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Journal of Vascular Surgery Jul 2021Creating a diverse workforce is paramount to the success of the surgical field. A diverse workforce allows us to meet the health needs of an increasingly diverse... (Comparative Study)
Comparative Study
OBJECTIVE
Creating a diverse workforce is paramount to the success of the surgical field. A diverse workforce allows us to meet the health needs of an increasingly diverse population and to bring new ideas to spur technical innovation. The purpose of this study was to assess trends in workforce diversity within vascular surgery (VS) and general surgery (GS) as compared with orthopedic surgery (OS)-a specialty that instituted a formal diversity initiative over a decade ago.
METHODS
Data on the trainee pool for VS (fellowships and integrated residencies), GS, and OS were obtained from the U.S. Graduate Medical Education reports for 1999 through 2017. Medical student demographic data were obtained from the Association of American Medical Colleges U.S. medical school enrollment reports. The representation of surgical trainee populations (female, Hispanic, and black) was normalized by their representation in medical school. We also performed the χ test to compare proportions of residents over dichotomized time periods (1999-2005 and 2013-2017) as well as a more sensitive trend of proportions test.
RESULTS
The proportion of female trainees increased significantly between the time periods for the three surgical disciplines examined (P < .001). Hispanic trainees also represented an increasing proportion of all three disciplines (P ≤ .001). The proportion of black trainees did not significantly change in any discipline between the two periods. Relative to their proportion in medical school, Hispanic trainees were well represented in all surgical specialties studied (normalized ratio [NR], 0.95-1.52: 0.95 OS, 1.00 GS, 1.53 VS fellowship, and 1.23 VS residency). Compared with their representation in medical school, women were under-represented as surgical trainees (NR: 0.32 OS, 0.82 GS, 0.56 VS fellowship, and 0.78 VS residency) as were black trainees (NR: 0.63 OS, 0.90 GS, 0.99 VS fellowship, and 0.81 VS residency).
CONCLUSIONS
Although there were significant increases in the number of women and Hispanic trainees in these three surgical disciplines, only Hispanic trainees enter the surgical field at a rate higher than their proportion in medical school. The lack of an increase in black trainees across all specialties was particularly discouraging. Women and black trainees were under-represented in all specialties as compared with their representation in medical school. The data presented suggest potential problems with recruitment at multiple levels of the pipeline. Particular attention should be paid to increasing the pool of minority medical school graduates who are both interested in and competitive for surgical specialties.
Topics: Black or African American; Cultural Competency; Cultural Diversity; Female; Gender Equity; General Surgery; Hispanic or Latino; Humans; Internship and Residency; Male; Orthopedic Surgeons; Personnel Selection; Physicians, Women; Racism; Sexism; Students, Medical; Surgeons; Time Factors; Vascular Surgical Procedures
PubMed: 33348000
DOI: 10.1016/j.jvs.2020.12.063 -
Urologia Internationalis 2011Retrograde exploration of the ureter and kidneys is currently a widely used and well-established procedure to deal with problems of a diagnostic and therapeutic nature... (Review)
Review
Retrograde exploration of the ureter and kidneys is currently a widely used and well-established procedure to deal with problems of a diagnostic and therapeutic nature with reduced invasiveness. The process of miniaturizing the instruments combined with the steady improvement in video quality has continuously amplified its potential applications, maintaining the procedure safe and rapid. During an operation, however, unexpected events may condition a change to the programme or determine the onset of even more serious complications. Our aim is to analyze such events and complications and recommend potential solutions to prevent and/or deal with such happenings.
Topics: Constriction, Pathologic; Endoscopy; Female; Hemorrhage; Humans; Intraoperative Complications; Kidney; Male; Research Design; Surgical Procedures, Operative; Ureter; Ureteral Obstruction; Ureteroscopy
PubMed: 21734359
DOI: 10.1159/000329286 -
Surgical Endoscopy Jun 2017Since the introduction of minimally invasive surgery, surgeons appear to be experiencing more occupational musculoskeletal injuries. The aim of this study is to...
BACKGROUND
Since the introduction of minimally invasive surgery, surgeons appear to be experiencing more occupational musculoskeletal injuries. The aim of this study is to investigate the current frequency and effects of occupational musculoskeletal injuries on work absence.
METHODS
An online questionnaire was conducted among all surgeons affiliated to the Dutch Society for Endoscopic Surgery, Gastrointestinal Surgery, and Surgical Oncology. In addition, this survey was conducted among surgeons, gynaecologists, and urologists of one cluster of training hospitals in the Netherlands.
