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Baig SJ, Kulkarni GV, Priya P, Afaque MY, Bueno-Lledo J, Chintapatla S, de Beaux A, Gandhi JA, Urena MAG, Hammond TM, Lomanto D, Liu R, Mehta A, Miserez M, Montgomery A, Morales-Conde S, Palanivelu C, Pauli EM, Rege SA, Renard Y, Rosen M, Sanders DL, Singhal VK, Slade DAJ, Warren OJ, Wijerathne S. Delphi consensus statement for understanding and managing the subcostal hernia: subcostal hernias collaborative report (scholar study). Hernia 2024:10.1007/s10029-024-02963-8. [PMID: 38366238 DOI: 10.1007/s10029-024-02963-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/05/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Subcostal hernias are categorized as L1 based on the European Hernia Society (EHS) classification and frequently involve M1, M2, and L2 sites. These are common after hepatopancreatic and biliary surgeries. The literature on subcostal hernias mostly comprises of retrospective reviews of small heterogenous cohorts, unsurprisingly leading to no consensus or guidelines. Given the limited literature and lack of consensus or guidelines for dealing with these hernias, we planned for a Delphi consensus to aid in decision making to repair subcostal hernias. METHODS We adopted a modified Delphi technique to establish consensus regarding the definition, characteristics, and surgical aspects of managing subcostal hernias (SCH). It was a four-phase Delphi study reflecting the widely accepted model, consisting of: 1. Creating a query. 2. Building an expert panel. 3. Executing the Delphi rounds. 4. Analysing, presenting, and reporting the Delphi results. More than 70% of agreement was defined as a consensus statement. RESULTS The 22 experts who agreed to participate in this Delphi process for Subcostal Hernias (SCH) comprised 7 UK surgeons, 6 mainland European surgeons, 4 Indians, 3 from the USA, and 2 from Southeast Asia. This Delphi study on subcostal hernias achieved consensus on the following areas-use of mesh in elective cases; the retromuscular position with strong discouragement for onlay mesh; use of macroporous medium-weight polypropylene mesh; use of the subcostal incision over midline incision if there is no previous midline incision; TAR over ACST; defect closure where MAS is used; transverse suturing over vertical suturing for closure of circular defects; and use of peritoneal flap when necessary. CONCLUSION This Delphi consensus defines subcostal hernias and gives insight into the consensus for incision, dissection plane, mesh placement, mesh type, and mesh fixation for these hernias.
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Affiliation(s)
- S J Baig
- Department of Minimal Access Surgery, Belle Vue Clinic, Digestive Surgery Clinic, Bellevue Hospital Kolkata, Kolkata, 700017, India.
| | - G V Kulkarni
- Department of Colorectal Surgery, Broomfield Hospital (Mid and South Essex NHS Trust), Essex, UK
| | - P Priya
- Department of Minimal Access Surgery, Belle Vue Clinic, Digestive Surgery Clinic, Bellevue Hospital Kolkata, Kolkata, 700017, India
| | - M Y Afaque
- Department of Surgery, J N Medical College, AMU, Aligarh, Uttar Pradesh, 202002, India
| | - J Bueno-Lledo
- Hospital Universitari I Politecnic La Fe, Universidad de Valencia, Valencia, Spain
| | - S Chintapatla
- Department of General Surgery, York Abdominal Wall Unit (YAWU), York & Scarborough Teaching Hospitals NHS Foundation Trust, Wigginton Road, York, UK
| | - A de Beaux
- Spire Murrayfield Hospital, Edinburgh, UK
| | - J A Gandhi
- Department of Surgery, King Edward Memorial Hospital, Parel, Mumbai, 400012, India
| | - M A Garcia Urena
- Department of Surgery, Hospital Universitario del Henares, 28822, Madrid, Spain
| | - T M Hammond
- Department of Colorectal Surgery, Broomfield Hospital (Mid and South Essex NHS Trust), Essex, UK
| | - D Lomanto
- Minimally Invasive Surgical Centre, National University Hospital, Singapore, 119074, Singapore
| | - R Liu
- Med Director Robotic Surgery, Alta Bates Summit Medical Center, Oakland, CA, 94609, USA
| | - A Mehta
- Department of Colorectal Surgery, St. Mark's Hospital, London, UK
| | - M Miserez
- Department of Abdominal Surgery, University Hospital Gasthuisberg, KU Leuven, Louvain, Belgium
| | - A Montgomery
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, University of Sevilla, Seville, Spain
| | - C Palanivelu
- GEM Hospital and Research Centre, Coimbatore, India
| | - E M Pauli
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - S A Rege
- Department of Surgery, King Edward Memorial Hospital, Parel, Mumbai, 400012, India
| | - Y Renard
- Reims Champagne-Ardennes, Department of General, Digestive and Endocrine Surgery, Robert Debré University Hospital, Reims, France
| | - M Rosen
- Department of Surgery, Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - D L Sanders
- Department of Abdominal Wall Surgery, Royal Devon University Foundation Trust, North Devon District Hospital, Barnstaple, UK
| | - V K Singhal
- Department of GI Surgery, Medanta Medicity Hospital, Gurugram, Haryana, India
| | - D A J Slade
- Department of Colorectal Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - O J Warren
- Department of Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - S Wijerathne
- Department of General Surgery, Alexandra Hospital, National University Health System), Singapore, Singapore
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Lainidi O, Jendeby MK, Montgomery A, Mouratidis C, Paitaridou K, Cook C, Johnson J, Karakasidou E. An integrative systematic review of employee silence and voice in healthcare: what are we really measuring? Front Psychiatry 2023; 14:1111579. [PMID: 37304444 PMCID: PMC10248453 DOI: 10.3389/fpsyt.2023.1111579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/02/2023] [Indexed: 06/13/2023] Open
Abstract
The history of inquiries into the failings of medical care have highlighted the critical role of communication and information sharing, meaning that speaking up and employee silence have been extensively researched. However, the accumulated evidence concerning speaking-up interventions in healthcare indicates that they achieve disappointing outcomes because of a professional and organizational culture which is not supportive. Therefore, there is a gap with regard to our understanding of employee voice and silence in healthcare, and the relationship between withholding information and healthcare outcomes (e.g., patient safety, quality of care, worker wellbeing) is complex and differentiated. The following integrative review is aimed at addressing the following questions; (1) How is voice and silence conceptualized and measured in healthcare?; and (2) What is the theoretical background to employee voice and silence?. An integrative systematic literature review of quantitative studies measuring either employee voice or employee silence among healthcare staff published in peer-reviewed journals during 2016-2022 was conducted on the following databases: PubMed, PsycINFO, Scopus, Embase, Cochrane Library, Web of Science, CINAHL and Google Scholar. A narrative synthesis was performed. A review protocol was registered on the PROSPERO register (CRD42022367138). Of the 209 initially identified studies for full-text screening, 76 studies met the inclusion criteria and were selected for the final review (N = 122,009, 69.3% female). The results of the review indicated the following: (1) concepts and measures are heterogenous, (2) there is no unifying theoretical background, and (3) there is a need for further research regarding the distinction between what drives safety voice versus general employee voice, and how both voice and silence can operate in parallel in healthcare. Limitations discussed include high reliance on self-reported data from cross-sectional studies as well as the majority of participants being nurses and female staff. Overall, the reviewed research does not provide sufficient evidence on the links between theory, research and implications for practice, thus limiting how research in the field can better inform practical implications for the healthcare sector. Ultimately, the review highlights a clear need to improve assessment approaches for voice and silence in healthcare, although the best approach to do so cannot yet be established.
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Affiliation(s)
- Olga Lainidi
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | | | - Anthony Montgomery
- Department of Psychology, Northumbria University, Newcastle, United Kingdom
| | | | | | - Clare Cook
- Department of Psychology, Northumbria University, Newcastle, United Kingdom
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds, United Kingdom
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Kassandrinou M, Lainidi O, Mouratidis C, Montgomery A. Employee silence, job burnout and job engagement among teachers: the mediational role of psychological safety. Health Psychol Behav Med 2023; 11:2213302. [PMID: 37215070 PMCID: PMC10197995 DOI: 10.1080/21642850.2023.2213302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/03/2023] [Indexed: 05/24/2023] Open
Abstract
Background: Teaching is a highly demanding profession, with teachers reporting increasing levels of burnout. Accumulated evidence indicates that inhibiting the expression of one's thoughts, emotions, and behaviors continuously can take a psychological toll actively resulting in physiological and psychological symptoms (e.g. stress, emotional exhaustion, strain). The purpose of this study was to assess the different types of employee silence among teachers and examine their relationship with job burnout, job engagement and psychological safety. Methods: A convenience sampling method approach was used whereby 150 primary school education teachers from Greece participated in a survey. Self-reported measures for burnout, work-engagement, psychological safety and employee silence motives were used in this cross-sectional study. Results: Psychological safety mediated the relationship between burnout and employee silence, and more specifically between the three core components of burnout and both acquiescent and quiescent silence, but not prosocial silence. In terms of engagement, the indirect effect was significant between vigor/dedication and both quiescent and acquiescent silence. Conclusions: The present research highlighted the importance of acquiescent and quiescent silence, two forms of silence that are rooted in fear and hopelessness respectively. This research adds to the growing picture of teaching as a profession that is characterized by increasing levels of burnout, employee silence and low levels of psychological safety.
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Affiliation(s)
- Maria Kassandrinou
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
| | - Olga Lainidi
- School of Psychology, University of Leeds, Leeds, UK
| | | | - Anthony Montgomery
- Department of Psychology, Northumbria University, Newcastle Upon Tyne, UK
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Androulakis GS, Georgiou DA, Lainidi O, Montgomery A, Schaufeli WB. The Greek Burnout Assessment Tool: Examining Its Adaptation and Validity. Int J Environ Res Public Health 2023; 20:ijerph20105827. [PMID: 37239554 DOI: 10.3390/ijerph20105827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
Burnout is a significant challenge in the workplace. Its extent is global and its unfavourable consequences are diverse, affecting the individual, the organization, and society. The aim of the present study was to examine the adaptation and assess the validity of the Greek version of the Burnout Assessment Tool (BAT). The adaptation process included the translation and back-translation of the BAT. Data were collected from 356 Greek employees from diverse sectors. Confirmatory factor analysis and item response theory were utilized to assess the validity of the Greek version of the BAT. According to the findings of the present research, the core symptoms scale and the secondary symptoms scale of BAT-23 and BAT-12 models demonstrated adequate structures for the analysis and measurement of burnout in the Greek context. Finally, the psychometric performance of the BAT-GR-12 compared to the BAT-GR-23 establishes it as a more optimum instrument for the assessment of burnout across Greek working adults.
