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Anaesthesia Jan 2013Patients presenting for emergency surgery represent a category at high risk of complications, with substantial morbidity and mortality, whose management may be extremely... (Review)
Review
Patients presenting for emergency surgery represent a category at high risk of complications, with substantial morbidity and mortality, whose management may be extremely challenging. In this first of two articles we consider the identification and evaluation of high risk emergency patients, the provision of critical care support, the management of sepsis, common postoperative complications and in-theatre death.
Topics: Anesthesia; Case Management; Death; Emergency Medical Services; General Surgery; Humans; Lactic Acid; Patient Care Planning; Postoperative Complications; Risk Assessment; Sepsis
PubMed: 23210552
DOI: 10.1111/anae.12054 -
World Journal of Emergency Surgery :... 2018A position paper (PP) should establish a unified voice in areas where controversy occurs based upon multiple practices and/or therapeutic choices. Typically, a position...
A position paper (PP) should establish a unified voice in areas where controversy occurs based upon multiple practices and/or therapeutic choices. Typically, a position paper should elucidate the knowledge gap, followed by an evidence-based review of options, leading to an "endorsed position." A position paper should represent more than the opinion or consensus of the authors but should present current opinions and practices supported by the World Society of Emergency Surgery (WSES). Accordingly, position papers should require the approval of an expert group of WSES and in parallel be presented at an annual meeting prior to submission for publication. It is important that a unified approach for drafting of position papers be established and endorsed by WSES in order to establish credibility and prevent misunderstandings during a smooth transition to publication. The purpose of this article is to suggest a uniform process for the development of WSES guidelines.
Topics: Emergency Treatment; Evidence-Based Medicine; General Surgery; Global Health; Humans; Publishing; Societies, Medical
PubMed: 29371878
DOI: 10.1186/s13017-018-0163-8 -
International Journal of Surgery... 2013The safety of the patient and its importance in a surgical setting is well recognised. However, in the literature far less emphasis is placed upon the safety of the... (Review)
Review
The safety of the patient and its importance in a surgical setting is well recognised. However, in the literature far less emphasis is placed upon the safety of the surgeon and his/her team. This review discusses the risks to which a surgeon is exposed, including blood-borne pathogens, radiation exposure, biomechanical stresses and fatigue, and the adverse effects of diathermy fumes. Strategies addressing these risks are presented and recommendations to improve surgical team safety are offered.
Topics: General Surgery; Humans; Occupational Diseases; Occupational Exposure; Occupational Health; Operating Rooms; Patient Care Team; Risk; Surgical Procedures, Operative
PubMed: 23246870
DOI: 10.1016/j.ijsu.2012.11.024 -
Leaving a foreign object in the body of a patient during abdominal surgery: still a current problem.Polski Przeglad Chirurgiczny May 2019Leaving a foreign object (retained surgical item, or RSI) during surgery involving the abdominal cavity and pelvis minor is a relatively frequent, underestimated... (Review)
Review
INTRODUCTION
Leaving a foreign object (retained surgical item, or RSI) during surgery involving the abdominal cavity and pelvis minor is a relatively frequent, underestimated phenomenon which is dangerous to the health of the patient and the legal security of the medical personnel. These adverse events are easy to avoid through the use of appropriate means of prevention. The aim of the present paper is the collection of epidemiological data and determination of risk factors, symptomatology, health effects, and prevention methods associated with RSIs.
MATERIAL AND METHODS
Analysis of global scientific publications in the databases PubMed, ClinicalKey, Google Scholar, ScienceDirect, and Scopus related to the subject of RSIs.
RESULTS
The frequency of RSI incidents ranges from 1 to 10 in 10,000 surgeries, which results in at least one case in an average multispeciality hospital on a yearly basis. The items most frequently left behind include soft foreign objects, such as swabs and bandages (90%). Risk factors include emergency surgical procedures, high patient BMI, significant loss of blood during surgery, and neglect in counting the material and surgical tools. The postoperative course, although in many cases asymptomatic, may be complicated by inflammation, bleeding, or perforation, leading to the necessity of a second operation and, in 2 to 4% of cases, even ending in death. Imaging tests are effective diagnostic tools. Effective methods of preventing RSIs are based on checklists and systems for counting and monitoring the location of material and tools.
