Featured Articles in Sep 2020

COVID19: - The Smallpox Epidemics in America in the 1700s and the Role of the Surgeons: Lessons to be Learned During the Global Outbreak of COVID-19

 

Author list – Per-Olof Hasselgren

Abstract

Today's COVID-19 pandemic offers many similarities with previous pandemics hitting our country. In particular, the smallpox epidemics during the 1700s threatened the lives of multitudes and created panic and fear in the society, similar to the situation caused by the coronavirus. Remedies that were instituted, especially inoculations, were met with opposition and even violence when first introduced. The newspapers were filled with headlines reflecting the disputes. There was a "six feet rule" during the smallpox epidemics, although it had a different meaning than today. Politicians and other leaders of the society were engaged in the war against the infection. Boston became involved in the fight against the smallpox by Dr. Zabdiel Boylston's and Rev. Cotton Mather's introduction of inoculations. When George Washington realized the benefits of the procedure and ordered mass inoculations of the Continental Army, it became an important factor in winning not only the fight against smallpox but the Revolutionary War as well. Looking back at history, realizing that we have survived previous outbreaks of devastating diseases, can provide hope during the current pandemic.

URL - https://link.springer.com/article/10.1007%2Fs00268-020-05670-4

 


Impact of Personal Protective Equipment on Surgical Performance During the COVID-19 Pandemic

 

Author list – Carlos Yánez Benítez, Antonio Güemes, José Aranda, Marcelo Ribeiro, Pablo Ottolino, Salomone Di Saverio, Henrique Alexandrino, Luca Ponchietti, Juan L. Blas, International Cooperation Group on PPE and Emergency Surgery, Juan Pablo Ramos, Elena Rangelova, Mercedes Muñoz & Carlos Yánez Sr.

 

Abstract

Background

The Severe Acute Respiratory Syndrome Coronavirus 2 pandemic has exposed surgeons to hazardous working conditions, imposing the need for personal protective equipment (PPE) use during surgery. The use of such equipment may affect their non-technical skills, augment fatigue, and affect performance. This study aimed to assess the surgeons’ perceptions of the impact of wearing PPE during emergency surgery throughout the pandemic.

 

Methods

An international cooperation group conducted an anonymous online survey among surgeons from over 30 countries, to assess perceptions about the impact of PPE use on non-technical skills, overall comfort, decision making, and surgical performance during emergency surgery on COVID-19 patients.

 

Results

Responses to the survey (134) were received from surgeons based on 26 countries. The vast majority (72%) were males. More than half of the respondents (54%) felt that their surgical performance was hampered with PPE. Visual impairment was reported by 63%, whereas 54% had communication impediments. Less than half (48%) felt protected with the use of PPE, and the same proportion perceived that the use of such equipment influenced their decision making. Decreased overall comfort was cited by 66%, and 82% experienced increased surgical fatigue.

 

Conclusions

Surgeons perceived impediment for both visibility and communication, and other non-technical skills while using PPE on emergency surgery in COVID-19 patients. Their perceived lack of protection and comfort and increased fatigue may have inhibited their optimal surgical performance. More attention should be placed in the design of more user-friendly equipment, given the possibility of a second wave of the pandemic.

URL - https://link.springer.com/article/10.1007%2Fs00268-020-05648-2

 


Editorial: Gratitude and Good Outcomes: Rediscovering Positivity and Perspective in an Uncertain Time

 

 

Author list – Wen T. Shen & Julie Ann Sosa

 

Abstract

No Abstract

 

URL - https://link.springer.com/article/10.1007%2Fs00268-020-05649-1

 

 


Evolution of the Surgical Residency System in Switzerland: An In-Depth Analysis Over 15 Years

 

Author list – Beat Moeckli, Lea C. Burgermeister, Michael Siiegrist, Pierre A. Clavien & Samuel A. Käser

Abstract

Background

The landscape of surgical training has been subject to many changes over the past 15 years. This study examines resident satisfaction, determinants of satisfaction, demographics, working hours and the teaching rate of common operations in a longitudinal fashion with the aim to identify trends, shortcomings and possible ways to improve the current training system.

 

Methods

The Swiss Medical Association administers an annual survey to all Swiss residents to evaluate the quality of postgraduate medical training (yearly respondents: 687–825, response rate: 68–72%). Teaching rates for general surgical procedures were obtained from the Swiss association for quality management in surgery.

 

Results

During the study period (2003–2018), the number of surgical residents (408–655 (+61%)) and graduates in general surgery per year (42–63 (+50%)) increased disproportionately to the Swiss population. While the 52 working hour restriction was introduced in 2005 reported average weekly working hours did not decline (59.9–58.4 h (−3%)). Workplace satisfaction (6 being highest) rose from 4.3 to 4.6 (+7%). Working climate and leadership culture were the main determinants for resident satisfaction. The proportion of taught basic surgical procedures fell from 24.6 to 18.9% (−23%).