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Affiliation(s)
- George S Androulakis
- Department of Business, Administration University of Patras, 26504 Patras, Greece
| | - Dimitra Ap Georgiou
- Department of Educational Sciences and Social Work, University of Patras, 26504 Patras, Greece
| | - Olga Lainidi
- School of Psychology, University of Leeds, Leeds LS29JT, UK
| | | | - Wilmar B Schaufeli
- Research Group Work Organizational and Personnel Psychology (WOPP), 3000 Leuven, Belgium
- Department of Social and Organizational Psychology, Utrecht University, 3584 CS Utrecht, The Netherlands
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Koutsimani P, Montgomery A. A Two-Wave Study On The Associations Of Burnout With Depression And Anxiety: The Mediating And Moderating Role Of Perceived Family Support. Psychol Rep 2023; 126:220-245. [PMID: 34841980 DOI: 10.1177/00332941211051263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Studies have shown strong associations between burnout and depression and burnout and anxiety but their exact interrelationships still remain unclear. Few studies have examined the psychosocial mechanisms that might underlie these two relationships. Non-work social factors such as perceived family support can affect mental health. The present study investigated the distinctiveness and the reciprocal associations between burnout and depression, and burnout and anxiety by collecting data twice over an 8 month interval. Perceived family support was examined as a mediating and a moderating factor underlying the two relationships. The Maslach Burnout Inventory-General Survey, the Hospital Depression and Anxiety Scale, and the Julkunen Family Support Scale were administered to employees of the general working population (N = 52). First, our results revealed moderate associations between burnout and depression, and burnout and anxiety, supporting the distinctiveness of burnout from the two psychological phenomena. Second, the exhaustion and cynicism burnout dimensions showed reciprocal associations with depression. Moreover, anxiety was found to be a consequence of cynicism while it presented reciprocal associations with the exhaustion dimension of burnout. Perceived family support did not mediate the burnout-depression and burnout-anxiety relationships. However, it moderated the depression-exhaustion relationship in a direction opposite from our hypothesis.
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Affiliation(s)
- Panagiota Koutsimani
- Department of Educational & Social Policy, School of Social Sciences, Humanities and Arts, 414877University of Macedonia, Egnatia, Greece
| | - Anthony Montgomery
- Department of Educational & Social Policy, School of Social Sciences, Humanities and Arts, 414877University of Macedonia, Egnatia, Greece
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Montgomery A, Lainidi O, Johnson J, Creese J, Baathe F, Baban A, Bhattacharjee A, Carter M, Dellve L, Doherty E, Jendeby MK, Morgan K, Srivastava M, Thompson N, Tyssen R, Vohra V. Employee silence in health care: Charting new avenues for leadership and management. Health Care Manage Rev 2023; 48:52-60. [PMID: 35713571 DOI: 10.1097/hmr.0000000000000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ISSUE Health care management is faced with a basic conundrum about organizational behavior; why do professionals who are highly dedicated to their work choose to remain silent on critical issues that they recognize as being professionally and organizationally significant? Speaking-up interventions in health care achieve disappointing outcomes because of a professional and organizational culture that is not supportive. CRITICAL THEORETICAL ANALYSIS Our understanding of the different types of employee silence is in its infancy, and more ethnographic and qualitative work is needed to reveal the complex nature of silence in health care. We use the sensemaking theory to elucidate how the difficulties to overcoming silence in health care are interwoven in health care culture. INSIGHT/ADVANCE The relationship between withholding information and patient safety is complex, highlighting the need for differentiated conceptualizations of silence in health care. We present three Critical Challenge points to advance our understanding of silence and its roots by (1) challenging the predominance of psychological safety, (2) explaining how we operationalize sensemaking, and (3) transforming the role of clinical leaders as sensemakers who can recognize and reshape employee silence. These challenges also point to how employee silence can also result in a form of dysfunctional professionalism that supports maladaptive health care structures in practice. PRACTICE IMPLICATIONS Delineating the contextual factors that prompt employee silence and encourage speaking up among health care workers is crucial to addressing this issue in health care organizations. For clinical leaders, the challenge is to valorize behaviors that enhance adaptive and deep psychological safety among teams and within professions while modeling the sharing of information that leads to improvements in patient safety and quality of care.
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Montgomery A, Lainidi O. Creating healthy workplaces in healthcare: Are we delaying progress by focusing on what we can do rather than what we should do? Front Public Health 2023; 11:1105009. [PMID: 36935666 PMCID: PMC10016614 DOI: 10.3389/fpubh.2023.1105009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/09/2023] [Indexed: 03/05/2023] Open
Abstract
All the available evidence points to the fact that healthcare is under considerable stress, and while change is urgently needed there is no quick fix; systemic and sustained changes in organizational cultures within healthcare are required. Moreover, the fragility of healthcare systems globally has been starkly exposed by the Coronavirus 2019 pandemic. We have gathered enough evidence to know what is driving poor wellbeing, and how these processes impact on quality of care and patient safety. Indeed, we have a good idea of what we need to do to improve the situation. Therefore, this begs a simpler question; If we know how to create healthy workplaces, why is it so difficult to achieve this in healthcare? In the following perspective paper, we will argue that we can do better if we address the following three issues: (1) we are ignoring the real problems, (2) limited successes that we are achieving are moving us further from tackling the real problems, (3) culture change is accepted as crucial, but we are not accepting what the evidence is telling us about healthcare culture. Tackling burnout is useful and necessary, but we must increase dignity among healthcare employees. Moreover, we need to train line managers to recognize and facilitate the need of employees to feel competent and be appreciated by others, while helping them set wellbeing boundaries.
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Affiliation(s)
- Anthony Montgomery
- Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
- *Correspondence: Anthony Montgomery
| | - Olga Lainidi
- School of Psychology, University of Leeds, Leeds, United Kingdom
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Börner G, Montgomery A. DD-05 INCISIONAL HERNIA PREVENTION - INVESTIGATION OF A NOVEL DEVICE FOR STANDARDIZED ABDOMINAL CLOSURE. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
Surgeons can reduce incisional hernia formation by adhering to standardized techniques for incisional wound closure. This is often neglected at the end of a long operation which can lead to wound infection, wound rupture and incisional hernia formation. To address this issue, a suturing device was developed for swift and standardized abdominal closure. Preclinical studies have shown an adherence to Suture-Length/Wound-Length ratio ≥4 (SL/WL ratio) of 95% with the device compared to 69% for manual suturing and a >30% reduction in closure time. The aim is to perform a first in man study to verify the device performance and user safety.
Method
The study will be performed in a four month period at a single center. Principal investigator are appointed and research nurse funded. Forty patients undergoing elective open surgery for colorectal disease will be assigned to the study and follow up time will be 45 days. Endpoints will be adherence to SL/WL ratio of 4, abdominal closure time and wound infection. The study will include usability assessment and scoring of surgeon satifaction.
Results
If previous promising results from preclinical studies in animal tissue models and cadavers are verified in patients, this novel suturing device can be an important tool to reduce abdominal wall closure related complications. This will have an impact on patient quality of life, save surgical resources and contribute to a more predictable postoperative pathway.
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Affiliation(s)
- G Börner
- Department of Surgery, Helsingborg Hospital , Helsingborg , Sweden
| | - A Montgomery
- Department of Surgery , SUS Malmö, Malmö , Sweden
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Börner G, Lööf E, Edelhamre M, Rogmark P, Montgomery A. OC-064 TISSUE KINDNESS: A COMPARISON OF TISSUE MANIPULATION BETWEEN A NOVEL SUTURING DEVICE FOR STANDARDIZED ABDOMINAL CLOSURE AND MANUAL NEEDLE TECHNIQUE. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
Wound healing is influenced by contamination, wound tension, and tissue handling. Suturing includes tweezer compression and medial traction that might compromise the fascia. This study compared forces involved in suturing with a novel suturing device for standardized abdominal closure and curved suture needles of two sizes.
Method
A model to measure suturing-forces was developed. Ten theatre nurses and 25 surgeons were introduced to the novel suturing-device. Participants performed 10×3 needle-pull-throughs using the device and two sizes of conventional suture needles: 36mm Large Needle (LN) and 26mm Small Needle (SN). Tweezer force and medial tissue traction force were recorded. Needle pull-through time, maximum and Area Under Curve forces (AUC) were calculated.
Results
Device training time was 4min 25s. Maximum tweezer-force was 892g (420.4) for the device, 1037g (457.5) for LN and 1097g (491.1) for SN (p<0.001). Maximum traction-force was 62g (57.6) for the device, 61g (45.4) for LN and 54g (50.0) for SN (p=0.117). Tweezer-force AUC was 2422gs (1797.2) for the device, 3442gs (1550.0) for LN and 3221gs (1588.9) for SN (p<0.001). Traction-force AUC was 148gs (239.0) for the device, 174gs (160.8) for LN and 142gs (161.0) for SN (p=0.068). Needle-pull through time was 3.4s (2.15) for the device, 4.4s (2.12) for LN and 3.9s (1.90) for SN (p<0.001)
Conclusion
The suturing device was faster and less traumatic to tissue for tweezer-force. Medial traction forces were similar. The novel suturing device is quick to learn and gentle to the tissue and device seems promising in facilitating fascial closure.
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Affiliation(s)
- G Börner
- Trauma & Emergency service Department of Surgery, Helsingborg Hospital , Helsingborg , Sweden
| | - E Lööf
- Lund University, Faculty of Medicine , Lund , Sweden
| | - M Edelhamre
- Colorectal Service Department of Surgery, Helsingborg Hospital , Helsingborg , Sweden
| | - P Rogmark
- Department of Surgery , SUS Malmö, Malmö , Sweden
| | - A Montgomery
- Department of Surgery , SUS Malmö, Malmö , Sweden
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Landry A, Setser J, Montgomery A, Albritton L. An Evaluation of the Suitability of Food Provided through the Arkansas Foodbank Backpack Program. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.08.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Montgomery A. Concerted Collusion: Studying Multiagency Institutional Cover-Up. Front Psychol 2022; 13:847376. [PMID: 35783708 PMCID: PMC9244796 DOI: 10.3389/fpsyg.2022.847376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Many important organizational events do not lend themselves easily to experimental manipulation, and thus, one can only study them retrospectively by combining the investigative tools provided by both the social sciences and humanities. A cover-up, meaning an attempt to prevent the public from discovering information about a serious crime or mistake, is such a phenomenon. The objective of the present paper is to develop an initial taxonomy of how organizational researchers can study what happens when multiple organizations and institutions conspire to cover-up the causes of a tragedy. For this purpose, the 1989 United Kingdom Hillsborough tragedy and the 27 year cover-up will be analyzed. Hillsborough is the best (and worst) example of a cover-up, in that the objective facts were known from early on but the subjective elements (i.e., attitudes, bias, and collusion) resulted in a 27 year search for justice for the victims. It deserves special attention as an example of multiagency institutional cover-up, in that the range and diversity of institutional actors pitted against the victims grossly outweighed them in terms of material resources, social power (in terms of social class differences), and the ability to control the narrative of the tragedy. Using a thematic analysis approach, five main themes were identified as: (1) Unwilling, but compliant, participants who are unlikely to be whistleblowers, (2) Suppressing/withholding important information, (3) Proactively engaging the support of related actors/institutions that helps create a critical mass, (4) Owning the narrative, and (5) Moral disengagement.