CONCLUSIONS
The globally occurring problem of RSIs requires education of the operating block personnel regarding risk factors and identification with elimination of adverse events of this type. Diagnostics based on imaging should take into account non-specific complaints resulting from a possible oligosymptomatic course. An RSI should not be regarded as a medical error. Changes in the perception of the phenomenon aim aimed at minimising the legal liability of the staff in the event of leaving a foreign object in a patient's body.
Topics: Abdominal Cavity; Foreign Bodies; Humans; Medical Errors; Patient Care Team; Patient Safety; Risk Factors; Surgical Instruments; Surgical Procedures, Operative
PubMed: 31849358
DOI: 10.5604/01.3001.0013.2024 -
Journal of Surgical Education 2020In response to ongoing concerns regarding transmission of the novel coronavirus (COVID-19), surgical practice has changed for the foreseeable future. Practice guidelines... (Review)
Review
OBJECTIVE
In response to ongoing concerns regarding transmission of the novel coronavirus (COVID-19), surgical practice has changed for the foreseeable future. Practice guidelines recommend only urgent or emergent surgical procedures be performed to minimize viral transmission. This effectively limits standard training and practice for surgical residents. The purpose of this article is to describe opportunities in surgical simulation, and highlights the challenges associated with training in the COVID-19 era.
DESIGN
This is a perspective summarizing the potential role of surgical simulation to target training gaps caused by decreased surgical caseloads.
CONCLUSIONS
This manuscript concisely discusses simulation options available to training programs, including the novel concept of "surgical kits." These kits include all instruments necessary to simulate a procedure at home, effectively pairing safety and utility.
Topics: COVID-19; Clinical Competence; Communicable Disease Control; Coronavirus Infections; Education, Medical, Graduate; Female; General Surgery; Humans; Internship and Residency; Male; Models, Educational; Otolaryngology; Pandemics; Pneumonia, Viral; Printing, Three-Dimensional; Safety Management; Simulation Training; United States
PubMed: 32773336
DOI: 10.1016/j.jsurg.2020.05.030 -
Journal of Thrombosis and Haemostasis :... Jun 2015Among adults undergoing non-cardiac surgery who are at risk of a myocardial infarction, a long-standing question has been whether these patients should receive aspirin... (Review)
Review
Among adults undergoing non-cardiac surgery who are at risk of a myocardial infarction, a long-standing question has been whether these patients should receive aspirin throughout the perioperative period. A large (n = 10,010 patients) international trial (POISE-2) demonstrated that perioperative aspirin did not prevent myocardial infarction, and the result was consistent both for patients who had been taking aspirin before the trial (continuation stratum, 4382 patients) and for patients who had not been taking aspirin before the trial (initiation stratum, 5628 patients). Aspirin did, however, increase the risk of major bleeding. Therefore, the best evidence does not support the use of aspirin for the prevention of myocardial infarction in patients undergoing non-cardiac surgery. In patients who have an indication for long-term aspirin usage and have their aspirin held during the perioperative period, it is important to ensure aspirin is restarted after the high-risk period for bleeding has passed (i.e., 8-10 days after surgery).
Topics: Animals; Aspirin; Cardiovascular Agents; Drug Administration Schedule; Hemorrhage; Humans; Myocardial Infarction; Perioperative Period; Risk Assessment; Risk Factors; Surgical Procedures, Operative; Time Factors; Treatment Outcome
PubMed: 26149039
DOI: 10.1111/jth.12975 -
British Journal of Anaesthesia Apr 2016The literature (2012-4) describing experimental pig surgery was reviewed to estimate the extent to which neuromuscular block (NMB) is used, to examine methods for... (Meta-Analysis)
Meta-Analysis Review
The literature (2012-4) describing experimental pig surgery was reviewed to estimate the extent to which neuromuscular block (NMB) is used, to examine methods for ensuring unconsciousness, and to identify the rationale for use of NMB and establish the anaesthetist's training. In the first stage of a two-stage review, NMB use was estimated using Web of Knowledge to identify articles describing NMB during pig surgeries. In the second stage, PubMed and Google Scholar were used to increase the number of articles for determining measures taken to prevent accidental awareness during general anaesthesia (AAGA). The corresponding authors of screened articles were emailed four times to establish the reason for using NMB and the anaesthetists' backgrounds (medical, veterinary, or technical). The first search revealed NMB use in 80 of 411 (20%) studies. Of the 153 articles analysed in the second stage, two described strategies to reduce AAGA. Some (6%) papers did not provide information on anaesthetic doses; citations supporting anaesthetic efficacy were found in only 13. Five of 69 papers using inhalation agents measured end-tidal anaesthetic concentrations based on human, not porcine, minimal alveolar concentrations. The methods in 13% of articles reporting anaesthetic depth assessment were incomplete or questionable, or both; four described using somatic motor reflexes. Corresponding authors of 121 articles reported that the principal reason for NMB was improved 'surgical visualization' (26%). Medical or veterinary anaesthetists supervised anaesthesia in 70% of studies; non-anaesthetists provided NMB, unsupervised, in 23. Nine respondents prioritized experimental expediency over pig welfare. In laboratory pig studies, AAGA may be prevalent; reported details of its attempted prevention are woefully inadequate.
