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Hemmila MR, Neiman PU, Hoppe BL, Gerhardinger L, Kramer KA, Jakubus JL, Mikhail JN, Yang AY, Lindsey HJ, Golden RJ, Mitchell EJ, Scott JW, Napolitano LM. Improving outcomes in emergency general surgery: Construct of a collaborative quality initiative. J Trauma Acute Care Surg 2024; 96:715-726. [PMID: 38189669 PMCID: PMC11042990 DOI: 10.1097/ta.0000000000004248] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND Emergency general surgery conditions are common, costly, and highly morbid. The proportion of excess morbidity due to variation in health systems and processes of care is poorly understood. We constructed a collaborative quality initiative for emergency general surgery to investigate the emergency general surgery care provided and guide process improvements. METHODS We collected data at 10 hospitals from July 2019 to December 2022. Five cohorts were defined: acute appendicitis, acute gallbladder disease, small bowel obstruction, emergency laparotomy, and overall aggregate. Processes and inpatient outcomes investigated included operative versus nonoperative management, mortality, morbidity (mortality and/or complication), readmissions, and length of stay. Multivariable risk adjustment accounted for variations in demographic, comorbid, anatomic, and disease traits. RESULTS Of the 19,956 emergency general surgery patients, 56.8% were female and 82.8% were White, and the mean (SD) age was 53.3 (20.8) years. After accounting for patient and disease factors, the adjusted aggregate mortality rate was 3.5% (95% confidence interval [CI], 3.2-3.7), morbidity rate was 27.6% (95% CI, 27.0-28.3), and the readmission rate was 15.1% (95% CI, 14.6-15.6). Operative management varied between hospitals from 70.9% to 96.9% for acute appendicitis and 19.8% to 79.4% for small bowel obstruction. Significant differences in outcomes between hospitals were observed with high- and low-outlier performers identified after risk adjustment in the overall cohort for mortality, morbidity, and readmissions. The use of a Gastrografin challenge in patients with a small bowel obstruction ranged from 10.7% to 61.4% of patients. In patients who underwent initial nonoperative management of acute cholecystitis, 51.5% had a cholecystostomy tube placed. The cholecystostomy tube placement rate ranged from 23.5% to 62.1% across hospitals. CONCLUSION A multihospital emergency general surgery collaborative reveals high morbidity with substantial variability in processes and outcomes among hospitals. A targeted collaborative quality improvement effort can identify outliers in emergency general surgery care and may provide a mechanism to optimize outcomes. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Mark R. Hemmila
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Pooja U. Neiman
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- National Clinical Scholars Program, University of Michigan, Ann Arbor, MI
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA
| | - Beckie L. Hoppe
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Laura Gerhardinger
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Kim A. Kramer
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Jill L. Jakubus
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Judy N. Mikhail
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Amanda Y. Yang
- Department of Surgery, Corewell Health, Grand Rapids, MI
| | | | - Roy J. Golden
- Department of Surgery, Trinity Health Ann Arbor, Ann Arbor, MI
| | - Eric J. Mitchell
- Department of Surgery, University of Michigan Health - West, Wyoming, MI
| | - John W. Scott
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Lena M. Napolitano
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
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Iacobucci G. Culture of surgery must change to support working parents, says royal college. BMJ 2022; 378:o2276. [PMID: 36130767 DOI: 10.1136/bmj.o2276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ingraham A, Schumacher J, Fernandes-Taylor S, Yang DY, Godat L, Smith A, Barbosa R, Cribari C, Salim A, Schroeppel T, Staudenmayer K, Crandall M, Utter G. General surgeon involvement in the care of patients designated with an American Association for the Surgery of Trauma-endorsed ICD-10-CM emergency general surgery diagnosis code in Wisconsin. J Trauma Acute Care Surg 2022; 92:117-125. [PMID: 34446657 PMCID: PMC8692334 DOI: 10.1097/ta.0000000000003387] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The current national burden of emergency general surgery (EGS) illnesses and the extent of surgeon involvement in the care of these patients remain largely unknown. To inform needs assessments, research, and education, we sought to: (1) translate previously developed International Classification of Diseases (ICD), 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes representing EGS conditions to ICD 10th Revision, CM (ICD-10-CM) codes and (2) determine the national burden of and assess surgeon involvement across EGS conditions. METHODS We converted ICD-9-CM codes to candidate ICD-10-CM codes using General Equivalence Mappings then iteratively refined the code list. We used National Inpatient Sample 2016 to 2017 data to develop a national estimate of the burden of EGS disease. To evaluate surgeon involvement, using Wisconsin Hospital Association discharge data (January 1, 2016 to June 30, 2018), we selected adult urgent/emergent encounters with an EGS condition as the principal diagnosis. Surgeon involvement was defined as a surgeon being either the attending provider or procedural physician. RESULTS Four hundred and eighty-five ICD-9-CM codes mapped to 1,696 ICD-10-CM codes. The final list contained 985 ICD-10-CM codes. Nationally, there were 2,977,843 adult patient encounters with an ICD-10-CM EGS diagnosis. Of 94,903 EGS patients in the Wisconsin Hospital Association data set, most encounters were inpatient as compared with observation (75,878 [80.0%] vs. 19,025 [20.0%]). There were 57,780 patients (60.9%) that underwent any procedure. Among all Wisconsin EGS patients, most had no surgeon involvement (64.9% [n = 61,616]). Of the seven most common EGS diagnoses, surgeon involvement was highest for appendicitis (96.0%) and biliary tract disease (77.1%). For the other five most common conditions (skin/soft tissue infections, gastrointestinal hemorrhage, intestinal obstruction/ileus, pancreatitis, diverticular disease), surgeons were involved in roughly 20% of patient care episodes. CONCLUSION Surgeon involvement for EGS conditions ranges from highly likely (appendicitis) to relatively unlikely (skin/soft tissue infections). The wide range in surgeon involvement underscores the importance of multidisciplinary collaboration in the care of EGS patients. LEVEL OF EVIDENCE Prognostic/epidemiological, Level III.
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Affiliation(s)
- Angela Ingraham
- From the Department of Surgery (A.I., J.S., S.F.-T., D.-Y.Y.), University of Wisconsin-Madison, Madison, Wisconsin; Department of Surgery (L.G., A.S.), University of California-San Diego, San Diego, California; Department of Surgery (R.B.), Legacy Health, Portland, Oregon; Department of Surgery (C.C.), University of Colorado Health, Loveland, Colorado; Department of Surgery (A.S.), Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery (T.S.), University of Colorado Health, Colorado Springs, Colorado; Department of Surgery (K.S.), Stanford University, Palo Alto, California; Department of Surgery (M.C.), University of Florida, Jacksonville, Florida; and Department of Surgery (G.U.), University of California-Davis, Sacramento, California
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Abstract
Obtaining wellness and enhancing resilience will be increasingly more important for General Surgeons. Although these concepts are not new, the increased complexity of health care delivery has elevated the importance of these essential attributes. Instilling these practices should be emphasized during surgery residency and be modeled by surgical educators and surgeon leaders. The enhanced emphasis of wellness and resiliency is a positive step forward; however, more must be accomplished to ensure the well-being of a particularly group of vulnerable physicians. This chapter discusses the history and scientific theory behind wellness and resiliency, as well as practical suggestions for consideration.
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Affiliation(s)
- Jessica Brittany Weiss
- Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Joint Base Lewis McChord, WA 98433, USA
| | - Michael Minh Vu
- Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Joint Base Lewis McChord, WA 98433, USA
| | - Quinton Morrow Hatch
- Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Joint Base Lewis McChord, WA 98433, USA
| | - Vance Young Sohn
- Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Joint Base Lewis McChord, WA 98433, USA.
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Ellis RJ, Nicolas JD, Cheung E, Zhang L, Ma M, Turner P, Nussbaum MS, Are C, Smink DS, Etkin C, Bilimoria KY, Hu YY. Comprehensive Characterization of the General Surgery Residency Learning Environment and the Association With Resident Burnout. Ann Surg 2021; 274:6-11. [PMID: 33605580 DOI: 10.1097/sla.0000000000004796] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To characterize the learning environment (ie, workload, program efficiency, social support, organizational culture, meaning in work, and mistreatment) and evaluate associations with burnout in general surgery residents. BACKGROUND SUMMARY DATA Burnout remains high among general surgery residents and has been linked to workplace exposures such as workload, discrimination, abuse, and harassment. Associations between other measures of the learning environment are poorly understood. METHODS Following the 2019 American Board of Surgery In-Training Examination, a cross-sectional survey was administered to all US general surgery residents. The learning environment was characterized using an adapted Areas of Worklife survey instrument, and burnout was measured using an abbreviated Maslach Burnout Inventory. Associations between burnout and measures of the learning environment were assessed using multivariable logistic regression. RESULTS Analysis included 5277 general surgery residents at 301 programs (85.6% response rate). Residents reported dissatisfaction with workload (n = 784, 14.9%), program efficiency and resources (n = 1392, 26.4%), social support and community (n = 1250, 23.7%), organizational culture and values (n = 853, 16.2%), meaning in work (n = 1253, 23.7%), and workplace mistreatment (n = 2661, 50.4%). The overall burnout rate was 43.0%, and residents were more likely to report burnout if they also identified problems with residency workload [adjusted odds ratio (aOR) 1.60, 95% confidence interval (CI) 1.31-1.94], efficiency (aOR 1.74; 95% CI 1.49-2.03), social support (aOR 1.37, 95% CI 1.15-1.64), organizational culture (aOR 1.64; 95% CI 1.39-1.93), meaning in work (aOR 1.87; 95% CI 1.56-2.25), or experienced workplace mistreatment (aOR 2.49; 95% CI 2.13-2.90). Substantial program-level variation was observed for all measures of the learning environment. CONCLUSIONS Resident burnout is independently associated with multiple aspects of the learning environment, including workload, social support, meaning in work, and mistreatment. Efforts to help programs identify and address weaknesses in a targeted fashion may improve trainee burnout.