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Montgomery A, Pisanti R, Panagopoulou E. Editorial: Integrating Healthcare Worker Wellbeing and Clinical Practice: Sisyphean Task or Reconcilable Duty? Front Psychol 2022; 13:863896. [PMID: 35391956 PMCID: PMC8981080 DOI: 10.3389/fpsyg.2022.863896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
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Georganta K, Montgomery A. Workplace fun is not enough: the role of work engagement and trust. Cogent Psychology 2022. [DOI: 10.1080/23311908.2022.2060603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Katerina Georganta
- Department of Educational and Social Policy, School of Social Sciences, Humanities and Arts, University of Macedonia, Greece
| | - Anthony Montgomery
- Department of Educational and Social Policy, School of Social Sciences, Humanities and Arts, University of Macedonia, Greece
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Montgomery A, Lainidi O. Understanding the Link Between Burnout and Sub-Optimal Care: Why Should Healthcare Education Be Interested in Employee Silence? Front Psychiatry 2022; 13:818393. [PMID: 35432023 PMCID: PMC9008194 DOI: 10.3389/fpsyt.2022.818393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/16/2022] [Indexed: 11/26/2022] Open
Abstract
Evidence on the association of burnout with objective indicators of performance is scarce in healthcare. In parallel, healthcare professionals ameliorate the short-term impact of burnout by prioritizing some tasks over others. The phenomenon of employee silence can help us understand the evolution of how culture is molded toward the prioritization of some tasks over others, and how this contributes to burnout. Silence in healthcare has been associated with concealing errors, reduced patient safety, and covering up errors made by others. Conversely, there is evidence that in organizations where employees are encouraged to speak up about concerns, and where concerns are responded to appropriately, better patient outcomes such as improved patient safety and patient experience occur. Interventions to promote "speaking-up" in healthcare have not been successful and are rooted in a professional culture that does not promote speaking out. In this paper, we review the evidence that exists within healthcare to argue why healthcare education should be interested in employee silence, and how silence is a key factor in understanding how burnout develops and impacts quality of care. The following key questions have been addressed; how employee silence evolves during medical education, how is silence maintained after graduation, and how can leadership style contribute to silence in healthcare. The impact of withholding information on healthcare professional burnout, patient safety and quality of care is significant. The paper concludes with a suggested future research agenda and additional recommendations.
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Henriksen NA, Nazari T, Simons MP, Hope W, Montgomery A. Guidelines for Treatment of Umbilical and Epigastric Hernias From the European and Americas Hernia Societies-A Web-Based Survey on Surgeons' Opinion. J Abdom Wall Surg 2022; 1:10260. [PMID: 38314164 PMCID: PMC10831711 DOI: 10.3389/jaws.2022.10260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/25/2022] [Indexed: 02/06/2024]
Abstract
Background and aims: The European and Americas Hernia Society's (EHS and AHS) Guidelines on the treatment of primary midline ventral hernias were launched to guide surgeons. As a part of a dissemination plan of the guideline, this study aimed to evaluate the level of consensus between recommendations and the current surgical practices of EHS and AHS members before implementation. Material and methods: A questionnaire was constructed including questions on the current practice of the members and nine selected key recommendations from the guidelines. An on-stage consensus voting was performed at the EHS Congress in Hamburg 2019 followed by a SurveyMonkey sent to all EHS and AHS members. Consensus with a recommendation was defined as an agreement of ≥70%. Results: A total of 178 votes were collected in Hamburg. A further 499/1,754 (28.4%) of EHS and 150/1,100 (13.6%) of AHS members participated in the SurveyMonkey. A consensus was reached for 7/9 (78%) of the recommendations. The two recommendations that did not reach consensus were on indication and the technique used for laparoscopic repair. In current practice, more AHS participants used a preformed patch; 50.7% (76/150) compared with EHS participants 32.1% (160/499), p < 0.001. Conclusion: A consensus was achieved for most recommendations given by the new guideline for the treatment of umbilical and epigastric hernias. Recommendations that did not reach consensus were on indication and technique for laparoscopic repair, which may reflect the lack of evidence on these topics.
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Affiliation(s)
- N. A. Henriksen
- Department of Gastrointestinal and Liver Diseases, Herlev Hospital, Herlev, Denmark
- Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - T. Nazari
- Department of Surgery, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - M. P. Simons
- Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, Netherlands
| | - W. Hope
- New Hanover Regional Medical Center, Wilmington, DE, United States
| | - A. Montgomery
- Faculty of Medicine, Department of Surgery, Skane University Hospital, Malmö, Sweden
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16
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Mahmoud A, Aly M, Shanmuganathan K, Rocos B, Sedra F, Montgomery A, Aftab S. 5 Cervical Spine Pedicle Screw Accuracy in Open Fluoroscopic, Navigated and Template Guided Systems- a Systematic Review. Br J Surg 2022. [DOI: 10.1093/bjs/znac040.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Pedicle screws provide excellent fixation for a wide range of indications; their adoption in the cervical spine has been slower than in the thoracic and lumbar spine, largely due to the smaller pedicle sizes and proximity to neurovascular structures in the neck. Recent years have seen the development of technology to improve accuracy and thereby safety in cervical pedicle screw placement over traditional fluoroscopic techniques, including intraoperative 3D navigation, computer assisted systems and physical templates with screw guides. We have performed a systematic review into the accuracy rates of the various systems.
Method
PubMed and Cochrane Library databases were searched; keywords "pedicle screw cervical spine" were searched; 9 valid papers involving 1427 screws were found.
Results
Accuracy rates were 80.6% for fluoroscopy, 91.4% for navigation methods, and 96.7% for templates.
Conclusions
Superior results for templates are complemented by reduced radiation exposure to patient and surgeon; however, the technology requires prolonged pre-operative planning to create the bespoke template, and the development of an infrastructure to allow for their rapid production and delivery is needed before they become more widely available.
Two broad methods of navigation currently exist: intraoperative CT scanning providing real-time 3D navigation and preoperative CT registration in relation to a fixed reference with intraoperative computer assistance. At present, these methods are more commonly used, due to their proven improved accuracy rates over fluoroscopy, availability in emergencies and alongside minimally invasive techniques.
Despite their novelty and limitations, templates provide promising accuracy scores, although practical considerations may inhibit their proliferation.
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Affiliation(s)
- A. Mahmoud
- Trauma and Orthopaedic Department of Royal London Hospital, London, United Kingdom
| | - M. Aly
- Trauma and Orthopaedic Department of Royal London Hospital, London, United Kingdom
| | - K. Shanmuganathan
- Trauma and Orthopaedic Department of Royal London Hospital, London, United Kingdom
| | - B. Rocos
- Trauma and Orthopaedic Department of Royal London Hospital, London, United Kingdom
| | - F. Sedra
- Trauma and Orthopaedic Department of Royal London Hospital, London, United Kingdom
| | - A. Montgomery
- Trauma and Orthopaedic Department of Royal London Hospital, London, United Kingdom
| | - S. Aftab
- Trauma and Orthopaedic Department of Royal London Hospital, London, United Kingdom
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17
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Koutsimani P, Montgomery A. Cognitive functioning in non-clinical burnout: Using cognitive tasks to disentangle the relationship in a three-wave longitudinal study. Front Psychiatry 2022; 13:978566. [PMID: 36061283 PMCID: PMC9428402 DOI: 10.3389/fpsyt.2022.978566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Burnout is often characterized by cognitive deficits and it has been associated with depression and anxiety. However, it is not clear whether cognitive impairment is a burnout consequence or employees with poor cognitive skills are more prone in developing burnout. Moreover, the exact nature of the association between burnout and depression, and burnout and anxiety is still unknown. Depression and anxiety are also related to cognitive impairments but their prospective associations are not fully understood. The aim of the present three-wave longitudinal study was to investigate the causality between cognitive functioning, burnout, depression, and anxiety among non-clinical burnout employees. The cause-effect associations of burnout with depression and anxiety were also explored. Perceived family support as a protective factor against cognitive decline, burnout, depression and anxiety was examined as well. A wide range of cognitive tasks tapping different cognitive domains were administered to employees of the general working population. Burnout, depression, anxiety, and perceived family support were assessed with self-reported questionnaires. Present results suggest that visuospatial functioning deficits are a burnout consequence and they indicate the role of automatic processing skills and executive functions in burnout onset. Additionally, current findings support that burnout is differentiated from depression and anxiety but it is reciprocally associated with the two psychological phenomena. Lastly, current results support the inclusion of perceived family support as an intervention to help individuals who suffer from mental health and cognitive difficulties.
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Affiliation(s)
- Panagiota Koutsimani
- Department of Educational and Social Policy, School of Social Sciences, Humanities and Arts, University of Macedonia, Thessaloniki, Greece
| | - Anthony Montgomery
- Department of Psychology, Northumbria University Newcastle, Newcastle upon Tyne, United Kingdom
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18
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Koutsimani P, Montgomery A. Burnout and Cognitive Functioning: Are We Underestimating the Role of Visuospatial Functions? Front Psychiatry 2022; 13:775606. [PMID: 35401261 PMCID: PMC8983930 DOI: 10.3389/fpsyt.2022.775606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/28/2022] [Indexed: 11/21/2022] Open
Abstract
Job burnout is a psychological syndrome which results from chronic occupational stress and cognitive impairments are among its negative consequences. The demands of the COVID-19 pandemic have challenged the healthcare system increasing the risk of job burnout among healthcare professionals. The studies conducted so far have mainly focused on the effects of job burnout on executive functions. Visuospatial functions are a cognitive domain which plays an important role in healthcare workers' optimal performance. Healthcare workers are constantly relying on their visuospatial abilities in order to care for their patients as they are required to use techniques that involve manipulation of medical instruments, they need to have excellent hand-eye coordination and great perception of spatial anatomy, factors that can affect healthcare workers' performance is of significance and can put patient safety at risk. However, our understanding of how visuospatial functions are being affected in job burnout is limited. The scope of this mini-review is to examine the evidence concerning the relationship of job burnout with visuospatial functions. The sparsity of the relevant empirical evidence does not allow for definite conclusions. However, given the implications of diminished visuospatial abilities in patient safety we highlight the need for studies exploring the effects of job burnout on visuospatial functions. Limitations of studies are discussed.
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Affiliation(s)
- Panagiota Koutsimani
- Department of Educational & Social Policy, School of Social Sciences, Humanities and Arts, University of Macedonia, Thessaloniki, Greece
| | - Anthony Montgomery
- Department of Educational & Social Policy, School of Social Sciences, Humanities and Arts, University of Macedonia, Thessaloniki, Greece
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19
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Hernández-Granados P, Henriksen NA, Berrevoet F, Cuccurullo D, López-Cano M, Nienhuijs S, Ross D, Montgomery A. European Hernia Society guidelines on management of rectus diastasis. Br J Surg 2021; 108:1189-1191. [PMID: 34595502 PMCID: PMC10364860 DOI: 10.1093/bjs/znab128] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/21/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND The definition, classification and management of rectus diastasis (RD) are controversial in the literature and a variety of different surgical treatments have been described. This article reports on the European Hernia Society (EHS) Clinical Practice Guideline for RD. METHOD The Guideline group consisted of eight surgeons. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done in November 2018 and updated in November 2019 and October 2020. Nine Key Questions (KQs) were formulated. RESULTS Literature reporting on the definition, classification, symptoms, outcomes and treatments was limited in quality, leading to weak recommendations for the majority of the KQs. The main recommendation is to define RD as a separation between rectus muscles wider than 2 cm. A new classification system is suggested based on the width of muscle separation, postpregnancy status and whether or not there is a concomitant hernia. Impaired body image and core instability appear to be the most relevant symptoms. Physiotherapy may be considered before surgical management. It is suggested to use linea alba plication in patients without concomitant hernia and a mesh-based repair of RD with concomitant midline hernias. CONCLUSION RD should be defined as a separation of rectus muscles wider than 2 cm and a new classification system is suggested.
