerta 12, 46008, Valencia, Spain
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Mental Health and the SARS-COV-2 Epidemic-Polish Research Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197015. [PMID: 32992807 PMCID: PMC7579123 DOI: 10.3390/ijerph17197015] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 12/20/2022]
Abstract
Background: The aim of this study was to assess the mental state of Poles in the first weeks of the SARS-COV-2 epidemic. Methods: In the study, the General Health Questionnaire-28 (GHQ-18), The Perceived Stress Scale (PSS-10), and Mini-Cope were used. Results: The study was conducted on a group of 443 individuals, including 348 women (78.6%) and 95 men (21.4%). There were more women (χ2 = 6.42, p = 0.02) in the group of people with high results in the GHQ-28 questionnaire and the differentiating factors between those with sten scores above 7 (significantly deteriorated mental health) and those with average or low results (sten score below 7) turned out to be: treatment for mental disorders before the pandemic (χ2 = 19.57, p < 0.001) and the use of psychotherapy during the pandemic (χ2 = 4.21, p = 0.04) and psychiatric pharmacotherapy (χ2 = 8.31, p = 0.01). The presence of suicidal thoughts since the appearance of the pandemic-related restraints and limitations significantly differentiates the compared groups (χ2 = 38.48, p < 0.001). Conclusions: Every fourth person in the examined group (over 26% of the respondents) recorded results that indicate a high probability of mental functioning disorders. Approximately 10% of the respondents signalled the occurrence of suicidal thoughts since the beginning of the pandemic. The respondents complain mainly about problems in everyday life, lack of satisfaction from one’s own activities, tension, trouble sleeping, and feelings of exhaustion. Individuals with significantly reduced mental well-being use non-adaptive coping strategies, such as denying problems, emotional discharge, taking substances, discontinuation of action, and blaming themselves for the situation. The risk factors for the deterioration of the mental state of the respondents during the pandemic include psychiatric treatment before the beginning of the pandemic, the presence of suicidal thoughts during forced isolation, and the use of non-adaptive coping strategies (denial of the existence of problems, emotional discharge, use of psychoactive substances, discontinuation of action, and blaming oneself for the situation).
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