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Affiliation(s)
- Ryan J Ellis
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- American College of Surgeons, Chicago, Illinois
| | - Joseph D Nicolas
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Elaine Cheung
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lindsey Zhang
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- American College of Surgeons, Chicago, Illinois
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Meixi Ma
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- American College of Surgeons, Chicago, Illinois
- Department of Surgery, University of Alabama Birmingham, Birmingham, Alabama
| | - Patricia Turner
- American College of Surgeons, Chicago, Illinois
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Michael S Nussbaum
- Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Chandrakanth Are
- Department of Surgery, University of Nebraska School of Medicine, Omaha, Nebraska
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Caryn Etkin
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- American College of Surgeons, Chicago, Illinois
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Surek A, Ferahman S, Gemici E, Dural AC, Donmez T, Karabulut M. Effects of COVID-19 pandemic on general surgical emergencies: are some emergencies really urgent? Level 1 trauma center experience. Eur J Trauma Emerg Surg 2021; 47:647-652. [PMID: 33136190 PMCID: PMC7604226 DOI: 10.1007/s00068-020-01534-7] [Citation(s) in RCA: 34] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/17/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE The aim of this paper is to investigate the effect of COVID-19 pandemic on general surgical emergencies as well as analyzing the effectiveness of measures taken in reducing the incidence of COVID-19 in patients and healthcare professionals. METHODS Patients who underwent emergency surgery between the pandemic period of March 14th to May 15th 2020 and within the same period from the previous year were reviewed retrospectively. COVID-19 incidence in patients and health professionals working in the general surgery department during these periods was questioned. RESULTS Demographic data were similar between the two time periods. The number of patients who underwent surgery in the pandemic group (n = 103) was lower than the control group (n = 252). There was a 59.1% reduction in emergency surgeries. The biggest decreases were the admissions of incarcerated hernia, uncomplicated appendicitis and acute cholecystitis (92%, 81.3%, 47.3%, respectively). During the pandemic, an increase was of patient rates who underwent surgery for complicated appendicitis and AMIO (p = 0.001, p = 0.019, respectively). The rate of mortality was higher in patients who underwent emergency surgery during pandemic (p = 0.049). The results of COVID-19 screening were positive in 6 (6/103, 5.82%) patients undergoing emergency surgery. None of the doctors working in the ward were infected with COVID-19 infection (0/20). The screening tests were positive in only two nurses working on the ward (2/24, 8.33%). CONCLUSION In this and similar pandemics, we suggest that a new algorithm is necessary to approach emergencies and the results of this study can contribute to that end.
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Affiliation(s)
- Ahmet Surek
- Department of General Surgery, Turkish Ministry of Health, University of Health Sciences (UHS), Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Building A, Level 4, Tevfik Saglam Cad. Nr:11, Bakirkoy, Istanbul, Turkey.
| | - Sina Ferahman
- Department of General Surgery, Turkish Ministry of Health, University of Health Sciences (UHS), Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Building A, Level 4, Tevfik Saglam Cad. Nr:11, Bakirkoy, Istanbul, Turkey
| | - Eyup Gemici
- Department of General Surgery, Turkish Ministry of Health, University of Health Sciences (UHS), Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Building A, Level 4, Tevfik Saglam Cad. Nr:11, Bakirkoy, Istanbul, Turkey
| | - Ahmet Cem Dural
- Department of General Surgery, Turkish Ministry of Health, University of Health Sciences (UHS), Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Building A, Level 4, Tevfik Saglam Cad. Nr:11, Bakirkoy, Istanbul, Turkey
| | - Turgut Donmez
- Department of General Surgery, Turkish Ministry of Health, University of Health Sciences (UHS), Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Building A, Level 4, Tevfik Saglam Cad. Nr:11, Bakirkoy, Istanbul, Turkey
| | - Mehmet Karabulut
- Department of General Surgery, Turkish Ministry of Health, University of Health Sciences (UHS), Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Building A, Level 4, Tevfik Saglam Cad. Nr:11, Bakirkoy, Istanbul, Turkey
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McCrum ML, Wan N, Lizotte SL, Han J, Varghese T, Nirula R. Use of the spatial access ratio to measure geospatial access to emergency general surgery services in California. J Trauma Acute Care Surg 2021; 90:853-860. [PMID: 33797498 PMCID: PMC8068585 DOI: 10.1097/ta.0000000000003087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Emergency general surgery (EGS) encompasses a spectrum of time-sensitive and resource-intensive conditions, which require adequate and timely access to surgical care. Developing metrics to accurately quantify spatial access to care is critical for this field. We sought to evaluate the ability of the spatial access ratio (SPAR), which incorporates travel time, hospital capacity, and population demand in its ability to measure spatial access to EGS care and delineate disparities. METHODS We constructed a geographic information science platform for EGS-capable hospitals in California and mapped population location, race, and socioeconomic characteristics. We compared the SPAR to the shortest travel time model in its ability to identify disparities in spatial access overall and for vulnerable populations. Reduced spatial access was defined as >60 minutes travel time or lowest three classes of SPAR. RESULTS A total of 283 EGS-capable hospitals were identified, of which 142 (50%) had advanced resources. Using shortest travel time, only 166,950 persons (0.4% of total population) experienced prolonged (>60 minutes) travel time to any EGS-capable hospital, which increased to 1.05 million (2.7%) for advanced-resource centers. Using SPAR, 11.5 million (29.5%) had reduced spatial access to any EGS hospital, and 13.9 million (35.7%) for advanced-resource centers. Rural residents had significantly decreased access for both overall and advanced EGS services when assessed by SPAR despite travel times within the 60-minute threshold. CONCLUSION While travel time and SPAR showed similar overall geographic patterns of spatial access to EGS hospitals, SPAR identified a greater a greater proportion of the population as having limited access to care. Nearly one third of California residents experience reduced spatial access to EGS hospitals when assessed by SPAR. Metrics that incorporate measures of population demand and hospital capacity in addition to travel time may be useful when assessing spatial access to surgical services. LEVEL OF EVIDENCE Cross-sectional study, level VI.
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Affiliation(s)
- Marta L McCrum
- From the Department of Surgery (M.L.M., T.V., R.N.), and Department of Geography (N.W., S.L.L., J.H.), University of Utah, Salt Lake City, Utah
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Meer E, Hughes BD, Martin CA, Rios-Diaz AJ, Patel V, Pugh CM, Berry C, Stain SC, Britt LD, Stein SL, Butler PD. Reassessing career pathways of surgical leaders: An examination of surgical leaders' early accomplishments. Am J Surg 2021; 222:933-936. [PMID: 33894978 DOI: 10.1016/j.amjsurg.2021.04.012] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/03/2021] [Accepted: 04/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The American College of Surgeon (ACS), American Surgical Association (ASA), Association of Women Surgeons (AWS), and Society of Black Academic Surgeons (SBAS) partnered to gain insight into whether inequities found in surgical society presidents may be present earlier. METHODS ACS, ASA, AWS, and SBAS presidents' CVs were assessed for demographics and scholastic achievements at the time of first faculty appointment. Regression analyses controlling for age were performed to determine relative differences across societies. RESULTS 66 of the 68 presidents' CVs were received and assessed (97% response rate). 50% of AWS future presidents were hired as Instructors rather than Assistant professors, compared to 29.4% of SBAS, 25% of ASA and 29.4% of ACS. The future ACS, ASA, and SBAS presidents had more total publications than the AWS presidents, but similar numbers of 1st and Sr. author publications. CONCLUSION Gender inequities in academic surgeon hiring practices and perceived scholastic success may be present at first hire.
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Affiliation(s)
- Elana Meer
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Byron D Hughes
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Colin A Martin
- Department of Surgery, University of Alabama Birmingham/Children's of Alabama, Birmingham, AL, USA
| | - Arturo J Rios-Diaz
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA; Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Viren Patel
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Carla M Pugh
- Department of Surgery, Stanford University, Stanford, CA, USA
| | - Cherisse Berry
- Department of Surgery, New York University School of Medicine, New York, NY, USA
| | - Steven C Stain
- Department of Surgery, Albany Medical Center, Albany, NY, USA
| | - L D Britt
- Department of Surgery, Eastern Virginia Medical School (EVMS), Norfolk, VA, USA
| | - Sharon L Stein
- Department of Surgery, University Hospitals/Cleveland Medical Center, USA
| | - Paris D Butler
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
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Dhahri AA, Ahmad R, Shaikh BF, Sajinyan O, Warrag I, Patel M, Ivanov B. Hybrid Surgical Hot Clinic (HSHC): Evaluation of Surgical Hot Clinic Services during COVID-19 Lockdown. World J Surg 2021; 45:955-961. [PMID: 33554298 PMCID: PMC7868112 DOI: 10.1007/s00268-021-05981-0] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2021] [Indexed: 12/20/2022]
Abstract
Background Surgical Hot Clinic (SHC) is an acute, ambulatory service for management provided on an outpatient basis. Following the start of global Novel Coronavirus (COVID-19) pandemic and as per the statement released by the Association of Surgeons of Great Britain and Ireland (ASGBI), we also modified our services to hybrid SHC (HSHC) by mainly providing telephonic follow-up with an occasional face-to-face (F2F) service. We conducted a service evaluation to assess the effectiveness and serviceability of HSHC during a pandemic. Methods This service evaluation was conducted from 30th March till 26th May 2020. The pathway was developed to mostly telephonic consultation with selective face-to-face consultation at a designated area in the medical ambulatory unit. The analysis then performed using SPSS version 21. Results As the overall attendance fell in hospital, 149 patients, including 54(36.2%) male, and 95(63.8%) females, attended SHC during COVID-19 lockdown. Out of these 149, 87(58.3%) were referred from Accident & Emergency (A&E), 2(1.3%) from GP, 9(6.04%) after scan through radiology department, while 51(34.2%) after discharge from hospital. Out of those who have telephonic consultation (n = 98), 12 patients were called in for review with either blood tests or further clinical examination. In total, only 10 out of 149 patients required admission to the hospital, for either intervention or symptomatic treatment. Conclusion Hybrid Surgical Hot Clinic (HSHC) with both telephonic & face-to-face consultation, as per requirement, is flexible, effective and safe patient-focused acute surgical service during COVID-19 like crisis.