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Affiliation(s)
- P Hernández-Granados
- General Surgery Unit, Fundación Alcorcón University Hospital, Rey Juan Carlos University, Alcorcón, Spain
| | - N A Henriksen
- Department of Surgery, Gastro Unit, Herlev Hospital, Zealand University Hospital and University of Copenhagen, Copenhagen, Denmark
| | - F Berrevoet
- General and Hepatopancreatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - D Cuccurullo
- Department of General, Laparoscopic and Robotic Surgery, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - M López-Cano
- Abdominal Wall Surgery Unit, Val d'Hebrón University Hospital, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - S Nienhuijs
- Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - D Ross
- Department of Plastic Surgery, The London Clinic and St Thomas' Hospital, London, UK
| | - A Montgomery
- Surgical Department, Skåne University Hospital Malmö, Lund University, Sweden
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20
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Jakobsson L, Montgomery A, Ingvar J, Löfgren A, Liedberg F. Urostomal ileal conduit complications in association with abdominal wall mesh implantation. Scand J Urol 2021; 56:1-5. [PMID: 34623226 DOI: 10.1080/21681805.2021.1986571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Parastomal hernia (PH) in association with an ileal conduit is a common complication that is difficult to treat. Mesh reinforcement has been suggested to improve outcomes; either as prophylaxis or for treatment of a parastomal hernia during abdominal wall reconstruction. PATIENTS AND METHODS A retrospective study was performed in consecutive patients subjected to mesh implantation between 2000 and 2016 having a concurrent or previous ileal conduit reconstruction. Postoperative and late urostomal complications, as well as hernia occurrence, were ascertained by a chart review of patients' records. RESULTS A total of 25 patients were included of whom 13 (52%) developed either a urostomal complication, a PH, or both. Complications were caused by mesh erosion in four patients, of which three were diagnosed more than five years after surgery. Four patients developed a urostomal stenosis. One out of eight patients with urostomal complications were subjected to a new ileal conduit reconstruction and another four to other types of revisional surgery. CONCLUSIONS Every second patient with an ileal conduit developed either a local urostomal complication, a PH, or both after abdominal wall mesh reconstruction. A careful and cautious attitude towards the use of mesh in patients with an ileal conduit is suggested.
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Affiliation(s)
- L Jakobsson
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - A Montgomery
- Institution of Clinical Sciences Malmö, Surgical Research Unit, Lund University, Malmö, Sweden
| | - J Ingvar
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - A Löfgren
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - F Liedberg
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Institution of Translational Medicine, Lund University, Malmö, Sweden
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21
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Grove TN, Kontovounisios C, Montgomery A, Heniford BT, Windsor ACJ, Warren OJ. Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement. BJS Open 2021; 5:6375607. [PMID: 34568888 PMCID: PMC8473840 DOI: 10.1093/bjsopen/zrab082] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 08/03/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The incidence of incisional hernia after major abdominal surgery via a midline laparotomy is 20-41 per cent with short-term follow-up, and over 50 per cent in those surviving an abdominal catastrophe. Abdominal wall reconstruction (AWR) requires complex operations, often involving mesh resection, management of scarred skin, fistula takedown, component separation or flap reconstruction. Patients tend to have more complex conditions, with multiple co-morbidities predisposing them to a vicious cycle of complications and, subsequently, hernia recurrence. Currently there appears to be variance in perioperative practice and minimal guidance globally. The aim of this Delphi consensus was to provide a clear benchmark of care for the preoperative assessment and perioperative optimization of patients undergoing AWR. METHODS The Delphi method was used to achieve consensus from invited experts in the field of AWR. Thirty-two hernia surgeons from recognized hernia societies globally took part. The process included two rounds of anonymous web-based voting with response analysis and formal feedback, concluding with a live round of voting followed by discussion at an international conference. Consensus for a strong recommendation was achieved with 80 per cent agreement, and a weak recommendation with 75 per cent agreement. RESULTS Consensus was obtained on 52 statements including surgical assessment, preoperative assessment, perioperative optimization, multidisciplinary team and decision-making, and quality-of-life assessment. Forty-six achieved over 80 per cent agreement; 14 statements achieved over 95 per cent agreement. CONCLUSION Clear consensus recommendations from a global group of experts in the AWR field are presented in this study. These should be used as a baseline for surgeons and centres managing abdominal wall hernias and performing complex AWR.
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Affiliation(s)
- T N Grove
- Department of Surgery, Chelsea and Westminster Hospital, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - C Kontovounisios
- Department of Surgery, Chelsea and Westminster Hospital, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK.,Department of General Surgery, Royal Marsden Hospital, London, UK
| | - A Montgomery
- Department of Surgery, Skåne University Hospital SUS, Malmö, Sweden
| | - B T Heniford
- Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | | | - O J Warren
- Department of Surgery, Chelsea and Westminster Hospital, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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22
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Johnson J, Al-Ghunaim TA, Biyani CS, Montgomery A, Morley R, O’Connor DB. Burnout in Surgical Trainees: a Narrative Review of Trends, Contributors, Consequences and Possible Interventions. Indian J Surg 2021; 84:35-44. [PMID: 34341627 PMCID: PMC8319710 DOI: 10.1007/s12262-021-03047-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 02/03/2023] Open
Abstract
Surgical disciplines are popular and training places are competitive to obtain, but trainees report higher levels of burnout than either their non-surgical peers or attending or consultant surgeons. In this review, we critically summarise evidence on trends and changes in burnout over the past decade, contributors to surgical trainee burnout, the personal and professional consequences of burnout and consider the evidence for interventions. There is no evidence for a linear increase in burnout levels in surgeons over the past decade but the impact of the COVID-19 pandemic has yet to be established and is likely to be significant. Working long hours and experiencing stressful interpersonal interactions at work are associated with higher burnout in trainees but feeling more supported by training programmes and receiving workplace supervision are associated with reduced burnout. Burnout is associated with poorer overall mental and physical well-being in surgical trainees and has also been linked with the delivery of less safe patient care in this group. Useful interventions could include mentorship and improving work conditions, but there is a need for more and higher quality studies.
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Affiliation(s)
- Judith Johnson
- School of Psychology, University of Leeds, Leeds, LS29JT UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, BD96RJ UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052 Australia
| | | | - Chandra Shekhar Biyani
- Department of Urology, St James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
- Cadaveric Simulation Programme, Anatomy Department, School of Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Anthony Montgomery
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
| | - Roland Morley
- Imperial College Healthcare NHS Trust, London, W2 1NY UK
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23
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Parker SG, Halligan S, Berrevoet F, de Beaux AC, East B, Eker HH, Jensen KK, Jorgensen LN, Montgomery A, Morales-Conde S, Miserez M, Renard Y, Sanders DL, Simons M, Slade D, Torkington J, Blackwell S, Dames N, Windsor ACJ, Mallett S. Reporting guideline for interventional trials of primary and incisional ventral hernia repair. Br J Surg 2021; 108:1050-1055. [PMID: 34286842 DOI: 10.1093/bjs/znab157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/02/2021] [Accepted: 04/13/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Primary and incisional ventral hernia trials collect unstandardized inconsistent data, limiting data interpretation and comparison. This study aimed to create two minimum data sets for primary and incisional ventral hernia interventional trials to standardize data collection and improve trial comparison. To support these data sets, standardized patient-reported outcome measures and trial methodology criteria were created. METHODS To construct these data sets, nominal group technique methodology was employed, involving 15 internationally recognized abdominal wall surgeons and two patient representatives. Initially a maximum data set was created from previous systematic and panellist reviews. Thereafter, three stages of voting took place: stage 1, selection of the number of variables for data set inclusion; stage 2, selection of variables to be included; and stage 3, selection of variable definitions and detection methods. A steering committee interpreted and analysed the data. RESULTS The maximum data set contained 245 variables. The three stages of voting commenced in October 2019 and had been completed by July 2020. The final primary ventral hernia data set included 32 variables, the incisional ventral hernia data set included 40 variables, the patient-reported outcome measures tool contained 25 questions, and 40 methodological criteria were chosen. The best known variable definitions were selected for accurate variable description. CT was selected as the optimal preoperative descriptor of hernia morphology. Standardized follow-up at 30 days, 1 year, and 5 years was selected. CONCLUSION These minimum data sets, patient-reported outcome measures, and methodological criteria have allowed creation of a manual for investigators aiming to undertake primary ventral hernia or incisional ventral hernia interventional trials. Adopting these data sets will improve trial methods and comparisons.
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Affiliation(s)
- S G Parker
- Abdominal Wall Unit, General Surgery, University College London Hospital, London, UK
| | - S Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - F Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation, University Hospital Ghent, Ghent, Belgium
| | - A C de Beaux
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - B East
- 3rd Department of Surgery, Motol University Hospital, 1st and 2nd Medical Faculty of Charles University, Prague, Czech Republic
| | - H H Eker
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - K K Jensen
- General Surgery, Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - L N Jorgensen
- General Surgery, Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A Montgomery
- Department of Surgery, Skåne University Hospital Malmö, Malmö, Sweden
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of Surgery, University Hospital Virgen del Rocio, University of Seville, Seville, Spain
| | - M Miserez
- Department of Abdominal Surgery, University Hospitals of the Katholieke Universiteit Leuven, Leuven, Belgium
| | - Y Renard
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - D L Sanders
- Department of General and Upper Gastrointestinal Surgery, North Devon District Hospital, Barnstaple, UK
| | - M Simons
- Department of Surgery, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, the Netherlands
| | - D Slade
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - J Torkington
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | | | - N Dames
- Patient Representative, Glasgow, UK
| | - A C J Windsor
- Abdominal Wall Unit, General Surgery, University College London Hospital, London, UK
| | - S Mallett
- Centre for Medical Imaging, University College London, London, UK
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24
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Birckhead A, Combs M, Croser E, Montgomery A, Peters A, Stark D, Malik R. Presumptive neural microsporidiosis in a young adult German Shepherd dog from rural Australia. Aust Vet J 2021; 99:351-355. [PMID: 33904161 DOI: 10.1111/avj.13071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/21/2021] [Accepted: 03/27/2021] [Indexed: 11/29/2022]
Abstract
CASE REPORT A 1-year-old, neutered male German Shepherd was presented with a 5-month history of episodic lethargy, intermittent fever, weight loss and a hunched posture. The dog was diagnosed with presumptive microsporidian meningoencephalitis based on cytological findings on cerebrospinal fluid analysis and a positive PCR test. The dog initially responded favourably to a 4-week course of trimethoprim-sulfadiazine, pyrimethamine and fenbendazole, and remained well for 12 weeks following cessation of treatment. Disease then recurred, and despite an initial positive response to treatment, he deteriorated and was euthanased 11 weeks later, 7.5 months after definitive diagnosis and 13 months after clinical signs were first reported. CONCLUSION To the authors knowledge, this is the first case of canine microsporidiosis in Australia.