RESULTS
There were 127 respondents. Fifty-six surgeons currently suffer from musculoskeletal complaints, and 30 have previously suffered from musculoskeletal complaints with no current complaints. Frequently reported localizations were the neck (39.5 %), the erector spinae muscle (34.9 %), and the right deltoid muscle (18.6 %). Most of the musculoskeletal complaints were present while operating (41.8 %). Currently, 37.5 % uses medication and/or therapy to reduce complaints. Of surgeons with past complaints, 26.7 % required work leave and 40.0 % made intraoperative adjustments. More surgeons with a medical history of musculoskeletal complaints have current complaints (OR 6.1, 95 % CI 1.9-19.6). There were no significant differences between surgeons of different operating techniques in localizations and frequency of complaints, or work leave.
CONCLUSIONS
Despite previous various ergonomic recommendations in the operating room, the current study demonstrated that musculoskeletal complaints and subsequent work absence are still present among surgeons, especially among surgeons with a positive medical history for musculoskeletal complaints. Even sick leave was necessary to fully recover. There were no significant differences in reported complaints between surgeons of different operating techniques. Almost half of the respondents with complaints made intraoperative ergonomic adjustments to prevent future complaints. The latter would be interesting for future research.
Topics: Adult; Cross-Sectional Studies; Ergonomics; Female; General Surgery; Gynecology; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Musculoskeletal Diseases; Netherlands; Occupational Diseases; Operating Rooms; Sick Leave; Urology
PubMed: 27752811
DOI: 10.1007/s00464-016-5247-5 -
World Journal of Emergency Surgery :... 2018The increasing prevalence of advanced cirrhosis among operative candidates poses a major challenge for the acute care surgeon. The severity of hepatic dysfunction,... (Review)
Review
The increasing prevalence of advanced cirrhosis among operative candidates poses a major challenge for the acute care surgeon. The severity of hepatic dysfunction, degree of portal hypertension, emergency of surgery, and severity of patients' comorbidities constitute predictors of postoperative mortality. Comprehensive history taking, physical examination, and thorough review of laboratory and imaging examinations typically elucidate clinical evidence of hepatic dysfunction, portal hypertension, and/or their complications. Utilization of specific scoring systems (Child-Pugh and MELD) adds objectivity to stratifying the severity of hepatic dysfunction. Hypovolemia and coagulopathy often represent major preoperative concerns. Resuscitation mandates judicious use of intravenous fluids and blood products. As a general rule, the most expeditious and least invasive operative procedure should be planned. Laparoscopic approaches, advanced energy devices, mechanical staplers, and topical hemostatics should be considered whenever applicable to improve safety. Precise operative technique must acknowledge common distortions in hepatic anatomy, as well as the risk of massive hemorrhage from porto-systemic collaterals. Preventive measures, as well as both clinical and laboratory vigilance, for postoperative hepatic and renal decompensation are essential.
Topics: Emergency Medical Services; End Stage Liver Disease; General Surgery; Humans; Hypertension, Portal; Perioperative Care; Quality of Health Care; Severity of Illness Index; Ultrasonography
PubMed: 30034510
DOI: 10.1186/s13017-018-0194-1 -
Minerva Pediatrics Oct 2021Inevitably, along with other healthcare specializations, pediatric surgery was affected by the Coronavirus disease-19 (COVID-19) pandemic. Children were reported to... (Review)
Review
Inevitably, along with other healthcare specializations, pediatric surgery was affected by the Coronavirus disease-19 (COVID-19) pandemic. Children were reported to manifest mild to moderate symptoms and mortality was primarily observed in patients aged <1 year and having underlying comorbidities. Most of the cases were asymptomatic in children, hence, posing a challenge for pediatric surgery centers to take drastic measures to reduce the virus transmission. Telemedicine was introduced and out-patient consultations were conducted online as out-patient clinics were closed. Elective surgeries were postponed with delayed appointments while the healthcare sector was diverted towards tackling COVID-19. Case urgency was classified and triaged, leading to limited surgeries being performed only in COVID-19 negative patients following an extensive screening process. The screening process consisted of online history taking and RT-PCR tests. Newer practices such as mouth rinse, video laryngoscopy, and anesthesia were introduced to restrict patients from crying, coughing, and sneezing, as an attempt to avoid aerosolization of viral particles and safely conduct pediatric surgeries during the pandemic. Surgical trainees were also affected as the smaller number of surgeries conducted reduced the clinical experience available to medical enthusiasts. There is still room for advanced practices to be introduced in pediatric surgery and restore all kinds of surgeries to improve the quality of life of the patient.