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Affiliation(s)
| | | | | | | | | | | | - Bogdan Ivanov
- The Princess Alexandra Hospital NHS Trust, Harlow, UK
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Tahir H, Beg MA, Siddiqui F. The reduction in clinical and surgical exposure of trainees during COVID-19 and its impact on their training. J PAK MED ASSOC 2021; 71(Suppl 1):S18-S22. [PMID: 33582717] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the impact of coronavirus disease on surgical training. METHODS The cross-sectional study was conducted at the General Surgery Department of Liaquat National Hospital, Karachi, from August 2019 to May 2020, and comprised surgical trainees from year 1 to 4. The subjects were interviewed and inquired about their opinion regarding the impact of coronavirus disease on their training. Data was prospectively collected in two equal phases of 5 months each, separating the phases on the basis of the application of preventive measures and changes relating to coronavirus disease. Data of cases from log books was divided into major and minor cases. RESULTS Of the 24 surgical trainees available, 18(75%) participated; 12(66.6%) females and 6(33.3%) males. There was a significant difference between the two phases, with the number of surgical case going down drastically in the second phase (p=0.005), affecting the training process. CONCLUSIONS Considering the ongoing pandemic, it may be worthwhile to look into the possibility of increasing the duration of training.
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Affiliation(s)
| | - Mirza Arshad Beg
- Department of General Surgery, Liaquat National Hospital & Medical College, Karachi , Pakistan
| | - Faisal Siddiqui
- Department of General Surgery, Liaquat National Hospital, Karachi, Pakistan
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Saqib SU, Saleem O, Riaz A, Riaz Q, Zafar H. Impact of a global pandemic on surgical education and training- review, response, and reflection. J PAK MED ASSOC 2021; 71(Suppl 1):S49-S55. [PMID: 33582723] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The catastrophic effects of the coronavirus disease-2019 global pandemic have revolutionised human society. The unprecedented impact on surgical training needs to be analysed in detail to achieve an understanding of how to deal with similar situations arising in the foreseeable future. The challenges faced by the surgical community initiated with the suspension of clinical activities and elective practice, and included the lack of appropriate personal protective equipment, and the self-isolation of trainees and reassignment to coronavirus patient-care regions. Together, all these elements had deleterious effects on the psychological health of the professionals. Surgical training irrespective of specialty is equally affected globally by the pandemic. However, the global crisis inadvertently has led to a few constructive adaptations in healthcare systems, including the development of tele-clinics, virtual academic sessions and conferences, and increased usage of simulation. The current review article was planned to highlight the impact of corona virus disease on surgical training and institutions' response to the situation in order to continue surgical training, and lessons learnt from the pandemic.
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Affiliation(s)
- Sabah Uddin Saqib
- Departments of General Surgery, Aga Khan University, Karachi, Pakistan
| | - Omair Saleem
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Amna Riaz
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Qamar Riaz
- Department of Educational Development and Surgery, Aga Khan University, Karachi, Pakistan
| | - Hasnain Zafar
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Chan DL, Tam PTH, Kan IY, Wong SKH, Ng EKW. Bariatric Surgery in Vegetarians: Asia-Pacific Metabolic and Bariatric Surgery Society (APMBSS) survey of Asian surgeon experience. Asian J Surg 2020; 44:303-306. [PMID: 32800753 DOI: 10.1016/j.asjsur.2020.07.016] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/23/2020] [Accepted: 07/12/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Bariatric and metabolic surgery is increasing in Asia to address the growing obesity epidemic. Literature is scarce regarding this surgery in vegetarian patients. We aim to survey surgeons regarding their practices and experiences with the vegetarian population. MATERIALS AND METHODS The regional bariatric and metabolic surgery society distributed a multi-national electronic questionnaire to surgeon members. The questionnaire was in the English and Chinese languages. RESULTS Fifty-six bariatric and metabolic surgeons responded to the questionnaire (response rate 40.6%). Twenty-two respondents (48.9%) have vegetarian patients in their case volume. Patients mostly consume a vegetarian diet for religious (66.7%) and health (66.7%) reasons. More than 60% of surgeons are unsure of micronutrient deficiency status amongst these patients. Over half of the respondents (58.8%) reported that their vegetarian patients do not take multivitamins or vitamin supplements. Significant proportions of respondents (44.4-61.1%) were unsure of the iron, vitamin B12, vitamin D, zinc, and folic acid deficiency status of these patients. Only 38.9% of respondents routinely prescribe multivitamin supplementation. CONCLUSIONS Vegetarian bariatric patients in East and South-East Asia are an under-recognized patient cohort at risk of micronutrient deficiencies. There is a knowledge gap among regional surgeons in long-term nutritional assessment and management.
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Affiliation(s)
- Daniel Leonard Chan
- Division of Upper Gastrointestinal & Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; School of Medicine, Western Sydney University, Sydney, New South Wales, Australia; Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Prudence Tai-Huen Tam
- Division of Upper Gastrointestinal & Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Ingrid Ym Kan
- Division of Upper Gastrointestinal & Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Simon Kin-Hung Wong
- Division of Upper Gastrointestinal & Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Enders Kwok-Wai Ng
- Division of Upper Gastrointestinal & Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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13
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Kakeji Y, Yamamoto H, Ueno H, Eguchi S, Endo I, Sasaki A, Takiguchi S, Takeuchi H, Hashimoto M, Horiguchi A, Masaki T, Marubashi S, Yoshida K, Miyata H, Konno H, Gotoh M, Kitagawa Y, Mori M, Seto Y. Development of gastroenterological surgery over the last decade in Japan: analysis of the National Clinical Database. Surg Today 2020; 51:187-193. [PMID: 32681353 DOI: 10.1007/s00595-020-02075-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/07/2020] [Accepted: 06/05/2020] [Indexed: 12/19/2022]
Abstract
The National Clinical Database (NCD) of Japan was established in 2010 with the board certification system. A joint committee of 16 gastroenterological surgery database-affiliated organizations has been nurturing this nationwide database and utilizing its data for various analyses. Stepwise board certification systems have been validated by the NCD and are used to improve the surgical outcomes of patients. The use of risk calculators based on risk models can be particularly helpful for establishing appropriate and less invasive surgical treatments for individual patients. Data obtained from the NCD reflect current developments in the surgical approaches used in hospitals, which have progressed from open surgery to endoscopic and robot-assisted procedures. An investigation of the data acquired by the NCD could answer some relevant clinical questions and lead to better surgical management of patients. Furthermore, excellent surgical outcomes can be achieved through international comparisons of the national databases worldwide. This review examines what we have learned from the NCD of gastroenterological surgery and discusses what future developments we can expect.
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Affiliation(s)
- Yoshihiro Kakeji
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan.
- National Clinical Database, Tokyo, Japan.
| | - Hiroyuki Yamamoto
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
- National Clinical Database, Tokyo, Japan
| | - Hideki Ueno
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Susumu Eguchi
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Itaru Endo
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Akira Sasaki
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Shuji Takiguchi
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Hiroya Takeuchi
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Masaji Hashimoto
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Akihiko Horiguchi
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Tadahiko Masaki
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Shigeru Marubashi
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Kazuhiro Yoshida
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Hiroaki Miyata
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
- National Clinical Database, Tokyo, Japan
| | - Hiroyuki Konno
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Mitsukazu Gotoh
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
- National Clinical Database, Tokyo, Japan
| | - Yuko Kitagawa
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
- National Clinical Database, Tokyo, Japan
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Mazingi D, Ihediwa G, Ford K, Ademuyiwa AO, Lakhoo K. Mitigating the impact of COVID-19 on children's surgery in Africa. BMJ Glob Health 2020; 5:e003016. [PMID: 32527851 PMCID: PMC7292041 DOI: 10.1136/bmjgh-2020-003016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Dennis Mazingi
- Department of Surgery, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - George Ihediwa
- Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Surulere, Lagos, Nigeria
| | - Kathryn Ford
- Department of Specialist Neonatal And Paediatric Surgery, Great Ormond Street Hospital, London, UK
- Department of Population, Policy and Practice, Institute of Child Health, University College London, London, UK
| | - Adesoji O Ademuyiwa
- Department of Surgery, College of Medicine, University of Lagos, Lagos, Lagos, Nigeria
| | - Kokila Lakhoo
- Nuffield Department of Surgical Sciences, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK
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15
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Patriti A, Baiocchi GL, Catena F, Marini P, Catarci M. Emergency general surgery in Italy during the COVID-19 outbreak: first survey from the real life. World J Emerg Surg 2020; 15:36. [PMID: 32448333 PMCID: PMC7245630 DOI: 10.1186/s13017-020-00314-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [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: 04/06/2020] [Accepted: 05/06/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND COVID-19 pandemic has rapidly spread in Italy in late February 2020. Almost all surgical services have been reorganized, with the aim of maintaining an adequate therapeutic path, especially for surgical emergencies. The knowledge of how surgeons dealing with emergency surgery have reacted to the epidemic in the real life can be useful while drafting clinical recommendations. METHODS Surgeons from multiple Italian regions were invited answering to an online survey in order to make a snapshot of their current behaviors towards COVID-19-positive patients bearing urgent surgical diseases. Questions about institutional rules and personal approach for patient treatment and to limit epidemic spread were included in a 37-item questionnaire. RESULTS Seventy-one questionnaires from institutions dealing with emergency surgery were accepted. Participating surgeons were equally subdivided from a geographical point of view, with a large proportion of public (97.2%) and non-academical (91.5%) centers. In 80.3% of cases, the hospitals treated COVID-19 patients; in 69.1% of centers, a change in work plan was necessary, and 33.8% of teams had almost a surgeon infected or in preventive quarantine. The vast majority of surgeons operated only on urgent cases (73.9%), but the number of interventions significantly dropped. Up to 40% of non-traumatic abdominal emergency cases had an unusual delayed treatment. The laparoscopic approach was used in 69.6% of interventions on COVID-19 patients. Strategies to protect health care workers against COVID-19 infection and to identify asymptomatic infected surgeons were suboptimal with respect to the WHO recommendations in 70.4% and 90.2% of centers, respectively. Advanced personal protective equipment for operating room workers was adopted for all surgeries in only 12.7% of centers. DISCUSSION This survey confirms that the COVID-19 outbreak is dramatically changing the practice of emergency surgery centers in Italy. Despite the reduction in number, urgent cases were on average more challenging owing to diagnostic delay. Recommendations from the International Scientific Societies are frequently not complied concerning the use of laparoscopic approach, the availability of personal protective equipment in the operating rooms, and the testing of both asymptomatic physicians and patients scheduled for surgery. A further evaluation of the short-term results of these attitudes is warranted to modulate international recommendations.