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Affiliation(s)
- A Birckhead
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2650, Australia
| | - M Combs
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2650, Australia
| | - E Croser
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2650, Australia
| | - A Montgomery
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2650, Australia
| | - A Peters
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2650, Australia
| | - D Stark
- Microbiology Department, St Vincent's Hospital, Sydney, New South Wales, 2010, Australia
| | - R Malik
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, 2650, Australia.,Centre for Veterinary Education, University of Sydney, Sydney, New South Wales, 2006, Australia
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25
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Harji D, Thomas C, Antoniou SA, Chandraratan H, Griffiths B, Henniford BT, Horgan L, Köckerling F, López-Cano M, Massey L, Miserez M, Montgomery A, Muysoms F, Poulose BK, Reinpold W, Smart N. A systematic review of outcome reporting in incisional hernia surgery. BJS Open 2021; 5:6220250. [PMID: 33839746 PMCID: PMC8038267 DOI: 10.1093/bjsopen/zrab006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/20/2020] [Accepted: 01/13/2021] [Indexed: 01/13/2023] Open
Abstract
Background The incidence of incisional hernia is up to 20 per cent after abdominal surgery. The management of patients with incisional hernia can be complex with an array of techniques and meshes available. Ensuring consistency in reporting outcomes across studies on incisional hernia is important and will enable appropriate interpretation, comparison and data synthesis across a range of clinical and operative treatment strategies. Methods Literature searches were performed in MEDLINE and EMBASE (from 1 January 2010 to 31 December 2019) and the Cochrane Central Register of Controlled Trials. All studies documenting clinical and patient-reported outcomes for incisional hernia were included. Results In total, 1340 studies were screened, of which 92 were included, reporting outcomes on 12 292 patients undergoing incisional hernia repair. Eight broad-based outcome domains were identified, including patient and clinical demographics, hernia-related symptoms, hernia morphology, recurrent incisional hernia, operative variables, postoperative variables, follow-up and patient-reported outcomes. Clinical outcomes such as hernia recurrence rates were reported in 80 studies (87 per cent). A total of nine different definitions for detecting hernia recurrence were identified. Patient-reported outcomes were reported in 31 studies (34 per cent), with 18 different assessment measures used. Conclusions This review demonstrates the significant heterogeneity in outcome reporting in incisional hernia studies, with significant variation in outcome assessment and definitions. This is coupled with significant under-reporting of patient-reported outcomes.
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Affiliation(s)
- D Harji
- Northern Surgical Trainees Research Association (NoSTRA), Northern Deanery, Newcastle Upon Tyne, UK
| | - C Thomas
- Northern Surgical Trainees Research Association (NoSTRA), Northern Deanery, Newcastle Upon Tyne, UK
| | - S A Antoniou
- Department of Surgery, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - H Chandraratan
- Notre Dame University, General Surgery, Murdoch, Western Australia, Australia
| | - B Griffiths
- Newcastle Surgical Education, Newcastle Upon Tyne, UK
| | - B T Henniford
- Division of Gastrointestinal and Minimally Invasive Surgery Carolinas Medical Center, Charlotte, North Carolina, USA
| | - L Horgan
- Upper Gastrointestinal Surgical Department, Northumbria Healthcare NHSFT, North Shields, UK
| | - F Köckerling
- Department of Surgery and Centre for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany
| | - M López-Cano
- Abdominal Wall Surgery Unit, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - L Massey
- Department of Surgery, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - M Miserez
- Department of Abdominal Surgery, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - A Montgomery
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - F Muysoms
- Department of Surgery, Maria Middelares, Ghent, Belgium
| | - B K Poulose
- Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - W Reinpold
- Department of Surgery and Reference Hernia Centre, Gross Sand Hospital Hamburg, Hamburg, Germany
| | - N Smart
- Department of Surgery, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
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Montgomery A, Doulougeri K, Panagopoulou E. Do critical incidents lead to critical reflection among medical students? Health Psychol Behav Med 2021; 9:206-219. [PMID: 34104557 PMCID: PMC8158269 DOI: 10.1080/21642850.2021.1899827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Context Medical students are exposed during their training to a wide range of experiences and behaviors that can affect their learning regarding professionalism and their behavior and attitudes towards patient-centered care. The aim of the study is to explore learning associated with critical incidents and levels of critical reflection among medical students. Approach Medical students' were invited to narrate a critical incident and reflect on the learning associated with it. All students' narratives were audio-recorded and analyzed thematically. Mezirow's theory of transformative learning was used to analyze the level of reflection reached in students' narratives. Findings For the present analysis critical incidents narrated by 70 clinical students (4th-6th year) were included. Fifty-two of them were females. Students' experiences are derived from three types of interactions: observed interactions between doctors and patients, personal interactions between students and patients, and interactions between doctors and students. Reflections deriving from the experiences included: behaving to patients as humans not as cases, emotional aspects of care, doctors as role models, skills needed when working under pressure, 'tasting' the real profession, emotional management, the importance of communication skills, teaching qualities of doctors, becoming a doctor, and reflections of future practice. Analyzing the actual level of reflection indicated that only 32 (45.7%) students were categorized as reflectors. Conclusions Student interactions with doctors and patients provide insights about; the daily experience of being a doctor, the most common challenges, what qualities are necessary for being a doctor and what do they need to develop their professional identity. However, it is noteworthy that while the majority of students shared a critical incident crucial to their professional development, there is little evidence of critical reflection.
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Affiliation(s)
- Anthony Montgomery
- School of Social Sciences, Humanities and Arts, Department of Educational & Social Policy, University of Macedonia, Thessaloniki, Greece
| | - Karolina Doulougeri
- Eindhoven School of Education, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Efharis Panagopoulou
- Aristotle University of Thessaloniki, Faculty of Health Sciences, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
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Koutsimani P, Montgomery A, Masoura E, Panagopoulou E. Burnout and Cognitive Performance. Int J Environ Res Public Health 2021; 18:ijerph18042145. [PMID: 33671754 PMCID: PMC7926785 DOI: 10.3390/ijerph18042145] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 01/16/2023]
Abstract
The aim of this study was to investigate the relationship between burnout and cognitive functioning. The associations of depression, anxiety and family support with burnout and cognitive functioning were also examined both independently and as potential moderators of the burnout–cognitive functioning relationship. Seven different cognitive tasks were administered to employees of the general working population and five cognitive domains were assessed; i.e., executive functions, working memory, memory (episodic, visuospatial, prospective), attention/speed of processing and visuospatial abilities. Burnout, depression, anxiety and family support were assessed with the Maslach Burnout Inventory-General Survey, the Hospital Anxiety and Depression Scale and the Family Support Scale respectively. In congruence with the first and fourth (partially) Hypotheses, burnout and perceived family support are significantly associated with some aspects of cognitive functioning. Moreover, in line with the third Hypothesis, perceived family support is inversely related to burnout. However, in contrast to the second and fourth Hypotheses, depression, anxiety and perceived family support do not moderate the burnout–cognitive functioning relationship. Additional results reveal positive associations between burnout depression and anxiety. Overall findings suggest that cognitive deficits, depression and anxiety appear to be common in burnout while they underpin the role of perceived family support in both mental health and cognitive functioning. Implications for practice are discussed.
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Affiliation(s)
- Panagiota Koutsimani
- Department of Educational & Social Policy, School of Social Sciences, Humanities and Arts, University of Macedonia, Egnatia 156, 54636 Thessaloniki, Greece;
- Correspondence: ; Tel.: +30-2310-891-308
| | - Anthony Montgomery
- Department of Educational & Social Policy, School of Social Sciences, Humanities and Arts, University of Macedonia, Egnatia 156, 54636 Thessaloniki, Greece;
| | - Elvira Masoura
- Department of Experimental Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Efharis Panagopoulou
- Laboratory of Hygiene, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
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Rystedt JML, Wiss J, Adolfsson J, Enochsson L, Hallerbäck B, Johansson P, Jönsson C, Leander P, Österberg J, Montgomery A. Routine versus selective intraoperative cholangiography during cholecystectomy: systematic review, meta-analysis and health economic model analysis of iatrogenic bile duct injury. BJS Open 2020; 5:6056685. [PMID: 33688957 PMCID: PMC7944855 DOI: 10.1093/bjsopen/zraa032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/26/2020] [Accepted: 09/28/2020] [Indexed: 01/07/2023] Open
Abstract
Background Bile duct injury (BDI) is a severe complication following cholecystectomy. Early recognition and treatment of BDI has been shown to reduce costs and improve patients’ quality of life. The aim of this study was to assess the effect and cost-effectiveness of routine versus selective intraoperative cholangiography (IOC) in cholecystectomy. Methods A systematic review and meta-analysis, combined with a health economic model analysis in the Swedish setting, was performed. Costs per quality-adjusted life-year (QALY) for routine versus selective IOC during cholecystectomy for different scenarios were calculated. Results In this meta-analysis, eight studies with more than 2 million patients subjected to cholecystectomy and 9000 BDIs were included. The rate of BDI was estimated to 0.36 per cent when IOC was performed routinely, compared with to 0.53 per cent when used selectively, indicating an increased risk for BDI of 43 per cent when IOC was used selectively (odds ratio 1.43, 95 per cent c.i. 1.22 to 1.67). The model analysis estimated that seven injuries were avoided annually by routine IOC in Sweden, a population of 10 million. Over a 10-year period, 33 QALYs would be gained at an approximate net cost of €808 000 , at a cost per QALY of about €24 900. Conclusion Routine IOC during cholecystectomy reduces the risk of BDI compared with the selective strategy and is a potentially cost-effective intervention.
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Affiliation(s)
- J M L Rystedt
- Department of Surgery, Skane University Hospital, Clinical Sciences, Lund University, Sweden
| | - J Wiss
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden
| | - J Adolfsson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden
| | - L Enochsson
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - B Hallerbäck
- Department of Surgery, Northern Alvsborg Hospital, Trollhattan, Sweden
| | - P Johansson
- PublicHealth&Economics, Stockholm, Sweden.,Research Centre for Health and Welfare, Halmstad University, Halmstad, Sweden
| | - C Jönsson
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - P Leander
- Department of Radiology, Skane University Hospital, Malmö, Sweden
| | - J Österberg
- Department of Surgery, Mora Hospital, Mora, Sweden
| | - A Montgomery
- Department of Surgery, Skane University Hospital, Clinical Sciences, Lund University, Sweden
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Henriksen NA, Montgomery A. Author response to: Comment on: Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. Br J Surg 2020; 107:e216. [PMID: 32342486 DOI: 10.1002/bjs.11576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 11/08/2022]
Affiliation(s)
- N A Henriksen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - A Montgomery
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
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Henriksen NA, Montgomery A. Author response to: Comment on: Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. Br J Surg 2020; 107:e218. [PMID: 32342494 DOI: 10.1002/bjs.11578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 11/12/2022]
Affiliation(s)
- N A Henriksen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - A Montgomery
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
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Henriksen NA, Montgomery A, Kaufmann R, Berrevoet F, East B, Fischer J, Hope W, Klassen D, Lorenz R, Renard Y, Garcia Urena MA, Simons MP. Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. Br J Surg 2020; 107:171-190. [PMID: 31916607 DOI: 10.1002/bjs.11489] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/31/2019] [Accepted: 12/02/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Umbilical and epigastric hernia repairs are frequently performed surgical procedures with an expected low complication rate. Nevertheless, the optimal method of repair with best short- and long-term outcomes remains debatable. The aim was to develop guidelines for the treatment of umbilical and epigastric hernias. METHODS The guideline group consisted of surgeons from Europe and North America including members from the European Hernia Society and the Americas Hernia Society. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, the Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists, and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done on 1 May 2018, and updated on 1 February 2019. RESULTS Literature reporting specifically on umbilical and epigastric hernias was limited in quantity and quality, resulting in a majority of the recommendations being graded as weak, based on low-quality evidence. The main recommendation was to use mesh for repair of umbilical and epigastric hernias to reduce the recurrence rate. Most umbilical and epigastric hernias may be repaired by an open approach with a preperitoneal flat mesh. A laparoscopic approach may be considered if the hernia defect is large, or if the patient has an increased risk of wound morbidity. CONCLUSION This is the first European and American guideline on the treatment of umbilical and epigastric hernias. It is recommended that symptomatic umbilical and epigastric hernias are repaired by an open approach with a preperitoneal flat mesh.
