-
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 -
World Journal of Emergency Surgery :... Mar 2021Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a...
BACKGROUND
Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers.
METHOD
A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology.
RESULTS
Given the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts' opinion.
CONCLUSIONS
The aim of this position paper is to provide an exhaustive guidelines to perform emergency surgery in a safe and protected environment for surgical patients and for healthcare workers under COVID-19 and to offer the best management of COVID-19 patients needing for an emergency surgical treatment. We recommend screening for COVID-19 infection at the emergency department all acute surgical patients who are waiting for hospital admission and urgent surgery. The screening work-up provides a RT-PCR nasopharyngeal swab test and a baseline (non-contrast) chest CT or a chest X-ray or a lungs US, depending on skills and availability. If the COVID-19 screening is not completed we recommend keeping the patient in isolation until RT-PCR swab test result is not available, and to manage him/she such as an overt COVID patient. The management of COVID-19 surgical patients is multidisciplinary. If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every effort to protect the operating room staff for the safety of the patient.
Topics: COVID-19; COVID-19 Testing; Emergencies; Global Health; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Laparoscopy; Pandemics; Perioperative Care; Personal Protective Equipment; Surgical Procedures, Operative
PubMed: 33752721
DOI: 10.1186/s13017-021-00349-0 -
BJS Open Jul 2021Core surgical training programmes are associated with a high risk of burnout. This study aimed to assess the influence of a novel enhanced stress-resilience training...
INTRODUCTION
Core surgical training programmes are associated with a high risk of burnout. This study aimed to assess the influence of a novel enhanced stress-resilience training (ESRT) course delivered at the start of core surgical training in a single UK statutory education body.
METHOD
All newly appointed core surgical trainees (CSTs) were invited to participate in a 5-week ESRT course teaching mindfulness-based exercises to develop tools to deal with stress at work and burnout. The primary aim was to assess the feasibility of this course; secondary outcomes were to assess degree of burnout measured using Maslach Burnout Inventory (MBI) scoring.
RESULTS
Of 43 boot camp attendees, 38 trainees completed questionnaires, with 24 choosing to participate in ESRT (63.2 per cent; male 13, female 11, median age 28 years). Qualitative data reflected challenges delivering ESRT because of arduous and inflexible clinical on-call rotas, time pressures related to academic curriculum demands and the concurrent COVID-19 pandemic (10 of 24 drop-out). Despite these challenges, 22 (91.7 per cent) considered the course valuable and there was unanimous support for programme development. Of the 14 trainees who completed the ESRT course, nine (64.3 per cent) continued to use the techniques in daily clinical work. Burnout was identified in 23 trainees (60.5 per cent) with no evident difference in baseline MBI scores between participants (median 4 (range 0-11) versus 5 (1-11), P = 0.770). High stress states were significantly less likely, and mindfulness significantly higher in the intervention group (P < 0.010); MBI scores were comparable before and after ESRT in the intervention cohort (P = 0.630, median 4 (range 0-11) versus 4 (1-10)).
DISCUSSION
Despite arduous emergency COVID rotas ESRT was feasible and, combined with protected time for trainees to engage, deserves further research to determine medium-term efficacy.
Topics: Adult; Anxiety; Burnout, Professional; COVID-19; Curriculum; Depression; Feasibility Studies; Female; General Surgery; Humans; Male; Mindfulness; Pandemics; Resilience, Psychological; Stress, Psychological; Surgeons; Surveys and Questionnaires; United Kingdom; Work Schedule Tolerance
PubMed: 34323917
DOI: 10.1093/bjsopen/zrab054 -
The British Journal of Surgery Sep 2020The ongoing pandemic is having a collateral health effect on delivery of surgical care to millions of patients. Very little is known about pandemic management and... (Review)
Review
BACKGROUND
The ongoing pandemic is having a collateral health effect on delivery of surgical care to millions of patients. Very little is known about pandemic management and effects on other services, including delivery of surgery.
METHODS
This was a scoping review of all available literature pertaining to COVID-19 and surgery, using electronic databases, society websites, webinars and preprint repositories.
RESULTS
Several perioperative guidelines have been issued within a short time. Many suggestions are contradictory and based on anecdotal data at best. As regions with the highest volume of operations per capita are being hit, an unprecedented number of operations are being cancelled or deferred. No major stakeholder seems to have considered how a pandemic deprives patients with a surgical condition of resources, with patients disproportionally affected owing to the nature of treatment (use of anaesthesia, operating rooms, protective equipment, physical invasion and need for perioperative care). No recommendations exist regarding how to reopen surgical delivery. The postpandemic evaluation and future planning should involve surgical services as an essential part to maintain appropriate surgical care for the population during an outbreak. Surgical delivery, owing to its cross-cutting nature and synergistic effects on health systems at large, needs to be built into the WHO agenda for national health planning.
CONCLUSION
Patients are being deprived of surgical access, with uncertain loss of function and risk of adverse prognosis as a collateral effect of the pandemic. Surgical services need a contingency plan for maintaining surgical care in an ongoing or postpandemic phase.