Topics: Asymptomatic Infections; COVID-19; COVID-19 Nucleic Acid Testing; Child; Child, Preschool; Elective Surgical Procedures; General Surgery; Humans; Incidence; Infant; Pandemics; Patient Selection; Pediatrics; Preoperative Care; Surgical Procedures, Operative; Telemedicine; Triage
PubMed: 33845565
DOI: 10.23736/S2724-5276.21.06146-6 -
Revista Do Colegio Brasileiro de... 2013The damage control surgery is a widely accepted concept today among abdominal trauma specialists when it comes to the severely traumatized. In these patients, the death... (Review)
Review
The damage control surgery is a widely accepted concept today among abdominal trauma specialists when it comes to the severely traumatized. In these patients, the death is due, in most cases, to the installation of the lethal triad (hypothermia, coagulopathy and acidosis) and not the inability to repair the serious initial damage. In this review, the authors address the lethal triad in its three phases and emphasize the measures taken to prevent them, as well as discussing the indication and employment of damage control surgery in its various stages. Restoring the physiological status of the patient in the ICU, so that he/she can be submitted to final operation and closure of the abdominal cavity, another challenge in severe trauma patients, is also discussed.
Topics: Humans; Patient Selection; Postoperative Complications; Safety Management; Surgical Procedures, Operative
PubMed: 23752642
DOI: 10.1590/s0100-69912013000200011 -
Morphologie : Bulletin de L'Association... Sep 2020The pandemic Covid-19 is responsible for a major education crisis globally and has a drastic impact on medical training as well. The objective of the present study was...
The pandemic Covid-19 is responsible for a major education crisis globally and has a drastic impact on medical training as well. The objective of the present study was to envision the present and future impact of Covid-19 on anatomy learning and research. The virtual education is the only mode of teaching in current scenario. Every anatomist is unlocking technology to deliver best education however understanding of the subject without dissections or other practical teaching aids like bones, specimens, embryology models, microscopic slides etc. is challenging. This approach misses the feel and human visual impacts. Potential educational disruption is felt currently and will be experienced even after the pandemic is over due to scarcity of cadavers. As the body donor may be carrier or died of Covid-19 and there is no proven screening to rule out this infection in donor, so the acceptance of body donations is not advisable for the safety of medical students and health care workers. To conclude, anatomy education is cadaverless currently due to Covid-19 lockdown and it is prophesied that after the pandemic, real cadavers will be replaced by virtual cadavers because of paucity of cadavers. Research in the field of anatomy will also be adversely affected.
Topics: Anatomy; Betacoronavirus; COVID-19; Cadaver; Coronavirus Infections; Dissection; General Surgery; Humans; Internship and Residency; Pandemics; Pneumonia, Viral; SARS-CoV-2; Simulation Training; Students, Medical
PubMed: 32518047
DOI: 10.1016/j.morpho.2020.05.003 -
Minerva Surgery Jun 2021In the surgical scenario, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diffusion worldwide entails on the one hand the need to continue to perform...
BACKGROUND
In the surgical scenario, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diffusion worldwide entails on the one hand the need to continue to perform surgery at least in case of emergency or oncologic surgery, in patients with or without COronaVIrus Disease 2019 (COVID-19); and on the other hand, to avoid the pandemic diffusion both between patients and medical and nursing team. The aim of this study was to report our surgical management protocol during the COVID-19 pandemic in an Italian non-referral center.
METHODS
Data retrieved during the outbreak for the COVID-19 pandemic, from March 8 to May 4, 2020 (study period) were analyzed and compared to data obtained during the same period in 2019 (control period).
RESULTS
During the study period, 41 surgical procedures (24 electives, 17 emergency surgical procedures) underwent surgery in comparison to 99 procedures in the control period. Stratifying the procedures in elective and emergency surgery, and based on the indication for surgery, the only statistically significant difference was observed in the elective surgery regarding the abdominal wall surgery (0 vs. 13 procedures, P=0.0339). Statistically significant differences were not observed regarding the colorectal and the breast oncologic surgery. All stuff members were COVID-19 free.
CONCLUSIONS
The present protocol proved to be safe and useful to prevent SARS-CoV-2 infection before and after surgery for both patients and stuff. The pandemic was responsible for the reduction in number of procedures performed, anyway for the oncologic surgery a statistically significant volume reduction in comparison to 2019 was not observed.
Topics: Abdominal Wall; COVID-19; COVID-19 Testing; Elective Surgical Procedures; Emergency Treatment; Humans; Italy; Neoplasms; Operating Rooms; Pandemics; Retrospective Studies; Surgical Procedures, Operative
PubMed: 33179469
DOI: 10.23736/S2724-5691.20.08632-0 -
BMJ (Clinical Research Ed.) Nov 1990
Topics: Acquired Immunodeficiency Syndrome; Cross Infection; General Surgery; HIV Antibodies; Humans; Occupational Diseases; Risk Assessment; Risk Factors; Surgical Procedures, Operative; United Kingdom
PubMed: 2082964
DOI: 10.1136/bmj.301.6759.1003 -
British Medical Journal (Clinical... Jan 1988
Topics: Acquired Immunodeficiency Syndrome; General Surgery; Humans; London; Occupational Diseases; Risk Factors
PubMed: 3122963
DOI: 10.1136/bmj.296.6615.80