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Affiliation(s)
- N A Henriksen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - A Montgomery
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - R Kaufmann
- Erasmus University Medical Centre, Rotterdam, the Netherlands.,Tergooi, Hilversum, the Netherlands
| | - F Berrevoet
- Department of General and Hepatopancreatobiliary Surgery, Ghent University Hospital, Ghent, Belgium
| | - B East
- Third Department of Surgery at Motol University Hospital, First and Second Faculty of Medicine at Charles University, Prague, Czech Republic
| | - J Fischer
- University of Pennsylvania Health System, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - W Hope
- New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - D Klassen
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - R Lorenz
- Praxis 3+ Chirurgen, Berlin, Germany
| | - Y Renard
- Department of Digestive Surgery, Robert Debré University Hospital, Reims, France
| | - M A Garcia Urena
- Henares University Hospital, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - M P Simons
- Department of Surgery, OLVG Hospital, Amsterdam, the Netherlands
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Henriksen NA, Kaufmann R, Simons MP, Berrevoet F, East B, Fischer J, Hope W, Klassen D, Lorenz R, Renard Y, Garcia Urena MA, Montgomery A. EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances. BJS Open 2020; 4:342-353. [PMID: 32207571 PMCID: PMC7093793 DOI: 10.1002/bjs5.50252] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/26/2019] [Indexed: 01/11/2023] Open
Abstract
Background Rare locations of hernias, as well as primary ventral hernias under certain circumstances (cirrhosis, dialysis, rectus diastasis, subsequent pregnancy), might be technically challenging. The aim was to identify situations where the treatment strategy might deviate from routine management. Methods The guideline group consisted of surgeons from the European and Americas Hernia Societies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used in formulating the recommendations. The Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists were used to evaluate the quality of full‐text papers. A systematic literature search was performed on 1 May 2018 and updated 1 February 2019. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was followed. Results Literature was limited in quantity and quality. A majority of the recommendations were graded as weak, based on low quality of evidence. In patients with cirrhosis or on dialysis, a preperitoneal mesh repair is suggested. Subsequent pregnancy is a risk factor for recurrence. Repair should be postponed until after the last pregnancy. For patients with a concomitant rectus diastasis or those with a Spigelian or lumbar hernia, no recommendation could be made for treatment strategy owing to lack of evidence. Conclusion This is the first European and American guideline on the treatment of umbilical and epigastric hernias in patients with special conditions, including Spigelian and lumbar hernias. All recommendations were weak owing to a lack of evidence. Further studies are needed on patients with rectus diastasis, Spigelian and lumbar hernias.
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Affiliation(s)
- N A Henriksen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - R Kaufmann
- Erasmus University Medical Centre, Rotterdam, the Netherlands.,Tergooi, Hilversum, the Netherlands
| | - M P Simons
- Department of Surgery, OLVG Hospital, Amsterdam, the Netherlands
| | - F Berrevoet
- Department of General and Hepato-Pancreato-Biliary Surgery, Gent University Hospital, Gent, Belgium
| | - B East
- Third Department of Surgery, Motol University Hospital, Prague, Czech Republic.,First and Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - J Fischer
- University of Pennsylvania Health System, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - W Hope
- New Hanover Regional Medical Center, Wilmington, North Carolina, USA
| | - D Klassen
- Department of Surgery, Dalhousie University, Halifax, Canada
| | - R Lorenz
- Praxis 3+CHIRURGEN, Berlin, Germany
| | - Y Renard
- Department of Digestive Surgery, Robert Debré University Hospital, Reims, France
| | - M A Garcia Urena
- Henares University Hospital, Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - A Montgomery
- Department of Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
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Parker SG, Halligan S, Liang MK, Muysoms FE, Adrales GL, Boutall A, de Beaux AC, Dietz UA, Divino CM, Hawn MT, Heniford TB, Hong JP, Ibrahim N, Itani KMF, Jorgensen LN, Montgomery A, Morales-Conde S, Renard Y, Sanders DL, Smart NJ, Torkington JJ, Windsor ACJ. International classification of abdominal wall planes (ICAP) to describe mesh insertion for ventral hernia repair. Br J Surg 2019; 107:209-217. [PMID: 31875954 DOI: 10.1002/bjs.11400] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/25/2019] [Accepted: 09/18/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Nomenclature for mesh insertion during ventral hernia repair is inconsistent and confusing. Several terms, including 'inlay', 'sublay' and 'underlay', can refer to the same anatomical planes in the indexed literature. This frustrates comparisons of surgical practice and may invalidate meta-analyses comparing surgical outcomes. The aim of this study was to establish an international classification of abdominal wall planes. METHODS A Delphi study was conducted involving 20 internationally recognized abdominal wall surgeons. Different terms describing anterior abdominal wall planes were identified via literature review and expert consensus. The initial list comprised 59 possible terms. Panellists completed a questionnaire that suggested a list of options for individual abdominal wall planes. Consensus on a term was predefined as occurring if selected by at least 80 per cent of panellists. Terms scoring less than 20 per cent were removed. RESULTS Voting started August 2018 and was completed by January 2019. In round 1, 43 terms (73 per cent) were selected by less than 20 per cent of panellists and 37 new terms were suggested, leaving 53 terms for round 2. Four planes reached consensus in round 2, with the terms 'onlay', 'inlay', 'preperitoneal' and 'intraperitoneal'. Thirty-five terms (66 per cent) were selected by less than 20 per cent of panellists and were removed. After round 3, consensus was achieved for 'anterectus', 'interoblique', 'retro-oblique' and 'retromuscular'. Default consensus was achieved for the 'retrorectus' and 'transversalis fascial' planes. CONCLUSION Consensus concerning abdominal wall planes was agreed by 20 internationally recognized surgeons. Adoption should improve communication and comparison among surgeons and research studies.
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Affiliation(s)
- S G Parker
- Abdominal Wall Unit, University College London Hospital, London, UK
| | - S Halligan
- UCL Centre for Medical Imaging, London, UK
| | - M K Liang
- Department of Surgery, McGovern Medical Center, University of Texas Health Science Center, Houston, Texas, USA
| | - F E Muysoms
- Department of Surgery, Maria Middelares Hospital, Ghent, Belgium
| | - G L Adrales
- Division of Minimally Invasive Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - A Boutall
- Colorectal Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - A C de Beaux
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - U A Dietz
- Department of Visceral, Vascular and Thoracic Surgery, Kantonal Hospital of Olten, Olten, Switzerland
| | - C M Divino
- Department of General Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, USA
| | - M T Hawn
- Department of Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - T B Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - J P Hong
- Department of Plastic Surgery, Asan Medical Centre, University of Ulsan, Seoul, South Korea
| | - N Ibrahim
- Department of General Surgery, Macquarie University Hospital, Macquarie University, Sydney, New South Wales, Australia
| | - K M F Itani
- Department of General Surgery, Veterans Affairs Boston Health Care System, Boston and Harvard Universities, West Roxbury, Massachusetts, USA
| | - L N Jorgensen
- Digestive Disease Centre, Bispebjerg University Hospital, Copenhagen, Denmark
| | - A Montgomery
- Department of Surgery, Skåne University Hospital Malmö, Malmö, Sweden
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital 'Virgen del Rocio', Seville, Spain
| | - Y Renard
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Reims Champagne-Ardenne, Reims Cedex, France
| | - D L Sanders
- Department of General and Upper Gastrointestinal Surgery, North Devon District Hospital, Barnstaple, UK
| | - N J Smart
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter Hospital, Exeter, UK
| | - J J Torkington
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | - A C J Windsor
- Abdominal Wall Unit, University College London Hospital, London, UK
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Dalkou M, Angelopoulou P, Montgomery A, Panagopoulou E. Can self-pampering act as a buffer against depression in women? A cross-sectional study. Health Psychol Res 2019; 7:7967. [PMID: 31872145 PMCID: PMC6904847 DOI: 10.4081/hpr.2019.7967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 11/27/2019] [Indexed: 11/23/2022] Open
Abstract
Despite preliminary evidence that self-pampering can alleviate psychological burden that may lead to depression among women, no studies have so far examined the link between pampering and depression. The aim of this study was to explore the differential effect of pampering on depression depending on women’s marital, parental, or caregiving status. A cross-sectional design was employed. The sample consisted of 154 women employees of the municipal authority of Thessaloniki, Greece. The Pampering Behaviors Inventory was developed for the purposes of the present study. Depression was assessed with the Hospital Anxiety and Depression Scale. Controlling for the effects of age, self-pampering was negatively related to depression (p=.001). Married women, women with children, and women caregivers engaged in self-pampering activities less frequently. Married women who did not use pampering were more depressed than married women who used pampering (p=.002). Women with children who did not use pampering were more depressed than women with children who used pampering (p=.004). Results of the present study contribute to a deeper understanding of the importance of self-pampering as a buffer against depression. Given the rising prevalence of depression today, it is essential to explore the potential of minimal interventions.
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Affiliation(s)
- Marianna Dalkou
- Department of Medicine, Aristotle University of Thessaloniki
| | | | - Anthony Montgomery
- Department of Social and Educational Policy, University of Macedonia, Greece
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Gutlic N, Gutlic A, Petersson U, Rogmark P, Montgomery A. Randomized clinical trial comparing total extraperitoneal with Lichtenstein inguinal hernia repair (TEPLICH trial). Br J Surg 2019; 106:845-855. [PMID: 31162663 DOI: 10.1002/bjs.11230] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/05/2019] [Accepted: 04/09/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Chronic pain is reported after 10-35 per cent of inguinal hernia operations. The aim was to compare quality of life (QoL) after total extraperitoneal (TEP) and Lichtenstein hernia repairs in the setting of an RCT with operations performed by department-certified hernia surgeons. METHODS Men aged 30-75 years with an ASA grade I-II primary inguinal hernia were randomized to TEP or Lichtenstein repair. Primary endpoint was pain at 1 year assessed with the Inguinal Pain Questionnaire (IPQ). Clinical examination, IPQ, SF-36® and study-specific questions were recorded before surgery, and at 1 and 3 years. RESULTS Some 416 patients (202 TEP and 214 Lichtenstein) had surgery; 95·2 per cent completed 1-year and 89·9 per cent 3-year follow-up. At 1 year 'pain during last week' was reported by 6·9 per cent after TEP and by 9·8 per cent after Lichtenstein repair (P = 0·303), and 'pain right now' by 3·7 and 5·9 per cent respectively (P = 0·315). Favourable outcomes for TEP were duration of operation, 30-day complications, time to full recovery, foreign body sensation and sick leave. Groin sensory changes diminished after TEP but increased after Lichtenstein repair. Preoperative QoL was affected, especially in the physical subscales, but was restored to normal after surgery. At 1 and 3 years, 98·3 and 97·4 per cent respectively of the patients were satisfied; 1·6 per cent (6 of 374) suffered a recurrence at 3 years, four after TEP and two after Lichtenstein repair. CONCLUSION In the medium term, both TEP and Lichtenstein hernia repair had similar outcomes after 1 year, with high rates of patient satisfaction and low rates of chronic pain and recurrence. There were short-term advantages for pain and recovery rate after TEP repair. Registration number: NCT00803985 ( www.clinicaltrials.gov).