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Affiliation(s)
- Alberto Patriti
- Department of Surgery, Azienda Ospedaliera Marche Nord, Ospedale San Salvatore, Piazzale Cinelli 1, Pesaro-Fano, Italy.
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Pierluigi Marini
- General Surgery Unit, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy
| | - Marco Catarci
- General Surgery Unit, Ospedale "C. e G. Mazzoni", ASUR Marche AV5, Ascoli Piceno, Italy
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16
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Zhao J, Forsythe R, Langerman A, Melton GB, Schneider DF, Jackson GP. The Value of the Surgeon Informatician. J Surg Res 2020; 252:264-271. [PMID: 32402396 DOI: 10.1016/j.jss.2020.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 10/15/2019] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 01/21/2023]
Abstract
Clinical informatics is an interdisciplinary specialty that leverages big data, health information technologies, and the science of biomedical informatics within clinical environments to improve quality and outcomes in the increasingly complex and often siloed health care systems. Core competencies of clinical informatics primarily focus on clinical decision making and care process improvement, health information systems, and leadership and change management. Although the broad relevance of clinical informatics is apparent, this review focuses on its application and pertinence to the discipline of surgery, which is less well defined. In doing so, we hope to highlight the importance of the surgeon informatician. Topics covered include electronic health records, clinical decision support systems, computerized order entry, data analytics, clinical documentation, information architectures, implementation science, quality improvement, simulation, education, and telemedicine. The formal pathway for surgeons to become clinical informaticians is also discussed.
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Affiliation(s)
- Jane Zhao
- Departments of Surgery and Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.
| | - Raquel Forsythe
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alexander Langerman
- Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Genevieve B Melton
- Department of Surgery and Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota
| | - David F Schneider
- Division of Endocrine Surgery, University of Wisconsin School of Medicine, Madison, Wisconsin
| | - Gretchen Purcell Jackson
- IBM Watson Health, Cambridge, Massachusetts; Departments of Pediatric Surgery, Pediatrics, and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
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17
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Coccolini F, Moore EE, Kluger Y, Biffl W, Leppaniemi A, Matsumura Y, Kim F, Peitzman AB, Fraga GP, Sartelli M, Ansaloni L, Augustin G, Kirkpatrick A, Abu-Zidan F, Wani I, Weber D, Pikoulis E, Larrea M, Arvieux C, Manchev V, Reva V, Coimbra R, Khokha V, Mefire AC, Ordonez C, Chiarugi M, Machado F, Sakakushev B, Matsumoto J, Maier R, di Carlo I, Catena F. Kidney and uro-trauma: WSES-AAST guidelines. World J Emerg Surg 2019; 14:54. [PMID: 31827593 PMCID: PMC6886230 DOI: 10.1186/s13017-019-0274-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [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: 09/10/2019] [Accepted: 10/23/2019] [Indexed: 12/22/2022] Open
Abstract
Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard. As with all traumatic conditions, the management of urogenital trauma should be multidisciplinary including urologists, interventional radiologists, and trauma surgeons, as well as emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) kidney and urogenital trauma management guidelines.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, Via Paradisia, 56124 Pisa, Italy
| | | | - Yoram Kluger
- Division of General Surgery Rambam Health Care Campus, Haifa, Israel
| | - Walter Biffl
- Trauma Surgery Dept., Scripps Memorial Hospital, La Jolla, California USA
| | - Ari Leppaniemi
- General Surgery Dept., Mehilati Hospital, Helsinki, Finland
| | - Yosuke Matsumura
- Department of Emergency and Critical Care Medicine, Chiba University Hospital, Chiba, Japan
| | - Fernando Kim
- Urology Department, University of Colorado, Denver, USA
| | | | - Gustavo P. Fraga
- Trauma/Acute Care Surgery & Surgical Critical Care, University of Campinas, Campinas, Brazil
| | - Massimo Sartelli
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Goran Augustin
- Department of Surgery, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Andrew Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Alberta Canada
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Imitiaz Wani
- Department of Surgery, DHS Hospitals, Srinagar, Kashmir India
| | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, Perth, Australia
| | - Emmanouil Pikoulis
- 3rd Department of Surgery, Attiko Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Martha Larrea
- General Surgery, “General Calixto García”, Habana Medicine University, Havana, Cuba
| | - Catherine Arvieux
- Clin. Univ. de Chirurgie Digestive et de l’Urgence, CHUGA-CHU Grenoble Alpes UGA-Université Grenoble Alpes, Grenoble, France
| | - Vassil Manchev
- General and Trauma Surgery Department, Pietermaritzburg Hospital, Pietermaritzburg, South Africa
| | - Viktor Reva
- General and Emergency Surgery, Sergei Kirov Military Academy, Saint Petersburg, Russia
| | - Raul Coimbra
- Department of General Surgery, Riverside University Health System Medical Center, Moreno Valley, CA USA
| | - Vladimir Khokha
- General Surgery Department, Mozir City Hospital, Mozir, Belarus
| | - Alain Chichom Mefire
- Department of Surgery and Obstetrics and Gynecology, University of Buea, Buea, Cameroon
| | - Carlos Ordonez
- Trauma and Acute Care Surgery, Fundacion Valle del Lili, Cali, Colombia
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery, Pisa University Hospital, Via Paradisia, 56124 Pisa, Italy
| | - Fernando Machado
- General and Emergency Surgery Department, Montevideo Hospital, Montevideo, Paraguay
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Junichi Matsumoto
- Department of Emergency and Critical Care Medicine, Saint-Marianna University School of Medicine, Kawasaki, Japan
| | - Ron Maier
- Department of Surgery, Harborview Medical Centre, Seattle, USA
| | - Isidoro di Carlo
- Department of Surgical Sciences and Advanced Technologies “GF Ingrassia”, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
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18
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Azzaza M, Melki S, Nouira S, Ben Abdelaziz A, Rouis S, Ben Abdelaziz A. Thirty years of Tunisian publication of «case reports» in General Surgery (1989-2018). Tunis Med 2019; 97:1316-1325. [PMID: 32173799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To describe the bibliometric profile of Tunisian "case report" publications in general surgery over the last thirty years (1989-2018). METHODS This is a descriptive bibliometric study on "case reports", general surgery, Tunisian affiliation, indexed in the Medline database, between January 1, 1989 and December 31, 2018. The themes of Search articles were defined by referring to their major keywords used for their indexing. RESULTS During 30 years of study, Medline indexed 188 papers in "General Surgery" type "case reports", signed by 80 authors in first position and 71 authors in last position, belonging to ten academic specialties and 19 professional affiliations. These papers were published by 60 journals, including the Ugandan magazine "Pan African Medical Journal", which published 23% of these "case reports" alone. The number of major indexing keywords was 299 words, mainly "Echinococcosis", "Pancreatic Cancers" and "Echinococcosis of the liver", together accounting for 18.1% of articles. CONCLUSION The plethora of "case reports" in Tunisian general surgery publications over the last three decades was accompanied by a preferential edition in the journal "Pan Afr Med J" and a thematic focus on hydatid cysts and cancers pancreatic. Hence the importance of strengthening the capacity of Tunisian surgeons in research methodology and scientific medical writing.
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19
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Picetti E, Rossi S, Abu-Zidan FM, Ansaloni L, Armonda R, Baiocchi GL, Bala M, Balogh ZJ, Berardino M, Biffl WL, Bouzat P, Buki A, Ceresoli M, Chesnut RM, Chiara O, Citerio G, Coccolini F, Coimbra R, Di Saverio S, Fraga GP, Gupta D, Helbok R, Hutchinson PJ, Kirkpatrick AW, Kinoshita T, Kluger Y, Leppaniemi A, Maas AIR, Maier RV, Minardi F, Moore EE, Myburgh JA, Okonkwo DO, Otomo Y, Rizoli S, Rubiano AM, Sahuquillo J, Sartelli M, Scalea TM, Servadei F, Stahel PF, Stocchetti N, Taccone FS, Tonetti T, Velmahos G, Weber D, Catena F. WSES consensus conference guidelines: monitoring and management of severe adult traumatic brain injury patients with polytrauma in the first 24 hours. World J Emerg Surg 2019; 14:53. [PMID: 31798673 PMCID: PMC6884766 DOI: 10.1186/s13017-019-0270-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/04/2019] [Indexed: 12/11/2022] Open
Abstract
The acute phase management of patients with severe traumatic brain injury (TBI) and polytrauma represents a major challenge. Guidelines for the care of these complex patients are lacking, and worldwide variability in clinical practice has been documented in recent studies. Consequently, the World Society of Emergency Surgery (WSES) decided to organize an international consensus conference regarding the monitoring and management of severe adult TBI polytrauma patients during the first 24 hours after injury. A modified Delphi approach was adopted, with an agreement cut-off of 70%. Forty experts in this field (emergency surgeons, neurosurgeons, and intensivists) participated in the online consensus process. Sixteen recommendations were generated, with the aim of promoting rational care in this difficult setting.