Topics: COVID-19; Delivery of Health Care; Global Health; Humans; Infection Control; Pandemics; Perioperative Care; Practice Guidelines as Topic; Surgical Procedures, Operative
PubMed: 32350857
DOI: 10.1002/bjs.11670 -
CA: a Cancer Journal For Clinicians 1997Laparoscopy is an effective tool for diagnosis and staging of malignancies. Laparoscopic resection of abdominal tumors has been performed rarely, with two exceptions:... (Review)
Review
Laparoscopy is an effective tool for diagnosis and staging of malignancies. Laparoscopic resection of abdominal tumors has been performed rarely, with two exceptions: laparoscopic adrenalectomy and laparoscopic resection of colorectal cancer. One of the best applications of minimally invasive surgery is the use of laparoscopic techniques for palliation of abdominal cancer. Requiring thorough training and preparation of surgeons and mandating their strict credentialing will reduce the risk of complications from laparoscopic surgery.
Topics: Abdominal Neoplasms; Adrenal Gland Neoplasms; Adrenalectomy; Cholecystectomy, Laparoscopic; Colectomy; Colonic Neoplasms; Credentialing; Digestive System Neoplasms; Gallbladder Neoplasms; General Surgery; Humans; Intraoperative Complications; Laparoscopy; Minimally Invasive Surgical Procedures; Neoplasm Staging; Palliative Care; Postoperative Complications; Rectal Neoplasms; Risk Factors
PubMed: 9371056
DOI: 10.3322/canjclin.47.6.327 -
Revista Da Associacao Medica Brasileira... 2010Patients with impaired hepatic functional reserve when submitted to surgeries may have high rates of morbidity and mortality. Pre-existing liver disease should be... (Review)
Review
Patients with impaired hepatic functional reserve when submitted to surgeries may have high rates of morbidity and mortality. Pre-existing liver disease should be detected without need for invasive methods. Clinical history and physical examination provide important clues. Laboratory liver function is not necessary unless there are changes in history or physical examination. Liver disease has many effects on surgery and anesthesia. A decrease in oxygenation and increased risk of liver dysfunction can be caused by anesthesia, hemorrhage, hypoxemia, hypotension, vasoactive drugs or the patient's position on the operating table during and after surgery. Emergency surgery is a major predictor of poor prognosis as well as sepsis and reoperations. The nature of liver disease, severity and type of surgery to be performed should take into account for a correct preoperative preparation. Some actions must be taken at preoperative to decrease chances of complications in patients with liver disease undergoing surgical procedures. Very close attention should be given to coagulopathy, encephalopathy, ascites, renal and pulmonary dysfunction, spontaneous bacterial peritonitis and esophageal varices. Patients with Child-Pugh score C and MELD>15 should not undergo elective surgery. Patients with Child-Pugh score B and MELD 10 to 15 may undergo minor surgical procedures with care in cases of extreme necessity. Patients with Child-Pugh score A and MELD<10 may be submitted to elective surgery.
Topics: Elective Surgical Procedures; Emergency Medical Services; Humans; Liver Diseases; Postoperative Complications; Preoperative Care; Severity of Illness Index; Surgical Procedures, Operative
PubMed: 20498999
DOI: 10.1590/s0104-42302010000200023 -
Canadian Journal of Surgery. Journal... Apr 2003
Topics: Humans; Medical Errors; Surgical Procedures, Operative
PubMed: 12691342
DOI: No ID Found -
Anaesthesia Jan 2013In this second article we examine the principles underlying delivery of the components of anaesthesia. Topics considered include anaesthetic technique, management of the... (Review)
Review
In this second article we examine the principles underlying delivery of the components of anaesthesia. Topics considered include anaesthetic technique, management of the airway and lung ventilation, induction and maintenance of anaesthesia, patient monitoring including the place of cardiac output devices. We summarise recent research on the management of shock and sepsis syndromes including goal directed therapy and examine some controversies around intravenous fluid therapy. Finally, we discuss intra-operative awareness and challenges during emergence including peri-operative cognitive dysfunction.
Topics: Airway Management; Anesthesia; Anesthetics; Blood Circulation; Emergency Medical Services; Fluid Therapy; General Surgery; Humans; Intraoperative Awareness; Monitoring, Physiologic; Postoperative Care; Respiration, Artificial; Shock
PubMed: 23210553
DOI: 10.1111/anae.12057 -
World Journal of Emergency Surgery :... Apr 2020The current COVID-19 pandemic underlines the importance of a mindful utilization of financial and human resources. Preserving resources and manpower is paramount in...
The current COVID-19 pandemic underlines the importance of a mindful utilization of financial and human resources. Preserving resources and manpower is paramount in healthcare. It is important to ensure the ability of surgeons and specialized professionals to function through the pandemic. A conscious effort should be made to minimize infection in this sector. A high mortality rate within this group would be detrimental.This manuscript is the result of a collaboration between the major Italian surgical and anesthesiologic societies: ACOI, SIC, SICUT, SICO, SICG, SIFIPAC, SICE, and SIAARTI. We aim to describe recommended clinical pathways for COVID-19-positive patients requiring acute non-deferrable surgical care. All hospitals should organize dedicated protocols and workforce training as part of the effort to face the current pandemic.
Topics: Humans; Betacoronavirus; Coronavirus Infections; COVID-19; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Italy; Pandemics; Pneumonia, Viral; SARS-CoV-2; Surgeons; Surgical Procedures, Operative
PubMed: 32264898
DOI: 10.1186/s13017-020-00307-2 -
British Journal of Anaesthesia Sep 2021
Topics: Combined Modality Therapy; Delivery of Health Care, Integrated; Enhanced Recovery After Surgery; Humans; Interdisciplinary Communication; Pain Clinics; Pain Management; Pain, Postoperative; Patient Care Team; Risk Factors; Surgical Procedures, Operative; Transitional Care; Treatment Outcome
PubMed: 34090681
DOI: 10.1016/j.bja.2021.04.018