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Affiliation(s)
- N Gutlic
- Department of Surgery, Skåne University Hospital, University of Lund, Malmö, Sweden
| | - A Gutlic
- Department of Surgery, Skåne University Hospital, University of Lund, Malmö, Sweden
| | - U Petersson
- Department of Surgery, Skåne University Hospital, University of Lund, Malmö, Sweden
| | - P Rogmark
- Department of Surgery, Skåne University Hospital, University of Lund, Malmö, Sweden
| | - A Montgomery
- Department of Surgery, Skåne University Hospital, University of Lund, Malmö, Sweden
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Abstract
Purpose
During the last years, workplace fun has emerged as a potential indicator of a healthy workplace. Congruently, organisations have become interested in enhancing positive experiences at work, such as joy in the workplace. While such trends have resulted in a growing literature on fun in the workplace, humour and play, academics and practitioners are still uncertain as to the nature of fun and its antecedents. The purpose of this paper is to explore the concept of fun in the modern organisation and understand the underlying elements necessary for creating environments that valorise and promote fun.
Design/methodology/approach
The authors conducted semi-structured individual interviews with open-ended questions with 34 employed individuals from a variety of professions. The data were analysed using thematic analysis.
Findings
The analyses revealed organised fun as a distinct type of workplace fun that can have a significant impact through its social support function and psychological safety as the underlying element for promoting healthy positive fun interactions. The culture of the organisation and management attitudes towards fun emerged as key issues in promoting a fun workplace.
Originality/value
Organised fun emerged as a new type of workplace fun. The relational characteristic of fun and its function as a social support method are discussed. The study has delineated the contextual factors that should be addressed by researchers when studying workplace fun.
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Abstract
Purpose: The aim of this meta-analysis was to synthesize the existing evidence examining how empathy changes during undergraduate medical education and assess whether different types of measures produce different results. Method: Three electronic bibliographic databases were last searched on 28 November 2018. Quantitative studies including a measure of empathy in medical undergraduate students and a comparison of the results among the different years of study were included. All analyses were guided by Lipsey and Wilson and conducted using Comprehensive Meta-Analysis software. Results: The overall sample size for the twelve studies (n = 12) was 4906 participants. Results indicate a significant effect (g = 0.487, SE = 0.113, 95% CI = 0.265, 0.709), suggesting that there is moderate evidence that empathy scores changed. Studies using the Jefferson's Scale for Physician Empathy (JSPE) reported higher effect sizes (g = 0.834, SE = 0.219, 95% CI = 0.406, 1.263), while the effect size for studies using other scales was smaller and non-significant (g = 0.099, SE = 0.052, 95% CI = -0.003, 0.201). Conclusions: This review indicated significant evidence that self-ratings of empathy changed across the years of medical education. However, we need to be cautious because this effect was only significant when empathy was assessed using the JSPE.
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Affiliation(s)
- Vasiliki Spatoula
- Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | | | - Anthony Montgomery
- School of Social Science, Humanities and Arts, University of Macedonia , Thessaloniki , Greece
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Affiliation(s)
| | - E Panagopoulou
- Hygiene Laboratory, Aristotle Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Esmail
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | | | - C Maslach
- University of California, Berkeley, CA, USA
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Petersson P, Montgomery A, Petersson U. Modified Peritoneal Flap Hernioplasty Versus Retromuscular Technique for Incisional Hernia Repair: a Retrospective Cohort Study. Scand J Surg 2019; 109:279-288. [PMID: 31328662 DOI: 10.1177/1457496919863943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS We present an open retromuscular mesh technique for incisional hernia repair, the modified peritoneal flap hernioplasty, where the fascia is sutured to the mesh and the hernia sac utilized for anterior mesh coverage. The aim was to describe the modified peritoneal flap hernioplasty technique and to compare it to a retromuscular repair, without component separation, regarding short-term complications, patient satisfaction, abdominal wall complaints, and recurrent incisional hernia. MATERIALS AND METHODS Consecutive patients operated electively with modified peritoneal flap hernioplasty technique (December 2012-December 2015) or retromuscular technique (Jan 2011-Oct 2014) were included in a retrospective single-center cohort study. Outcomes were evaluated from the Swedish Ventral Hernia Registry, by chart review, physical examination, and an abdominal wall complaints questionnaire. RESULTS The modified peritoneal flap hernioplasty group (n = 78) had larger hernias (mean width 10.4 vs 8.5 cm, p = 0.005), more advanced Centers for Disease Control classification (p = 0.009), and more simultaneous gastrointestinal-tract surgery (23.1% vs 11.5%, p = 0.041) than the retromuscular group (n = 96). No difference in short-term complications was seen. Incisional hernia recurrence was lower in the modified peritoneal flap hernioplasty group (1.4% vs 10.3%, p = 0.023), and patients were more satisfied (93.8% vs 81.7%, p = 0.032). Follow-up time was shorter in the modified peritoneal flap hernioplasty group (614 vs 1171 days, p < 0.001). CONCLUSION This retrospective study showed similar rates of short-term complications, despite more complex hernias in the modified peritoneal flap hernioplasty group. Furthermore, a lower incisional hernia recurrence rate for the modified peritoneal flap hernioplasty technique compared with the retromuscular technique used in our department was found. If this holds true with equally long follow-up remains to be proven.
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Affiliation(s)
- P Petersson
- Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - A Montgomery
- Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - U Petersson
- Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Malmö, Sweden
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Dockery L, Rubenstein A, Ding K, Mashburn S, Burkett W, Montgomery A, Doo D, Arend R, Moore K, Gunderson C. Extending the platinum-free Interval: The impact of omitting 2nd line platinum chemotherapy in intermediate platinum-sensitive ovarian cancer. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.03.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sheen AJ, Montgomery A, Simon T, Ilves I, Paajanen H. Randomized clinical trial of open suture repair versus totally extraperitoneal repair for treatment of sportsman's hernia. Br J Surg 2019; 106:837-844. [DOI: 10.1002/bjs.11226] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/22/2019] [Accepted: 04/04/2019] [Indexed: 12/31/2022]
Abstract
Abstract
Background
Sportsman's hernia/athletic pubalgia is a recognized cause of chronic groin pain in athletes. Both open and laparoscopic surgical repairs have been described for treatment, but there are no comparative studies. The hypothesis here was that relief of pain would be achieved earlier in patients treated with open minimal suture repair than totally extraperitoneal repair.
Methods
A randomized multicentre trial in four European countries was conducted to compare open minimal suture repair with totally extraperitoneal repair. The primary endpoint was complete relief of pain (visual analogue scale (VAS) score 20 or less on a scale from 0 to 100 mm) at 1 month. Secondary endpoints included complications, time to return to sporting activity, and number of patients returning to sport within 1 year.
Results
A total of 65 athletes (92 per cent men) with a median age of 29 years were enrolled (31 open repair, 34 totally extraperitoneal repair). By 4 weeks after surgery, median preoperative VAS scores had dropped from 70–80 to 10–20 in both groups (P < 0·001). Relief of pain (VAS score 20 or less) during sports activity 4 weeks after surgery was achieved in 14 of 31 patients after open repair and 24 of 34 after totally extraperitoneal repair (P = 0·047). Return to full sporting activity was achieved by 16 and 18 patients respectively after 1 month (P = 0·992), and by 25 versus 31 after 3 months (P = 0·408).
Conclusion
Totally extraperitoneal repair was less painful than open repair in the first month, but otherwise both procedures were similarly effective in treating chronic pain due to sportsman's hernia. Registration number: NCT02297711 ( http://www.clinical.trials.gov).
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Affiliation(s)
- A J Sheen
- Department of Surgery, Manchester University Foundation Trust, Manchester, UK
- Centre of Biomedicine Manchester Metropolitan University, Manchester, UK
- Fortius Clinic, London, UK
| | - A Montgomery
- Department of Surgery, Institution for Clinical Science, Lund University, Skåne University Hospital, Malmö, Sweden
| | - T Simon
- Department of General Surgery, GRN-Klinik Sinsheim, Heidelberg University Hospital, Heidelberg, Germany
| | - I Ilves
- Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland
| | - H Paajanen
- Department of Gastrointestinal Surgery, Kuopio University Hospital, Kuopio, Finland
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Koutsimani P, Montgomery A, Georganta K. The Relationship Between Burnout, Depression, and Anxiety: A Systematic Review and Meta-Analysis. Front Psychol 2019; 10:284. [PMID: 30918490 PMCID: PMC6424886 DOI: 10.3389/fpsyg.2019.00284] [Citation(s) in RCA: 388] [Impact Index Per Article: 77.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/29/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Burnout is a psychological syndrome characterized by emotional exhaustion, feelings of cynicism and reduced personal accomplishment. In the past years there has been disagreement on whether burnout and depression are the same or different constructs, as they appear to share some common features (e.g., loss of interest and impaired concentration). However, the results so far are inconclusive and researchers disagree with regard to the degree to which we should expect such overlap. The aim of this systematic review and meta-analysis is to examine the relationship between burnout and depression. Additionally, given that burnout is the result of chronic stress and that working environments can often trigger anxious reactions, we also investigated the relationship between burnout and anxiety. Method: We searched the online databases SCOPUS, Web of Science, MEDLINE (PubMed), and Google Scholar for studies examining the relationship between burnout and depression and burnout and anxiety, which were published between January 2007 and August 2018. Inclusion criteria were used for all studies and included both cross-sectional and longitudinal designs, published and unpublished research articles, full-text articles, articles written in the English language, studies that present the effects sizes of their findings and that used reliable research tools. Results: Our results showed a significant association between burnout and depression (r = 0.520, SE = 0.012, 95% CI = 0.492, 0.547) and burnout and anxiety (r = 0.460, SE = 0.014, 95% CI = 0.421, 0.497). However, moderation analysis for both burnout–depression and burnout–anxiety relationships revealed that the studies in which either the MBI test was used or were rated as having better quality showed lower effect sizes. Conclusions: Our research aims to clarify the relationship between burnout–depression and burnout–anxiety relationships. Our findings revealed no conclusive overlap between burnout and depression and burnout and anxiety, indicating that they are different and robust constructs. Future studies should focus on utilizing more longitudinal designs in order to assess the causal relationships between these variables.
