Subject(s)
Anesthetics, Local/adverse effects , Automobile Driving/legislation & jurisprudence , Cocaine/adverse effects , Drug-Related Side Effects and Adverse Reactions , Epinephrine/adverse effects , Nose/surgery , Administration, Intranasal , Anesthetics, Local/administration & dosage , Cocaine/administration & dosage , Dose-Response Relationship, Drug , Epinephrine/administration & dosage , Humans , United KingdomABSTRACT
OBJECTIVE: Increasing numbers of older patients are undergoing surgery. Older surgical patients are at a higher risk of perioperative complications and mortality. Multimorbidity, frailty, and physiological changes of ageing contribute to adverse outcomes. These complications are predominantly medical, rather than directly surgical. Guidelines recommend preoperative assessment of comorbidity, disability, and frailty in older patients undergoing surgery and closer perioperative collaboration between surgeons and geriatricians. We conducted a survey to assess knowledge and beliefs of surgical trainees toward common perioperative problems encountered in older surgical patients. DESIGN: Paper-based survey. SETTING: Unselected UK surgical training-grade physicians (CT1-ST8) attending the 2013 Congress of The Association of Surgeons of Great Britain and Ireland, Glasgow, UK, May 1-3, 2013. PARTICIPANTS: A total of 160 eligible UK surgical trainees attending the conference were invited to participate in the survey. Of them, 157 participated. RESULTS: Of the trainees, 68% (n = 107) reported inadequate training and 89.2% (n = 140) supported the inclusion of geriatric medicine issues in surgical curricula. Of the respondents, 77.2% (n = 122) were unable to correctly identify the key features required to demonstrate mental capacity, and only 3 of 157 respondents were familiar with the diagnostic criteria for delirium. Support from geriatric medicine was deemed necessary (84.7%, n = 133) but often inadequate (68.2%, n = 107). Surgical trainees support closer collaboration with geriatric medicine and shared care of complex, older patients (93.6%, n = 147). CONCLUSIONS: UK surgical trainees believe that they receive inadequate training in the perioperative management of complex, older surgical patients and are inadequately supported by geriatric medicine physicians. In this survey sample, trainee knowledge of geriatric issues such as delirium and mental capacity was poor. Surgical trainees support the concept of closer liaison and shared care of complex, older patients with geriatric medicine physicians. Changes to surgical training and service development are needed.
Subject(s)
Clinical Competence , Education, Medical, Graduate/standards , General Surgery/education , Geriatrics/education , Health Knowledge, Attitudes, Practice , Curriculum , Humans , Internship and Residency , Risk Factors , Surveys and Questionnaires , United KingdomSubject(s)
Chylothorax/surgery , Postoperative Complications/surgery , Thoracic Duct/surgery , Thoracoscopy , Humans , MaleABSTRACT
OBJECTIVES: To assess whether there is a difference in ENT knowledge amongst nurses caring for patients on a dedicated ENT ward and nurses caring for ENT patients in a similar hospital without a dedicated ENT ward. DESIGN: A test of theoretical knowledge of ENT nursing care was devised and administered to nurses working on a dedicated ENT ward and then to nurses working on generic non-subspecialist wards regularly caring for ENT patients in a hospital without a dedicated ENT ward. The test scores were then compared. SETTING: A single specialist ENT/Maxillo-Facial/Opthalmology ward in hospital A and 3 generic surgical wards in hospital B. Both hospitals are comparable district general hospitals in the south west of England. PARTICIPANTS: Nursing staff working in hospital A and hospital B on the relevant wards were approached during the working day. 11 nurses on ward 1, 10 nurses on ward 2, 11 nurses on ward 3 and 10 nurses on ward 4 (the dedicated ENT ward). MAIN OUTCOME MEASURES: Each individual test score was used to generate an average score per ward and these scores compared to see if there was a significant difference. RESULTS: The average score out of 10 on ward 1 was 6.8 (+/-1.6). The average score on ward two was 4.8 (+/-1.6). The average score on ward three was 5.5 (+/-2.1). The average score on ward 4, which is the dedicated ENT ward, was 9.7 (+/-0.5). The differences in average test score between the dedicated ENT ward and all of the other wards are statistically significant. CONCLUSION: Nurses working on a dedicated ENT ward have an average higher score in a test of knowledge than nurses working on generic surgical wards. This difference is statistically significant and persists despite banding or training.