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Affiliation(s)
- Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100 Parma, Italy
| | - Sandra Rossi
- Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100 Parma, Italy
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Luca Ansaloni
- Department of General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Rocco Armonda
- Department of Neurosurgery, Georgetown University School of Medicine, Washington, DC USA
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Miklosh Bala
- Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Zsolt J. Balogh
- Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle, NSW Australia
| | | | - Walter L. Biffl
- Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA USA
| | - Pierre Bouzat
- Department of Anaesthesiology and Critical Care, Grenoble Alps Trauma Center, University Hospital of Grenoble-Alpes, Grenoble Cedex, France
| | - Andras Buki
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
- János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Marco Ceresoli
- Department of General and Emergency Surgery, ASST, San Gerardo Hospital, Monza, Italy
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Randall M. Chesnut
- Department of Neurological Surgery, University of Washington, Harborview Medical Center, Seattle, WA USA
| | - Osvaldo Chiara
- General Surgery and Trauma Team, University of Milano, ASST Niguarda Milano, Milan, Italy
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- Neuro-Intensive Care, Department of Emergency and Intensive Care, ASST, San Gerardo Hospital, Monza, Italy
| | - Federico Coccolini
- Department of General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Loma Linda University School of Medicine, Moreno Valley, CA USA
| | - Salomone Di Saverio
- Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gustavo P. Fraga
- Division of Trauma Surgery, Hospital de Clinicas, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences and associated Jai Prakash Narain Apex Trauma Centre, New Delhi, India
| | - Raimund Helbok
- Department of Neurology, Neurocritical Care Unit, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter J. Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Andrew W. Kirkpatrick
- Departments of General Acute Care, Abdominal Wall Reconstruction and Trauma Surgery, Foothills Medical Centre, Calgary, AB Canada
| | - Takahiro Kinoshita
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Campus, Haifa, Israel
| | - Ari Leppaniemi
- Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland
| | - Andrew I. R. Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Ronald V. Maier
- Department of Surgery, Harborview Medical Centre, University of Washington School of Medicine, Seattle, WA USA
| | - Francesco Minardi
- Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100 Parma, Italy
| | | | - John A. Myburgh
- Department of Intensive Care Medicine, St. George Clinical School, University of New South Wales and The George Institute for Global Health, Sydney, Australia
| | - David O. Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sandro Rizoli
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Andres M. Rubiano
- INUB/MEDITECH Research Group, El Bosque University, Bogotá, Colombia
- MEDITECH Foundation, Clinical Research, Cali, Colombia
| | - Juan Sahuquillo
- Neurosurgery Department, Vall d’Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - Thomas M. Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD USA
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy
| | - Philip F. Stahel
- College of Osteopathic Medicine, Rocky Vista University, Parker, CO USA
| | - Nino Stocchetti
- Neuro ICU Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, Milan University, Milan, Italy
| | - Fabio S. Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Tommaso Tonetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100 Parma, Italy
| | - George Velmahos
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Dieter Weber
- Trauma and General Surgery, Royal Perth Hospital, Perth, Australia
| | - Fausto Catena
- Department of Emergency Surgery, Parma University Hospital, Parma, Italy
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20
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Abstract
OBJECTIVES This study aimed to explore how adult patients who received free mission-based elective surgery experienced surgery and its outcomes, in order to provide recommendations for improved service delivery, measurement of impact and future quality initiatives for the humanitarian organisation Mercy Ships and other mission-based surgical platforms. SETTING Data were collected in June 2017 in Cotonou, Benin, where the participants had previously received free mission-based elective surgery aboard the Africa Mercy, a non-governmental hospital ship. PARTICIPANTS Sixteen patients (seven male, nine female, age range 22-71, mean age 43.25) who had previously received surgical care aboard the Africa Mercy hospital ship between September 2016 and May 2017 participated in the study. METHODS Using a qualitative design, 16 individual semistructured interviews were conducted with the assistance of two interpreters. Participants were recruited using purposive sampling from the Mercy Ships patient database. Interview data were coded and organised into themes and subthemes using thematic content analysis in an interpretivist approach. FINDINGS Analysis of interview data revealed three main themes: barriers to surgery, experiences with Mercy Ships and changes in perspectives of surgery after their experiences. Key findings included barriers to local surgical provision such as cost, a noteworthy amount of fear and distrust of local surgical teams, exceptional positive experiences with the care at Mercy Ships, and impactful surgery, resulting in high levels of trust in foreign surgical teams. CONCLUSIONS While foreign surgical teams are meeting an immediate need for surgical care, the potential enduring legacy is one of trusting only foreigners for surgery. Patients are a critical component to a well-functioning surgical system, and mission-based surgical providers must formulate strategies to mitigate this legacy while strengthening the local surgical system.
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Affiliation(s)
- Kristin L Close
- Department of Public Health, University of Liverpool, Liverpool, UK
| | - Floor T E Christie-de Jong
- Department of Public Health, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
- Department of Public Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
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21
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Meyerson SL, Odell DD, Zwischenberger JB, Schuller M, Williams RG, Bohnen JD, Dunnington GL, Torbeck L, Mullen JT, Mandell SP, Choti MA, Foley E, Are C, Auyang E, Chipman J, Choi J, Meier AH, Smink DS, Terhune KP, Wise PE, Soper N, Lillemoe K, Fryer JP, George BC. The effect of gender on operative autonomy in general surgery residents. Surgery 2019; 166:738-743. [PMID: 31326184 PMCID: PMC7382913 DOI: 10.1016/j.surg.2019.06.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/02/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite an increasing number of women in the field of surgery, bias regarding cognitive or technical ability may continue to affect the experience of female trainees differently than their male counterparts. This study examines the differences in the degree of operative autonomy given to female compared with male general surgery trainees. METHODS A smartphone app was used to collect evaluations of operative autonomy measured using the 4-point Zwisch scale, which describes defined steps in the progression from novice ("show and tell") to autonomous surgeon ("supervision only"). Differences in autonomy between male and female residents were compared using hierarchical logistic regression analysis. RESULTS A total of 412 residents and 524 faculty from 14 general surgery training programs evaluated 8,900 cases over a 9-month period. Female residents received less autonomy from faculty than did male residents overall (P < .001). Resident level of training and case complexity were the strongest predictors of autonomy. Even after controlling for potential confounding factors, including level of training, intrinsic procedural difficulty, patient-related case complexity, faculty sex, and training program environment, female residents still received less operative autonomy than their male counterparts. The greatest discrepancy was in the fourth year of training. CONCLUSION There is a sex-based difference in the autonomy granted to general surgery trainees. This gender gap may affect female residents' experience in training and possibly their preparation for practice. Strategies need to be developed to help faculty and residents work together to overcome this gender gap.
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Affiliation(s)
| | - David D Odell
- Department of Surgery, Northwestern University, Chicago, IL
| | | | - Mary Schuller
- Department of Surgery, Northwestern University, Chicago, IL
| | | | - Jordan D Bohnen
- Department of Surgery, Massachusetts General Hospital, Boston
| | | | - Laura Torbeck
- Department of Surgery, Indiana University, Indianapolis
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston
| | | | - Michael A Choti
- Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, AZ
| | - Eugene Foley
- Department of Surgery, University of Wisconsin, Madison, WI
| | | | - Edward Auyang
- Department of Surgery, University of New Mexico, Albuquerque
| | | | - Jennifer Choi
- Department of Surgery, Indiana University, Indianapolis
| | - Andreas H Meier
- Department of Surgery, State University of New York Upstate Medical University, Syracuse
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Kyla P Terhune
- Department of Surgery, Vanderbilt University, Nashville, TN
| | - Paul E Wise
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | | | - Keith Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston
| | | | - Brian C George
- Department of Surgery, University of Michigan, Ann Arbor
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22
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Lamprecht J, Kolisch R, Pförringer D. The impact of medical documentation assistants on process performance measures in a surgical emergency department. Eur J Med Res 2019; 24:31. [PMID: 31492198 PMCID: PMC6729055 DOI: 10.1186/s40001-019-0390-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 05/10/2019] [Accepted: 08/20/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The administrative work of physicians, particularly documentation effort, consumes considerable time in surgical emergency departments. At the same time, the latter face an ever-growing influx of patients, leading to increasing waiting and flow times and thus patient dissatisfaction as well as overload of physicians and nurses. The deployment of medical documentation assistants, who specialize in and undertake documentation work currently performed by physicians, poses a solution to the problem. The goal of this study is to assess the impact of deploying medical documentation assistants on key performance indicators of a surgical emergency department, i.e. waiting and flow times of patients differentiated according to triage categories, utilization of physicians and time allocation of physicians. METHODS The underlying study has analysed the processes of the surgical emergency department of a major university medical centre and modelled them in a discrete event simulation. Data on patient arrivals as well as processing times in the X-ray department and the laboratory were obtained from the clinical information system, while processing times in the emergency department were recorded using time-motion studies. Though the emergency department currently does not deploy medical documentation assistants, the simulation model includes a variable number of such assistants. RESULTS The deployment of a medical documentation assistant frees up physician working time and decreases the waiting time and consequently the flow time of patients, in particular for standard and non-urgent patients. Adding additional documentation assistants leads to further improvements, however, with diminishing marginal returns. Under the assumption of medical documentation assistants being 35% more efficient than physicians in undertaking documentation work, one of the three physicians can be replaced in the analysed surgical emergency department with an average of 502 patient arrivals per week. CONCLUSIONS Medical documentation assistants are a viable way of improving the performance of surgical emergency departments. Depending on the goals of the hospital, medical documentation assistants can be used for an array of measures such as decreasing patients' waiting and flow times or increasing physicians' time spent on medical treatment.
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Affiliation(s)
- Johannes Lamprecht
- TUM School of Management, Technische Universität München, Arcisstr. 21, 80333 Munich, Germany
| | - Rainer Kolisch
- TUM School of Management, Technische Universität München, Arcisstr. 21, 80333 Munich, Germany
| | - Dominik Pförringer
- Klinikum Rechts der Isar, Technische Universität München, Klinik und Poliklinik für Unfallchirurgie, Ismaningerstr. 22, 81675 Munich, Germany
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23
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Abstract
Postpartum hemorrhage (PPH) is a serious complication of giving birth that can result in death. Interventional radiology allows for the use of uterine artery embolization and transcatheter arterial embolization to prevent and treat PPH. These procedures are minimally invasive options that use the uterine or internal iliac arteries to place either a balloon or embolic material to stop the bleeding. These techniques also can be used as a preventive treatment for women with known placental abnormalities who are at an increased risk of hemorrhaging. This article discusses causes, early recognition, and treatment of PPH. It also discusses nursing care for patients with PPH and presents a case report describing the use of interventional radiology before cesarean delivery for a patient with placenta accreta.