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Affiliation(s)
- Panagiota Koutsimani
- Department of Educational & Social Policy, School of Social Sciences, Humanities and Arts, University of Macedonia, Thessaloniki, Greece
| | - Anthony Montgomery
- Department of Educational & Social Policy, School of Social Sciences, Humanities and Arts, University of Macedonia, Thessaloniki, Greece
| | - Katerina Georganta
- Department of Educational & Social Policy, School of Social Sciences, Humanities and Arts, University of Macedonia, Thessaloniki, Greece
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Affiliation(s)
- Efharis Panagopoulou
- Laboratory of Hygiene, Aristotle Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anthony Montgomery
- Work and Organisational Psychology, University of Macedonia, Thessaloniki, Greece
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Petersson P, Montgomery A, Petersson U. Vacuum-Assisted Wound Closure and Permanent Onlay Mesh-Mediated Fascial Traction: A Novel Technique for the Prevention of Incisional Hernia after Open Abdomen Therapy Including Results From a Retrospective Case Series. Scand J Surg 2018; 108:216-226. [PMID: 30574843 DOI: 10.1177/1457496918818979] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Incisional hernia development is a frequent long-term sequel after open abdomen treatment. This report describes a novel technique, the vacuum-assisted wound closure and permanent onlay mesh-mediated fascial traction for temporary and final closure of the open abdomen, with the intention to decrease incisional hernia rates. Primary aim was to evaluate incisional hernia development and secondary aims to describe short-term complications and patient-reported outcome. MATERIALS AND METHODS The basics of the technique is an onlay mesh, applied early during open abdomen treatment by suturing to the fascia in two rows with a 3- to 4-cm overlap from the midline incision, used for traction and kept for reinforced permanent closure. A retrospective case series, including chart review, evaluation of computed tomography/ultrasound images, and an out-patient clinical examination were performed. The patients were asked to answer a modified version of the ventral hernia pain questionnaire. RESULTS A total of 11 patients were treated with vacuum-assisted wound closure and permanent onlay mesh-mediated fascial traction with median follow-up of 467 days. Fascial closure rate was 100% and 30 day mortality 0%. Two of nine patients, eligible for incisional hernia follow-up, developed a hernia. Neither of the hernias were symptomatic nor clinically detectable. Six of 10 patients eligible for short-term follow-up had a prolonged wound-healing time exceeding 3 weeks. One of seven patients eligible for patient-reported outcome have had pain during the last week. CONCLUSION The vacuum-assisted wound closure and permanent onlay mesh-mediated fascial traction is a promising new technique for open abdomen treatment and reinforced fascial closure. The results of the first 11 patients treated with this technique show a low incisional hernia rate with manageable short-term wound complications and few patient-reported disadvantages.
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Affiliation(s)
- P Petersson
- 1 Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Lund, Sweden.,2 Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - A Montgomery
- 1 Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Lund, Sweden.,2 Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - U Petersson
- 1 Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Lund, Sweden.,2 Department of Surgery, Skåne University Hospital, Malmö, Sweden
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Abstract
The purpose of medical education has changed over the last 70 years. The modern doctor is expected to be a leader who will be skilled in people management, team working and patient engagement. Moreover, the burgeoning literature on the development of medical leadership competency frameworks as a way to inform curriculum development is evidence of a desire to empower physicians to be healthcare leaders. The movement towards developing medical students as leaders has to be contrasted against the fact that high school exam performance and academic achievement continues to be the primary basis for selection to medical school. Not surprisingly, the smart kids are studying medicine. Unfortunately, there is a person–job mismatch between the initial skills that allows an individual entry to medical school and what the job will actually entail. For example, higher levels of intelligence are associated with less effective leadership styles. Thus, we seem to have a conundrum concerning input and output. In the following paper, I will examine the degree to which we are attempting to remould ‘square’ physicians to fit them into a ‘round’ medical landscape. The purpose of the paper is twofold. First, to assess the degree to which we can realistically expect the ‘average’ medical student to be moulded into a leader, and second, to identify what practical steps we can take to enable medical students to take a leadership role.
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DeBord J, Novitsky Y, Fitzgibbons R, Miserez M, Montgomery A. SSI, SSO, SSE, SSOPI: the elusive language of complications in hernia surgery. Hernia 2018; 22:737-738. [PMID: 30203373 DOI: 10.1007/s10029-018-1813-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 08/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- J DeBord
- University of Illinois College of Medicine at Peoria, Peoria, USA.
| | | | | | - M Miserez
- University Hospital Leuven, Leuven, Belgium
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López-Cano M, García-Alamino JM, Antoniou SA, Bennet D, Dietz UA, Ferreira F, Fortelny RH, Hernandez-Granados P, Miserez M, Montgomery A, Morales-Conde S, Muysoms F, Pereira JA, Schwab R, Slater N, Vanlander A, Van Ramshorst GH, Berrevoet F. EHS clinical guidelines on the management of the abdominal wall in the context of the open or burst abdomen. Hernia 2018; 22:921-939. [DOI: 10.1007/s10029-018-1818-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 08/21/2018] [Indexed: 12/22/2022]
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Kyle-Leinhase I, Köckerling F, Jørgensen LN, Montgomery A, Gillion JF, Rodriguez JAP, Hope W, Muysoms F. Comparison of hernia registries: the CORE project. Hernia 2018; 22:561-575. [PMID: 29307057 PMCID: PMC6061062 DOI: 10.1007/s10029-017-1724-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/27/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The aim of the international CORE project was to explore the databases of the existing hernia registries and compare them in content and outcome variables. METHODS The CORE project was initiated with representatives from all established hernia registries (Danish Hernia Database, Swedish Hernia Registry, Herniamed, EuraHS, Club Hernie, EVEREG, AHSQC) in March 2015 in Berlin. The following categories were used to compare the registries: initiation and funding, data collection and use for certification of hernia centers, patient data and data protection, operative data, registration of complications and follow-up data. RESULTS The Danish Hernia Database is the only one to qualify as a genuine national registry where participation is compulsory for entry of all procedures by all surgeons performing a hernia operation. All other registries have to be considered as voluntary and completeness of data depends upon the participating hospitals and surgeons. Only the Danish Hernia Database and the Swedish Hernia Registry are publicly funded. All other registries are reliant on financial support from the medical technology industry. As an incentive for voluntary participation in a hernia registry, hospitals or surgeons are issued a certificate confirming that they are taking part in a quality assurance study for hernia surgery. Due to data protection and privacy regulations, most registries are obliged or have chosen to enter their patient data anonymously or coded. The Danish Hernia Database and Swedish Hernia Registry utilize a national personal patient code. In the Herniamed Registry, patient data are saved in a coded and anonymous format after obtaining the patient's informed consent. CONCLUSION Despite the differences in the way data are collected for each of the listed hernia registries, the data are indispensable in clinical research.
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Affiliation(s)
- I Kyle-Leinhase
- EuraHS and Department of Surgery, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium
| | - F Köckerling
- HERNIAMED and Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital Spandau, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - L N Jørgensen
- DANISH HERNIA DATABASE and Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A Montgomery
- SWEDISH HERNIA REGISTRY and Department of Clinical Sciences, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| | - J F Gillion
- CLUB HERNIE and Unité de Chirurgie Viscérale et Digestive, Hôpital Privé d'Antony, Antony, France
| | | | - W Hope
- AHSQC and New Hanover Regional Medical Center, Wilmington, USA
| | - F Muysoms
- EuraHS and Department of Surgery, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium
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Manomenidis G, Panagopoulou E, Montgomery A. Resilience in nursing: The role of internal and external factors. J Nurs Manag 2018; 27:172-178. [DOI: 10.1111/jonm.12662] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/21/2018] [Accepted: 05/16/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Georgios Manomenidis
- Primary Health Care Lab, General Practice and Health Research, Department of Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Efharis Panagopoulou
- Primary Health Care Lab, General Practice and Health Research, Department of Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Anthony Montgomery
- Department of Educational and Social Policy; University of Macedonia; Thessaloniki Greece
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Köckerling F, Alam NN, Antoniou SA, Daniels IR, Famiglietti F, Fortelny RH, Heiss MM, Kallinowski F, Kyle-Leinhase I, Mayer F, Miserez M, Montgomery A, Morales-Conde S, Muysoms F, Narang SK, Petter-Puchner A, Reinpold W, Scheuerlein H, Smietanski M, Stechemesser B, Strey C, Woeste G, Smart NJ. What is the evidence for the use of biologic or biosynthetic meshes in abdominal wall reconstruction? Hernia 2018; 22:249-269. [PMID: 29388080 PMCID: PMC5978919 DOI: 10.1007/s10029-018-1735-y] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/11/2018] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Although many surgeons have adopted the use of biologic and biosynthetic meshes in complex abdominal wall hernia repair, others have questioned the use of these products. Criticism is addressed in several review articles on the poor standard of studies reporting on the use of biologic meshes for different abdominal wall repairs. The aim of this consensus review is to conduct an evidence-based analysis of the efficacy of biologic and biosynthetic meshes in predefined clinical situations. METHODS A European working group, "BioMesh Study Group", composed of invited surgeons with a special interest in surgical meshes, formulated key questions, and forwarded them for processing in subgroups. In January 2016, a workshop was held in Berlin where the findings were presented, discussed, and voted on for consensus. Findings were set out in writing by the subgroups followed by consensus being reached. For the review, 114 studies and background analyses were used. RESULTS The cumulative data regarding biologic mesh under contaminated conditions do not support the claim that it is better than synthetic mesh. Biologic mesh use should be avoided when bridging is needed. In inguinal hernia repair biologic and biosynthetic meshes do not have a clear advantage over the synthetic meshes. For prevention of incisional or parastomal hernias, there is no evidence to support the use of biologic/biosynthetic meshes. In complex abdominal wall hernia repairs (incarcerated hernia, parastomal hernia, infected mesh, open abdomen, enterocutaneous fistula, and component separation technique), biologic and biosynthetic meshes do not provide a superior alternative to synthetic meshes. CONCLUSION The routine use of biologic and biosynthetic meshes cannot be recommended.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center of Minimally Invasive Surgery, Vivantes Hospital, 13585, Berlin, Germany.
| | - N N Alam
- Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
| | - S A Antoniou
- Department of General Surgery, University Hospital of Heraklion, Heraklion, Greece
| | - I R Daniels
- Exeter Surgical Health Services Research Unit, Royal Devon & Exeter Hospital, Exeter, UK
| | - F Famiglietti
- Department of Abdominal Surgery, University Hospital Gasthuisberg Campus, Louvain, Belgium
| | - R H Fortelny
- Department of General Surgery, Wilhelminenspital, Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - M M Heiss
- Department of Visceral-, Vascular and Transplantation Surgery, Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany
| | - F Kallinowski
- Department of General and Visceral Surgery, Regional Hospital Bergstrasse GmbH, Heppenheim, Germany
| | | | - F Mayer
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - M Miserez
- Department of Abdominal Surgery, University Hospital Gasthuisberg Campus, Louvain, Belgium
| | - A Montgomery
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General und Digestive Surgery, University Hospital "Virgen del Rocio", Seville, Spain
| | - F Muysoms
- Department of Surgery, AZ Maria Middelares, Ghent, Belgium
| | - S K Narang
- Exeter Surgical Health Services Research Unit, Royal Devon & Exeter Hospital, Exeter, UK
| | - A Petter-Puchner
- Austrian Cluster of Tissue Regeneration, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - W Reinpold
- Department of Surgery and Hernia Center, Wilhelmsburger Hospital "Gross Sand", Hamburg, Germany
| | - H Scheuerlein
- Department of General and Visceral Surgery, St. Vincenz Hospital, Paderborn, Germany
| | - M Smietanski
- Department of Surgery & Hernia Centre, District Hospital in Puck, Medical University of Gdansk, Gdansk, Poland
- Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | | | - C Strey
- Department of Surgery, Friederiken-Hospital, Hanover, Germany
| | - G Woeste
- Department of Surgery, University Hospital, Frankfurt/Main, Germany
| | - N J Smart
- Exeter Surgical Health Services Research Unit, Royal Devon & Exeter Hospital, Exeter, UK
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