 

Conclusions

The number of residents and graduates in general surgery has risen markedly. At the same time, the proportion of taught operations is diminishing. Despite the introduction of working hour restrictions, the self-reported hours never reached the limit. The low teaching rate combined with the increasing resident number represents a major challenge to the maintenance of the current training quality.

URL - https://rdcu.be/b50uq

 


Invited Commentary: Cultural Barriers for Women in Surgery: How Thick is the Glass Ceiling?

 

Author list – Patricia J. Numann

Abstract

No Abstract

URL - https://rdcu.be/b50up


Invited Commentary: Surgery for Appendicitis: Where Do We Go? Rational Imaging and Surgical Approach

 

Author list – Airazat M. Kazaryan,  Eivind A. Warberg & Tom Mala

Abstract

No Abstract

URL - https://rdcu.be/b50uz


We Asked the Experts: Direct Peritoneal Resuscitation: A Modern Adaptation of a Historical Technique

 

Author list – Woon Cho Kim, Ronald B. Tesoriero, Deborah M. Stein

Abstract

No Abstract

URL - https://rdcu.be/b50uC


Local Anaesthesia Alone Versus Regional or General Anaesthesia in Excisional Haemorrhoidectomy: A Systematic Review and Meta-Analysis

 

Author list – Weisi Xia, Hoani S. MacFater, Wiremu S. MacFater, Bacil F. Otutaha, Ahmed W. H. Barazanchi, Tarik Sammour & Andrew G. Hill

Abstract

Background

Excisional haemorrhoidectomy has been traditionally performed under general or regional anaesthesia. However, these modes are associated with complications such as nausea, urinary retention and motor blockade. Local anaesthesia (LA) alone has been proposed to reduce side effects as well as to expedite ambulatory surgery. This systematic review aims to assess LA versus regional or general anaesthesia for excisional haemorrhoidectomy.

Methods

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, EMBASE and CENTRAL databases were searched to 13 January 2020. All randomised controlled trials comparing LA only versus regional or general anaesthesia in patients who received excisional haemorrhoidectomy were included. The main outcomes included pain, adverse effects and length of stay.

Results

Nine trials, consisting of six studies comparing local versus regional anaesthesia and three comparing LA versus general anaesthesia, were included. Meta-analysis showed a significantly lower relative risk for need of rescue analgesia (RR 0.32 [95% CI 0.16–0.62]), intra-operative hypotension (RR 0.17 [95% CI 0.04–0.76]), headache (RR 0.13 [0.02–0.67]) and urinary retention (RR 0.17 [95% CI 0.09–0.29]) for LA when compared with regional anaesthesia. There was mixed evidence for both regional and general anaesthesia in regard to post-operative pain.

Conclusions

LA alone may be considered as an alternative to regional anaesthesia for excisional haemorrhoidectomy with reduced complications and reduction in the amount of post-operative analgesia required. The evidence for LA compared to general anaesthesia for haemorrhoidectomy is low grade and mixed.

 URL - https://rdcu.be/b50ws


Disparities in Adult and Pediatric Trauma Outcomes: a Systematic Review and Meta-Analysis

 

Author list – Carol Sanchez, Saamia Shaikh, Brianna Dowd, Radleigh Santos, Mark McKenney & Adel Elkbuli

Abstract

Background

 

Although safeguards requiring emergency care are provided regardless of a patient’s payor status, disparate outcomes have been reported in trauma populations. The purpose of this systematic review and meta-analysis was to determine whether race/ethnicity or insurance status had an effect on mortality and to systematically present the literature in the adult and pediatric trauma populations during the last decade.

 

Methods

 

An online search of PubMed, Cochrane Library, Google Scholar, and SAGE Journals was performed for publications from January 2009 to March 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used. The GRADE Working Group criteria were utilized to assess the evidence quality. A meta-analysis was conducted to compare mortality between insured/uninsured and Caucasian/non-Caucasian patients.

 

Results

 

Our search revealed 680 publications that qualified for evaluation. Of these, 41 were included in the final analysis. Twenty-six studies included adults only, nine studies included pediatric patients only, and six studies evaluated both. Twelve studies evaluated the effects of race/ethnicity, 18 examined insurance status, and 11 investigated both. Uninsured patients had 22% greater odds of death than insured patients (OR 1.22; CI 1.21–1.24). Non-Caucasian patients had 18% greater risk of death than Caucasian patients (OR 1.18; CI 1.17–1.20).

 

Conclusion

 

Both the adult and pediatric trauma populations suffer outcome disparities based on race/ethnicity and insurance status. Overall, patients without insurance coverage and minority groups (i.e., non-Caucasians) had worse outcomes, as measured by odds of death and all-cause mortality.

URL - https://rdcu.be/b50wD

 


 

BACK