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24
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Behrns KE. Strengthen Your Core. Am Surg 2019; 85:678-684. [PMID: 31405407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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25
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Triponez F, Demartines N. [Not Available]. Rev Med Suisse 2019; 15:1207. [PMID: 31194293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Frédéric Triponez
- Service de chirurgie thoracique et endocrinienne, Département de chirurgie, HUG, Genève
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26
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Lauerman MH, Herrera AV, Albrecht JS, Chen HH, Bruns BR, Tesoriero RB, Scalea TM, Diaz JJ. Interhospital Transfers with Wide Variability in Emergency General Surgery. Am Surg 2019; 85:595-600. [PMID: 31267899 PMCID: PMC6995344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Interhospital transfer of emergency general surgery (EGS) patients is a common occurrence. Modern individual hospital practices for interhospital transfers have unknown variability. A retrospective review of the Maryland Health Services Cost Review Commission database was undertaken from 2013 to 2015. EGS encounters were divided into three groups: encounters not transferred, encounters transferred from a hospital, and encounters transferred to a hospital. In total, 380,405 EGS encounters were identified, including 12,153 (3.2%) encounters transferred to a hospital, 10,163 (2.7%) encounters transferred from a hospital, and 358,089 (94.1%) encounters not transferred. For individual hospitals, percentage of encounters transferred to a hospital ranged from 0 to 30.05 per cent, encounters transferred from a hospital from 0.02 to 14.62 per cent, and encounters not transferred from 69.25 to 99.95 per cent of total encounters at individual hospitals. Percentage of encounters transferred from individual hospitals was inversely correlated with annual EGS hospital volume (P < 0.001, r = -0.59), whereas percentage of encounters transferred to individual hospitals was directly correlated with annual EGS hospital volume (P < 0.001, r = 0.51). Individual hospital practices for interhospital transfer of EGS patients have substantial variability. This is the first study to describe individual hospital interhospital transfer practices for EGS.
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27
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Abstract
OBJECTIVES The aim of this study was to identify current problems and potential solutions to improve the working environment for the delivery of safe surgical care in the UK. DESIGN Prospective, questionnaire-based cross-sectional study. SETTING/PARTICIPANTS Following validation, an electronic questionnaire was distributed to postgraduate local education and training board distribution lists, the Royal College of Surgeons of Edinburgh (RCSEd) mailing lists and trainee organisations. This consisted of a single open-ended question inviting five open-ended responses. Throughout the 13-week study period, the survey was also published on a number of social media platforms. RESULTS A total of 505 responders completed the survey, of which 35% were consultants, 30% foundation doctors, 17% specialty trainees, 11% specialty doctors, 5% core trainees and <1% surgical nurse practitioners. A total of 2238 free-text answers detailed specific actions to improve the working environment. These responses were individually coded and then grouped into nine categories (staff resources, non-staff resources, support, working conditions, communication and team work, systems improvement, patient centred, training and education, and miscellaneous). CONCLUSIONS The results of this study have identified a number of key areas that, if addressed, may improve the environment for the delivery of safer surgical care. Common themes that emerged across all grades included: increased front-line staff; a return to a 'firm' structure to improve team continuity; greater senior support; and improved hospital facilities to help staff rest and recuperate. While unlimited funding remains unrealistic, many of the suggestions could be implemented in a cost-neutral fashion and include insightful ideas for remodelling or restructuring the workforce to improve the efficiency of the surgical team. The findings of this study formed the basis of a set of recommendations published by the RCSEd as a discussion paper.
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Affiliation(s)
- Alice Baggaley
- Department of Surgery, Homerton University Hospital, London, UK
| | - Lydia Robb
- Clinical Surgery, Edinburgh Royal Infirmary, Edinburgh, UK
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28
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MacQueen IT, Kirchhoff P, Chen DC. Blended Learning Methods for Surgical Education. Surg Technol Int 2018; 33:127-132. [PMID: 30204926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The emergence and maturation of the concept of blended learning in public and military education may prove equally valuable in CME surgical education and training. Creating a learner-centric environment in which multiple modes of education are encouraged, available, integrated, and accredited can increase the level of competence achieved in CME courses. This paper defines a framework for blended surgical training using principles developed for the military and it is applied in courses at a major post-graduate surgical education center.
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Affiliation(s)
- Ian T MacQueen
- Lichtenstein Amid Hernia Clinic, David Geffen School of Medicine at University, of California, Los Angeles, Santa Monica, CA
| | | | - David C Chen
- Lichtenstein Amid Hernia Clinic, David Geffen School of Medicine at University, of California, Los Angeles, Santa Monica, CA
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29
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Abstract
The Mercy case study documents evidence of a clinically integrated supply chain strategy implemented in the peri-operative programs in three of the 46 hospitals in the Mercy system. Mercy became the first US health system to achieve "the perfect order," a supply chain industry standard with end-to-end integration of supply chain best practice in the Mercy system. To date, the Mercy strategy has demonstrated revenue growth of $8 billion, a 70% reduction in Never Events, a 33.3% reduction in supplies cost/case and a 29.5% reduction in labour costs/case in the perioperative programs in three hospitals.
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Affiliation(s)
- Anne W Snowdon
- A professor of Strategy and Entrepreneurship, the chair of the World Health Innovation Network and CEO of SCAN Health, at the Odette School of Business at the University of Windsor
| | - Betty J Rocchio
- The system chief nursing optimization officer for Mercy, the fifth largest Catholic healthcare system in the United States. She is a nurse anesthetist and was formerly VP of nursing and the chief nursing officer
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30
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Abstract
Communication failures can lead to sentinel events in the operating room. Knowledge of basic surgical steps is important for all team members to ensure work flow efficiency. Surgeons and non-surgeons were surveyed to determine perceived and actual quality of communication between team members, using knowledge of surgical steps as a marker of communication quality. Participants agreed that communication was important, but non-surgeons were unable to name the four key steps of a laparoscopic cholecystectomy (p = 5.0E-07), indicating poor communication between surgeons and non-surgeons.
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Affiliation(s)
- Dahlia Kenawy
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, USA 10461
| | - Daniel Schwartz
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, USA 10461
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31
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Cohen MS. Innovation series. Surgery 2018; 166:142. [PMID: 30227998 DOI: 10.1016/j.surg.2018.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/06/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Mark S Cohen
- University of Michigan, Department of Surgery, 2920K Taubman Center, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109.
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32
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DeGirolamo K, D'Souza K, Apte S, Ball CG, Armstrong C, Reso A, Widder S, Mueller S, Gillman LM, Singh R, Nenshi R, Khwaja K, Minor S, de Gara C, Hameed SM. A day in the life of emergency general surgery in Canada: a multicentre observational study. Can J Surg 2018; 61:237-243. [PMID: 30067181 PMCID: PMC6066383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Emergency general surgery (EGS) services are gaining popularity in Canada as systems-based approaches to surgical emergencies. Despite the high volume, acuity and complexity of the patient populations served by EGS services, little has been reported about the services' structure, processes, case mix or outcomes. This study begins a national surveillance effort to define and advance surgical quality in an important and diverse surgical population. METHODS A national cross-sectional study of EGS services was conducted during a 24-hour period in January 2017 at 14 hospitals across 7 Canadian provinces recruited through the Canadian Association of General Surgeons Acute Care Committee. Patients admitted to the EGS service, new consultations and off-service patients being followed by the EGS service during the study period were included. Patient demographic information and data on operations, procedures and complications were collected. RESULTS Twelve sites reported resident coverage. Most services did not include trauma. Ten sites had protected operating room time. Overall, 393 patient encounters occurred during the study period (195/386 [50.5%] operative and 191/386 [49.5%] nonoperative), with a mean of 3.8 operations per service. The patient population was complex, with 136 patients (34.6%) having more than 3 comorbidities. There was a wide case mix, including gallbladder disease (69 cases [17.8%]) and appendiceal disease (31 [8.0%]) as well as complex emergencies, such as obstruction (56 [14.5%]) and perforation (23 [5.9%]). CONCLUSION The characteristics and case mix of these Canadian EGS services are heterogeneous, but all services are busy and provide comprehensive operative and nonoperative care to acutely ill patients with high levels of comorbidity.
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Affiliation(s)
- Kristin DeGirolamo
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Karan D'Souza
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Sameer Apte
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Chad G Ball
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Christopher Armstrong
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Artan Reso
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Sandy Widder
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Sarah Mueller
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Lawrence M Gillman
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Ravinder Singh
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Rahima Nenshi
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Kosar Khwaja
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Samuel Minor
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - Chris de Gara
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
| | - S Morad Hameed
- From the Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC (DeGirolamo, Hameed); the Faculty of Medicine, University of British Columbia, Vancouver, BC (D'Souza); the Department of Surgery, University of Alberta, Edmonton, Alta. (Apte, Widder, de Gara); the Department of Surgery, University of Calgary, Calgary, Alta. (Ball, Armstrong, Reso); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Mueller); the Department of Surgery, University of Manitoba, Winnipeg, Man. (Gillman); the Department of Surgery, Northern Ontario School of Medicine, North Bay, Ont. (Singh); the Department of Surgery, McMaster University, Hamilton, Ont. (Nenshi); the Department of Surgery, McGill University, Montréal, Que. (Khwaja); the Department of Surgery, Dalhousie University, Halifax, NS (Minor); and the Department of Trauma Services, Vancouver General Hospital, Vancouver, BC (Hameed)
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Abstract
The careful coordination of care throughout the perioperative continuum offered by the perioperative surgical home (PSH) is important in the treatment of postoperative pain. Physician anesthesiologists have expertise in acute pain management, pharmacology, and regional and neuraxial anesthetic techniques, making them ideal leaders for managing perioperative analgesia within the PSH. Severe postoperative pain is one of many patient- and surgery-specific factors in the development of chronic postsurgical pain. Delivering adequate perioperative analgesia is important to avoid this development, to decrease perioperative morbidity, and to improve patient satisfaction.