Topics: Anesthesiology; Animal Welfare; Animals; General Surgery; Neuromuscular Blockade; Neuromuscular Blocking Agents; Sus scrofa; Swine
PubMed: 26934943
DOI: 10.1093/bja/aew019 -
European Review For Medical and... Apr 2015Comparing the minimally invasive video-assisted thyroidectomy (MIVAT) with conventional thyroidectomy in safety and clinical application. (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
Comparing the minimally invasive video-assisted thyroidectomy (MIVAT) with conventional thyroidectomy in safety and clinical application.
STUDY DESIGN
A systematic review of the literature and meta-analysis.
MATERIALS AND METHODS
Randomized controlled trials comparing the MIVAT with conventional thyroidectomy were ascertained by methodical search using Medline, Embase, Pubmed, and The Cochrane Library. The trials data were extracted and statistical analyzed using STATA 11.0.
RESULTS
Nine trials were identified. Operative time was significantly less with conventional thyroidectomy than with MIVAT, while MIVAT was associated with less pain at 24 hours postoperatively. MIVAT was associated with less scarring and greater cosmetic result. There were no statistically significant differences for the presence of transient recurrent laryngeal nerve palsy and the presence of transient hypoparathyroidism.
CONCLUSIONS
MIVAT is a feasible, practical, and safe procedure with cosmetic benefit. It is a promising new technique for modern patients, with benefits over the established surgery.
Topics: Cicatrix; Humans; Hypoparathyroidism; Minimally Invasive Surgical Procedures; Pain, Postoperative; Randomized Controlled Trials as Topic; Thyroidectomy; Video-Assisted Surgery
PubMed: 25967712
DOI: No ID Found -
ANZ Journal of Surgery Oct 2020
Topics: COVID-19; Elective Surgical Procedures; Humans; Surgical Procedures, Operative
PubMed: 32748460
DOI: 10.1111/ans.16245 -
The Surgeon : Journal of the Royal... Apr 2010Some 20-30% of HCAI are considered to be preventable through an extensive infection prevention and control programme. Through an extensive literature review we aim to... (Review)
Review
BACKGROUND/AIMS
Some 20-30% of HCAI are considered to be preventable through an extensive infection prevention and control programme. Through an extensive literature review we aim to critically appraise studies which have utilised education initiatives to decrease HCAI.
METHODS
An extensive review of the literature was carried out in both online medical journals and through the Royal College of Surgeons in Ireland library.
FINDINGS
Many studies over the last 10 years have demonstrated success in educating nursing staff, critical care healthcare workers as well as medical students and junior doctors in the infection prevention and control of infection. Comparatively few have focussed on surgical trainees. A blended learning approach, with particular focus on the small group format is important. Interventions involving web-based learning in combination with established education formats are proving successful in changing behaviour.
CONCLUSIONS
The development of an educational strategy for surgical trainees focussing on infection prevention and control is overdue. Such a programme would have far reaching benefits for individual patients, contribute to significant economic savings within health services and enhance the quality and safety of patient care.
Topics: Cross Infection; General Surgery; Health Personnel; Humans; Inservice Training; Teaching
PubMed: 20303891
DOI: 10.1016/j.surge.2009.11.009