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Affiliation(s)
- John-Paul J Pozek
- Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1034, Kansas City, KS 66160, USA
| | - Martin De Ruyter
- Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1034, Kansas City, KS 66160, USA
| | - Talal W Khan
- Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1034, Kansas City, KS 66160, USA.
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Abstract
The management of acute pain for the phenotypically different patient who suffers from chronic pain is challenging. The care of these patients is expensive and siloed. The physician-led, multidisciplinary, patient-centric, care coordination framework of the perioperative surgical home is an optimal vehicle for the management of these patients. The engagement of physician anesthesiologists in the optimization, in-hospital management, and postdischarge care of the patient with chronic pain will lead to improved outcomes, reduced health care expenditures, and improve the health of this challenging population.
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Affiliation(s)
- Talal W Khan
- Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1034, Kansas City, KS 66160, USA.
| | - Smith Manion
- Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1034, Kansas City, KS 66160, USA
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Abstract
A keystone of operating room (OR) management is proper OR allocation to optimize access, safety, efficiency, and throughput. Access is important to surgeons, and overlapping surgery may increase patient access to surgeons with specialized skill sets and facilitate the training of medical students, residents, and fellows. Overlapping surgery is commonly performed in academic medical centers, although recent public scrutiny has raised debate about its safety, necessitating monitoring. This article introduces a system to monitor overlapping surgery, providing a surgeon-specific Key Performance Indicator, and discusses overlapping surgery as an approach toward OR management goals of efficiency and throughput.
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Affiliation(s)
- Amanda J Morris
- Department of Anesthesiology, Stanford Health Care, 300 Pasteur Drive H3580, Stanford, CA 94305, USA.
| | - Joseph A Sanford
- Department of Anesthesiology, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR 72205, USA
| | - Edward J Damrose
- Division of Laryngology, Stanford Health Care, 801 Welch Road, Stanford, CA 94305, USA
| | - Samuel H Wald
- Department of Anesthesiology, Stanford Health Care, 300 Pasteur Drive H3580, Stanford, CA 94305, USA
| | - Bassam Kadry
- Department of Anesthesiology, Stanford Health Care, 300 Pasteur Drive H3580, Stanford, CA 94305, USA
| | - Alex Macario
- Department of Anesthesiology, Stanford Health Care, 300 Pasteur Drive H3580, Stanford, CA 94305, USA
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Capretti G, Boggi U, Salvia R, Belli G, Coppola R, Falconi M, Valeri A, Zerbi A. Application of minimally invasive pancreatic surgery: an Italian survey. Updates Surg 2018; 71:97-103. [PMID: 29770922 DOI: 10.1007/s13304-018-0535-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 02/17/2018] [Accepted: 05/08/2018] [Indexed: 12/29/2022]
Abstract
The value of minimally invasive pancreatic surgery (MIPS) is still debated. To assess the diffusion of MIPS in Italy and identify the barriers preventing wider implementation, a questionnaire was developed under the auspices of three Scientific Societies (AISP, It-IHPBA, SICE) and was sent to the largest possible number of Italian surgeons also using the mailing list of the two main Italian Surgical Societies (SIC and ACOI). The questionnaire consisted of 25 questions assessing: centre characteristics, facilities and technologies, type of MIPS performed, surgical techniques employed and opinions on the present and future value of MIPS. Only one reply per unit was considered. Fifty-five units answered the questionnaire. While 54 units (98.2%) declared to perform MIPS, the majority of responders were not dedicated to pancreatic surgery. Twenty-five units (45.5%) performed < 20 pancreatic resections/year and 39 (70.9%) < 10 MIPS per year. Forty-nine units (89.1%) performed at least one minimally invasive (MI) distal pancreatectomy (DP), and 10 (18.2%) at least one MI pancreatoduodenectomy (PD). Robotic assistance was used in 18 units (31.7%) (14 DP, 7 PD). The major constraints limiting the diffusion of MIPS were the intrinsic difficulty of the technique and the lack of specific training. The overall value of MIPS was highly rated. Our survey illustrates the current diffusion of MIPS in Italy and underlines the great interest for this approach. Further diffusion of MIPS requires the implementation of standardized protocols of training. Creation of a prospective National Registry should also be considered.
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Lane T. Care and Culpability. Ann R Coll Surg Engl 2018; 100:349. [PMID: 29708433 DOI: 10.1308/rcsann.2018.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Coccolini F, Kluger Y, Ansaloni L, Moore EE, Coimbra R, Fraga GP, Kirkpatrick A, Peitzman A, Maier R, Baiocchi G, Agnoletti V, Gamberini E, Leppaniemi A, Ivatury R, Sugrue M, Sartelli M, Di Saverio S, Biffl W, Catena F. WSES worldwide emergency general surgery formation and evaluation project. World J Emerg Surg 2018; 13:13. [PMID: 29563962 PMCID: PMC5851068 DOI: 10.1186/s13017-018-0174-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 03/02/2018] [Accepted: 03/06/2018] [Indexed: 12/29/2022] Open
Abstract
Optimal management of emergency surgical patients represents one of the major health challenges worldwide. Emergency general surgery (EGS) was identified as multidisciplinary surgery performed for traumatic and non-traumatic acute conditions during the same admission in the hospital. EGS represents the easiest viable way to provide affordable and high-quality level of care to emergency surgical and trauma patients. It may result from the association of different physicians with other specialties in a cooperative model. The World Society of Emergency Surgery (WSES) has been working on the EGS organization and implementation since its foundation believing in the need of common benchmarks for training and educational programs throughout the world. This is a plea in different languages to all World Prime Ministers and Presidents to support the creation in all nations of an organized hub-spoke system for emergency general surgery to improve standards of care and to save lives.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, 47521 Cesena, Italy
| | - Yoram Kluger
- Division of General Surgery Rambam Health Care Campus Haifa, Haifa, Israel
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, 47521 Cesena, Italy
| | | | - Raul Coimbra
- Trauma Surgery, Riverside University Health System Medical Center, Riverside, CA USA
| | - Gustavo P. Fraga
- Faculdade de Ciências Médicas (FCM)—Unicamp Campinas, Campinas, SP Brazil
| | | | - Andrew Peitzman
- Department of Surgery, Trauma and Surgical Services, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Ron Maier
- Department of Surgery, Harborview Medical Centre, Seattle, USA
| | - Gianluca Baiocchi
- General and Emergency Surgery, Civili University Hospital, Brescia, Italy
| | | | | | - Ari Leppaniemi
- Second Department of Surgery, Meilahti Hospital, Helsinki, Finland
| | - Rao Ivatury
- Virginia Commonwealth University, Richmond, VA USA
| | - Michael Sugrue
- General Surgery Department, Letterkenny Hospital, Letterkenny, Ireland
| | | | - Salomone Di Saverio
- Trauma Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Walt Biffl
- Emergency and Trauma Surgery, Scripps Memorial Hospital, La Jolla, CA USA
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39
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Dell AJ, Kahn D. Where are general surgeons located in South Africa? S AFR J SURG 2018; 56:12-18. [PMID: 29638087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Human resources are the backbone of health-care delivery systems and the lack of surgical workforce in developing countries is often the greatest challenge to providing surgical care. The workforce availability and composition is an important indicator of the strength of the health system. This study aimed to analyse the distribution of general surgeons within South Africa. METHOD A descriptive analysis of the general surgical workforce in South Africa was performed. The total number of specialist and non-specialist general surgeons working in the public sector in South Africa was documented between the periods from the 1 October 2014 until 31 December 2014. RESULTS There were significant disparities in the number and distribution of general surgeons in South Africa. There were 1.78 specialist general surgeons per 100 000, of which 0.69 per 100 000 specialist general surgeons were working in the public sector. There were 2.90 non-specialist general surgeons per 100 000. There were 6 specialist general surgeons per 100 000 insured population working in the private sector, which is comparable with the United States (US). Urban provinces such as Gauteng, the Western Cape and KwaZulu-Natal had the largest number of specialist general surgeons per 100 000. These areas had the largest number of medical aid beneficiaries and nearly 60% of specialist general surgeons were estimated to work exclusively in the private sector. CONCLUSION There was a major shortage of surgical providers in South Africa, and in particular the public sector.
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Affiliation(s)
- A J Dell
- Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - D Kahn
- Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town, South Africa
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40
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Affiliation(s)
- Rebecca M Minter
- A.R. Curreri Professor, Chair, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Khubchandani JA, Ingraham AM, Daniel VT, Ayturk D, Kiefe CI, Santry HP. Geographic Diffusion and Implementation of Acute Care Surgery: An Uneven Solution to the National Emergency General Surgery Crisis. JAMA Surg 2018; 153:150-159. [PMID: 28979986 PMCID: PMC5838713 DOI: 10.1001/jamasurg.2017.3799] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/25/2017] [Indexed: 01/14/2023]
Abstract
Importance Owing to lack of adequate emergency care infrastructure and decline in general surgery workforce, the United States faces a crisis in access to emergency general surgery (EGS) care. Acute care surgery (ACS), an organized system of trauma, general surgery, and critical care, is a proposed solution; however, ACS diffusion remains poorly understood. Objective To investigate geographic diffusion of ACS models of care and characterize the communities in which ACS implementation is lagging. Design, Setting, and Participants A national survey on EGS practices was developed, tested, and administered at all 2811 US acute care hospitals providing EGS to adults between August 2015 and October 2015. Surgeons responsible for EGS coverage at these hospitals were approached. If these surgeons failed to respond to the initial survey implementation, secondary surgeons or chief medical officers at hospitals with only 1 general surgeon were approached. Interventions Survey responses on ACS implementation were linked with geocoded hospital data and national census data to determine geographic diffusion of and access to ACS. Main Outcomes and Measures We measured the distribution of hospitals with ACS models of care vs those without over time (diffusion) and by US counties characterized by sociodemographic characteristics of county residents (access). Results Survey response rate was 60% (n = 1690); 272 responding hospitals had implemented ACS by 2015, steadily increasing from 34 in 2001 to 125 in 2010. Acute care surgery implementation has not been uniform. Rural regions have limited ACS access, with hospitals in counties with greater than the 75th percentile population having 5.4 times higher odds (95% CI, 1.66-7.35) of implementing ACS than hospitals in counties with less than 25th percentile population. Communities with greater percentages of adults without a college degree also have limited ACS access (OR, 3.43; 95% CI, 1.81-6.48). However, incorporating EGS into ACS models may be a potential equalizer for poor, black, and Hispanic communities. Conclusions and Relevance Understanding and addressing gaps in ACS implementation across communities will be crucial to ensuring health equity for US residents experiencing general surgery emergencies.
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Affiliation(s)
| | | | - Vijaya T. Daniel
- University of Massachusetts Medical School, Department of Surgery, Worcester
| | - Didem Ayturk
- University of Massachusetts Medical School, Department of Surgery, Worcester
| | - Catarina I. Kiefe
- University of Massachusetts Medical School, Department of Quantitative Health Sciences, Worcester
| | - Heena P. Santry
- University of Massachusetts Medical School, Department of Surgery, Worcester
- University of Massachusetts Medical School, Department of Quantitative Health Sciences, Worcester
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Radford M, Abbassi A, Williamson A, Johnston P. Redefining Perioperative Advanced Practice the Nurse Specialist in Anaesthesia and Emergency Surgery. ACTA ACUST UNITED AC 2017; 13:468-71. [PMID: 14649122 DOI: 10.1177/175045890301301104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The development of the specialist nursing role was born out of an honest and clinically-driven review of the system that emergency patients experienced. The approaches taken during this review consistently returned facts that this pathway was less than optimal, and a great many improvements could be made. It is important to identify at this stage that simply adding more resources, i.e.: theatre space and beds, would not have improved the patient's experience. The pathway needed greater continuity and better co-ordination. This required a great deal of cooperation between clinical and managerial staff, including some fundamental re-examination of traditionally held beliefs about the role that perioperative nursing could have in managing this patient group. Part Two of the paper (Radford et al 2003) will present the details of how the development of this post challenged the care delivery system for emergency surgical patients. Particular reference will be made to the scope of practice, clinical and organisational impacts and future directions.
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Affiliation(s)
- Mark Radford
- Department of Anaesthesia, Good Hope Hospital NHS Trust
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43
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DeGirolamo K, Murphy PB, D'Souza K, Zhang JX, Parry N, Haut E, Leeper WR, Leslie K, Vogt KN, Hameed SM. Processes of Health Care Delivery, Education, and Provider Satisfaction in Acute Care Surgery: A Systematic Review. Am Surg 2017; 83:1438-1446. [PMID: 29336769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In recent years, significant workload, high acuity, and complexity of emergency general surgery conditions have led hospitals to replace the traditional on-call model with dedicated acute care surgery (ACS) service models. A systematic search of Ovid, EMBASE, and MEDLINE was undertaken to examine the impact of ACS services on health-care delivery processes and cost, education, and provider satisfaction. From 1827 papers, reviewers identified 22 studies that met inclusion criteria and subsequently used The Evidence-Based Practice for Improving Quality method and Newcastle-Ottawa Scale to score quality and level of evidence. Most studies found an increase in daytime operating, improved patient transit from emergency department to operating room to home, and decreased length of stay. Higher and more diverse case volumes improved resident education and operative experience. ACS services enhanced the educational experience of residents on subspecialty services by offloading emergency work from those services. Finally, surgeons generally felt that ACS services improved job satisfaction, productivity, and billing. The ACS model has demonstrated improvement in timeliness of care, diversified case mix, decreased costs, improved trainee learning, and increased surgeon job satisfaction.
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Affiliation(s)
- Michelle M Mello
- Stanford Law School and Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Edward H Livingston
- Deputy Editor, JAMA3Department of Surgery at the UT Southwestern School of Medicine, Dallas, Texas4Northwestern University, Evanston, Illinois
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45
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Tariq H, Thomson D, Kahn D. 10-year review of Africa's first student surgical society - UCT Surgical Society. S AFR J SURG 2017; 55:6-7. [PMID: 28876616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The UCT Student Surgical Society is an undergraduate surgical society based at the University of Cape Town (UCT) which aims to promote surgical education amongst medical students early in their medical careers. Founded in 2006, this was Africa's first student surgical society and has been joined by other medical schools in Africa also establishing their own undergraduate student surgical societies. In this review of the first 10 years of the society, we describe its objectives, its evolution and its international role.
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MESH Headings
- Education, Medical, Undergraduate/history
- Education, Medical, Undergraduate/organization & administration
- General Surgery/education
- General Surgery/history
- General Surgery/organization & administration
- History, 21st Century
- Humans
- Schools, Medical/history
- Schools, Medical/organization & administration
- Societies, Medical/history
- Societies, Medical/organization & administration
- South Africa
- Students, Medical/history
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Affiliation(s)
- H Tariq
- Faculty of Health Sciences, University of Cape Town
| | - D Thomson
- Department of Surgery, Faculty of Health Sciences, University of Cape Town
| | - D Kahn
- Department of Surgery, Faculty of Health Sciences, University of Cape Town
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Sakowska MM, Thomas MV, Connor S, Roberts R. Hospital-wide implementation of an electronic-workflow solution aiming to make surgical practice improvement easy. ANZ J Surg 2017; 87:143-148. [PMID: 27770497 DOI: 10.1111/ans.13805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 07/19/2016] [Revised: 08/22/2016] [Accepted: 08/30/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND In measuring quality of health-care delivery, digital infrastructure is essential. The aim at this tertiary centre was to create a hospital-wide workflow system that collected data prospectively as part of daily practice. METHODS In moving towards an electronic health record, a hospital-wide integrated workflow system was introduced in 2013, which electronically managed the perioperative patient journey while simultaneously facilitating surgical audit. Analysis of its implementation was carried out presenting early outcomes using general surgery as an example. RESULTS Theatre-bookings (44 953) were made with compliance approaching 90% for all services. Of 7179 general surgical operations over 24 months, 5785 (80%) had an operation note created using the new system. Cumulative summation of uptake of synoptic operative reporting (SOR) for laparoscopic cholecystectomy (LC) was 81% with documentation being superior in terms of antibiotic use and steps to safe cholecystectomy (P < 0.001). A LC SOR took 4 min to complete (interquartile ranges 2-5 min, n = 425) and was immediately available on the day of surgery compared to narrative operative reports taking 2 days (interquartile ranges 1-5 days, n = 174) (P < 0.001). From July 2014 to November 2015, 557 (10%) complications were recorded for 5749 general surgical operations with 99% of complications being reviewed. CONCLUSION The rapid and sustained uptake of both theatre-bookings and SOR likely reflect high end-user satisfaction with the system. Service metrics indicate a significant improvement in the time of delivery. The ability to seamlessly complete the audit cycle at an individual, department and hospital level has been achieved.
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Affiliation(s)
- Magdalena M Sakowska
- Department of General Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Megan V Thomas
- Department of General Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Saxon Connor
- Department of General Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
- E-Clinical Health Lead, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Ross Roberts
- Department of General Surgery, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
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Fitzgerald BM, Nagy CJ, Goosman EF, Gummerson MC, Wilson JE. Humanitarian Surgical Missions: Guidelines for Successful Anesthesia Support. J Spec Oper Med 2017; 17:56-62. [PMID: 29256196 DOI: 10.55460/4e3x-vt6h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2017] [Indexed: 06/07/2023]
Abstract
Many anesthesiologists and CRNAs are provided little training in preparing for a humanitarian surgical mission. Furthermore, there is very little published literature that outlines how to plan and prepare for anesthesia support of a humanitarian surgical mission. This article attempts to serve as an in-depth planning guide for anesthesia support of humanitarian surgical missions. Recommendations are provided on planning requirements that most anesthesiologists and CRNAs do not have to consider on routinely, such as key questions to be answered before agreeing to support a mission, ordering and shipping supplies and medications, travel and lodging arrangements, and coordinating translators in a host nation. Detailed considerations are included for all the phases of mission planning: advanced, mission-specific, final, mission-execution, and postmission follow-up planning, as well as a timeline in which to complete each phase. With the proper planning and execution, the anesthetic support of humanitarian surgical missions is a very manageable task that can result in an extremely satisfying sense of accomplishment and a rewarding experience. The authors suggest this article should be used as a reference document by any anesthesia professional tasked with planning and supporting a humanitarian surgical mission.
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48
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Navarro Reynoso FP. [On the fifty-eighth National Surgical Week]. CIR CIR 2016; 84:445-446. [PMID: 27938881 DOI: 10.1016/j.circir.2016.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 11/19/2022]
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Watanabe H, Shimojo Y, Hira E. [THE FIRST ESTABLISHMENT OF DEPARTMENT OF ACUTE CARE SURGERY IN JAPAN]. Nihon Geka Gakkai Zasshi 2016; 117:547-549. [PMID: 30173484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Abstract
Background: To assess the relationship between hospital volume and early postoperative outcome the incidence and early outcome of all esophagectomies, pancreaticoduodenectomies and gastric resections in Denmark from 1996 to 2004 was described. Methods: The National Patient Registry and discharge information from all hospital departments were analysed for all the operations due to a malignant diagnosis. All information was examined for postoperative length of stay and hospital mortality. Results: During the study period 26 departments performed at least one esophageal resection, 13 departments performed at least one Whipple procedure and 37 departments performed at least one gastric resection. Four departments performed more than 20 esophageal resections per year, whereas one department performed more than 20 Whipple procedures and one more than 20 gastric resections per year. The overall mean length of stay was 21.6 days, 24 days and 18 days for esophageal, pancreatic and gastric resections, respectively, with no difference between high and low volume departments. The hospital mortality was 8.6%, 8.9% and 8.2%, respectively. Conclusion: The overall high mortality and long postoperative stay in patients undergoing upper gastrointestinal cancer surgery in Denmark calls for improvement by regionalisation into 3–4 departments and monitoring of results.
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Affiliation(s)
- L S Jensen
- Department of Surgery L, Aarhus Sygehus, Aarhus, Denmark.
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